Infliximab - Recommendations practiques pour le traitment de la maladie de Crohn

Infliximab is a monoclonal chimeric antibody, with high affinity and specificity for tumour necrosis factor alpha (TNFalpha) that plays a central role in the pathogenesis of immune mediated inflammatory disorders including Crohn's disease and ulcerative colitis. Globally over 600000 patients have been treated with infliximab to date. This global experience led to a better definition of the overall safety and efficacy profile of this medication. The goal of the present recommendations is to provide practical information to physicians involved in the care of patients with inflammatory bowel disease.

[Pyelonephritis treatment in children in 2007: current literature review]

Four studies, including two being published as an abstract, have recently demonstrated the feasibility of oral treatment of pyelonephritis in children, with no increased risk of treatment failure, early urinary tract re-infection, or renal scars. To do so, the pediatrician must ensure that: (1) the patient does not appear toxic, has no vomiting; (2) there is no known severe obstructive or refluxing uropathy and (3) parents are deemed to be adherent to the treatment. If these criteria are fulfilled, the pediatrician can start an oral treatment with a 3rd generation cephalosporine for 10 to 14 days. Ambulatory follow-up is crucial, and persistance of fever after 3 days is a reason for a new outpatient visit, additional or supplementary imaging studies (renal ultrasonography) and eventually a switch to intravenous treatment.

[Epidemiology of osteoporotic fractures in Switzerland]

Fractures occurring after 50 years of age are among the leading causes of hospitalizations in Switzerland. At the age of 50 years, in Switzerland, the remaining lifetime probability of suffering an osteoporotic fracture is 51% and 20% for women and men, respectively, i.e. every other woman and every fifth man. According to the demographic projection scenarios, the number of elderly aged 65 years or more will have doubled by year 2050. In the absence of targeted interventions, the considerable human, social, and economic burden represented by osteoporotic fractures should increase by the same order of magnitude. With FRAX (fracture risk assessment tool), validated for Switzerland in tight collaboration with the World Heath Organization, the individual probability of fracture during the next 10 years can be predicted.

[Towards the Swiss systemic lupus erythematosus cohort study (SSCS)]

Systemic lupus erythematosus (SLE) is a rare disease mainly affecting women of childbearing age. It is characterized by a very large spectrum of clinical manifestations accompanied by prototypic abnormalities of the immune system. While recent advances in therapeutic approaches have taken place, SLE still has a profound impact on the quality of life and life expectancy of affected persons. The Swiss cohort for longitudinally studying SLE named SSCS responds to the necessity of better understanding the history of the disease, the mechanisms involved in its pathogenesis, to identify and apply new therapeutic and prevention strategies, as well as to analyze the impact that SLE has at the social and personal levels in Switzerland. SSCS is a tool to be used by all researchers interested to provide answers to the many open questions in SLE.

[Diagnostic pitfalls about a specific case of low back pain]

Diagnostic pitfalls about a specific case of low back pain Low back pain is classified into two principle categories: specific and non specific. This difference is important in terms of screening, medical care and treatment. Specific low back pain has various etiologies that imply specific treatment. This report describes one case of rare specific low back pain. The purpose of this article is to highlight the pitfalls that can represent such a common pathology, to show that obtaining an early diagnosis can be challenging, and finally to prevent care providers from stereotypes related to low back pain management.

Coopération cardio-vasculaire avec l’Hôpital BPKIHS, à Dharan Bazar, Népal

Grâce à une collaboration entre des cardiologues suisses, la Fondation Cœur de la Tour et l’Hôpital universitaire BPKIHS à Dharan, il a été possible en l’espace de deux ans, en utilisant une approche «hybride», de développer le premier programme de cardiologie invasive et interventionnelle indépendant dans l’est du Népal. Depuis janvier 2011, 496 patients ont pu être investigués et traités en 23 mois (coronarographies, angioplasties coronaires, pose de pacemakers temporaires et définitifs, drainages péricardiques, etc.). Parallèlement à cet axe principal, la Fondation a également soutenu un programme préexistant de prévention des facteurs de risque cardio-vasculaires dans cette région, et a apporté un appui financier à la mise sur pied d’un projet de dépistage et de traitement des atteintes cardiaques rhumatismales chez les enfants en âge scolaire.

Questions and answers regarding the use of rivaroxaban in daily practice.

Several new oral anticoagulants are now on the Swiss market and the general practitioner faces new challenges regarding the management of these new drugs. This consensus document aims to answer to the most frequently asked questions regarding rivaroxaban and covers different topics such as indications, initiation of treatment, drug-drug interactions and perioperative management.

Consensus 2012 sur le diagnostic et le traitement des patients atteints de démence en Suisse

Le consensus 2012 sur le diagnostic et le traitement des patients atteints de démence en Suisse a été élaboré par une conférence d’experts qui s’est déroulée du 23 au 25 mars 2012 à Lucerne. Après revue des données scientifiques récentes, les auteurs ont rédigé un projet qui a été soumis à de nombreux experts de la démence en Suisse dans le cadre d’une procédure de consultation. Après adaptation et révisions du document initial en fonction des remarques exprimées, l’ensemble des spécialistes consultés et les membres du groupe d’experts adhèrent expressément aux prises de position énoncées dans ce document. La conférence d’experts a été financée par le Forum Alzheimer Suisse.

L’hépatite auto-immune

Autoimmune hepatitis is a systemic disease, difficult to diagnose due the high variability of the clinical presentation and some non specific histological features. The recent identification of additional autoantibodies used as serological markers, as well as simplified diagnostic criteria should help the primary care physician to advance with the diagnostic process. These progresses are crucial as undiagnosed and therefore untreated autoimmune hepatitis has a poor prognosis, whereas immunosuppressive therapy leads to remission in a majority of cases.