Malnutrition has been reported in alcohol use disorder patients as having a possible influence on cognitive function. The aim of this study was to analyse the prevalence of ascorbic acid (AA) deficiency in inpatients admitted for alcohol detoxification and the associated factors, including cognitive impairment in the early period of abstinence. A retrospective chart review was conducted. The AA level was categorised into three groups: deficiency (AAD) (<2 mg/L), insufficiency (AAI) (2–5 mg/L) and normal level. The cognitive impairment was screened using the Montreal Cognitive Assessment (MoCA). Ninety-six patients were included (74 men; mean age 49.1 years (±11.5)). Twenty-seven AAD (28.1%) and twenty-two AAI (22.9%) were observed. In multivariate analysis, risk factors for AAD versus normal AA level were men (OR 17.8, 95%CI (1.63–194)), compensated cirrhosis (OR 9.35, 95%CI (1.60–54.6)) and street homelessness (OR 5.76, 95%CI (1.24–26.8) versus personal housing). The MoCA score was available for 53 patients (mean MoCA score: 25.7 (±3.3)). In multivariate analysis, the natural logarithm of AA (β = 1.18, p = 0.037) and sedative use disorder (β = −2.77, p = 0.046) were associated with the MoCA score. AAD and AAI are frequent in inpatients admitted for alcohol detoxification. A low level of AA was associated with cognitive impairment in the early period of abstinence.
Altered cytochromes P450 enzymes (CYP) and P-glycoprotein transporter (P-gp) activity may explain variabilities in drug response. In this study, we analyzed four years of phenotypic assessments of CYP/P-gp activities to optimize pharmacotherapy in psychiatry. A low-dose probe cocktail was administered to evaluate CYP1A2, 2B6, 2D6, 2C9, 2C19, 3A4, and P-gp activities using the probe/metabolite concentration ratio in blood or the AUC. A therapeutic adjustment was suggested depending on the phenotyping results. From January 2017 to June 2021, we performed 32 phenotypings, 10 for adverse drug reaction, 6 for non-response, and 16 for both reasons. Depending on the CYP/P-gp evaluated, only 23% to 56% of patients had normal activity. Activity was decreased in up to 57% and increased in up to 60% of cases, depending on the CYP/P-gp evaluated. In 11/32 cases (34%), the therapeutic problem was attributable to the patient’s metabolic profile. In 10/32 cases (31%), phenotyping excluded the metabolic profile as the cause of the therapeutic problem. For all ten individuals for which we had follow-up information, phenotyping allowed us to clearly state or clearly exclude the metabolic profile as a possible cause of therapeutic failure. Among them, seven showed a clinical improvement after dosage adaptation, or drug or pharmacological class switching. Our study confirmed the interest of CYP and P-gp phenotyping for therapeutic optimization in psychiatry.
RESUME Objectifs.-En 2018, une évaluation des pratiques professionnelles en nutrition parentérale a été réalisée chez des patients adultes hospitalisés au Centre Hospitalier Universitaire de Rennes. Patients et méthodes.-Deux audits ont permis l'analyse rétrospective de 48 dossiers patients sous nutrition parentérale. La liste des données à recueillir a été élaborée à partir de la grille d'évaluation des pratiques professionnelles sur la nutrition parentérale de la Société Francophone de Nutrition Clinique et Métabolisme (SFNCM). Résultats.-L'indication de la prescription était justifiée dans 75% des cas. Un quart des prescriptions coïncidait avec les apports énergétiques recommandés de 25-35 kcal/kg/j. 77,1% des prescriptions sont complémentées par des vitamines et oligo-éléments. L'Indice de Masse Corporelle était calculé pour 77% des patients. Le poids du mois précédent était inscrit à 87,5% dans le dossier patient. Le calcul de la perte de poids n'était mentionné que dans 23% des dossiers. La surveillance clinique et biologique était incomplète pour l'ensemble des patients. Conclusion.-Cette évaluation des pratiques professionnelles met en évidence des points positifs dans nos pratiques mais également de nombreux axes d'amélioration. Elle devra être suivie par la mise en place d'actions correctrices ciblant 3 axes d'amélioration retenus : la prescription de vitamines et d'oligoéléments, un bilan biologique complet avant l'instauration et pour la surveillance d'une nutrition parentérale et le recueil systématique des indicateurs nutritionnels pour l'évaluation de la dénutrition (ex
BackgroundNivolumab is a human monoclonal antibody used in the pneumology unit to treat patients with metastatic non-small cell lung cancer (NSCLC) with progression on, or after, platinum-based chemotherapy. Nivolumab is administered intravenously at a dose of 3 mg/kg every 2 weeks or at a dose of 240 mg (dose based on the median body weight of 80 kg in patients in American clinical trials).PurposeIn order to meet the increasing demand for chemotherapy in our hospital we consider introducing a system of standardised dose-banding.Material and methodsIn making an assessment of nivolumab prescriptions and of the patient characteristics who received nivolumab in 2016, we analysed the medical records on our chemotherapy software Asclepios®.ResultsIn 2016, our centralised reconstitution unit had prepared 472 nivolumab doses. Bodyweights of ours patients were clustered: 43 to 114 kg, with a median of 72 kg. The use of banded doses to give doses within 10% of the prescribed dose was considered acceptable practice by our prescribers. Therefore a standard dose of 240 mg could be administered to patients between 74 and 88 kg and a standard dose of 198 mg could be administered to patients between 60 and 73 kg. In view of our patients’ bodyweights in 2016, 40% of the prepared nivolumab could have been matched with the 240 mg standard dose and 36% with the 200 mg (rounded value of 198 mg) standard dose. Following this analysis, a meeting between the pneumology unit and the pharmacy allowed the creation of two nivolumab protocols: 200 mg (for weights≤73 kg) and 240 mg (for weights>73 kg).ConclusionDose-banding of nivolumab is effective since May 2017. Previous protocols were replaced by the two new protocols. This standardisation permits a reduction in waiting times for patients (nivolumab doses were prepared the day before) and reduces the waste when treatments are deferred (due to ability to re-asign the preparations).References and/or AcknowledgementsVidal, Asclepios, medical records.No conflict of interest
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