Revue médicale suisse
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Revue médicale suisse · Feb 2020
Review[Cigarette smoke and nicotine during pregnancy : where are we today?]
In Switzerland, about 13 % of pregnant women smoke, giving birth to more than 11'000 infants per year exposed to tobacco in utero. Although this proportion is stable since the 2000's, the users of nicotine with new devices (electronic cigarettes, inhaled heated tobacco, sniffed or chewed tobacco) are increasing. ⋯ Available data suggest that in utero exposure to e-cigarette could also expose the fetus to a similar profile of adverse effects. In this article, we review briefly the known epidemiological and mechanistic data on the short- and long-term effects of prenatal cigarette smoke and nicotine consumption.
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Revue médicale suisse · Dec 2019
Review[Direct oral anticoagulants in the treatment of cancer-associated thrombosis].
The use of direct oral anticoagulants (DOACs) has been largely -implemented in the management of venous thromboembolic disease in non-cancer patients. In cancer-associated thrombosis, low molecular weight heparins (LMWHs) and especially dalteparin have long been the reference standard therapy. ⋯ In patients with gastrointestinal or genitourinary cancers however, a higher bleeding risk has been shown with DOACs. LMWHs thus remain the treatment of choice in this group of patients.
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Revue médicale suisse · Oct 2019
Review[« ARNI » (Angiotensin Receptor-Neprilysin Inhibitor): when, for whom and how?]
The association of an angiotensin II receptor antagonist and a neprilysin inhibitor (ARNI or Angiotensin Receptor-Neprilysin Inhibitor) is a new actor in the management of heart failure with reduced left ventricular ejection fraction (LVEF). The PARADIGM-HF trial performed in outpatients with a LVEF ≤ 35-40 % demonstrated that sacubitril-valsartan was superior to enalapril in reducing cardiovascular mortality and heart failure hospitalizations. Precautions in the initiation of sacubitril-valsartan, its use as well as its place in the drug management strategy for chronic heart failure are described in the present review. Additional data in patients hospitalized with reduced LVEF, in patients with LVEF > 45 % as well as the effects on blood pressure, renal or cognitive functions are presented.
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Revue médicale suisse · Sep 2019
Review[The refeeding syndrome in the elderly population : from hospital to home].
The refeeding syndrome (RS) is a consequence of passing from a catabolic state to an anabolic state triggered by renutrition that is followed by a prolonged period of fasting. Often under-diagnosed in the context of malnutrition or multimorbid patients, RS presents itself through nonspecific symptoms (oedema and tachycardia) that can rapidly progress in the first 72 hours into life threatening states. ⋯ Several recent studies have addressed hypophosphatemia as a predominant marker allowing to better estimate refeeding syndrome gravity and risk. Patients who present a risk should have a progressive renutrition with an electrolyte substitution if required.
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The emergence of immunotherapy has generated great enthusiasm in oncology improving the prognosis of pathologies such as melanoma, lung cancer, kidney cancer, bladder and head and neck cancers. This enthusiasm concerns also older patients in view of the good tolerance of immunotherapy in young people. ⋯ This article summarizes the experience of immunotherapy in large clinical trials. It appears that the immune checkpoint inhibitors are effective and well tolerated in the elderly.