Pédiatrie [Current progress in pediatrics: obesity and diagnosis approach to the febrile child]

The literature shows that obesity is a public health problem concerning especially the general paediatrician. While prevention has probably more chances of success than treatment, drugs or, in case of failure, the surgical approach are reserved for extreme cases. In the domain of infectiology the different laboratory tests allow only partially to diagnose severe infections. But in the context of a potential influenza pandemic rapid virologic tests become more and more important. They allow a more precise diagnosis and a reduction of hospitalisations and of antibiotic prescriptions. A review of the north American experience with the pneumococal vaccine shows that the heptavalent vaccine will change our approach in infants with fever in whom we suspect a severe infection.

Evaluation préopératoire des patients ages [Preoperative assessment in elderly patients].

Age-related physiological changes and comorbidities affect older patients' tolerance to surgery. Pre-operative assessment in these patients requires, beside the usual physical evaluation, the systematic screening of common geriatric syndromes. Cognitive, gait and balance, nutritional, and functional impairments, all flag patients at higher risk for per- and postoperative complications. Preoperative assessment is an opportunity to detect these syndromes and propose preventative interventions (physical therapy, nutritional and cognitive support measures) likely to reduce the incidence of postoperative morbidity.

Convention-cadre pour la lutte antitabac: un instrument puissant de santé publique. [The Framework Convention for Tobacco Control (FCTC): a powerful public health instrument].

The Framework Convention on Tobacco Control (FCTC) isa global and comprehensive legal framework for reducing demand for tobacco (e.g. price measures; ban on smoking in enclosed places; contents of tobacco products; packaging and labeling; advertising, promotion and sponsorship; liability, tobacco cessation, etc.) and supply (e.g. illicit trade; sales to/by minors, etc.). Adopted in 2003, the FCTC has been ratified by 174 countries so far. Switzerland has signed the treaty in 2004 but ratification will necessitate the implementation of stronger tobacco control measures at the national level. The FCTC is a priority of any strategy to reduce noncommunicable diseases in populations. Broad implementation of the FCTC has the potential to prevent a substantial proportion of the billion of tobacco-related deaths expected in the 21st

Les comportements face au VIH/sida des hommes qui ont des relations sexuelles avec des hommes: enquête Gaysurvey 2012

Gaysurvey est une enquête menée périodiquement en Suisse parmi les hommes qui ont des relations sexuelles avec des hommes (HSH). Elle s'inscrit dans le dispositif de surveillance du VIH, établi par l'Office fédéral de la santé publique, en tant qu'instrument de suivi des comportements face au VIH/Sida dans ce groupe cible. Elle a déjà été réalisée à neuf reprises : en 1987, 1990, 1992, 1994, 1997, 2000, 2004, 2007 et 2009. En 2010, l'enquête européenne EMIS a permis d'obtenir certains indicateurs qui sont présentés avec les données des enquêtes Gaysurvey lorsqu'ils sont disponibles. Les résultats de cette enquête servent directement au pilotage et à l'évaluation de la stratégie de lutte contre le VIH/Sida en Suisse, telle qu'elle a été définie par l'OFSP et ses partenaires. Elle permet d'établir des tendances temporelles au niveau des pratiques sexuelles et des expositions au risque d'infection par le VIH. Elle permet, en outre, d'approfondir certaines thématiques pertinentes pour le travail de prévention (gestion du risque au sein d'une relation stable, entrée dans la sexualité, pratiques de réduction des risques). Ce rapport a pour objectif de faire la synthèse des tendances, mises à jour lors de la dernière vague d'enquête réalisée en 2012. [Introduction p. 17]

Médecines complémentaires: vers un consensus "evidence-based" à l'hôpital universitaire. [Complementary and alternative medicines (CAM): towards an "evidence-based" consensus in the University hospital]

Après la votation fédérale demandant de prendre en compte les médecines complémentaires, un consensus a été recherché dans quatorze services et unités du Centre hospitalier universitaire vaudois (CHUV). Confrontés aux données de la littérature (Plus de 2000 publications en "Evidence-based complementary medicine" depuis 1998), les soignants étaient tous surpris par l'ampleur des résultats cliniques disponibles actuellement. Tous identifiaient un besoin en formation et en informations sur le sujet. Une prise de position officielle de l'institution était aussi souhaitée, instituant l'enseignement et la recherche sur les médecines complémentaires et assurant la production d'informations rigoureuses et pertinentes pour la clinique. [Abstract] While a popular vote supported a new article on complementary and alternative medicines (CAM) in the Swiss Constitution, this assessment in 14 wards of the University Hospital of Lausanne, Switzerland, attempted at answering the question: How can CAM use be better taken into account and patients informed with more rigor and respect for their choices? Confronted with a review of the literature (> 2000 publications in "Evidence-based cornplementary medicine" since 1998), respondents declared their ignorance of the clinical data presently available on CAM. All were in favour of more teaching and information on the subject, plus an official statement from the Hospital direction, ensuring production and diffusion of rigorous and cJinically significant information on CAM.

Les sinusites d'origine dentaire: diagnostic et prise en charge [Diagnosis and management of sinusitis of odontogenic origin]

Les sinusites maxillaires sont des infections fréquentes de la sphère ORL. On retrouve une étiologie dentaire dans environ 10% des cas. L'extension des infections dentaires dans le sinus maxillaire est possible en raison de la proximité des racines des dents postérieures avec le bas fond sinusien. Une source odontogène doit être suspectée chez les patients ayant une anamnèse de douleur ou d'infection dentaires, de soins dentaires récents et qui présentent une sinusite unilatérale prolongée ou résistant à un traitement conservateur habituel. Les infections d'origine dentaire possèdent une flore bactérienne mixte. Le diagnostic et la prise en charge nécessitent un bilan radiologique précis. Le traitement doit prendre en charge conjointement la cause dentaire et la sinusite. Un geste chirurgical peut être indiqué dans un deuxième temps afin de restaurer la fonction sinusienne. Maxillary sinusitis are common infections. A dental origin is found in about 10% of the cases. The roots of the posterior maxillary teeth are adjacent to the sinus floor. Extensions of dental infections are therefore possible to the sinus. An odontogenic source should be considered in patients with a history of dental pain or recent oral surgery and those with extended unilateral sinusitis or unilateral sinusitis resistant to conventional treatment. Maxillary sinusitis of dental origin are polymicrobial infections. Conventional radiographs and CT-scans are required for the diagnosis and proper management. Dental treatments to remove the underlying cause combined with oral antibiotics to treat the infection are required. Endoscopic or open surgery may be necessary to complete the treatment and restore adequate sinusal function.

Maladies infectieuses en pratique ambulatoire (sauf sida) [Infectious diseases (beside AIDS)]

A simplified version of the US guidelines for prophylaxis of infectious endocarditis was published in 2007. Changes are expected in Switzerland as well. Posaconsole is a new antifungal agent available mostly for prophylaxis in immunocompromised patients. Epidemiology of sexually transmitted infections warrants screening in young adults and after one episode. A meta-analysis clarified the impact of antibiotic therapy in patients with Campylobacter spp. infection. In the field of emerging diseases, we discuss Norovirus epidemics, community-acquired bacteria producing extended-spectrum betalactamases, extensively resistant tuberculosis, and new respiratory viruses. Finally, we address a basic research topic that may change practice in the future: the relationship between individual susceptibility to infection and innate immunity.

Genetic characterization of the ABO blood group in Neandertals

Background: The high polymorphism rate in the human ABO blood group gene seems to be related to susceptibility to different pathogens. It has been estimated that all genetic variation underlying the human ABO alleles appeared along the human lineage, after the divergence from the chimpanzee lineage. A paleogenetic analysis of the ABO blood group gene in Neandertals allows us to directly test for the presence of the ABO alleles in these extinct humans. Results: We have analysed two male Neandertals that were retrieved under controlled conditions at the El Sidron site in Asturias (Spain) and that appeared to be almost free of modern human DNA contamination. We find a human specific diagnostic deletion for blood group O (O01 haplotype) in both Neandertal individuals. Conclusion: These results suggest that the genetic change responsible for the O blood group in humans predates the human and Neandertal divergence. A potential selective event associated with the emergence of the O allele may have therefore occurred after humans separated from their common ancestor with chimpanzees and before the human-Neandertal population divergence.

Prise en charge des jeunes patients avec endocrinopathies pediatriques chroniques: les défis d'une transition souvent difficile [Caring for patients with pediatric endocrinopathies and diabetes into adulthood: challenges of an often difficult transition].

The success of therapies for a number of pediatric disorders has posed new challenges for the long-term follow-up of adolescents with chronic endocrinopathies. Unfortunately, too many patients are lost during the transfer from pediatric to adult clinics. The transition process should be well-organized and include the young person and family. Recognizing the special needs of these adolescents is an important step in developing patient-centered approaches to care that enable patients to develop autonomy and self care skills. Key elements in this process include structured policies and guidelines, communication and close collaboration between pediatric and adult clinics, and integrating nurse clinicians in the transition process to help close the gaps in care.

Maladies inflammatoires de l'intestin [Main therapeutic advances in IBD in 2007].

In 2008 three biological agents against TNFalpha will be available. The combination of infliximab with azathioprine is no longer recommended, as hepatosplenic lymphomas with a particularly bad prognosis have been associated with this combined therapy. Regular maintenance therapy with infliximab is as effective in preventing the development of anti-infliximab antibodies as co-administration of this anti-TNFalpha agent with an immunomodulator. The benefit of regular maintenance therapy is probably linked to the presence of residual trough levels of infliximab between perfusions.

Prescription des psychotropes au cabinet médical [Psychotropic drug prescription in general practice].

General practitioners treat patients with psychiatric disorders, for whom they have to evaluate the indication of a psychotropic medication. In addition to the patient's symptoms, the clinician has to take into account transferential and countertransferential elements linked to the prescription. Sociological factors also influence both the patient and the clinician, partly due to the western society's value of performance. Consistent with the bio-psycho-social model of disease, we recommend that the evaluation of the indication of a psychotropic medication includes the patient's symptoms, but also the psychological and sociological factors.

La néphrectomie partielle dans le cancer du rein: un nouveau standard [Partial nephrectomy in renal cancer: a new standard?]

Rising renal cell carcinoma incidence is in relationship with early diagnosis during radiological exams. Radical nephrectomy was the gold standard treatment for 30 years. Partial nephrectomy is nowadays a validated therapeutic option for renal cell carcinoma up to 7 cm with comparable oncological results associated with better life quality and survival. Partial nephrectomy is tricky and laparoscopic approach remains reserved for expert centers.