La Revue du praticien最新文献

PERITONEAL DIALYSIS IN THE TREATMENT OF END-STAGE RENAL DISEASE. Peritoneal dialysis (PD) is a replacement therapy for patients with stage 5 chronic kidney disease (CKD5). Its use varies from country to country. In France, only 11% of CKD5 patients are treated with PD, with great disparity between regions, the majority being supported with center hemodialysis (HD). Yet this treatment offers many advantages. It is a home-based treatment, allowing greater autonomy, and easy for patients to learn. In the event of incapacity, assistance can be provided by a nurse or a relative. No vascular approach is required. Its effectiveness in terms of patient survival is at least identical to that of HD patients. It is vital that all patients at MRC4 or 5 stage should be managed within the care pathway recommended by Haute Autorité de santé, so that they can benefit, among other things, from informed pre-dialysis information on the different dialysis modalities.

DIAGNOSTIC MANAGEMENT OF FIRST SEIZURE AND EPILEPSY. Diagnosis of a first seizure and epilepsy is complex. It is a source of error, with a risk of over or under-diagnosis. A clear understanding of the stages in the diagnostic process is essential, particularly for practitioners dealing with patients in acute situations where the diagnosis has not yet been made: general practitioners, paediatricians, geriatricians, emergency physicians, intensive care specialists... The French National Authority for Health has recently proposed an update of these diagnostic management steps.

THERAPEUTIC MANAGEMENT OF ADULTS WITH EPILEPSY. With the development of numerous antiseizure medications, therapeutic options for the management of patients suffering from epilepsy have greatly diversified. This diversification of the therapeutic arsenal means that treatment can now be better adapted to each individual patient. The choice of molecule for new-onset epilepsy in adults thus takes into account both the expected efficacy of the molecule in the epileptic syndrome from which the patient suffers, and its suitability for the patient's specific characteristics, whether in terms of gender, age or co-morbidities. This approach is essential for all patients, with particular attention to young women of childbearing age. In situations of drug resistance, it is essential to remain alert to the risk of treatment side-effects, without ignoring non-pharmacological options. This is particularly important in the case of focal epilepsies, where the pre-surgical evaluation must be discussed as a matter of principle.

IMPACT OF EPILEPSY ON PERSONAL AND PROFESSIONAL LIFE. Epilepsy is more than the occurrence of seizures and their direct consequences. Epilepsy is a chronic, often ostracizing disease, which has repercussions in many areas, both personal and professional. Knowing about these repercussions (on schooling, employment, driving) and inform patients about them, so as to offer them solutions adapted to their individual situation, is essential and forms part of the overall management of epilepsy. Numerous resources exist and can be made available to patients, although there are disparities in access to certain resources depending on where they live.

Antimicrobial resistance in human and veterinary medicine: WHERE ARE WE ? In both human and veterinary medicine, the evolution of antimicrobial resistance is worrying for some antibiotics or bacterial species, but less for others. In humans and animals, the picture for respiratory infections is rather favorable. On the other hand, resistance to fluoroquinolones of bacteria causing sexually transmitted infections in humans, or of Campylobacter_in animals, has increased significantly. Two major indicators of antimicrobial resistance, common to both sectors, are resistance to 3rd generation cephalosporins in Enterobacterales and resistance to methicillin in Staphylococcus aureus. Favorable trends in humans and animals are shown ; they remind of the dual importance, in the fight against antimicrobial resistance in a One Health approach of controlling antibiotic consumption on the one hand, and of respecting hygiene practices, on the other.

HOW TO READ NEW ANTIMICROBIAL SUSCEPTIBILITY TESTING RESULTS? Antimicrobial susceptibility testing (AST) results (formerly 'susceptible', 'intermediate' and 'resistant') are now expressed with the new susceptibility categories 'susceptible, standard dosing regimen', 'susceptible, increased exposure' and 'resistant'. These new categories introduce a paradigm shift in the way clinicians have to interpret AST results: uncertainties (previously embedded in the 'intermediate' category) now have to be dealt with exclusively by the laboratory, independently from the clinical categorization itself, and both 'susceptible, standard dosing regimen' and 'susceptible, increased exposure' categories are associated with a high likelihood of therapeutic success if appropriate dosing regimen is used. To help clinicians, a dosing table (fitting dosing regimens usually recommended in France, and consistent with clinical breakpoints) is now available as an appendix to the CA-SFM document (Comité de l'antibiogramme de la Société française de microbiologie), and can also be downloaded from the SPILF website (Société de pathologie infectieuse de langue française).