Revue medicale suisse最新文献

Autoimmune diseases affecting the CNS can be part of a systemic disease, such as systemic lupus erythematosus, or an exclusive neurological disorder, such as multiple sclerosis. While the clinical phenotypes show some overlap, the underlying pathophysiological mechanisms diverge in each condition. The rarity of these dysimmune diseases in paediatrics implies the effectiveness, or immaturity, of the immune system in preventing or rectifying autoimmune reactions induced by various environmental agents. However, when such diseases commence in this age group, they show a particularly inflammatory course which warrants the awareness of their diagnostic criteria and underlying mechanisms, to ensure prompt and appropriate treatment.

Juvenile idiopathic arthritis (JIA) and systemic lupus erythematosus (SLE) are complex pediatric rheumatologic diseases with a significant genetic component. These conditions include various subtypes, each of which presents unique diagnostic and therapeutic challenges. Recent advances in biotherapy and genetics have revolutionized the management of these diseases, allowing for more targeted and effective treatments. This article explores the different aspects of JIA and SLE, as well as pediatric systemic vasculitis and certain immune deficiencies associated with dysimmunity, and highlights recent progress in the understanding and treatment of these diseases.

Shadowing is a teaching method that involves accompanying people in their daily activities without disturbing them. During their final year externship in a family doctor's practice, medical students from the University of Lausanne meet a patient at home and observe other professionals, thus enriching their understanding of collaborative practice. To illustrate this method described in the article «Shadowing as a pedagogical method for teaching interprofessional collaboration»a recently published in this journal, this article presents the experience of a trainee doctor who shadowed a patient and her care network during her externship in family medicine.

All health providers have implicit biases that can result in discriminatory care for racialized patients. Contrary to explicit bias, such acts are unintended, but can nonetheless have important consequences to patient care. These types of biases have been found to result in inadequate pain management, a false identification of urgency, and poor patient-provider communication. This second article in a series on racism in healthcare, explores the various forms of implicit biases in care, the extent of their impact, and how health providers can mitigate them. The aim of this review will be to inform readers on how to provide more equitable care for racialized patients.

In pediatric gastroenterology and hepatology, autoimmune diseases, such as inflammatory bowel diseases, celiac disease, and autoimmune hepatitis, are challenging for practitioners due to their increasing incidence, high morbidity, and substantial impact on children's quality of life. These conditions share similar pathophysiological mechanisms, including genetic predisposition, the role of the microbiome, and the influence of environmental and immunological factors. This review aims to explore their pathophysiology, diagnostic strategies, treatments, and future perspectives. It highlights the importance of early and multidisciplinary management to improve outcomes for affected children.

Autoimmune thyroid diseases, including Hashimoto's thyroiditis and Graves' disease, are the most common causes of acquired thyroid dysfunction in children and adolescents. They are often diagnosed at puberty, with a female predominance. A familial predisposition and associations with other autoimmune diseases such as celiac disease and type 1 diabetes point to underlying genetic mechanisms. This predisposition is attributed to the polymorphism of multiple HLA (Human Leukocyte Antigen) and non-HLA susceptibility genes, opening the field for the development of targeted therapies that can potentially modify the course and prognosis of autoimmune thyroid diseases.

Vitiligo and alopecia areata are chronic autoimmune dermatoses that are relatively common in the pediatric population. Vitiligo is a pigmentation disorder and alopecia areata is a non-scarring alopecia. Both conditions can be highly stigmatizing and have a significant impact on the mental health and quality of life of young patients and their families. There are no large-scale prospective therapeutic studies in the pediatric population. As a result, the expertise of the pediatric dermatologist, along with shared decision-making with the patient and his/her parents, is critical for effective management. This process should carefully consider the individual benefit-risk ratio to ensure the best possible outcome.