Presse Med
-
Neurostimulation of neuropathic pain is based on surgical implantation of devices for several types of neuromodulatory treatment (stimulation of the spinal cord, cortex, deep brain or thalamus, or occiput). Spinal cord stimulation is a recognized treatment, with a high level of proof. ⋯ Cortical stimulation is effective in 50 to 70% of cases but should be performed only in several specialized centers. Thalamic stimulation, with its efficacy rate of only 30 to 50%, should be reserved for patients for whom the preceding techniques have failed.
-
Genital human papillomavirus (HPV) infection is one of the most common sexually transmitted infections worldwide. Two HPV vaccines are now available in many countries: (i) the first vaccine is quadrivalent and indicated in the prevention of CIN 2/3, cervical cancers, VIN 2/3, VaIN 2/3 and genital warts associated with the HPV types 6, 11, 16 and 18, (ii) the second vaccine is bivalent and indicated in the prevention of CIN 2+ and cervical cancers associated with the HPV types 16 and 18. ⋯ This review is to my knowledge, the most comprehensive and up-to date review to be published in French on HPV epidemiology and related diseases. It will be of great value to educate medical and paramedical personnel on HPV infection and associated diseases and it will be of great help to public health authorities and decision makers when they have to evaluate the convenience of introducing HPV vaccination in a given population.
-
Interindividual variability in pain perception and response to opioids in terms of efficacy and side effects has been long noted. Numerous genes have been proposed as ideal candidate genes for the study of the genetic component of pain and pharmacogenetics of opioids. Despite the inherent complexity in studying pain, it is obvious that several genetic polymorphisms contribute to modulate nociception and the antinociceptive effects of opioids; specifically those involved in pharmacokinetics and the metabolism of opioids (cytochrome P450) and neurotransmitters (catechol-O-methyltransferase), as well as those affecting pharmacodynamics or the drug targets such as the mu-opioid receptor or the unexpected melanocortin 1-receptor.
-
Apeced syndrome is a rare disease, with autosomal recessive transmission and associated with mutations of the AIRE gene, which is involved in central and peripheral immune tolerance mechanisms. Its diagnosis is classically based on the combination of any two of the following three major criteria: chronic mucocutaneous candidiasis, hypoparathyroidism and autoimmune chronic adrenocortical insufficiency (Addison disease). One single criterion is sufficient to diagnosis a sibling of a patient already diagnosed. ⋯ Potentially fatal disease (hepatitis or severe malabsorption) requires immunosuppressant therapy. Before beginning this aggressive treatment, underlying infectious foci, especially of candidiasis, must be sought and treated to prevent the development of extremely serious systemic infections in this context. A workup for splenic atrophy is also recommended.