Revue médicale suisse
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Revue médicale suisse · Nov 2014
Review[Idiopathic pulmonary fibrosis: recent diagnostic and therapeutic advances].
Idiopathic pulmonary fibrosis (IPF) is the most frequent of the idiopathic interstitial pneumonias. It is a progressive disorderwith a poor prognosis. Its diagnosis requires the careful exclusion of potential causes, and a pattern of usual interstitial pneumonia at high-resolution computed tomography or video-assisted surgical lung biopsy. ⋯ The combination of prednisone and azathioprine, often prescribed until recently, has been shown to be harmful and is no longer indicated. N-acetylcystein, also used in the past decade, failed to show an efficacy. However, two new antifibrotic drugs, pirfenidone and nintedanib, have for the first time proven effective in slowing disease progression.
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Pneumonia is an importance cause of mortality and morbidity in adults. Two types of pneumonia are defined: community-acquired and nosocomial pneumonia with their corresponding etiology such as pneumococci or Haemophilus influenzae and Pseudomonas or enterobacteriaceae, respectively. ⋯ Culture in the case of nosocomial pneumonia is especially important to obtain the antibiotic susceptibility of the infectious agent and to adjust therapy. Moreover for immunocompromised patients, the differential diagnosis is much wider looking for viruses, filamentous fungi and Pneumocystis can be very informative, using new molecular assays.
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Age-related physiological changes and comorbidities affect older patients' tolerance to surgery. Pre-operative assessment in these patients requires, beside the usual physical evaluation, the systematic screening of common geriatric syndromes. Cognitive, gait and balance, nutritional, and functional impairments, all flag patients at higher risk for per- and postoperative complications. Preoperative assessment is an opportunity to detect these syndromes and propose preventative interventions (physical therapy, nutritional and cognitive support measures) likely to reduce the incidence of postoperative morbidity.
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Revue médicale suisse · Nov 2014
Review[Electives during preclinical medical curriculum: the Geneva experience ].
Electives have come of age in Medical Schools throughout Europe since the Bologna Guidelines were issued. At the Faculty of Medicine of Geneva its importance was recognized early to satisfy the students' curiosity, enlarge their visions, or deepen their knowledge in certain aspects of their curriculum. ⋯ The experience has so far been a success, with high satisfaction as well of the student as of the teacher body. A major challenge for the future will be opening further these Electives to other Faculties and other professions.