Exposition au VIH, à l'hépatite B et C au cabinet médical et à l'hôpital. Prévention et prophylaxie postexpositionnelle [Exposure to HIV, hepatitis B and C in office practice and hospital. Prevention and post-exposure prophylaxis]

Suite à un accident exposant à du sang (piqûre; coupure), provenant d'un patient infecté, le risque d'infection par VIH est d'environ 0,3% et par le virus de l'hépatite C (VHC) d'environ 0,5%. Chez les personnes vaccinées avec une réponse immunitaire adéquate (titre d'anticorps HBs >100 mUI/ml), aucune infection professionnelle par hépatite B n'a été reconnue en Suisse. La plupart des infections par VIH et VHB peuvent être prévenues par un traitement d'urgence et une prophylaxie postexpositionnelle (PEP). Il n'y a actuellement aucune prophylaxie postexpositionnelle pour le VHC. En cas de transmission de VHC, un traitement rapide par peginterféron et ribavirine est à envisager. Chaque hôpital et cabinet médical doivent mettre sur pied un système pour assurer une prise en charge optimale et en urgence des blessures par piqûres ou coupures. Lors de blessures accidentelles avec du sang de patients séropositifs pour le VIH et dans des situations complexes, il est recommandé de consulter un médecin du personnel ou un infectiologue expérimenté. The risk of infection after an occupational needle stick injury with blood from an infected source patient is approximately 0.3% for HIV and 0.5% for hepatitis C virus (HCV). In Switzerland no cases of occupational HBV infection have been recorded in fully vaccinated persons with a documented adequate vaccine response (HBsantibody titer >100 mIU/mL). Most occupational HIV und HBV infections can be prevented by appropriate emergency measures and post-exposure prophylaxis (PEP). No HCV-PEP is currently available. Early therapy with peginterferon and ribavirin should be considered in cases of occupational HCV seroconversion. Every hospital and office practice should establish a system for 24 h/24 h emergency management of occupational needle stick injuries. In the setting of an HIV-seropositive source patient and in complex situations, early consultation with a specialist in occupational medicine or infectious diseases should be considered.

Effets secondaires meconnus des glucocorticoi'des: prevention et traitement spécifiques requis [Some less well known side effects of glucocorticoids: specific prevention and treatment?]

Steroid treatment is required in many clinical settings and if prolonged can be associated with serious side effects. Certain less well-known side effects may require specific prevention, diagnosis and treatment. The risk of developing hyperglycemia, psychiatric disorders and opportunistic infections associated with immunosuppression is often forgotten. We present herein some evidence on the prevalence, preventive measures and treatment of some of these side effects. Large controlled trials are lacking and do not allow to provide strong recommendations. Nevertheless, we try to provide some suggestions based on a review of the literature.

Prévention des adhérences péricardiques avec une membrane biorésorbable [Prevention of pericardial adhesions with a bioresorbable membrane]

A bioresorbable membrane made of sodium hyaluronate and carboxymethycellulose, has been reported to prevent peritoneal adhesion. This study was designed to test its efficiency in the prevention of pericardial adhesions. Two groups of six pigs (mean weight 72 +/- 8 kg) were chosen for the experiment. The heart was exposed through a left thoracotomy and a wide patch of pericardium was excised. In the test group (n = 6), the left ventricular area without pericardium was divided into two areas: area A where six stitches of Prolene were performed, and area B which was left intact. The membrane was applied on the both areas as well as on the adjacent area covered with pericardium (area C). In the control group (n = 6), the same protocol was performed except for the membrane application. The animals were sacrificed one month later. The adhesion status as well as the visibility of the coronary anatomy was assessed according to severity scores ranging from 0 to 3 for the adhesions and from 0 to 2 for the visibility. The difference between groups was considered significant when p < 0.05. The adhesion score of the area A was 1.7 +/- 0.5 in the test group versus 2.5 +/- 0.5 in the control group (p = 0.02) and the visibility score was 1.3 +/- 0.8 and 2 +/- 0 respectively (p = 0.07). In the area B, the adhesion score was 1 +/- 0 in the test group versus 2 +/- 0.6 in the control group (p = 0.03) and the visibility score was 0.7 +/- 0.5 and 2 +/- 0 respectively (p = 0.001). Lastly, in the area C, the adhesion score was 1 +/- 0 in both groups (n.s.) and the visibility score was 0.7 +/- 0.4 in the test group versus 0.5 +/- 0.5 in the control group (n.s.). In this animal model, the role of the bioresorbable membrane in the prevention of pericardial adhesions is limited to the areas without pericardial cover and without foreign material. The presence of foreign material neutralizes its effect.

Iowa Crime Rate Comparisons Report, Iowa Department of Public Safety,1999

This report describes how Iowa compares to other states in the nation. To promote consistency, the Iowa totals and the other states’ information have been taken entirely from the FBI’s national publication called Crime in the United States; 1999. The Iowa information in Crime in the United States; 1999 is based upon actual summary totals for selected reporting jurisdictions and produced by the U.S. Department of Justice, F.B.I. These Iowa totals cannot be compared to the 1999 Incident-Based Iowa Uniform Crime Reports, which are based on actual totals for all reporting Iowa law enforcement jurisdictions.

Iowa Crime Rate Comparisons Report, 2000

This report describes how Iowa compares to other states in the nation. To promote consistency, the Iowa totals and the other states’ information have been taken entirely from the FBI’s national publication called Crime in the United States; 2000. The Iowa information in Crime in the United States; 2000 is based upon actual summary totals for selected reporting jurisdictions and produced by the U.S. Department of Justice, F.B.I. These Iowa totals cannot be compared to the 2000 Incident-Based Iowa Uniform Crime reports, which are based on actual totals for all reporting Iowa law enforcement jurisdictions.

Iowa Crime Rate Comparisons Report, Iowa Department of Public Safety, 2001

This report describes how Iowa compares to other states in the nation. To promote consistency, the Iowa totals and the other states’ information have been taken entirely from the FBI’s national publication called Crime in the United States; 2001. The Iowa information in Crime in the United States; 2001 is based upon actual summary totals for selected reporting jurisdictions and produced by the U.S. Department of Justice, F.B.I. These Iowa totals cannot be compared to the 2001 Incident-Based Iowa Uniform Crime Reports, which are based on actual totals for all reporting Iowa law enforcement jurisdictions.

Iowa Uniform Crime Report, Iowa Department of Public Safety, 1997

In 1974, the 65th Iowa General Assembly enacted a provision of Chapter 749 B of the Code of Iowa requiring law enforcement agencies to submit reports of crime and arrests to the Bureau of Criminal Investigation. The following language now is contained in section 692.15 Code of Iowa concerning Uniform Crime Reports: If it comes to the attention of a sheriff, police department or other law enforcement agency that a public offense has been committed in its jurisdiction, the law enforcement agency shall report information concerning such a public offense to the department on a form to be furnished by the department not more than thirty-five days from the time the public offense first comes to the attention of the law enforcement agency. The reports shall be used to generate crime statistics. The department shall submit statistics to the governor, the general assembly, and the division of criminal and juvenile justice planning of the department of human rights on a quarterly and yearly basis.

Iowa Crime Rate Comparisons Report, Iowa Department of Public Safety,1998

This report describes how Iowa compares to other states in the nation. To promote consistency, the Iowa totals and the other states’ information have been taken entirely from the FBI’s national publication called Crime in the United States; 1998. The Iowa information in Crime in the United States; 1998 is based upon actual summary totals for selected reporting jurisdictions and produced by the U.S. Department of Justice, F.B.I. These Iowa totals cannot be compared to the 1998 Incident-Based Iowa Uniform Crime Reports which are based on actual totals for all reporting Iowa law enforcement jurisdictions.

Iowa Uniform Crime Report, Iowa Department of Public Safety, 1998

If it comes to the attention of a sheriff, police department or other law enforcement agency that a public offense has been committed in its jurisdiction, the law enforcement agency shall report information concerning such a public offense to the department on a form to be furnished by the department not more than thirty-five days from the time the public offense first comes to the attention of the law enforcement agency. The reports shall be used to generate crime statistics. The department shall submit statistics to the governor, the general assembly, and the division of criminal and juvenile justice planning of the department of human rights on a quarterly and yearly basis.

Iowa Uniform Crime Report, Iowa Department of Public Safety, 1999

If it comes to the attention of a sheriff, police department or other law enforcement agency that a public offense has been committed in its jurisdiction, the law enforcement agency shall report information concerning such a public offense to the department on a form to be furnished by the department not more than thirty-five days from the time the public offense first comes to the attention of the law enforcement agency. The reports shall be used to generate crime statistics. The department shall submit statistics to the governor, the general assembly, and the division of criminal and juvenile justice planning of the department of human rights on a quarterly and yearly basis.

Iowa Uniform Crime Report, Iowa Department of Public Safety, 2000

If it comes to the attention of a sheriff, police department or other law enforcement agency that a public offense has been committed in its jurisdiction, the law enforcement agency shall report information concerning such a public offense to the department on a form to be furnished by the department not more than thirty-five days from the time the public offense first comes to the attention of the law enforcement agency. The reports shall be used to generate crime statistics. The department shall submit statistics to the governor, the general assembly, and the division of criminal and juvenile justice planning of the department of human rights on a quarterly and yearly basis.

Iowa Uniform Crime Report, Iowa Department of Public Safety, 2002

If it comes to the attention of a sheriff, police department or other law enforcement agency that a public offense has been committed in its jurisdiction, the law enforcement agency shall report information concerning such a public offense to the department on a form to be furnished by the department not more than thirty-five days from the time the public offense first comes to the attention of the law enforcement agency. The reports shall be used to generate crime statistics. The department shall submit statistics to the governor, the general assembly, and the division of criminal and juvenile justice planning of the department of human rights on a quarterly and yearly basis.

1995 Iowa Uniform Crime Report

If it comes to the attention of a sheriff, police department or other law enforcement agency that a public offense has been committed in its jurisdiction, the law enforcement agency shall report information concerning such a public offense to the department on a form to be furnished by the department not more than thirty-five days from the time the public offense first comes to the attention of the law enforcement agency. The reports shall be used to generate crime statistics. The department shall submit statistics to the governor, the general assembly, and the division of criminal and juvenile justice planning of the department of human rights on a quarterly and yearly basis.

Iowa Uniform Crime Report, 2001

If it comes to the attention of a sheriff, police department or other law enforcement agency that a public offense has been committed in its jurisdiction, the law enforcement agency shall report information concerning such a public offense to the department on a form to be furnished by the department not more than thirty-five days from the time the public offense first comes to the attention of the law enforcement agency. The reports shall be used to generate crime statistics. The department shall submit statistics to the governor, the general assembly, and the division of criminal and juvenile justice planning of the department of human rights on a quarterly and yearly basis.