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Biomedical subjects

Claude Pichard

Publications and source records attributed to Claude Pichard.

At least 55 records · Page 3Linked to original sources
PubMed2004

[Screening and treatment of malnutrition: European Council Resolution and its potential application in Switzerland].

The deleterious consequences of hospital malnutrition are progressively being recognized by the public. The Committee of the Ministers of the European Council has released a resolution for food and nutrition and ask the state members to apply national recommendations in their hospitals. The evaluated domains and actions to be undertaken are based on 4 elements: Access to a healthy and varied food supply is a fundamental human right; a high number of patients hospitalized in Europe are malnourished (30-60%); the demonstration that malnutrition of hospitalized patients increases length of hospital stay and medical costs; the demonstrated beneficial effects of a hospital food service and of optimal nutritional care on morbidity, healing and quality of life. The resolution indicates clearly the options to be followed to optimize the actions and decisions at three levels: patient care, support services, and administration. All caregivers must be involved in the implementation of the recommendations in a way to adapt them to the local needs and restrictions. This review summarizes the actions to be taken by medical and other caregivers in order to sensitize them to the above-mentioned problems and to initiate practical options to treat malnourished patients or patients at risk of becoming malnourished.

Europe↗
PubMed2004

[Dysphagia and nutritional treatment: decision tree].

Dysphagia is very frequent in hospitals and the geriatric population. It leads to serious physical and psychological consequences such as aspiration, lung infection, progressive undernutrition which all impair the quality of life and the survival. Early diagnosis and appropriate treatment of dysphagia are therefore essential to avoid or minimize these complications which increase the length of hospital stay and cost. This review describes the symptoms and the clinical approach of dysphagia. The importance of informing and sensitizing all the health care providers to this pathology is highlighted. It also emphazised the need of an interdisciplinary management of dysphagia, including the dietetic approach.

Aged↗
PubMed2004

[Metabolic adaptation to hypoxia: chronic obstructive pulmonary disease and high altitude].

The effect of oxygen in modulating metabolism has been largely investigated in vitro and in animal studies, but very little in humans. Body weight loss and muscle fatigability is a common finding in chronic obstructive pulmonary diseases, often difficult to reverse despite an optimal nutritional intake. The aim of this paper is to review recent literature regarding pathological and physiological situations characterized by hypoxia exposure, particularly chronic obstructive pulmonary diseases and high altitude staying.

Adaptation, Physiological↗
PubMed2003

Four-year follow-up of body compostion in lung transplant patients.

BACKGROUND: Both undernutrition and overnutrition can affect the quality of life and survival of patients with pulmonary disease and lead to quantitative and functional alterations of fat-free mass (FFM). This longitudinal study determines the changes in weight, FFM, and body fat before and up to 4 years after lung transplant (LTR). METHODS: Height, weight, and body composition measurements (bioelectrical impedance) were obtained in 37 LTR patients. FFM and body fat were measured before and at 1, 3, 6, 9, 12, 18, 24, 36, and 48 months after LTR. RESULTS: Weight changed by +16.6%, +3.2%, -0.2%, and -3.2% and FFM by +14.0%, +2.5%, -0.3%, and -1.0% during years 1, 2, 3, and 4, respectively. A diagnosis of obliterative bronchiolitis after LTR was associated with loss of body weight, FFM, and body fat, compared with stable weight or gain in weight, FFM, and body fat in obliterative bronchiolitis-negative subjects; 76.2% and 85.7%, and 28% and 38% of men and women, respectively, demonstrated low FFM at 1 month and at 2 years after LTR, respectively. The FFM change was higher (39% of weight) during year 1 than during year 2 (25%) or year 3 (21%). CONCLUSIONS: After LTR, patients gained weight, FFM, and body fat, and two-thirds reached normal levels of FFM by year 2. A weight increase resulted in an FFM increase. Contrary to studies after heart or liver transplantation, our results suggest that despite posttransplant infections and grafts rejection, LTR permits FFM recovery.

Adipose Tissue↗
PubMed2003

The role of visceral proteins in the nutritional assessment of intensive care unit patients.

PURPOSE OF REVIEW: This review analyses the recently published literature focusing on nutritional assessment in intensive care unit patients. The metabolic response to nutritional intervention is difficult to evaluate in critically ill patients whose body weight is influenced largely by massive fluid administration or losses. Visceral protein plasma levels have been proposed for this purpose, because they reflect hepatic synthesis in response to nutrient supply. However, in acute inflammatory states, liver activity is converted to the synthesis of acute-phase response proteins, resulting in a dramatic drop in visceral proteins, despite nutritional support. RECENT FINDINGS: The data regarding visceral protein levels were examined in relation to nutritional supplementation, and compared with other nutritional parameters and clinical outcomes. Transthyretin and retinol-binding protein levels seem to be the most sensitive to nutritional intervention. They are also the earliest to rise at the decrease of acute-phase protein levels, therefore representing a good index of the reversing reprioritization of hepatic protein synthesis. An inconsistent relationship was found between visceral protein plasma levels and clinical outcome in intensive care unit patients, probably because of the difficulty in demonstrating clearly a beneficial effect of nutritional supplementation in highly catabolic conditions. SUMMARY: In the acute stage of critical illness, the bi-weekly measurement of transthyretin together with acute-phase response protein plasma levels seems to be a 'window' on the metabolic condition (anabolism versus catabolism). However, only in the presence of stable inflammatory parameters do transthyretin levels reflect the adequacy of nutritional coverage.

Acute-Phase Proteins↗
PubMed2003

Body composition measurements: interpretation finally made easy for clinical use.

PURPOSE OF REVIEW: This review presents the latest clinical applications of bioelectrical impedance analysis. It discusses the evaluation of nutritional status by using fat-free mass and body fat, percentiles of fat-free mass and body fat, height-normalized fat-free mass and body fat mass indices and a resistance/reactance vector graph. RECENT FINDINGS: Fat-free mass and body fat can be used to evaluate nutritional status by comparing individuals or groups of individuals with themselves or with reference values. Percentile distributions are also useful in determining whether individuals or groups fall within the population range. Percentile ranks can also be used to define nutritional depletion and obesity. The use of the fat-free mass and body fat mass indices has the advantage of compensating for differences in body height. The use of low, normal, high and very high fat-free mass and body fat mass indices ranges that correspond to underweight, normal, overweight and obese body mass index categories further aid in the nutritional assessment process. With vector bioelectrical impedance analysis, an individual impedance vector is compared with the 50, 75, and 95% tolerance ellipses calculated in the reference, healthy population, allowing evaluation in any clinical condition. More accurate estimates of conventional bioelectrical impedance analysis equations might be obtained in individuals with a normal impedance vector. SUMMARY: The assessment of fat-free mass and body fat provides valuable information about changes in body composition with weight gain or loss and physical activity, and during ageing. The use of percentiles and height-normalized fat-free mass and body fat permit the classification of patients as under or overnourished.

Adipose Tissue↗
PubMed2003

Hip fracture discrimination study: QUS of the radius and the calcaneum.

As an emerging alternative to current radiation-based bone densitometry techniques, there is a growing interest in the use of quantitative ultrasound (QUS) measurements for the noninvasive assessment of fracture risk in the management of osteoporosis. However, there are also a multiplicity of technologically different QUS devices available on the market and, so far, no study has compared heel and radius QUS device for the discrimination of subjects with hip fractures. Our study evaluated the ability of three QUS devices (one calcaneal gel-coupled system, one calcaneal water-coupled system, and one radius system) to discriminate osteoporotic from controls subjects, using the same population. We also checked if the combination of two different skeletal sites (i.e., calcaneum and radius) improve the discriminatory ability of the QUS devices. Forty-five women aged 79.1+/-7.1 yr with hip fractures within the last 4 d were used as the hip-fracture group and compared to 40 healthy controls from 65-87 yr. In addition, 47 young controls, aged 20-40 yr, were used as reference population to express some of the results as T-scores. QUS measurements were performed with the Hologic Sahara, Ge-Lunar Achilles+, and Sunlight Omnisense devices according to the manufacturer's recommendations. Adjusted odds ratio results showed that a decrease in Omnisense SOS of 1 standard deviation (SD) was associated with a significant increase in fracture risk (OR adj.=2.83) comparable with Sahara BUA (OR adj.=2.42) and Achilles BUA (OR adj.=3.29). However, given the large overlap between the 95% intervals of each odds ratio, no significant difference was found between the devices. Similarly, comparison between the areas under ROC curves did not show any significant difference between all the parameters. Considering the parameters provided per default by each QUS device, the Sahara, Achilles, and Omnisense devices classified correctly 70, 67.5, and 62.5% of the subjects, respectively. Although the OR of the combination of radius and calcaneum is improved (3.62 to 4.74) compared with either one of the single skeletal site, the large confidence intervals do not allow to claim a significant difference. The three QUS technologies tested against hip fractures seem to show the same discriminatory ability. However, there is some differences in the definition of the diagnostic threshold underlying the nonusability of the World Health Organization (WHO) osteoporosis definition. Finally the combination of several site using two different devices is not clinically relevant. Potential interest could be seen in combining several sites using the same device, supposing that such device would measure differently active bone.

Aged↗
PubMed2003

[Determination of energy expenditure in the clinical setting].

A patient's nutritional support is a critical part of his general health care scheme. It aims to prevent or correct malnutrition, reduce morbidity, length of hospital stay and treatment costs. It equally optimises the patient's convalescence and quality of life. An optimal support requires the nutritional evaluation of the patient which includes determination of the energy expenditure. Once the energy needs have been evaluated, the clinician is then able to treat any nutritional deficiencies. This article therefore looks at the different methods available for predicting and measuring energy expenditure. The clinical limitations of these techniques and particular cases encountered (intensive care unit, anorexia and severe obesity, geriatrics, HIV infection, etc) will also be discussed.

Critical Care↗
PubMed2003

[Growth hormone and carcinogenesis: the point on the question].

Over the past 20 years, the use of recombinant growth hormone (rhGH) has become more frequent and the indications for this therapy extended to more common conditions than primary pituitary dysfunction. GH, a very strong anabolic agent, alters body growth and composition, and metabolic pathways. RhGH therapy seems to be beneficial in certain types of pathologies and surgical procedures, by preventing the deleterious effects due to catabolism and by increasing immune function, healing process and muscular strength. Several types of tumors have been studied to investigate the rhGH-related oncological risks. This article aims at reviewing the clinical studies focused on the possible association between rhGH and cancer.

Growth Hormone↗
PubMed2003

[Awareness on nutritional problems at hospitals: which solutions?].

Malnutrition is very frequent in hospitalized patients, particularly if they are elderly and suffer of chronic diseases. Many studies show the correlation between the degree of malnutrition and the frequency of complications, the length of hospital stay and the rate of mortality. However, despite the rising interest of scientists for the role of nutrition in the pathogenesis of the diseases, little attention is devoted to the nutritional status of patients. This article reviews the recent literature regarding hospital malnutrition. At hospital admission, 30 to 40% of patients presents a certain degree of malnutrition. However, only a small percentage is recognized to be malnourished and receive an adequate treatment. The reason for this attitude of medical and paramedical teams seems to be a low priority assigned to nutrition. In addition, they seem to lack the most basic knowledge regarding the metabolic needs of their patients. Another finding, reported by several surveys, is that a large portion of hospital food is not consumed by the patients but is wasted. In fact, meals are not sufficiently-adapted to the taste and the appetite of those for whom they are prepared. This article summarizes the recommendation of the Europe Council regarding the nutritional evaluation and treatment of patients.

Hospitalization↗
PubMed2002

Position paper of the ESICM Working Group on Nutrition and Metabolism. Metabolic basis of nutrition in intensive care unit patients: ten critical questions.

The metabolic changes associated with critical illness involve several pathways acting at different steps of the utilization of nutritive substrates. The understanding of the role of these pathways and of their complex regulation has led to the development of new strategies for the metabolic and nutritional management of critically ill patients, including the development of new products for nutritional support. The rationale for changing the profile of nutritional support solutions by adding novel substrates is also discussed. This review focuses on the metabolic specificities of critically ill patients and also includes an analysis of the adequacy of tools to monitor the metabolic status and the adequacy of the nutritional support.

Critical Care↗
PubMed2002

Unlabelled iododeoxyuridine increases the rate of uptake of [125I]iododeoxyuridine in human xenografted glioblastomas.

5-Iodo-2'-deoxyuridine (IdUrd), a thymidine (TdR) analogue, can be radiolabelled with iodine-125, an Auger radiation emitter, to provoke double-strand breaks once incorporated into DNA of cancer cells. We have previously shown that co-incubation of [125I]IdUrd with unlabelled IdUrd provided an additive cytotoxicity in two human glioblastoma cell lines. This observation was unexpectedly correlated with an increase in the rate of DNA incorporation of [125I]IdUrd. Here, we further evaluated the effects of unlabelled IdUrd on the uptake of [125I]IdUrd in vitro and in vivo in mice xenografted with three human glioblastoma lines. The results showed that, in these three glioblastoma lines, unlabelled IdUrd increased the rate of uptake of [125I]IdUrd in vitro by 2- to 4.4-fold and in vivo by 1.5- to 2.8-fold. The rate of uptake of [125I]IdUrd in normal rapidly dividing tissues was also increased by 1.3- to 2.8-fold. TdR completely blocked [125I]IdUrd uptake in tumours and tissues. Analogues of IdUrd, such as deoxyuridine and 5-iodo-1,3-dimethyuracil, did not reproduce the effect of IdUrd on the uptake of [125I]IdUrd, suggesting that it is not related to protection against [125I]IdUrd degradation. It is concluded that combined administration of unlabelled IdUrd may improve the use of radiolabelled IdUrd for cancer diagnosis or therapy.

Animals↗
PubMed2002

Body composition in 995 acutely ill or chronically ill patients at hospital admission: a controlled population study.

OBJECTIVE: To determine if fat-free mass and fat mass in acutely ill and chronically ill patients differed from healthy controls at hospital admission and if prevalence of malnutrition differed by body mass index (BMI) or fat-free mass percentile. SUBJECTS/SETTING: 995 consecutive patients 15 to 100 years of age admitted to the hospital were measured in the hospital admission center and compared with 995 healthy age- and height-matched subjects DESIGN: Cross-sectional study. Fat-free mass, fat mass, and percentage fat mass were determined by 50 kHz bioelectrical impedance analysis. Prevalence of malnutrition was determined by BMI < or = 20 kg/m2 or fat-free mass in the 10th percentile. STATISTICAL ANALYSIS: Analysis of variance was used to examine differences between acutely ill and chronically ill patients and controls and between age groups. RESULTS: Fat-free mass was significantly lower in patients than controls (P< or = .05), and the difference with age in fat-free mass in patients was greater than the age-related difference in the controls. A higher percentage fat mass was found in spite of lower BMI in chronically ill patients older than 55 years. Among participants, 25% of acutely ill and 37.3% of chronically ill patients fell below fat-free mass in the 10th percentile, compared with 15.6% of acutely ill and 18.9% of chronically ill patients falling below BMI < or = 20 kg/m2. APPLICATIONS/CONCLUSION: Weight and BMI do not evaluate body compartments and therefore do not reveal if weight changes result in loss of fat-free mass or gain in fat mass. In spite of minimal differences in BMI between patients and controls, we found that fat-free mass was lower and fat mass was higher in acutely ill and chronically ill patients than controls. The objective measurement of body composition, as part of a comprehensive nutritional assessment, helps to identify subjects who have low fat-free mass or high fat mass.

Acute Disease↗