La Revue du praticien最新文献

VIRAL HEPATITIS AND PREGNANCY. The event of pregnancy, the risks of obstetrical complications and vertical transmission will vary according to the type of viral hepatitis. Hepatitis A is transmitted via feacal-oral transmisson, is generally mild, but may increase the risk of obstetric complications. Hepatitis B, the most common, can be transmitted from mother to child, particularly during delivery. Its management includes prenatal screening and antiviral treatment to prevent vertical transmission. Hepatitis C is mainly blood-borne. Hepatitis D superinfects those with HBV, with limited treatment options during pregnancy. Hepatitis E, common in low-income countries, is severe particularly in the third trimester, and may lead to fulminant hepatitis. Mother-to-child transmission is rare for all these viruses, and breastfeeding is generally permitted.

METHODS OF CEREBRAL STIMULATION IN PSYCHIATRY. Psychiatric disorders are a frequent reason for consultation, accounting for 15% of general medical visits. Some patients have severe disorders, meaning they have a significant impact on their daily functioning. Others have treatment-resistant disorders, defined as an insufficient response to at least two antidepressant treatments prescribed at an adequate dosage for a sufficient length of time. Some symptoms are inacessible to pharmacological treatment. Because of their systemic action, pharmacological therapies may expose patients to adverse metabolic or neurological effects. Brain stimulation is a new therapeutic approach that helps mitigate systemic adverse effects through its focal action. Various brain stimulation techniques are used in routine clinical practice in France (electroconvulsive therapy) or within the research field (rTMS: repetitive transcranial magnetic stimulation, TDCS: transcranial direct-current stimulation, DBS: deep brain stimulation, and VNS: vagus nerve stimulation).

NEW TECHNIQUES OF PROSTATE IRRADIATION. Radiotherapy is a leading treatment in the management of prostate cancer. Technological developments and experience have made it possible to develop innovative techniques, to carry out shorter treatments, with fewer sessions and similar effectiveness, with a good control of toxicity. Historical treatments involving 40 sessions have been replaced by much shorter cycles of 20 sessions and even as few as 5 sessions in carefully selected cases. The hindsight seems sufficient, and ongoing studies suggest the installation of new treatment standards, and in the goal for the future is one session treatments.

WHAT ARE THE KEY TAKEAWAYS FROM THE HAS RECOMMENDATIONS REGARDING SPECIAL POPULATIONS (ELDERLY POPULATIONS AND PREGNANCY OR PLANNING TO BECOME PREGNANT) ? Type 2 diabetes in elderly patients is a common reason for consultation in general practice. Its management is challenging due to the heterogeneity of this particular population, which often combines age-related and diabetes-related complications. A geriatric assessment is necessary to set glycemic targets and define the therapeutic strategy. Therapeutic means are based on lifestyle modifications combined with medical treatment with particular attention to the risk of hypoglycemia and malnutrition. The indications for cardio- and nephroprotective treatments are the same as for younger subjects. Regular reassessment of health status is necessary and therapeutic deintensification should be considered when appropriate.

THROMBOTIC MICROANGIOPATHIES. The syndrome of thrombotic microangiopathy (TMA) is defined by the combination of mechanical hemolytic anemia, consumptive thrombocytopenia, and organ failure secondary to microvascular obstruction by microthrombi. TMAs include thrombotic thrombocytopenic purpura and atypical hemolytic uremic syndrome and require specific therapies that have significantly improved the prognosis ; post-infectious HUS (including shigatoxin-associated HUS), and secondary TMAs that occur in specific contexts (infection, neoplasia, transplantation, autoimmune disease, medication or toxin exposure, severe hypertension, etc.). The main etiological entities, their pathophysiology, clinical phenotypes, and appropriate management, are reviewed below, with a focus on situations requiring specific and urgent treatment.