[Pediatrics. Diagnosis of generalized joint hypermobility in children].

Joint hypermobility is a common feature in children and adolescents, often physiological and benign, but it is also a manifestation of hereditary connective tissue disorders. In pediatrics, there is a real need to differentiate Ehlers-Danlos syndrome (EDS) hypermobile type (hEDS) from benign hypermobility, in the absence of a genetic marker specific to this form of EDS. In 2023, the International Ehlers-Danlos Consortium revised the diagnostic criteria for children and adolescents, introducing the concept of hypermobility spectrum disorder.

[Myalgic encephalomyelitis : etiopathogenesis, diagnosis and treatment].

Myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), is a neurological disorder involving multiple pathophysiological mechanisms and etiologies. Symptoms include asthenia, myalgia, post-exertional malaise and neurocognitive disorders. While the numerous patient complaints pose a diagnostic challenge, the advent of new technologies paves the way for innovative methods to reveal ME.

[A map for the improvement of healthcare: Swiss Health Care Atlas].

The Swiss Health Care Atlas (ASSS) is a free platform accessible to healthcare professionals and the general public. It provides a detailed overview of healthcare practices and the use of pharmaceutical and technological resources in both acute and outpatient care settings throughout Switzerland. It serves as an interactive tool for visualizing medical services and practices in Switzerland, along with regional variations.

[COPD : a still neglected condition].

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung disorder with a complex clinical picture. The diagnosis may be difficult at times, as COPD may develop insidiously and remain unnoticed for a long time. Therefore, general practitioners play a central role in early detection of disease.

[Novelties in the Treatment of Asthma].

For general practitioners there have been important novelties in the treatment of asthma due to recent modifications of the international guidelines from Global Initiative for Asthma (GINA). In Step 1, use of short-acting beta2-agonists (SABA) without concomitant inhaled corticosteroids (ICS) as controller is no longer recommended for lack of efficacy and safety reasons. Instead, low dose ICS-formoterol as needed is recommended.

[Use of non-pharmacological home remedies in ENT: research informs our practices and those of our patients].

Upper respiratory tract infections (URTIs) are a common presenting condition in family medicine. The vast majority of URTIs are treated symptomatically with pharmacological or non-pharmacological treatments. This article presents some of the results of our research projects to compile a list of non-pharmacological home remedies to relieve symptoms such as sore throat, coughs and colds.

[Management of chronic ulcers: punch grafting].

Chronic ulcers are a common but important dermatological problem and a major source of expense in the western countries. Skin graft is a surgical procedure in which skin or skin substitute is transplanted in order to close a wound. This article aims to review the different categories of grafts, their indications for the healing of chronic ulcers of the lower limbs, emphasizing the position of punch grafts in the treatment arsenal.

[The efficacy of omalizumab in the treatment of chronic rhinosinusitis with nasal polyps: a discussion of 2 refractory cases].

Nasal polyposis is a specific phenotype of chronic rhinosinusitis (CRS). Some cases can be managed with topical and infrequent use of systemic steroids, while many patients require surgery. Despite postoperative, regular steroid administration, recurrences may be found especially in patients suffering from Aspirin exacerbated respiratory disease (AERD), a particularly severe form of CRS with polyps, asthma and non-steroid-anti-inflammatory-drug (NSAID) intolerance.

[The organ transplanted patient in the dental clinic].

Patients with solid organ transplants can be challenge to manage pre- and postoperatively. Dental care should be given to these patients prior to surgery in order to achieve healthy oral conditions. Periodontitis has to be treated, in- sufficient root canal treatments need to be revised, cavities shall be filled and teeth that cannot be salvaged should be extracted.

[Amoxicillin with clavulanic acid - standard antibiotic in general dentistry].

This script gives a pragmatic advice for gen-eral dentists on accurate use of amoxicillin with clavulanic acid considering current liter-ature at acute inflammatory disease. In ab-sence of contraindications a twice daily for- mulation of 1g amoxicillin with clavulanic acid is the first choice for concomitant therapy after treating the cause of inflammation or prophy-laxis. Compared to clindamycin the concen-tration of amoxicillin in teeth and bone (Hallig 2014) is higher and has less gastrointestinal side-effects (Bax 2007).

[Drug-induced anaphylaxis - Adrenalin as emergency drug in anaphylaxis.].

Anaphylaxis is defined as a serious allergic or hypersensitivity reaction in the most cases as a result of an IgE-mediated allergic reaction that is rapid in onset and may cause death. Common triggers are foods, insect stings, and medications. The medical treatment includes, epinephrine, glucocorticoids, antihistamines and inhaled bronchodilators, with the aim to prevent progression to life-threatening respiratory and/or cardiovascular symptoms.

[The role of surgery in the treatment of acne scars].

Severe acne lead to inesthetic scars on the face of young adults. A new classification based on the morphology of acne scars allows to establish the more appropriate therapeutic strategy. The surgical technics are: punch-excision, punch-elevation, subcission, dermal graft or adipose tissue autotransplantation.

[Neurogenic ectopic ossification: a physiatry update].

The first aim of this paper is to present a critical review of the existing literature on neurogenic ectopic ossification. The second aim is to introduce the two papers published in this issue of the journal. In addition, etiopathogenic aspects are described as well as some insights in classical therapies and new therapeutic options which could prove to be useful in the near future.

[Useful examinations and therapies in immunologic diseases].

Screening by immune disease is useful for one part in the various ocular inflammatory processes, uveitis, vasculitis, (epi)scleritis and myositis, for the other in collagen diseases with possible eye complications. The various forms of uveitis can be related either to rheumatic disease, to some HLA antigen, to a microbiological agent, sometimes to sarcoidosis. Retinal vasculitis remains almost always of unknown origin, while scleritis and myositis are often related to rheumatic disease, eventually to Wegener's granulomatosis.

[Pathogenesis and treatment of primary closed-angle glaucoma].

With an incidence of about 1/1000, primary angle-closure glaucoma is 4 to 5 times less frequent than primary open-angle glaucoma. It occurs most frequently due to pupillary block, itself both due to anatomical configuration and to either physiological or pathological changes in the anterior chamber. Pupillary block causes an increase of pressure in the posterior chamber, which leads to anterior displacement of the iris and, finally, to angle closure.

[Ocular complications of AIDS. Diagnostic problems].

Presentation is made of the ocular complications of AIDS which were observed in the ophthalmologic clinic of the University Hospital in Zurich from 1986 to 1991. Besides cotton-wool spots, CMV-retinitis is the most frequent and best known infectious complication. In all other infections, diagnosis is most difficult, because it could never be supported by histological examination.

[At-risk keratoplasty, HLA antigens and cyclosporin A].

Keratoplasty in a calm and avascular cornea usually involves no histocompatibility problem. This is not the case if the recipient cornea is inflamed or vascularized. In such cases, and in those where the donor button has been rejected, HLA matching and particularly the search of HLA DR is important.

[Mechanism of action of beta-blockers].

If beta-blockage does not cause lowering of aqueous humor secretion, in itself responsible for the maintenance of intraocular pressure, what is the mechanism of action? The antagonism for indolamines, recently measured in aqueous humor, the absence of nocturnal effect, and the amplitude diminution of diurnal variations thus produced suggest that beta-blockers could interact with indolamines, since the latter are probably responsible for intraocular pressure regulation. Aqueous humor secretion depends to a major extent on the sodium-potassium pump and its enzyme, Na+K(+)-ATPase. Serotonin, known for its activating action on Na+K(+)-ATPase, is present in the greatest amounts in the morning, precisely when the aqueous humor secretion is the highest.

[Sense and nonsense of examinations in hematogenous and exogenous intra-ocular infections].

Diagnosis of intraocular inflammations can be difficult, particularly if the patient is suffering from immunodeficiency. Among the endogenous inflammations this applies mainly to cases of hyaloretinitis caused by Candida or other fungi, often presenting as an acute hyalitis with sudden onset; the various ocular complications of AIDS, especially those due to toxoplasmosis (rare) and cytomegalovirus, and lyme disease, which can occasionally cause chronic panuveitis. Among the exogenous cases it applies to postoperative and posttraumatic endophthalmitis.