Premature epiphyseal closure in an adolescent treated by retinoids for acne: an unusual cause of anterior knee pain.

Retinoids are effective and widely prescribed in the treatment of severe acne. However their use can be associated with numerous side effects. Some rare cases of premature epiphyseal closure were reported. We present the case of a sixteen-year-old soccer player referred for progressive anterior pain in both knees, evoking a patellar problem. Careful pharmacological questioning revealed use of isotretinoin for several months. MRI findings showed an irregularity of the growth plate and an important metaphyso-epiphyseal oedema, more noticeable in the left knee. Retinoid-induced premature epiphyseal closure was diagnosed. The treatment was stopped, with a resolution of pain within two months. After recovery a persisting small sequelar thumbprint-like growth plate lesion was observed on the control MRI. Retinoids induce an invasion of the growth plate by osteoclasts and a decrease in proteoglycans synthesis. It seems that the knee is the most affected joint. This complication being rare, a radiological follow-up of the young patients treated by retinoids is not proposed.

Reduction in the proportion of fevers associated with Plasmodium falciparum parasitaemia in Africa: a systematic review.

BACKGROUND: Malaria is almost invariably ranked as the leading cause of morbidity and mortality in Africa. There is growing evidence of a decline in malaria transmission, morbidity and mortality over the last decades, especially so in East Africa. However, there is still doubt whether this decline is reflected in a reduction of the proportion of malaria among fevers. The objective of this systematic review was to estimate the change in the Proportion of Fevers associated with Plasmodium falciparum parasitaemia (PFPf) over the past 20 years in sub-Saharan Africa. METHODS: Search strategy. In December 2009, publications from the National Library of Medicine database were searched using the combination of 16 MeSH terms.Selection criteria. Inclusion criteria: studies 1) conducted in sub-Saharan Africa, 2) patients presenting with a syndrome of 'presumptive malaria', 3) numerators (number of parasitologically confirmed cases) and denominators (total number of presumptive malaria cases) available, 4) good quality microscopy.Data collection and analysis. The following variables were extracted: parasite presence/absence, total number of patients, age group, year, season, country and setting, clinical inclusion criteria. To assess the dynamic of PFPf over time, the median PFPf was compared between studies published in the years ≤2000 and > 2000. RESULTS: 39 studies conducted between 1986 and 2007 in 16 different African countries were included in the final analysis. When comparing data up to year 2000 (24 studies) with those afterwards (15 studies), there was a clear reduction in the median PFPf from 44% (IQR 31-58%; range 7-81%) to 22% (IQR 13-33%; range 2-77%). This dramatic decline is likely to reflect a true change since stratified analyses including explanatory variables were performed and median PFPfs were always lower after 2000 compared to before. CONCLUSIONS: There was a considerable reduction of the proportion of malaria among fevers over time in Africa. This decline provides evidence for the policy change from presumptive anti-malarial treatment of all children with fever to laboratory diagnosis and treatment upon result. This should insure appropriate care of non-malaria fevers and rationale use of anti-malarials.

Médecine d'urgence [Emergency medicine: update 2010].

Several scores with predictive value for morbidity or mortality have been published this year. Their current purpose is to improve the direction of admissions and lengths of stay in hospital. Their use permits more directed care, especially for the elderly, and therefore could improve the proper orientation and admission of patients. Also this year, certain procedures are undergoing evaluation, namely: new assays for troponin, and non-contrast CT in the diagnosis of acute appendicitis. Furthermore in the therapeutic realm: the importance of cardiac massage and the advantages of therapeutic hypothermia in cardiac arrest, and the efficacy of oxygen therapy in cluster headache.

Young People and Food: Adolescent Dietary Beliefs and Understandings

This research provides fresh insight into the dichotomy between young people's knowledge of food safety and nutrition, and their behaviour.

Migraine, céphalées de l'enfant et de l'adolescent

La migraine de l'enfant est paradoxale à plus d'un titre : lors des crises, la douleur est sévère, les enfants sont souvent livides, « cadavériques », incapables de bouger, ils sont obligés de s'allonger dans la pénombre, vomissent parfois massivement, voient, sentent, entendent des « choses bizarres » - correspondant aux auras ; mais ils se réveillent en pleine forme après avoir dormi quelques heures... et tous les examens sont normaux. Alors que 5 à 10 % des enfants sont migraineux, le diagnostic n'est posé que pour une petite partie d'entre eux. La migraine est pourtant la première cause de céphalées intenses récurrentes chez l'enfant, la plupart des professionnels cherchant vainement une cause, et évoquant « les yeux, une gastro, les sinus ou bien une origine psy... ». Cet ouvrage a pour double objectif de présenter l'état de la science (épidémiologie, physiopathologie, génétique...) qui s'est largement enrichi ces dix dernières années et d'apporter aux professionnels des outils concrets pour identifier les céphalées et améliorer la prise en charge des enfants et des adolescents migraineux. Les céphalées de tension, les céphalées chroniques, les syndromes épisodiques associés à la migraine sont aussi détaillés. Illustré de nombreuses vignettes cliniques, cet ouvrage précise les critères diagnostiques, les pièges et les idées fausses ; il décrit comment rechercher les facteurs déclenchants et particulièrement ceux d'origine psychosociale, comment utiliser et combiner les traitements médicamenteux et non médicamenteux (notamment les approches psychothérapeutiques et psychocorporelles). Telle est l'ambition de ce livre, destiné à tous les professionnels confrontés à des enfants et des adolescents migraineux, mais également accessible en grande partie aux familles.

Médecine sociale en 2013 : quand la précarité précède la pauvreté [Social medicine : does it still make sense in 2013?]

Social medicine is a medicine that seeks to understand the impact of socio-economic conditions on human health and diseases in order to improve the health of a society and its individuals. In this field of medicine, determining the socio-economic status of individuals is generally not sufficient to explain and/or understand the underlying mechanisms leading to social inequalities in health. Other factors must be considered such as environmental, psychosocial, behavioral and biological factors that, together, can lead to more or less permanent damages to the health of the individuals in a society. In a time where considerable progresses have been made in the field of the biomedicine, does the practice of social medicine in a primary care setting still make sense? La médecine sociale est une médecine qui cherche à comprendre l'impact des conditions socio-économiques sur la santé humaine et les maladies, dans la perspective d'améliorer l'état de santé d'une société et de ses individus. Dans ce domaine, la détermination du statut socio-économique des individus ne suffit généralement pas à elle seule pour expliquer et comprendre les mécanismes qui sous-tendent les inégalités sociales de santé. D'autres facteurs doivent être pris en considération, tels que les facteurs environnementaux, psychosociaux, comportementaux et biologiques, facteurs qui peuvent conduire de manière synergique à des atteintes plus ou moins durables de l'état de santé des individus d'une société. A une époque où les connaissances, les compétences et les moyens à disposition en biomédecine ont fait des progrès considérables, la pratique de la médecine sociale en cabinet a-t-elle encore sa place en 2013?

Adult consequences of late adolescent alcohol consumption: a systematic review of cohort studies.

Alcohol is responsible for a significant portion of the global burden of disease. There is widespread concern reported in the media and other sources about drinking trends among young people, particularly heavy episodic or “binge” drinking. Prominent among policy responses, in the UK and elsewhere, have been attempts to manage antisocial behaviour related to intoxication in public spaces. Much less attention has been given to the longer term effects of excessive drinking in adolescence on later adult health and well-being. Some studies suggest that individuals “mature out” of late adolescent drinking behaviour, whilst others identify enduring effects on drinking and broader health and social outcomes in adulthood. If adolescent drinking does not cause later difficulties in adulthood then intervention approaches aimed at addressing the acute consequences of alcohol, such as unintentional injuries and anti-social behaviour, may be the most appropriate solution. If causal relationships do exist, however, this approach will not address the cumulative harms produced by alcohol, unless such intervention successfully modifies the long-term relationship with alcohol, which seems unlikely. To address this issue a systematic review of cohort studies was conducted, as this approach provides the strongest observational study design to evaluate evidence for causal inference.This resource was contributed by The National Documentation Centre on Drug Use.

Third annual report of child and adolescent mental health services (CAMHS)

16,080 Irish children (1.55% of population under 18 yrs.) availing of Community Child and Adolescent Mental Health Services   7,849 new cases were seen by community CAMHS teams between October 2010 and September 2011,compared with 7,561 in the previous 12 months   45% of referrals are seen within 1 month of referral and 69% within 3 months   Numbers waiting for CAMHS services down by 20%   61 multi-disciplinary Child and Adolescent Mental Health Services teams in place .This resource was contributed by The National Documentation Centre on Drug Use.

Essential community medicine

This textbook is a definitive guide to the complete spectrum of community medicine. The basic concepts are set out in a clear readable and concise way. The main types of health data are described, as are the principles of disease prevention and its main strategies.This resource was contributed by The National Documentation Centre on Drug Use.

Learning collaboration in General Internal Medicine: a pilot project for undergraduate students in nursing, physiotherapy and medicine

Background: A form of education called Interprofessional Education (IPE) occurs when two or more professions learn with, from and about each other. The purpose of IPE is to improve collaboration and the quality of care. Today, IPE is considered as a key educational approach for students in the health professions. IPE is highly effective when delivered in active patient care, such as in clinical placements. General internal medicine (GIM) is a core discipline where hospital-based clinical placements are mandatory for students in many health professions. However, few interprofessional (IP) clinical placements in GIM have been implemented. We designed such a placement. Placement design: The placement took place in the Department of Internal Medicine at the CHUV. It involved students from nursing, physiotherapy and medicine. The students were in their last year before graduation. Students formed teams consisting of one student from each profession. Each team worked in the same unit and had to take care of the same patient. The placement lasted three weeks. It included formal IP sessions, the most important being facilitated discussions or "briefings" (3x/w) during which the students discussed patient care and management. Four teams of students eventually took part in this project. Method: We performed a type of evaluation research called formative evaluation. This aimed at (1) understanding the educational experience and (2) assessing the impact of the placement on student learning. We collected quantitative data with pre-post clerkship questionnaires. We also collected qualitative data with two Focus Groups (FG) discussions at the end of the placement. The FG were audiotaped and transcribed. A thematic analysis was then performed. Results: We focused on the qualitative data, since the quantitative data lacked of statistical power due to the small numbers of students (N = 11). Five themes emerged from the FG analysis: (1) Learning of others' roles, (2) Learning collaborative competences, (3) Striking a balance between acquiring one's own professional competences and interprofessional competences, (4) Barriers to apply learnt IP competences in the future and (5) Advantages and disadvantages of IP briefings. Conclusions: Our IP clinical placement in GIM appeared to help students learn other professionals' roles and collaborative skills. Some challenges (e.g. finding the same patient for each team) were identified and will require adjustments.

Submission from the Irish Society of Physicians in Geriatric Medicine for the National Dementia strategy

The submission from the Irish Society of Physicians in Geriatric Medicine to the Minister for Health and Children for the National Dementia strategy is available to read here

Gériatrie [Review in geriatric medicine 2013].

Physical activity appears once again as the single most effective preventative intervention in older persons to delaying functional decline, avoiding falls, and mitigating the odds of developing dementia. Integrated care that promotes interdisciplinary collaboration among healthcare professionals is a major avenue to improve care coordination in polymorbid older patients. A study depicts the large gap between physicians and nurses' views about their respective skills and role in such a collaboration. On the cognitive side, while several studies show that new cohorts of older persons appear to age in better cognitive shape, results of trials of semagestat, a gamma-secretase inhibitor, and post-menopausal estrogenic therapy were disappointing. Finally, a study challenges the benefits of hydration in terminally ill patients.

Child and Adolescent Mental Health Service (CAMHS). Tier 4 Service Review - East Midlands

The project objectives were to: - Review the current situation for the population of the East Midlands, across the Tier 4 services and for young people in Out of Area Placements. - Examine current commissioning arrangements across the region and across the agencies of health, social care and education. - Consider the development of a shared framework within which future Tier 4 services could be planned and delivered. - Identify care pathways across the continuum of CAMHS services and highlight any gaps within CAMHS Tier 4 provision.

The feature of papers and citation analysis of eleven journals in tropical medicine indexed by Science Citation Index Expanded

To determine the features of papers, authors, and citation of eleven journals in tropical medicine indexed by Science Citation Index Expanded, the database of the Institute for Scientific Information, we analyzed original articles, editorials, reviews, corrections, letters, biographies, and news published in these journals. The results show that these journals covered 107 countries or regions on six continents. The average number of reference was 23.05, with 87.89% of the references from periodicals. The Price Index was 31.43% and the self-citing rate was 7.02%. The references in the first 20 journals ranked by the amount of citation accounted for 36.71% of the total citations. Brazil, United States, India, and England are more advanced in tropical medicine research. The conclusion is that these journals covered most research done in these countries or regions. Most researches were done by cooperation of the researchers, but many of the publications used outdated articles and should include newer information.