29 research outputs found

    Étude Comparative des ModalitĂ©s de la Price en Charge PĂ©riopĂ©ratore Nutritionnelle Lors de la Chirurgie Digestive Ă  Soissons (France) et Ă  Tanambao (Madagascar)

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    L’état nutritionnel d’un individu influence sur sa morbi-mortalitĂ© pĂ©riopĂ©ratoire. Les complications postopĂ©ratoires sont en augmentation jusqu’à 72% chez les patients prĂ©sentant une dĂ©nutrition en pĂ©riopĂ©ratoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalitĂ© en pĂ©riopĂ©ratoire de chirurgie digestive chez les sujets dĂ©nutris va jusqu’à 29%.  Objectif : Comparer les modalitĂ©s de prise en charge nutritionnelle pĂ©riopĂ©ratoire de chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et mĂ©thode : Il s’agit d’une Ă©tude observationnelle prospective sur douze mois (mai 2018 Ă  avril 2019). Les patients bĂ©nĂ©ficiant d’une chirurgie digestive par voie laparotomie mĂ©diane ont Ă©tĂ© inclus. Le test de Mann Whitney Ă©tait utilisĂ© pour la comparaison des variables portant sur les caractĂ©ristiques de la population d’étude, la prise en charge nutritionnelle pĂ©riopĂ©ratoire et la durĂ©e d’hospitalisation (XLSTATÂź 2019.4.2). Une valeur de p infĂ©rieur Ă  0,05 Ă©tait significative.  RĂ©sultats : Quarante-sept patients ĂągĂ©s de 63 [32- 100] ans ont Ă©tĂ© retenus Ă  Soissons et 43 patients, ĂągĂ©s de 45 [18- 79] ans, Ă  Tanambao. La population d’étude Ă©tait Ă  prĂ©dominance masculine (sex ratio = 1,5 Ă  Soissons et 2,1 Ă  Toliara). La durĂ©e du jeĂ»ne prĂ©opĂ©ratoire (<2h versus ≄6h ; p<0,001), l’apport protĂ©ino-Ă©nergĂ©tique prĂ©opĂ©ratoire (<25 kcal/kg/j versus sans apport ; p= 0,041 et apport protĂ©ique <1 g/kg/j versus sans apport ; p<0,001), l’apport protĂ©ino-Ă©nergĂ©tique postopĂ©ratoire ([25- 30 Kcal/kg/j versus <25 Kcal/kg/j ; p<0,001 et apport protĂ©ique [1- 1,5 g/kg/j versus <1 g/kg/j ; p<0,001) et la durĂ©e d’hospitalisation (10j versus 14j ; p<0,001) Ă©taient diffĂ©rents entre les deux centres hospitaliers. Le grade nutritionnel (GN 2, p= 0,244) et la morbi-mortalitĂ© Ă©taient comparables entre les deux centres hospitaliers (absence de complications, p= 0,817). Conclusion : L’état nutritionnel pĂ©riopĂ©ratoire constitue l’un des dĂ©terminants d’une rĂ©habilitation postopĂ©ratoire optimale. La prescription du support nutritionnel et du jeĂ»ne prĂ©opĂ©ratoire devrait ĂȘtre en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi Ă  Tanambao (Madagascar), cette prise en charge nutritionnelle reste Ă  amĂ©liorer suivant les recommandations. L’état nutritionnel d’un individu influence sur sa morbi-mortalitĂ© pĂ©riopĂ©ratoire. Les complications postopĂ©ratoires sont en augmentation jusqu’à 72% chez les patients prĂ©sentant une dĂ©nutrition en pĂ©riopĂ©ratoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalitĂ© en pĂ©riopĂ©ratoire de chirurgie digestive chez les sujets dĂ©nutris va jusqu’à 29%.   Objectif : Comparer les modalitĂ©s de prise en charge nutritionnelle pĂ©riopĂ©ratoire de chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et mĂ©thode : Il s’agit d’une Ă©tude observationnelle prospective sur douze mois (mai 2018 Ă  avril 2019). Les patients bĂ©nĂ©ficiant d’une chirurgie digestive par voie laparotomie mĂ©diane ont Ă©tĂ© inclus. Le test de Mann Whitney Ă©tait utilisĂ© pour la comparaison des variables portant sur les caractĂ©ristiques de la population d’étude, la prise en charge nutritionnelle pĂ©riopĂ©ratoire et la durĂ©e d’hospitalisation (XLSTATÂź 2019.4.2). Une valeur de p infĂ©rieur Ă  0,05 Ă©tait significative.  RĂ©sultats : Quarante-sept patients ĂągĂ©s de 63 [32- 100] ans ont Ă©tĂ© retenus Ă  Soissons et 43 patients, ĂągĂ©s de 45 [18- 79] ans, Ă  Tanambao. La population d’étude Ă©tait Ă  prĂ©dominance masculine (sex ratio = 1,5 Ă  Soissons et 2,1 Ă  Toliara). La durĂ©e du jeĂ»ne prĂ©opĂ©ratoire (<2h versus ≄6h ; p<0,001), l’apport protĂ©ino-Ă©nergĂ©tique prĂ©opĂ©ratoire (<25 kcal/kg/j versus sans apport ; p= 0,041 et apport protĂ©ique <1 g/kg/j versus sans apport ; p<0,001), l’apport protĂ©ino-Ă©nergĂ©tique postopĂ©ratoire ([25- 30 Kcal/kg/j versus <25 Kcal/kg/j ; p<0,001 et apport protĂ©ique [1- 1,5 g/kg/j versus <1 g/kg/j ; p<0,001) et la durĂ©e d’hospitalisation (10j versus 14j ; p<0,001) Ă©taient diffĂ©rents entre les deux centres hospitaliers. Le grade nutritionnel (GN 2, p= 0,244) et la morbi-mortalitĂ© Ă©taient comparables entre les deux centres hospitaliers (absence de complications, p= 0,817). Conclusion :L’état nutritionnel pĂ©riopĂ©ratoire constitue l’un des dĂ©terminants d’une rĂ©habilitation postopĂ©ratoire optimale. La prescription du support nutritionnel et du jeĂ»ne prĂ©opĂ©ratoire devrait ĂȘtre en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi Ă  Tanambao (Madagascar), cette prise en charge nutritionnelle reste Ă  amĂ©liorer suivant les recommandations.   Background: The nutritional state of a patient impacts on perioperative morbidity and mortality. Postoperative complications are up to 72% in patients with perioperative undernutrition against 29% against those who do not present undernutrition. The mortality rate in perioperative digestive surgery in malnourished subjects is up to 29%. Aim: To compare the modalities of perioperative nutritional management of digestive surgery in the hospitals of Soissons and Tanambao. Patients and methods: This is a prospective observational study over 12 months (May 2018 to April 2019). Patients undergoing digestive surgery via midline laparotomy were included. The Mann Whitney test was used to compare variables relating to the characteristics of the study population, perioperative nutritional management and length of hospital stay (XLSTATÂź 2019.4.2). A p- value of less than 0,05 was considered significant. Results: Forty- seven patients aged 63 [32- 100] years old were retained in Soissons while the study population was 43 (aged 45 [18- 79] years old) in Tanambao. The study population was mostly male (sex ratio = 1,5 in Soissons and 2,1 in Toliara). The duration of the preoperative fast (<2h versus ≄6h ; p<0,001), the preoperative protein-energy intake (<25 kcal/kg/day versus no intake ; p= 0,041 and energy intake <1 g/kg/day versus no intake ; p<0,001), the postoperative protein-energy intake ([25- 30 kcal/kg/day versus <25 kcal/kg/day ; p<0,001 and and energy intake [1- 1,5  g/kg/day versus <1 g/kg/day ; p<0,001), and length of hospitalization (10 days versus 14 days ; p<0,001) were different between the two hospitals. The nutritional grade (NG 2, p= 0,244) and morbidity and mortality were comparable between the two groups (absence of complications, p= 0,817). Conclusion: Perioperative nutritional status is one of the elements of good postoperative rehabilitation. The prescription of nutritional support and preoperative fasting should be according to nutritional grade and should cover daily nutritional needs

    Étude Comparative des ModalitĂ©s de la Price en Charge PĂ©riopĂ©ratore Nutritionnelle Lors de la Chirurgie Digestive Ă  Soissons (France) et Ă  Tanambao (Madagascar)

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    L’état nutritionnel d’un individu influence sur sa morbi-mortalitĂ© pĂ©riopĂ©ratoire. Les complications postopĂ©ratoires sont en augmentation jusqu’à 72% chez les patients prĂ©sentant une dĂ©nutrition en pĂ©riopĂ©ratoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalitĂ© en pĂ©riopĂ©ratoire de chirurgie digestive chez les sujets dĂ©nutris va jusqu’à 29%.  Objectif : Comparer les modalitĂ©s de prise en charge nutritionnelle pĂ©riopĂ©ratoire de chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et mĂ©thode : Il s’agit d’une Ă©tude observationnelle prospective sur douze mois (mai 2018 Ă  avril 2019). Les patients bĂ©nĂ©ficiant d’une chirurgie digestive par voie laparotomie mĂ©diane ont Ă©tĂ© inclus. Le test de Mann Whitney Ă©tait utilisĂ© pour la comparaison des variables portant sur les caractĂ©ristiques de la population d’étude, la prise en charge nutritionnelle pĂ©riopĂ©ratoire et la durĂ©e d’hospitalisation (XLSTATÂź 2019.4.2). Une valeur de p infĂ©rieur Ă  0,05 Ă©tait significative.  RĂ©sultats : Quarante-sept patients ĂągĂ©s de 63 [32- 100] ans ont Ă©tĂ© retenus Ă  Soissons et 43 patients, ĂągĂ©s de 45 [18- 79] ans, Ă  Tanambao. La population d’étude Ă©tait Ă  prĂ©dominance masculine (sex ratio = 1,5 Ă  Soissons et 2,1 Ă  Toliara). La durĂ©e du jeĂ»ne prĂ©opĂ©ratoire (<2h versus ≄6h ; p<0,001), l’apport protĂ©ino-Ă©nergĂ©tique prĂ©opĂ©ratoire (<25 kcal/kg/j versus sans apport ; p= 0,041 et apport protĂ©ique <1 g/kg/j versus sans apport ; p<0,001), l’apport protĂ©ino-Ă©nergĂ©tique postopĂ©ratoire ([25- 30 Kcal/kg/j versus <25 Kcal/kg/j ; p<0,001 et apport protĂ©ique [1- 1,5 g/kg/j versus <1 g/kg/j ; p<0,001) et la durĂ©e d’hospitalisation (10j versus 14j ; p<0,001) Ă©taient diffĂ©rents entre les deux centres hospitaliers. Le grade nutritionnel (GN 2, p= 0,244) et la morbi-mortalitĂ© Ă©taient comparables entre les deux centres hospitaliers (absence de complications, p= 0,817). Conclusion : L’état nutritionnel pĂ©riopĂ©ratoire constitue l’un des dĂ©terminants d’une rĂ©habilitation postopĂ©ratoire optimale. La prescription du support nutritionnel et du jeĂ»ne prĂ©opĂ©ratoire devrait ĂȘtre en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi Ă  Tanambao (Madagascar), cette prise en charge nutritionnelle reste Ă  amĂ©liorer suivant les recommandations. L’état nutritionnel d’un individu influence sur sa morbi-mortalitĂ© pĂ©riopĂ©ratoire. Les complications postopĂ©ratoires sont en augmentation jusqu’à 72% chez les patients prĂ©sentant une dĂ©nutrition en pĂ©riopĂ©ratoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalitĂ© en pĂ©riopĂ©ratoire de chirurgie digestive chez les sujets dĂ©nutris va jusqu’à 29%.   Objectif : Comparer les modalitĂ©s de prise en charge nutritionnelle pĂ©riopĂ©ratoire de chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et mĂ©thode : Il s’agit d’une Ă©tude observationnelle prospective sur douze mois (mai 2018 Ă  avril 2019). Les patients bĂ©nĂ©ficiant d’une chirurgie digestive par voie laparotomie mĂ©diane ont Ă©tĂ© inclus. Le test de Mann Whitney Ă©tait utilisĂ© pour la comparaison des variables portant sur les caractĂ©ristiques de la population d’étude, la prise en charge nutritionnelle pĂ©riopĂ©ratoire et la durĂ©e d’hospitalisation (XLSTATÂź 2019.4.2). Une valeur de p infĂ©rieur Ă  0,05 Ă©tait significative.  RĂ©sultats : Quarante-sept patients ĂągĂ©s de 63 [32- 100] ans ont Ă©tĂ© retenus Ă  Soissons et 43 patients, ĂągĂ©s de 45 [18- 79] ans, Ă  Tanambao. La population d’étude Ă©tait Ă  prĂ©dominance masculine (sex ratio = 1,5 Ă  Soissons et 2,1 Ă  Toliara). La durĂ©e du jeĂ»ne prĂ©opĂ©ratoire (<2h versus ≄6h ; p<0,001), l’apport protĂ©ino-Ă©nergĂ©tique prĂ©opĂ©ratoire (<25 kcal/kg/j versus sans apport ; p= 0,041 et apport protĂ©ique <1 g/kg/j versus sans apport ; p<0,001), l’apport protĂ©ino-Ă©nergĂ©tique postopĂ©ratoire ([25- 30 Kcal/kg/j versus <25 Kcal/kg/j ; p<0,001 et apport protĂ©ique [1- 1,5 g/kg/j versus <1 g/kg/j ; p<0,001) et la durĂ©e d’hospitalisation (10j versus 14j ; p<0,001) Ă©taient diffĂ©rents entre les deux centres hospitaliers. Le grade nutritionnel (GN 2, p= 0,244) et la morbi-mortalitĂ© Ă©taient comparables entre les deux centres hospitaliers (absence de complications, p= 0,817). Conclusion :L’état nutritionnel pĂ©riopĂ©ratoire constitue l’un des dĂ©terminants d’une rĂ©habilitation postopĂ©ratoire optimale. La prescription du support nutritionnel et du jeĂ»ne prĂ©opĂ©ratoire devrait ĂȘtre en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi Ă  Tanambao (Madagascar), cette prise en charge nutritionnelle reste Ă  amĂ©liorer suivant les recommandations.   Background: The nutritional state of a patient impacts on perioperative morbidity and mortality. Postoperative complications are up to 72% in patients with perioperative undernutrition against 29% against those who do not present undernutrition. The mortality rate in perioperative digestive surgery in malnourished subjects is up to 29%. Aim: To compare the modalities of perioperative nutritional management of digestive surgery in the hospitals of Soissons and Tanambao. Patients and methods: This is a prospective observational study over 12 months (May 2018 to April 2019). Patients undergoing digestive surgery via midline laparotomy were included. The Mann Whitney test was used to compare variables relating to the characteristics of the study population, perioperative nutritional management and length of hospital stay (XLSTATÂź 2019.4.2). A p- value of less than 0,05 was considered significant. Results: Forty- seven patients aged 63 [32- 100] years old were retained in Soissons while the study population was 43 (aged 45 [18- 79] years old) in Tanambao. The study population was mostly male (sex ratio = 1,5 in Soissons and 2,1 in Toliara). The duration of the preoperative fast (<2h versus ≄6h ; p<0,001), the preoperative protein-energy intake (<25 kcal/kg/day versus no intake ; p= 0,041 and energy intake <1 g/kg/day versus no intake ; p<0,001), the postoperative protein-energy intake ([25- 30 kcal/kg/day versus <25 kcal/kg/day ; p<0,001 and and energy intake [1- 1,5  g/kg/day versus <1 g/kg/day ; p<0,001), and length of hospitalization (10 days versus 14 days ; p<0,001) were different between the two hospitals. The nutritional grade (NG 2, p= 0,244) and morbidity and mortality were comparable between the two groups (absence of complications, p= 0,817). Conclusion: Perioperative nutritional status is one of the elements of good postoperative rehabilitation. The prescription of nutritional support and preoperative fasting should be according to nutritional grade and should cover daily nutritional needs

    Étude Comparative des ModalitĂ©s de la Prise en Change PĂ©riopĂ©ratoire Nutritionnelle Lors de la Chirurgie Digestive Ă  Soissons (France) et Ă  Tanambao (Madagascar)

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    L’état nutritionnel d’un individu influence sa morbi-mortalitĂ© pĂ©riopĂ©ratoire. Les complications postopĂ©ratoires sont en augmentation jusqu’à 72% chez les patients prĂ©sentant une dĂ©nutrition en pĂ©riopĂ©ratoire contre 29% chez ceux qui ne le sont pas. Le taux de mortalitĂ© pĂ©riopĂ©ratoire en chirurgie digestive chez les sujets dĂ©nutris va jusqu’à 29%.  Objectif : Comparer les modalitĂ©s de prise en charge nutritionnelle pĂ©riopĂ©ratoire en chirurgie digestive dans les centres hospitaliers de Soissons (France) et de Tanambao (Madagascar). Patients et mĂ©thode : Il s’est agi d’une Ă©tude observationnelle prospective sur douze mois (mai 2018 Ă  avril 2019). Les patients bĂ©nĂ©ficiant d’une chirurgie digestive par voie laparotomique mĂ©diane ont Ă©tĂ© inclus. Le test de Mann Whitney Ă©tait utilisĂ© pour la comparaison des variables portant sur les caractĂ©ristiques de la population d’étude, la prise en charge nutritionnelle pĂ©riopĂ©ratoire et la durĂ©e d’hospitalisation (XLSTATÂź 2019.4.2). Une valeur de p infĂ©rieur Ă  0,05 Ă©tait significative.  RĂ©sultats : A Soissons, 47 patients ĂągĂ©s de 63 [32- 100] ans ont Ă©tĂ© inclus, Ă  prĂ©dominance masculine (sex ratio = 1,5). Le jeĂ»ne prĂ©opĂ©ratoire Ă©tait de 8 heures [4- 18]. Dix-huit patients (38,3%) ont bĂ©nĂ©ficiĂ© d’un support nutritionnel pendant 4 jours [2- 14]. En postopĂ©ratoire, les patients ont bĂ©nĂ©ficiĂ© d’un support nutritionnel durant 8 jours [1- 29]. L’alimentation entĂ©rale en postopĂ©ratoire a Ă©tĂ© reprise au 6Ăšme jour [1- 13]. Huit patients ont prĂ©sentĂ© des complications dont un dĂ©cĂ©dĂ©. La durĂ©e totale d’hospitalisation Ă©tait de 10 jours [5- 29]. A Tanambao, 43 patients Ă©taient inclus, ĂągĂ©s de 45 [18- 79] ans. La classe 1 et 2 de l’ASA Ă©taient respectivement Ă  37,2% et Ă  39,5%. Le jeĂ»ne prĂ©opĂ©ratoire durait 10 heures [3- 18]. Neuf patients ont reçu un support nutritionnel prĂ©opĂ©ratoire pendant 3 jours [1- 7]. En postopĂ©ratoire, l’alimentation entĂ©rale a Ă©tĂ© autorisĂ©e au 7Ăšme jour [2- 14], un support nutritionnel Ă©tait administrĂ© pendant 8 jours [3- 15]. Les patients restaient Ă  l’hĂŽpital pendant 15 jours [6- 30]. Conclusion : L’état nutritionnel pĂ©riopĂ©ratoire constitue l’un des dĂ©terminants d’une rĂ©habilitation postopĂ©ratoire optimale. La prescription du support nutritionnel et du jeĂ»ne prĂ©opĂ©ratoire devrait ĂȘtre en fonction du grade nutritionnel et doit couvrir les besoins nutritionnels quotidiens.  A Soissons (France), mais aussi Ă  Tanambao (Madagascar), cette prise en charge nutritionnelle reste Ă  amĂ©liorer suivant les recommandations.   Background: The nutritional state of a patient impacts on perioperative morbidity and mortality. Postoperative complications are up to 72% in patients with perioperative undernutrition against 29% against those who do not present undernutrition. The mortality rate in perioperative digestive surgery in malnourished subjects is up to 29%. Aim: To compare the modalities of perioperative nutritional management of digestive surgery in the hospitals of Soissons and Tanambao. Patients and methods: This is a prospective observational study over 12 months (May 2018 to April 2019). Patients undergoing digestive surgery via midline laparotomy were included. The Mann Whitney test was used to compare variables relating to the characteristics of the study population, perioperative nutritional management and length of hospital stay (XLSTATÂź 2019.4.2). A p- value of less than 0,05 was considered significant. Results: In Soissons, 47 patients aged 63 [32-100] years were included, predominantly male (sex ratio = 1.5). The preoperative fast was 8 hours [4-18]. Eighteen patients (38.3%) received nutritional support for 4 days [2-14]. Postoperatively, patients received nutritional support for 8 days [1-29]. Postoperative enteral feeding was resumed on the 6th day [1-13]. Eight patients presented complications, one of which died. The total duration of hospitalization was 10 days [5-29]. In Tanambao, 43 patients were included, aged 45 [18-79] years. ASA class 1 and 2 were at 37.2% and 39.5% respectively. The preoperative fast lasted 10 hours [3-18]. Nine patients received preoperative nutritional support for 3 days [1-7]. Postoperatively, enteral feeding was authorized on the 7th day [2-14], nutritional support was administered for 8 days [3-15]. The patients stayed in the hospital for 15 days [6-30]. Conclusion: Perioperative nutritional status is one of the elements of good postoperative rehabilitation. The prescription of nutritional support and preoperative fasting should be according to nutritional grade and should cover daily nutritional needs

    Evaluation nutritionnelle peri-operatoire en chirurgie digestive majeure

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    Introduction: La dĂ©nutrition pĂ©ri-opĂ©ratoire est une des complications qui peut entraver la rĂ©habilitation postopĂ©ratoire et augmenter la morbimortalitĂ© dans les chirurgies digestives. Il est actuellement recommandĂ© d'Ă©valuer l'Ă©tat nutritionnel, notamment prĂ©-opĂ©ratoire des patients. L'objectif de cette Ă©tude Ă©tait d'Ă©valuer l'Ă©tat nutritionnel pĂ©ri-opĂ©ratoire dans les chirurgies digestives majeures au Centre Hospitalier d'Antananarivo. MĂ©thodes: Etude prospective de douze mois, chez des patients allant ĂȘtre opĂ©rĂ©s d'une chirurgie digestive nĂ©cessitant une exclusion intestinale prolongĂ©e postopĂ©ratoire, programmĂ©e. Avant et aprĂšs l'intervention, une pesĂ©e a Ă©tĂ© faite, la notion d'amaigrissement a Ă©tĂ© recherchĂ©e, le taux d'albumine mesurĂ© et les indices de masse corporelle et du risque nutritionnel calculĂ©s. La stratification nutritionnelle de chaque patient a Ă©tĂ© rĂ©alisĂ©e. RĂ©sultats: Trente patients, Ă  prĂ©dominance masculine et d'Ăąge moyen de 46,9 ans, ont Ă©tĂ© retenus pour l'Ă©tude. Un amaigrissement moyen de 15,1% du poids usuel a Ă©tĂ© constatĂ© dans 86,7%. Seize patients (53,3%) ont prĂ©sentĂ© un risque nutritionnel Ă©levĂ©. Un grade nutritionnel cĂŽtĂ© Ă  4 a Ă©tĂ© retrouvĂ© dans 73,3% ; celui-ci Ă©tant significativement corrĂ©lĂ© avec la perte pondĂ©rale, l'indice de masse corporelle et la valeur de l'albuminĂ©mie (p<0,05). En postopĂ©ratoire, 73,3% des patients, ont perdu en moyenne 4,1kg. La variation pondĂ©rale pĂ©ri-opĂ©ratoire Ă©tait significativement influencĂ©e par le dĂ©but (p=0,0184) et la durĂ©e (p=0,0364) de la nutrition. Le taux d'albuminĂ©mie a augmentĂ© dans 53,3% des cas. Aucune complication majeure n'a Ă©tĂ© retrouvĂ©e. Conclusion: Dans notre contexte, le risque nutritionnel des patients est encore Ă©levĂ©. La recherche de signes pertinents de dĂ©nutrition et la stratification des patients s'avĂšrent essentielles d'autant plus que la chirurgie est majeure. Cette Ă©valuation permet de mieux prendre en charge le patient avant son intervention.Key words: Chirurgie digestive majeure, dĂ©nutrition pĂ©ri-opĂ©ratoire, Ă©valuation nutritionnelle, grade nutritionnel, indice de masse corporelle, indice de risque nutritionne

    Necrose Etendue De L’estomac Sur Dilatation Gastrique Chez Un Patient Suivi Pour Tumeur Cerebelleuse

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    Acute necrosis with a gastric dilatation is very rare. It usually occurs on psychiatric and neurological field. The preoperative diagnosis is difficult, and it is often revealed by radiological exams. With or without surgery, mortality remains high. We report a case of gastric necrosis in a patient with a severe neurological history. The clinical signs were vomiting, without intestinal transit disorders, and poor general condition. The radiological exams revealed gastric gas gangrene in the stomach wall. The surgical management determined the limit of gastric necrosis and gastrectomy was performed

    Molecular Adaptation to Folivory and the Conservation Implications for Madagascar’s Lemurs

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    The lemurs of Madagascar include numerous species characterized by folivory across several families. Many extant lemuriform folivores exist in sympatry in Madagascar’s remaining forests. These species avoid feeding competition by adopting different dietary strategies within folivory, reflected in behavioral, morphological, and microbiota diversity across species. These conditions make lemurs an ideal study system for understanding adaptation to leaf-eating. Most folivorous lemurs are also highly endangered. The significance of folivory for conservation outlook is complex. Though generalist folivores may be relatively well equipped to survive habitat disturbance, specialist folivores occupying narrow dietary niches may be less resilient. Characterizing the genetic bases of adaptation to folivory across species and lineages can provide insights into their differential physiology and potential to resist habitat change. We recently reported accelerated genetic change in RNASE1, a gene encoding an enzyme (RNase 1) involved in molecular adaptation in mammalian folivores, including various monkeys and sifakas (genus Propithecus; family Indriidae). Here, we sought to assess whether other lemurs, including phylogenetically and ecologically diverse folivores, might show parallel adaptive change in RNASE1 that could underlie a capacity for efficient folivory. We characterized RNASE1in 21 lemur species representing all five families and members of the three extant folivorous lineages: (1) bamboo lemurs (family Lemuridae), (2) sportive lemurs (family Lepilemuridae), and (3) indriids (family Indriidae). We found pervasive sequence change in RNASE1 across all indriids, a dN/dS value \u3e 3 in this clade, and evidence for shared change in isoelectric point, indicating altered enzymatic function. Sportive and bamboo lemurs, in contrast, showed more modest sequence change. The greater change in indriids may reflect a shared strategy emphasizing complex gut morphology and microbiota to facilitate folivory. This case study illustrates how genetic analysis may reveal differences in functional traits that could influence species’ ecology and, in turn, their resilience to habitat change. Moreover, our results support the body of work demonstrating that not all primate folivores are built the same and reiterate the need to avoid generalizations about dietary guild in considering conservation outlook, particularly in lemurs where such diversity in folivory has probably led to extensive specialization via niche partitioning

    Multi-band analyses of the bright GRB~230812B and the associated SN2023pel

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    GRB~230812B is a bright and relatively nearby (z=0.36z =0.36) long gamma-ray burst that has generated significant interest in the community and therefore has been subsequently observed over the entire electromagnetic spectrum. We report over 80 observations in X-ray, ultraviolet, optical, infrared, and sub-millimeter bands from the GRANDMA (Global Rapid Advanced Network for Multi-messenger Addicts) network of observatories and from observational partners. Adding complementary data from the literature, we then derive essential physical parameters associated with the ejecta and external properties (i.e. the geometry and environment) and compare with other analyses of this event (e.g. Srinivasaragavan et al. 2023). We spectroscopically confirm the presence of an associated supernova, SN2023pel, and we derive a photospheric expansion velocity of v ∌\sim 17×103\times10^3 km s−1s^{-1}. We analyze the photometric data first using empirical fits of the flux and then with full Bayesian Inference. We again strongly establish the presence of a supernova in the data, with an absolute peak r-band magnitude Mr=−19.41±0.10M_r = - 19.41 \pm 0.10. We find a flux-stretching factor or relative brightness kSN=1.04±0.09k_{\rm SN}=1.04 \pm 0.09 and a time-stretching factor sSN=0.68±0.05s_{\rm SN}=0.68 \pm 0.05, both compared to SN1998bw. Therefore, GRB 230812B appears to have a clear long GRB-supernova association, as expected in the standard collapsar model. However, as sometimes found in the afterglow modelling of such long GRBs, our best fit model favours a very low density environment (log⁥10(nISM/cm−3)=−2.16−1.30+1.21\log_{10}({n_{\rm ISM}/{\rm cm}^{-3}}) = -2.16^{+1.21}_{-1.30}). We also find small values for the jet's core angle Ξcore=1.70−0.71+1.00 deg\theta_{\rm core}={1.70^{+1.00}_{-0.71}} \ \rm{deg} and viewing angle. GRB 230812B/SN2023pel is one of the best characterized afterglows with a distinctive supernova bump

    Multiband analyses of the bright GRB 230812B and the associated SN2023pel

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    GRB 230812B is a bright and relatively nearby (z = 0.36) long gamma-ray burst (GRB) that has generated significant interest in the community and has thus been observed over the entire electromagnetic spectrum. We report over 80 observations in X-ray, ultraviolet, optical, infrared, and submillimetre bands from the GRANDMA (Global Rapid Advanced Network for Multimessenger Addicts) network of observatories and from observational partners. Adding complementary data from the literature, we then derive essential physical parameters associated with the ejecta and external properties (i.e. the geometry and environment) of the GRB and compare with other analyses of this event. We spectroscopically confirm the presence of an associated supernova, SN2023pel, and we derive a photospheric expansion velocity of v ∌ 17 × 103 km s-1. We analyse the photometric data first using empirical fits of the flux and then with full Bayesian inference. We again strongly establish the presence of a supernova in the data, with a maximum (pseudo-)bolometric luminosity of 5.75 × 1042 erg s-1, at 15.76+-10.2181 d (in the observer frame) after the trigger, with a half-max time width of 22.0 d. We compare these values with those of SN1998bw, SN2006aj, and SN2013dx. Our best-fitting model favours a very low density environment (log10(nISM/cm-3) = -2.38+-11.6045) and small values for the jet's core angle Ξcore = 1.54+-01.8102 deg and viewing angle Ξobs = 0.76+-01.7629 deg. GRB 230812B is thus one of the best observed afterglows with a distinctive supernova bump

    A STUDY OF MAIN CONSTRUCTION DELAYS FACTORS RELATING TO PRODUCTIVITY AND QUALITY OF THE PRODUCT IN YOGYAKARTA CITY

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    Globally speaking, the problem of delay in all kind of engineering construction is a very common difficulty causing several unwonted results to all participants concerned. A literature review was directed to compose a list of delay factors. The resulting list of delay factors was subjected to a questionnaire survey for quantitative confirmation and identification of the most frequent causes of delay in Yogyakarta City. The overall results indicated that the most important causes are: Shortage of Labor supply, Poor selection of subcontractors, Shortage of Technical professionals with the contractor, Slow preparation and approval of shop drawings, Shortage/Availability, Quality assurance/Control, Obtaining permits from Government, Unrealistic time estimation, Conflicts in work schedules of subcontractors, Delay in work approval. And construction delay doesn’t really affect the productivity of Yogyakarta construction companies. And finally, the qualities of their product are proven that remain the same, even any delays are happening

    Monodimensional modeling and experimental study of the dynamic behavior of proton exchange membrane fuel cell stack operating in dead-end mode

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    International audienceThe dynamic behavior of a five cells proton exchange membrane fuel cell (PEMFC) stack operating in dead-end mode has been studied at room temperature, both experimentally and by simulation. Its performances in “fresh” and “aged” state have been compared. The cells exhibited two different response times: the first one at about 40 ms, corresponding to the time needed to charge the double-layer capacitance, and the second one at about 15–20 s. The first time response was not affected by the ageing process, despite the decrease of the performances, while the second one was. Our simulations indicated that a high amount of liquid water was present in the stack, even in “fresh” state. This liquid water is at the origin of the performances decrease with ageing, due to its effect on decreasing the actual GDL porosity that in turn cause the starving of the active layer with oxygen. As a consequence, it appears that water management issue in a fuel cell operating in dead-end mode at room temperature mainly consists in avoiding pore flooding instead of providing enough water to maintain membrane conductivity
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