Revue medicale suisse最新文献

The CIWA-Ar (Clinical Institute Withdrawal Assessment for Alcohol-revised) is the gold standard for assessing the severity of alcohol withdrawal. It allows the dosage of benzodiazepines to be adjusted according to symptom intensity rather than prescribing them at a fixed dose, with the aim of limiting prolonged use and the associated risk of dependence. Randomized trials have shown that this approach reduces both the total amount of benzodiazepines administered and the duration of treatment without compromising clinical efficacy or increasing alcohol withdrawal-related complications. However, CIWA-Ar use requires prior training of healthcare providers. Dosage is adjusted according to the score (<8: monitoring; 8-15: standard dose; >15: increased dose). The scale is contraindicated in uncooperative, confused, or intubated patients.

In 2025, several major advances have marked the field of neurology. Anti-FcRN and anti-C5 antibodies have confirmed their long-term efficacy in the treatment of myasthenia gravis. Bruton tyrosine kinase inhibitors have expanded the therapeutic arsenal for multiple sclerosis. An antibody targeting α-synuclein appears to slow motor decline in early-stage Parkinson's disease. The efficacy of late thrombolysis in strokes with radiological mismatch has been confirmed. A blood biomarker facilitates early detection of Alzheimer's disease, and Swiss guidelines specify the modality for the use of anti-amyloid therapies in this disease. Finally, in pregnant women with epilepsy, the recommended dose of folic acid has been reduced.

Regenerative and functional gynecology, which is rapidly expanding thanks to biotechnologies and energy-based devices, aims to restore the function and trophicity of tissues. It relies on biological approaches (platelet-rich plasma, botulinum toxin, hyaluronic acid) and physical modalities (lasers, radiofrequency, photobiomodulation), which show promise in the treatment of various vulvar pathologies, vulvodynia, as well as in postpartum perineal repair. Despite encouraging results, the level of evidence remains inconsistent. These techniques should complement conventional management and be performed by trained practitioners in accordance with regulatory standards. This article provides an updated synthesis of the current perspectives of regenerative medicine in gynecology.

Acute abdominal pain is a common complaint in primary care. Point-of-care ultrasonography, which is rapidly expanding, serves as a diagnostic aid and helps improve the management of certain conditions, such as cholecystitis, nephrolithiasis, or acute urinary retention, but its use must be targeted. Based on a few clinical cases, this article illustrates its use and discusses its limitations.

The health of transgender and non-binary adolescents has emerged as a major topic at the intersection of medicine, ethics, and societal issues. At the request of several cantonal medical officers, the National Advisory Commission on Biomedical Ethics published an opinion paper on the medical treatment of minors experiencing gender dysphoria at the end of 2024. The document provides a clear framework, based on scientific evidence and biomedical ethics, in a context of uncertainty and sociopolitical polarization. It emphasizes an individualized and careful evaluation of benefits and risks, the recognition of adolescents' evolving autonomy, interdisciplinary collaboration, and the protection of each adolescent's right to an open future.

Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment and significantly improved survival in many tumour types. However, blocking the immune system's inhibitory signaling pathways can trigger an excessive immune response against the body's own tissues, leading to immune-related adverse events (irAEs). These can potentially affect any organ system and represent a significant clinical challenge. This article provides a practical overview of irAEs management, with a particular focus on neurological complications. It presents evidence-based strategies for prevention, diagnosis and treatment, and discusses decision criteria for resuming ICI treatment after an irAE.

Presbyopia, atrophic age-related macular degeneration, and thyroid eye disease are ophthalmic conditions that can significantly affect patients' vision and quality of life. In this article, we present the most recent therapeutic innovations for their management, including the myotic eye drop aceclidine for presbyopia, complement inhibitors (pegcetacoplan, avacincaptad pegol) to slow the progression of atrophic AMD, and teprotumumab, an anti-IGF1-R antibody, to reduce proptosis and diplopia in thyroid eye disease.