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O presente trabalho tem como objectivo avaliar a adequabilidade de dois modelos empíricos de erosão, para o mapeamento do risco de erosão pós-fogo à escala da encosta, com base em Sistemas de Informação Geográfica. Foi desenvolvido no âmbito do projecto EROSFIRE, que pretende avaliar as vantagens e desvantagens de experiências de campo de simulação de chuva para mapear o risco de erosão, fornecendo dados necessários à calibração de modelos.

In the present work of investigation, the pulse cardiac is monitoring with a heart rate sensor. All data record is obtained of a healthy person group, five junior and one expert electric lineman, Pulse cardiac let show the behavior of the heart when responding to physical effort and stress situation. So that we relate the required physical effort evidenced by a calorific map, the condition of stress due to the fear of falling and the variability of the cardiac pulse. Study is presented in stages. In the first stage, it is possible to demonstrate the increase of the cardiac pulse due to the effort. In the second stage, the increase of the cardiac pulse due to a condition of stress or fear is presented. Finally, in the third stage, the cardiac pulse increases proportionally. Also the cardiac pulse is monitored when descending the concrete post. A variability of the cardiac rhythm between the participants is obtained. It checks that the heart rate after an effort or stress condition becomes unpredictable for different people.

Red eye is a common condition characterized by eye redness, often accompanied by itching, burning, pain, or discharge. This condition can be caused by a multitude of factors, ranging from minor irritations to severe infections. Red eyes are a frequent complaint in outpatient practice. Only a small percentage of patients with red eyes require urgent ophthalmological referral and treatment, while the vast majority can be managed by a general practitioner., Competing Interests: les auteur-es n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In 2015, in partnership with a research team, the PROFAN program was initiated by a group of peers to counter the increasing number of overdose-related deaths in Montreal. As of 2018, they have offered, in collaboration with the Association des intervenants en dépendance du Québec (AIDQ) (Quebec Association of Addiction Workers), over 160 training sessions, and have connected with 500 Québec organizations, resulting in a total of over 2,000 participants. A participative evaluation process was undertaken with respect to the expansion of the program. The level of engagement of both partners was evaluated for each stage of the research process, as well as the benefits reported by each party. Examining the level of engagement during the evaluation process highlighted the leadership exhibited by the PROFAN team regarding funding and the dissemination of results. The research team provided leadership for the production of the protocol and analysis, and helped with dissemination among researchers and specialists in the domain. Data collection involved a collaboration between both parties. As for reported benefits, some were associated with the program’s operations (increased credibility, support for it being updated, establishing partnerships), and others involved peer empowerment (skills development). The need to urgently intervene to decrease the number of overdose deaths seems to have facilitated the funding of the program and the development of partnerships. The partnership between PROFAN and the research team has been marked by collaboration and a sharing of expertise.

Despite optimized screening and prevention strategies, cervical cancer remains a major public health problem, even in developed countries. In France, the incidence is estimated at 3159 cases per year in 2023. While the management of early-stage cases is now highly standardized, few therapeutic advances were made in the treatment of metastatic stages before 2021, before the therapeutic arsenal that we know today took off. The aim of this review is to summarize these advances., (Copyright © 2023 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

The therapeutic management of age-related macular degeneration (AMD) is a major public health issue. One of its two late forms, neovascular AMD, is currently treated by intravitreal injections of pharmaceutical active ingredients. Although it is very effective in treating pathologies of the posterior segment of the eye, the intravitreal route is not an ideal option for the long-term management of a chronic disease such as AMD. Indeed, in the literature, some authors even call it a "burden" for the practitioners, the patients and the healthcare system. Thus, consideration should be given to less invasive routes. Among the possible administration routes to reach the posterior segment of the eye, the most suitable for the patient with the least risk of systemic adverse effects is the topical route. Several research teams have attempted to formulate molecules for topical administration in the treatment of atrophic or neovascular AMD. In this review, we emphasize the importance of the pharmaceutical formulation to meet the challenge of targeting the posterior segment of the eye by a topical route., (© 2023 médecine/sciences – Inserm.)

Objective: There is no specific recommendation for management in pregnant women: the aim of this review, based on a clinical case study, is to clarify its development, complications, risk factor and treatment., Methods: A review of the literature was performed by consulting the Pubmed, Cochrane Library, and Science Direct databases., Results: Primary hyperparathyroidism is defined as excessive production of parathyroid hormone resulting in hypercalcemia. The prevalence of primary hyperparathyroidism during pregnancy is not known. Indeed, the symptomatology, related to hypercalcemia, is not very specific and easily confused with the clinical manifestations of pregnancy. The physiological changes specific to the pregnant state frequently lead to a slight hypocalcemia which may complicate the diagnosis of primary hyperparathyroidism. Primary hyperparathyroidism results from a parathyroid adenoma in the majority of cases and is detected by ultrasound during pregnancy. Primary hyperparathyroidism in pregnancy causes significant risks to both mother and fetus. The maternal complication rate is 14-67%, however, the most serious complication is hypercalcemic crisis, which requires increased surveillance in the postpartum period. Obstetrical complications are also induced by primary hyperparathyroidism, such as acute polyhydramnios, or intrauterine growth retardation. The fetal complication rate can reach 45-80% of cases with neonatal hypocalcemia as the main complication. If medical treatment is based on hyperhydration, only surgical treatment is curative., Conclusion: Surgery should be proposed to symptomatic patients or those with high blood calcium levels, discussed in interdisciplinary committee and should be organized ideally in the second trimester to avoid maternal and fetal complications., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Compared to the general population, patients with inflammatory bowel disease (IBD), both ulcerative colitis (UC) or Crohn's disease (CD), are at increased risk of developing some cancers, particularly colorectal cancers (CRC). CRCs, the vast majority of which are adenocarcinomas, develop from a precancerous lesion called dysplasia (or intraepithelial neoplasia) via an inflammation-dysplasia-adenocarcinoma sequence. The advancements of new endoscopic techniques, including visualisation and resection techniques, has led to a reclassification of dysplasia lesions into visible and invisible lesions and their therapeutic management, with a more conservative approach to the colorectal setting. In addition, besides conventional dysplasia, of intestinal phenotype, classically described in IBD, non-conventional dysplasias (as opposed to conventional dysplasia of intestinal phenotype) are now described, including at least seven subtypes. Recognition of these unconventional subtypes, which are still poorly known from pathologists, is becoming crucial, as some of these subtypes appear to be at high risk of developing advanced neoplasia (i.e. high-grade dysplasia or CRC). This review briefly describes the macroscopic features of dysplastic lesions in IBD, as well as their therapeutic management, followed by the clinicopathological features of these dysplastic lesions, with particular emphasis on the new subtypes of unconventional dysplasia, both from a morphological and molecular point of view., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

About 5% of gastric cancers are associated with hereditary cancer syndromes. Histology is paramount in this context, as major susceptibility genes are associated with specific subtypes. Germline pathogenic variants in CDH1 and CTNNA1 cause Hereditary Diffuse Gastric Cancer (HDGC). Major advances have been made in the past ten years regarding HDGC. Penetrance estimates for diffuse cancer are now lower than previously thought, at 30-40%. Surveillance upper gastrointestinal endoscopy is now an acceptable alternative to prophylactic total gastrectomy. Indeed, its sensitivity in detecting advanced disease is satisfactory assuming it is performed by an expert and according to a specific protocol. The risk of intestinal-type gastric cancer is increased in patients with Lynch syndrome, although it is much lower than the risk of colorectal and endometrial cancer. Intestinal-type gastric cancers are also observed in excess in patients with hereditary polyposis, the main one being APC-associated familial adenomatous polyposis. The main and most clinically relevant manifestations in patients with polyposes remain colorectal and duodenal polyps and carcinomas, well ahead of gastric cancer. Finally, recent data point towards increased gastric cancer risk in hereditary breast and ovarian cancer., (Copyright © 2022 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Although asbestos has been banned in Switzerland since 1989, diseases caused by asbestos are still present and increasing today. In Switzerland, per year, occupational exposure to asbestos is responsible for approximately 135 deaths from mesothelioma and 930 deaths from lung cancer, though the latter is rarely recognized as an occupational disease. Taking an occupational history is essential for all such diagnosis, especially in smokers, whose risk of lung cancer increases due to the synergistic effect of asbestos and tobacco exposure. The medical practitioner can play an important role in occupational diseases being recognized as such, which is essential for the reimbursement of medical expenses by the accident insurance companies and the allocation of indemnities and pensions for the patient or their family., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Advances in bioanalytical technologies such as high throughput sequencing have paved the way for an exponential increase in the discovery of inborn errors of metabolism (IEM), which now sum up to more than 1800 IEM. These powerful technologies play a decisive role in shortening the diagnostic odyssey of patients affected by rare diseases. Yet, their added value in guiding therapy is still limited. Metabolic medicine remains a growing discipline that is particularly dependent on specialized laboratory analyses and has adopted early on the fundamental concept of a patient-centered care approach. The discovery of phenylketonuria (PKU) as a treatable cause of mental retardation has hence led to the implementation of newborn screening. With this example, we highlight some key concepts in caring for patients affected by IEM., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: Intérêts concurrents: James Stone déclare avoir reçu des honoraires et émoluments à titre de consultant pour Bayer Canada et Sanofi Canada. Le Dr Stone est directeur médical principal du Cardiovascular Health and Stroke Strategic Clinical Network des Services de santé de l’Alberta, et membre actif du conseil de gouvernance du Collège des médecins et chirurgiens de l’Alberta. Jason Andrade déclare avoir reçu une rémunération ou des honoraires de Medtronic, BiosenseWebster, Abbott, Biotronik, Bayer, Servier et BMS-Pfizer. Simon Bacon déclare avoir reçu des subventions de Moderna, versées à Respiplus pour la création de modules de formation sur la réticence aux vaccins et des honoraires de consultant et de conférencier de Respiplus. Il a fait partie de comités consultatifs pour Bayer, Sanofi, Respiplus et Lucilab, aucun n’étant en lien avec le présent article. Il est aussi titulaire d’une chaire en mentorat pour la Stratégie de recherche axée sur le patient des Instituts de recherche en santé du Canada (IRSC) (SMC-151518), et d’une chaire du Fonds de recherche du Québec (251618 et 309815). Harpreet Bajaj déclare avoir reçu des subventions de Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Gilead, Janssen, Kowa Pharmaceuticals, Merck, Novo Nordisk, Pfizer, Sanofi et Tricida, et des honoraires de conférencier de Eli Lilly et Novo Nordisk. Mark Gelfer déclare avoir reçu des honoraires de consultation de Cliniques Telus Santé et occupe un poste bénévole de président du conseil de GenXys Health Care Systems, dont il détient des actions. Jeffrey Habert déclare avoir reçu des honoraires de consultation de MDBriefcase, Liv, MedPlan, Master Clinician Alliance, Academy, Bridge, Seacourses, Thrombose Canada, Meducom, Antibody, Canadian Heart Research Centre, CTC Communications, STA Healthcare Communications, Canadian Collaborative Research Network, CPD Network, Telus Santé, EOCI Pharmacomm et Operatic. Le Dr Habert a aussi reçu des honoraires de Pfizer, Amgen, BMS, Bayer, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Purdue, Bausch, Allergan, AbbVie, AstraZeneca, Novartis, Lundbeck, CHEP+, Novo Nordisk, Janssen, Eisai, HLS, Otsuka, Sunovion et Jazz. Le Dr Habert a été coresponsable des Guides cliniques de Thrombose Canada (2018–2021). Karim Keshavjee déclare avoir reçu des honoraires de consultation de l’Université McMaster, Demers Professional Corporation et Normative. Darlene Kitty déclare avoir reçu une rémunération d’enseignante des facultés de médecine de l’Université d’Ottawa et de l’Université McGill pour des conférences occasionnelles et des bourses de voyage à titre de directrice du Programme autochtone de la Faculté de médecine de l’Université d’Ottawa. La Dre Kitty est présidente du Comité sur la santé autochtone du Collège des médecins de famille du Canada. David Lau déclare avoir reçu des subventions de Novo Nordisk, des honoraires de consultation de Amgen, Bayer, Boehringer Ingelheim, CME at Sea, HLS Therapeutics, Eli Lilly, Novo Nordisk et Viatris, des honoraires de Amgen, Bayer, Boehringer Ingelheim, CME at Sea, HLS Therapeutics, Eli Lilly et Novo Nordisk, et une rémunération en tant que témoin expert de l’Association canadienne de protection médicale. Le Dr Lau a occupé des postes de direction chez Obésité Canada et à l’Association canadienne des médecins et chirurgiens bariatriques. Laurent Macle déclare avoir reçu des subventions et des honoraires de BMS-Pfizer, Servier et Bayer. Michael McDonald déclare avoir reçu des honoraires de consultation de Boehringer Ingelheim, et des honoraires de Novartis et Servier. Le Dr McDonald a aussi fait partie du comité de surveillance de la sécurité des données pour l’essai IVVE. Kara Nerenberg déclare avoir fait partie des comités pour les lignes directrices de pratique clinique de la Fondation canadienne des maladies du cœur et de l’AVC, Obésité Canada, Hypertension Canada, Diabète Canada et la Société des obstétriciens et gynécologues du Canada. Glen Pearson déclare avoir reçu des honoraires de consultation de Novartis Canada en tant que participant à des comités consultatifs. Alexandre Poppe déclare avoir reçu une subvention de recherche de Stryker et des honoraires de Pfizer-BMS. Le Dr Poppe a aussi fait partie du comité de surveillance de la sécurité des données pour l’essai FLOW sur la fluoxétine après l’AVC et du comité de surveillance de l’innocuité pour l’essai AcT (Alteplase Compared to Tenecteplase in Patients With Acute Ischemic Stroke) sur le ténectéplase dans l’AVC aigu. Le Dr Poppe a reçu le soutien d’une bourse du programme de recherche de Servier. Diana Sherifali déclare avoir reçu un financement personnel par l’entremise de la chaire de recherche médicale interprofessionnelle de l’Institut de santé publique Heather M. Arthur et Hamilton Health Sciences. Peter Selby déclare avoir reçu des subventions du ministère ontarien de la Santé et de Pfizer (Bourses de recherche mondiale sur la dépendance à la nicotine). Il fait aussi partie du comité de rédaction C-CHANGE depuis 2010. Eric Smith déclare avoir reçu des honoraires de consultation de Bayer, Biogen, Alnylam et Cyclerion. Sol Stern déclare avoir reçu des émoluments et des honoraires de consultation de MDBriefcase.com et Sea Courses inc. George Thanassoulis déclare avoir reçu des subventions, des émoluments et des honoraires de consultation de Amgen, Sanofi, Novartis et Silence. Le Dr Thanassoulis a aussi été membre du Comité de rédaction de la Ligne directrice sur la dyslipidémie de la SCC. Kristin Terenzi déclare avoir reçu des honoraires de consultation pour des comités consultatifs, des honoraires de conférencière et un soutien pour sa participation à des réunions de AstraZeneca, Boehringer Ingelheim, Astellas, Allergan, Amgen, Aspen, Bayer, Lilly, Lundbeck, AbbVie, Aralez, GSK, Merck, Novo Nordisk, Pfizer et Novartis. Karen Tu déclare avoir reçu des subventions (versées à son établissement) des institutions suivantes: IRSC, Fondation de l’Hôpital St. Michael, Collège des médecins de famille du Canada, Fondation pour l’avancement de la médecine familiale, Fondation AMC, Fonds d’exploration de l’Hôpital général de North York, Fondations canadienne et ontarienne des maladies du cœur et de l’AVC, ministère de la Défense des États-Unis, Université de Toronto — Département de médecine familiale et communautaire, MaRS Innovation Fund, Fondation canadienne de dermatologie, Société canadienne de rhumatologie (Canadian Initiative for Outcomes in Rheumatology Care), PSI Foundation, Action Cancer Ontario, Toronto Rehab Institute Chair Fund, UTOPIAN, Société d’arthrite, Société canadienne de la SP, Réseau canadien vasculaire, Prix IMPACT ciblé de l’unité de soutien SPOR de l’Ontario et Fondation Rathlyn. La Dre Tu détient une bourse en tant que chercheuse au Département de médecine familiale et communautaire de l’Université de Toronto. Jacob Udell déclare avoir reçu des subventions de Boehringer Ingelheim, Janssen, Sanofi et Novartis, et des honoraires de AstraZeneca, GlaxoSmithKline et Sanofi. Le Dr Udell a aussi fait partie de comités consultatifs pour Boehringer Ingelheim, Sanofi et Novartis. Sean Virani déclare avoir reçu des subventions de Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Bayer, Novartis, Servier, Otsuka et Medtronic, des honoraires de consultation de Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Bayer, Novartis, Seriver et Otsuka, et des honoraires de Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bayer, Novartis, Servier, Otsuka et Medtronic. Le Dr Virani a aussi fait partie de comités de surveillance de la sécurité des données ou de comités consultatifs pour Abbott et Medtronic. Richard Ward déclare avoir reçu des honoraires de consultation de Eisai et Lilly-Boehringer Ingelheim, et une rémunération ou des honoraires de Boehringer Ingelheim, AstraZeneca, Janssen, Amgen, Lilly, Pfizer et Takeda. Le Dr Ward agit aussi à titre de directeur de l’Association médicale albertaine. Sean Wharton déclare avoir reçu des subventions et des honoraires de Novo Nordisk, Eli Lilly, Bausch Health Canada et Boehringer Ingelheim; il a fait partie comités de surveillance de la sécurité des données pour Novo Nordisk, Eli Lilly, Bausch Health Canada et Boehringer Ingelheim; et il a bénéficié de matériel et de services, de rédaction ou autres, de Novo Nordisk, Eli Lilly et Bausch Health Canada. Le Dr Wharton a aussi occupé un poste de responsabilité auprès de l’Obesity Society et d’Obésité Canada. Jennifer Zymantas déclare avoir reçu des honoraires de Pfizer comme modératrice lors de conférences portant sur l’anticoagulation. Diane Hua-Stewart occupe le poste de directrice du programme CHEP+. Peter Liu déclare avoir reçu des subventions de Génome Canada, de la Fondation des maladies du cœur et de l’AVC et des IRSC. Le Dr Liu détient un brevet pour l’IGFBP7, un biomarqueur de l’insuffisance cardiaque et il est directeur scientifique de l’Institut de cardiologie de l’Université d’Ottawa. Sheldon Tobe déclare avoir reçu une subvention et un soutien non matériel pour l’étude Zero to Five, remis à l’Institut de recherche Sunnybrook, des honoraires de consultation de AstraZeneca, et une rémunération pour le programme éducatif CHEP+ de Amgen, AstraZeneca, BMS, Bayer, Boehringer Ingelheim, Janssen, Lilly, Novartis, Novo Nordisk, Pfizer et Sanofi Genzyme. Le Dr Tobe agit aussi bénévolement auprès de l’American Hypertension Specialists Certification Program. Aucun autre intérêt n’a été déclaré.

In comparison to the general population, chronic inflammatory rheumatic diseases are more often associated with various comorbidities. Due to the important impact of these pathologies on the quality of life, on the choice of treatment and on the response to the latest, they need to be searched for actively. In this article, we present some of these comorbidities, as well as propositions for their management. We discuss the cardiovascular diseases, neoplasia, infections, interstitial lung disease and osteoporosis., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The current use of virtual reality (VR) in medicine is expanding rapidly. This non-pharmacological option is increasingly proposed as primary or complementary/multimodal analgesic or anxiolytic management. The role of VR in obstetrics remains to be defined. We propose a narrative review of the literature on the role of VR in obstetrics during childbirth, which shows promise. If used properly, this technique could help improve the experience of childbirth., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Several new techniques have recently been introduced in digestive endoscopy. Among these are anti-reflux mucosectomy (ARMS) or mucosal ablation (ARMA) which have demonstrated efficacy in the treatment of patients with refractory gastro-esophageal reflux disease. Both can be considered in the absence of a large hiatal hernia. Comparable to the well-established peroral endoscopic myotomy (POEM) for the treatment of achalasia, gastric POEM (G-POEM), an endoscopic antro-pyloromyotomy, represents an endoscopic technique for the treatment of gastroparesis, including diabetic, post-surgical and idiopathic subtypes. Finally, endoscopic ultrasound-guided radiofrequency ablation (EUSRA) can be considered as alternative to surgery in selected patients with small tumoral lesions of the pancreas., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The connectivitides are autoimmune diseases that affect many organs. All of them can cause interstitial lung disease, the most frequent forms being the NSIP (nonspecific interstitial pneumonia) and the UIP (usual interstitial pneumonia). The best screening method is the high-resolution chest CT. The treatment of ILD includes glucocorticoids, immunosuppressive and antifibrotic agents, as well as non-pharmacological therapies. We present the screening and treatment algorithm for the ILD in systemic sclerosis, which is very well established. We also discuss the management of the ILD in rheumatoid arthritis, a very prevalent disease, and though of large public interest., Competing Interests: Les auteures n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: Intérêts concurrents: Sean Wharton signale avoir reçu des honoraires et le remboursement de frais de voyage et participé à des comités consultatifs universitaires pour Novo Nordisk, Bausch Health, Eli Lilly et Janssen. Sean Wharton est aussi le directeur médical d’une clinique spécialisée en gestion du poids et du diabète. David Lau signale avoir reçu des subventions et un soutien à la recherche d’AstraZeneca, de Novo Nordisk et des Instituts de recherche en santé du Canada (IRSC); des honoraires de conférencier d’AstraZeneca, Bausch Health, Boehringer Ingelheim, Diabète Canada, Eli Lilly, Merck et Novo Nordisk; et des honoraires de consultant d’Amgen, AstraZeneca, Bausch Health, Boehringer Ingelheim, Gilead, HLS Therapeutics, Janssen, Eli Lilly et Novo Nordisk. Michael Vallis est membre de comités consultatifs pour Novo Nordisk, Bausch Health et LifeScan. Michael Vallis a aussi reçu des honoraires de consultant de Bausch Health, LifeScan, Novo Nordisk et Sanofi et des honoraires de conférencier de Novo Nordisk, Sanofi, Bausch Health, Abbott et AbbVie. Arya Sharma signale avoir reçu des honoraires de conférencier et de consultant de Novo Nordisk, Bausch Pharmaceuticals et AstraZeneca. Laurent Biertho signale avoir reçu des subventions de Johnson and Johnson et de Medtronic, et il est membre de comités consultatifs pour Novo Nordisk et Bausch Health, en dehors des travaux soumis. Denise Campbell-Scherer est à l’emploi de l’Université de l’Alberta (professeure au Département de médecine familiale). Elle ne signale aucun autre lien de nature financière, mais mentionne avoir reçu des subventions de recherche de la part des organisations suivantes au cours des trois dernières années : Novo Nordisk Alberta Diabetes Fund (NOVAD), une subvention conjointe accordée après examen par les pairs, en partenariat avec la Fondation de l’Hôpital universitaire, Novo Nordisk et Alberta Innovates; Alberta Innovates Health Solutions (concours lancés par Cancer Prevention Research Opportunity and Collaborative Research et par Innovation Opportunities), les IRSC (concours Stratégie de recherche axée sur le patient du Canada et Des connaissances à la pratique); le Northern Alberta Family Medicine Fund; et l’Alberta Cancer Prevention and Legacy Fund. Elle signale aussi avoir reçu du financement pour le transfert des connaissances des sources suivantes au cours des trois dernières années : subvention à la formation versée sans restriction par Obésité Canada, financée par Novo Nordisk Global; bourse aux fins de réunion du Réseau mondial d’universités; subvention de l’Agency for Healthcare Research and Quality R13 pour une recherche sur l’efficacité des soins de santé et les résultats; une subvention pour la formation médicale des Services de santé de l’Alberta et de l’Association médicale de l’Alberta. Angela Alberga signale avoir reçu les subventions suivantes : bourse Santé du Fonds de recherche du Québec, bourse Accélération du programme MITACS, et bourse d’entrepreneuriat de l’Université Concordia, en dehors des travaux soumis. Jennifer Brown signale avoir reçu un soutien non financier de Novo Nordisk, et des honoraires personnels de Bausch Health, Diététistes du Canada, Obésité Canada et l’Association canadienne des médecins et chirurgiens bariatriques. Yoni Freedhoff est copropriétaire du Bariatric Medical Institute et de Constant Health, qui fournissent des services de gestion du poids; Constant Health a reçu une subvention de Novo Nordisk. Yoni Freedhoff est aussi l’auteur de The diet fix : Why diets fail and how to make them work publié par Crown Publishing Group, et il reçoit des droits d’auteur pour ce livre. Il est également le seul auteur du blogue intitulé Weighty Matters et d’une rubrique pour Medscape et plusieurs autres lettres d’opinion et articles dans lesquels il a exprimé ouvertement ses positions concernant le traitement, la gestion et la prévention de l’obésité. Yoni Freedhoff s’exprime en outre régulièrement au sujet de l’obésité et il reçoit des honoraires et le remboursement de frais de déplacement pour ces activités. Michel Gagner signale avoir reçu des honoraires de conférencier d’Ethicon, WL Gore et Medtronic; des honoraires de consultant de Novo Nordisk, Bausch Health et Lexington Medical; et il détient des options d’achat d’actions de Lexington Medical. Margaret Hahn signale avoir reçu des honoraires de consultation d’Alkermes. Marie-France Langlois signale avoir reçu des honoraires personnels de Novo Nordisk, Valeant, Merck Canada, Sanofi, Eli Lilly et Boehringer Ingelheim; une subvention de Merck Canada et d’autres honoraires d’AstraZeneca et du groupe d’étude TIMI (Thrombolysis in Myocardial Infarction) pour la recherche clinique sur le diabète à titre de chercheuse principale, tous en dehors des travaux soumis. David Macklin signale avoir reçu des honoraires personnels de Novo Nordisk et Bausch Health, en dehors des travaux soumis. Priya Manjoo signale avoir reçu des honoraires personnels de Novo Nordisk, Bausch Health et Sanofi; et des subventions de Boehringer Ingelheim, Sanofi et AstraZeneca, en dehors des travaux soumis. Marie-Philippe Morin signale avoir reçu des honoraires de conférencière de Novo Nordisk, Bausch Health, Eli Lilly, Boehringer Ingelheim, Nestlé Health Science, Janssen et AstraZeneca; une subvention de recherche de Novo Nordisk et Sanofi; et des honoraires de consultante de Novo Nordisk, Bausch Health, Eli Lilly, Boehringer Ingelheim, Janssen et AstraZeneca. Sue Pedersen signale avoir reçu des honoraires personnels de Novo Nordisk, Bausch Health, Janssen, Eli Lilly, Merck, AstraZeneca, Boehringer Ingelheim, Sanofi et Pfizer; des subventions d’Eli Lilly, AstraZeneca, Boehringer Ingelheim et Sanofi; et un soutien non financier de Novo Nordisk, Bausch Health, Janssen, Eli Lilly, AstraZeneca, Boehringer Ingelheim et Sanofi, en dehors des travaux soumis. Megha Poddar signale avoir reçu des honoraires pour de la formation médicale continue (FMC) de Novo Nordisk, Bausch Health, Boehringer Ingelheim, Eli Lilly, Jenssen, Merck, du Canadian Collaborative Research Network et d’Antibody Network; des subventions à la formation de Novo Nordisk et Bausch Health; des honoraires de mentorat de Novo Nordisk; des honoraires de participation à des comités consultatifs de Novo Nordisk et Bausch Health; et une bourse pour un projet d’amélioration de la qualité de Boehringer Ingelheim. Paul Poirier signale avoir reçu des honoraires de consultation et de formation médicale continue d’AstraZeneca, Boehringer Ingelheim, Janssen, Eli Lilly, Novo Nordisk, Valeant et Bausch Health, en dehors des travaux soumis. Judy Shiau signale avoir reçu des honoraires personnels de Novo Nordisk de Bausch Health, en dehors des travaux soumis. Diana Sherifali signale avoir reçu des honoraires de consultante pour son avis sur la gestion de la maladie chronique et du diabète de Merck, et une subvention d’Obésité Canada pour soutenir le processus de revue de la documentation durant la conduite de l’étude. John Sievenpiper signale avoir reçu des subventions des IRSC, du Nutrition Trialists Fund de l’Université de Toronto, de l’International Nut and Dried Fruit Council Foundation, du Tate and Lyle Nutritional Research Fund de l’Université de Toronto, de l’American Society for Nutrition, du Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund de l’Université de Toronto, de la National Dried Fruit Trade Association, une bourse d’application des connaissances de la Fondation PSI Graham Farquharson, la bourse du clinicien-chercheur de Diabète Canada, la bourse du jeune chercheur Sun Life Financial Banting & Best Diabetes Centre, une bourse de la Fondation canadienne pour l’innovation et la bourse du Fonds ontarien de recherche du ministère de la Recherche et de l’Innovation de l’Ontario. Le Dr Sievenpiper a reçu des honoraires personnels des entités suivantes : Perkins Coie LLP, Tate & Lyle, Producteurs laitiers du Canada, PepsiCo, FoodMinds LLC, European Fruit Juice Association, International Sweeteners Association, Nestlé Health Science, Société canadienne d’endocrinologie et métabolisme, GI Foundation, Pulse Canada, Wirtschaftliche Vereinigung Zucker e.V., Abbott, Biofortis, Autorité européenne de sécurité des aliments, Physicians Committee for Responsible Medicine, Soy Nutrition Institute, Comité européen des fabricants de sucre. Le Dr Sievenpiper a reçu un soutien non financier de Tate & Lyle, PepsiCo, FoodMinds LLC, European Fruit Juice Association, International Sweeteners Association, Nestlé Health Science, Wirtschaftliche Vereinigung Zucker e.V., Abbott, Biofortis, Autorité européenne de sécurité des aliments, Physicians Committee for Responsible Medicine, Kellogg Canada, American Peanut Council, Barilla, Unilever, Unico Primo, Compagnies Loblaw, WhiteWave Foods, Quaker, California Walnut Commission, Almond Board of California, en dehors des travaux soumis. Le Dr Sievenpiper est membre de l’International Carbohydrate Quality Consortium et des comités d’experts en pratique clinique pour la rédaction des lignes directrices de Diabète Canada, European Association for the Study of Diabetes, Société canadienne de cardiologie et d’Obésité Canada, et il occupe les postes de membre de l’exécutif du Groupe d’étude sur le diabète et la nutrition de l’European Association for the Study of Diabetes et de directeur de la Toronto 3D Knowledge Synthesis and Clinical Trials Foundation. Il est aussi conseiller scientifique non rémunéré pour le programme de sécurité alimentaire, nutrition et réglementation et le comité sur les glucides de l’International Life Science Institute en Amérique du Nord. Il est en relation conjugale avec une personne qui travaille pour Anheuser-Busch InBev. Sanjeev Sockalingam signale avoir reçu des honoraires de Bausch Health Canada au cours des 36 derniers mois. Valerie Taylor signale avoir reçu des honoraires de conférencière de Sunovion. Shahebina Walji signale avoir reçu des honoraires de consultation ou de participation à des comités consultatifs pour Novo Nordisk, Bausch Health et Takeda et des honoraires de conférencière de Novo Nordisk et Bausch Health. Shahebina Walji signale aussi avoir vendu les substituts de repas Optifast à partir d’un centre de gestion du poids. Optifast est un produit fabriqué et vendu par Nestlé. Aucun autre intérêt concurrent n’a été déclaré.

Late 2019 a new coronavirus appeared, creating a pandemic, with the first case in Switzerland detected on the 25th of February 2020. Considering the rapid increase in the number of cases, with the fear of an over-burdening of the sanitary network, the Canton of Vaud created a surveillance system (SICOVID). The objective of the SICOVID was to produce a set of indicators, covering the breadth of the epidemiological impact and response as the epidemic progressed. These indicators where used for monitoring purposes, orienting strategies, operational decision-making, communication and research. The challenges encountered throughout this process underline the importance of anticipation and considering the function of a crisis information system, ideally integrating these elements into pandemic preparedness plans., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Current pandemic implies changes in patient care in rheumatology to reduce the risk of coronavirus transmission to patients visiting health-care facilities, by organizing less frequent blood tests, using teleconsultations, and switching from intravenous to subcutaneous drug administration. Patients under immunosuppressive treatment are considered at high risk of severe outcome and are protected accordingly by the Swiss authorities. However, current, scarce scientific evidence suggests that patients under immunosuppressive therapy do not necessarily develop severe COVID-19 presentations. Therefore, the current guidelines recommend pursuing the treatment throughout the pandemic. In case of SARS-CoV-2 infection, immunosuppressive drugs should be temporarily stopped, except for glucocorticoids, hydroxychloroquine and sulfasalazine., Competing Interests: Les auteurs n’ont declare aucun conflit d’interets en relation avec cet article.

Increases in opioid-related mortality have contributed to declines in life expectancy at birth in the United States and British Columbia. Canadian national mortality data from 2000 to 2016 were analyzed to determine the contribution of poisoning-related mortality to changes in life expectancy at birth by age group and sex. From 2000 to 2016, life expectancy at birth increased by almost three years; however, mortality due to unintentional poisonings, including those involving opioids, curbed this increase by 0.16 years. Although a national decrease in life expectancy at birth has not been observed in Canada during this period, current trends suggest that the national opioid overdose crisis will continue to attenuate gains to life expectancy., Competing Interests: There are no conflicts of interest to report.

Introduction: The association between health outcomes and socioeconomic status (SES) has been widely documented, and mortality due to unintentional injuries continues to rank among the leading causes of death among British Columbians. This paper quantified the SES-related disparities in the mortality burden of three British Columbia's provincial injury prevention priority areas: falls among seniors, transport injury, and youth suicide., Methods: Mortality data (2009 to 2013) from Vital Statistics and dissemination area or local health area level socioeconomic data from CensusPlus 2011 were linked to examine age-standardized mortality rates (ASMRs) and disparities in ASMRs of unintentional injuries and subtypes including falls among seniors (aged 65+) and transport-related injuries as well as the intentional injury type of youth suicide (aged 15 to 24). Disparities by sex and geography were examined, and relative and absolute disparities were calculated between the least and most privileged areas based on income, education, employment, material deprivation, and social deprivation quintiles., Results: Our study highlighted significant sex differences in the mortality burden of falls among seniors, transport injury, and youth suicide with males experiencing significantly higher mortality rates. Notable geographic variations in overall unintentional injury ASMR were also observed across the province. In general, people living in areas with lower income and higher levels of material deprivation had increasingly higher mortality rates compared to their counterparts living in more privileged areas., Conclusion: The significant differences in unintentional and intentional injury-related mortality outcomes between the sexes and by SES present opportunities for targeted prevention strategies that address the disparities., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article.

Excessive alcohol consumption can lead to liver damage characterized by steatosis, steatohepatitis, and fibrosis that can progress to cirrhosis and hepatocellular carcinoma. The focus of the new 2018 EASL recommendations is on screening for high-risk drinking, the importance of early diagnosis of liver fibrosis, and the modulation of factors that can influence evolution. The drug treatment of steatohepatitis is limited to corticosteroid therapy dictated by the Lille score. Abstinence remains the cornerstone of management and should, at the cirrhosis stage, be associated with the prevention of complications. Abstinence and correction of cofactors may be associated with partial regression of fibrosis during follow-up and thus constitute an additional objective., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: Ontario delisted high-strength fentanyl, hydromorphone and morphine from the public drug formulary for non-palliative care prescribers on 31 January, 2017. Our aim is to assess the early impact of this policy on prescribing patterns and to examine whether this impact varied by prescriber type, opioid type and opioid strength., Methods: We conducted a population-based, cross-sectional study on palliative and non-palliative care patients dispensed fentanyl, hydromorphone or morphine through the Ontario public drug program between 1 January, 2014, and 31 July, 2017. For each month during the study period, we reported the total number of high-strength opioid recipients stratified by prescriber type, and the total volume of each drug dispensed, stratified by strength. We used interventional autoregressive integrated moving average (ARIMA) models to assess the policy's impact on prescribing patterns., Results: We observed a 98% decrease in the total number of publicly funded recipients of high-strength opioids between December 2016 and July 2017 (5930 to 133 recipients) for all prescribers. The policy led to a significant decline in the total volume of all three opioids dispensed: hydromorphone from 20 374 621 to 16 952 097 mg (p < .01); morphine from 40 644 190 to 33 555 480 mg (p < .03); and fentanyl from 9 604 913 to 5 842 405 mcg/h (p < .01). For both fentanyl and hydromorphone, this reduction generally corresponded to an increase in the number of low-strength opioids dispensed., Conclusion: Delisting high-strength opioids substantially reduced the number of highstrength opioid recipients and reduced the overall volume of long-acting opioids dispensed in Ontario through the public drug program. Future studies should examine its impact on patient outcomes., Competing Interests: The authors declare no conflicts of interest with respect to the publication of this article.

There is little evidence on healthcare-associated infections in outpatient care. The Swiss Federal Office for Public Health commissioned a systematic review to estimate the incidence of healthcare-associated infections in non-institutional settings. A total of 126 papers were eligible for data abstraction. The identified reports and studies were heterogeneous and generally of low quality. The main outcomes were surgical site infections, central venous catheter-related bloodstream infections, and urinary tract infections. While no comparison to inpatients was possible for surgical site infection, the incidence of urinary tract infection and central venous catheter-related bloodstream infection in haemodialysis and home intravenous therapy was similar to the incidence of these infections observed in acute care settings., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts en relation avec cet article.

Arthritis and arthralgia during a viral infection are often polyarticular and symmetric and can mimic rheumatoid arthritis. Depending on germs, others signs and symptoms as fever, cutaneous rash (Parvovirus B19) or jaundice (hepatitis) can be present. Worldwide most common germs are Parvovirus B19, hepatitis B and C, HIV and alphavirus. There are significant differences throughout the world and epidemiology continues to evolve with a progression of vector-borne infections. Diagnosis of viral arthritis is often difficult and is based on epidemiological, clinical and serological data., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Tumor cells express checkpoint proteins in order to prevent an immune reaction by T-cells. Checkpoint inhibitors are successfully used in oncology to unleash a cytotoxic immune response. Unfortunately this treatment increasingly leads to immune-related adverse events which resemble various primary autoimmune disorders known in rheumatology. Potentially, checkpoint dysfunction also underlies rheumatic diseases which would open the way for new treatment options to restore immune tolerance., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: This study aimed to identify the epidemiological, clinical and therapeutic features of benign tumors of the breast treated in the department of senology at the university hospital Aristide Le Dantec, Dakar., Methods: We conducted a cross-sectional, descriptive and analytical study of 220 patients treated in the Department of Senology at the University Hospital Aristide Le Dantec, Dakar over the period from 1 January 2008 to 31 December 2013., Results: 220 patients out of 984 consultants had benign tumor of the breast (22.5%). Benign tumors of the breast accounted for 58.2% of tumor pathologies. The average age was 24 years. The age group 11-30 years was the most represented (70%). The quasi-totality of patients were women of childbearing age (95%), 58.6% were nulliparous women. The main reason for consultation was a breast mass in 94.5% of cases. The left side was most often affected (49.5%), especially the upper outer quadrant (41.6%). 145 patients (65.9% of cases) underwent ultrasound. Cytologic examination showed conjunctival epithelial hyperplasia in almost all cases (96.1%). 44 women underwent histologic examination, which confirmed the histologic nature of the lesions. Fibroadenoma and fibrocystic changes were the most retained diagnoses, accounting for 86.3% and 5.9% respectively. 28 patients (12.7%) underwent lumpectomy, all tumor types were taken together. The majority of patients had follow-up appointments within 3 months, with favorable outcome., Conclusion: Benign tumors are very frequent in senology consultations. The recommended diagnostic approach combines the clinico-radio-cytological triad and, in case of doubt or discrepancy, biopsy or surgical resection are essential. Surgery is not always the treatment of choice. This is based on the nature of the tumor.

Rare Diseases, defined by a prevalence of less than 1 per 2000 persons, affect 36 million people in Europe, 500 000 in Switzerland, corresponding to 6-8% of the general population. 7000 rare diseases are currently recorded.Mitochondrial diseases are a heterogeneous group of genetic diseases. They are characterized by intracellular failure of energy production and affect predominantly energy-dependent tissues. The clinical presentation is not always suggestive, particularly in adulthood. In order to reach the diagnosis, a prerequisite is to think of them. In this article, we will focus on the clinical aspects of mitochondrial disorders in order to give the internist simple tools on how not to miss those rare diseases in his daily practice., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Nutrition is central in pediatric care : essential for growth and development, it plays also a role in the prevention of many diseases.Even if breastfeeding is highly recommended, its implementation may be difficult in particular for premature and ill newborns. The creation of a specific unit for breastfeeding support in neonatology allows to help mothers willing to nurse and to improve the rate of breastfeeding for these vulnerable infants.Eating disorders represent an important challenge for patient care. Early detection and rapid management of anorexia is essential for the prognosis. This article describes the challenges and the practical process underlying the development of a practical guideline to manage children and adolescents hospitalized for anorexia., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Eosinophilic pneumonia is characterized by pulmonary eosinophilia associated with and/or alveolar eosinophilia. Furthermore, blood eosinophilia may be absent particularly in patients who have benefited beforehand of corticosteroids. The most common causes are parasites and drugs. According to the classification, we distinguish idiopathic pneumonia with eosinophils, those related to vasculitis and those of known etiology. Extrapulmonary involvement is frequently found in the subgroup of vasculitis. It is important to diagnose and start treatment quickly to reduce the risk of complications. The primary treatment is based on corticosteroids and in severe cases of vasculitis immunosuppressants are necessary., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Objective: Support groups can help to reach individuals with anxiety disorders who are not or are only partly obtaining health services. The present study is based on a program that involves peer helpers as animators of a self-treatment group (Zéro-ATAQ). Their perspective has been documented in order to identify the aspects of the program which can be improved., Methods: Eleven peer helpers led the 12 sessions of the program, which was dispensed in four regions of Quebec for 32 persons having panic disorders with agoraphobia. The perspectives of ten peer animators were documented based on a semi-structured interview that took place at the end of the program, and a focus group that was held over six months later with peer animators from each of the groups. Their comments were transcribed and a thematic content analysis was conducted., Results: All of the peer helper animators reported that they enjoyed participating in the program, that they appreciated being able to help others having an anxiety disorder, and that the program helped them in their role as animators of these types of activities. Nearly all of the peer helpers emphasized the importance of being able to count on the supervision of a professional when needed., Conclusion: This study revealed (1) the feasibility of implementing a program of this kind in partnership with peers, (2) the qualifications necessary to lead this type of program, (3) the requirements in terms of training and available material, and (4) the importance of supervision.

Context and Aims: Breast cancer prognosis and predictive biomarkers development would allow sparing some patients from chemotherapy or identifying patients for whom chemotherapy would be indicated. In this context, in 2009, the French National Cancer Institute, a National Health and Science Agency dedicated to cancer, in collaboration with the French society of senology and breast pathology (SFSPM) published a report on the assessment of the prognostic and the predictive clinical validity of tissular biomarkers, uPA/PAI-1, Oncotype DX™ and MammaPrint(®), in breast cancer management. They concluded that only the uPA/PAI-1 prognosis value reached the highest level of evidence (LOE I according to Hayes 1998 classification). In 2012, it was decided to update this report since new data have emerged and because information disparities among clinicians have been identified. This article aims to present the main conclusions together with the levels of evidence associated with those conclusions., Methods: The updating process was based on literature published since 2009 appraisal and on multidisciplinary and independent experts' opinion. The levels of evidence (LOE) used are those of the classification defined by Simon in 2009 (updated Hayes 1998 classification): LOE IA and LOE IB: high level of evidence; LOE IIB and LOE IIC: intermediate level of evidence; LOE IIIC and LOE IV-VD: low level of evidence., Conclusions: Among patients without lymph-node involvement, uPA/PAI-1, invasion process biomarkers, reach the highest level of evidence for 10 years recurrence free survival prognosis (LOE IA according to Simon). The predictive value to anthracyclins chemotherapy remains to be confirmed. Oncotype DX™ and MammaPrint(®) prognosis and predictive value do not reach the LOE I level. This updating' process confirms the 2009 levels of evidence for all the three biomarkers prognosis value. Besides, concerning Oncotype DX™ and MammaPrint(®), new data do not allow to conclude neither to their complementary clinical information to other clinicopathological existing biomarkers nor to a favorable cost-efficiency ratio in therapeutic decision making and this because of the methodological weakness and uncertainty that are identified in the selected studies. Practically, beyond the prognosis and predictive biomarkers validity, the clinical utility of a new biomarker for chemotherapy indication depends on its clinical added information with regard to validated biomarkers (HR, HER2 and Ki67) and to clinicopathological parameters. Since they are the sole validated biomarkers of the invasion process, uPA/PAI-1 could complete clinical information of other clinicopathological factors and consequently could confer an added clinical value. However, data concerning the impact of this information on chemotherapy clinical indication are lacking., (Copyright © 2014. Published by Elsevier Masson SAS.)

Introduction: The main objective of the MaterniDent study was to determine the nature and frequency of dental problems experienced by pregnant women and their associated factors. The secondary objective was to determine the frequency of dental visits during pregnancy and to identify associated factors., Methods: The MaterniDent study was a multicenter cross-sectional study conducted among 904 postpartum women in three French maternity wards. Data were collected using self-administered questionnaires. Measured variables included socio-demographic, health and behavioral characteristics., Results: 57% of women reported having experienced at least one dental problem during pregnancy, while 20% had experienced dental pain during pregnancy. Multiparity, vomiting, soda consumption and increased sugar consumption during pregnancy were significantly associated with dental pain (p<0.05). 56% of women did not visit a dentist during pregnancy, 26% consulted a dentist for a perceived problem, and 18% visited a dentist for a check-up. Younger pregnant women and those without supplemental insurance were less likely to see a dentist for a preventive dental visit (p <0.05)., Discussion: A significant proportion of women experienced a dental problem during pregnancy, although they did not necessarily consult a dentist to treat the problem. Given the impact of oral diseases for both mother and child, prevention and professional dental care during pregnancy should be promoted.

Objectives: Our study examined the barriers to treatment experienced by people with anxiety disorders (ADs) who had not received services for their problems. Recommendations to improve treatment access made by participants are reported., Method: A web-based questionnaire on treatment accessibility for anxiety disorders was completed by 610 people living in Quebec reporting an anxiety problem. Chi-square tests were used to compare answers from people who received services (n = 151) with answers from people who had not (n = 434 )., Results: Treatment wait times that were too long (X2 = 29.66, df = 1, P < 0.001 ), difficulties reaching a professional by phone (X2 = 13. 75, df = 1, P < 0.001 ), and geographical distance from service sites (X2 = 4.34, df = 1, P = 0.04) were obstacles that hindered participants who had not received the services they were seeking, more than those who had received services., Conclusions: Participant-reported barriers and recommendations highlight the need to increase access to health care professionals in terms of wait times, to train and inform primary care professionals about screening and treating ADs, and to develop psychotherapeutic services availability in the public health network.

Objective: To outline new guidelines for the management of mild traumatic brain injury (MTBI) and persistent postconcussive symptoms (PPCS) in order to provide information and direction to physicians managing patients’ recovery from MTBI., Quality of Evidence: A search for existing clinical practice guidelines addressing MTBI and a systematic review of the literature evaluating treatment of PPCS were conducted. Because little guidance on the management of PPCS was found within the traumatic brain injury field, a second search was completed for clinical practice guidelines and systematic reviews that addressed management of these common symptoms in the general population. Health care professionals representing a range of disciplines from across Canada and abroad were brought together at an expert consensus conference to review the existing guidelines and evidence and to attempt to develop a comprehensive guideline for the management of MTBI and PPCS., Main Message: A modified Delphi process was used to create 71 recommendations that address the diagnosis and management of MTBI and PPCS. In addition, numerous resources and tools were included in the guideline to aid in the implementation of the recommendations., Conclusion: A clinical practice guideline was developed to aid health care professionals in implementing evidencebased, best-practice care for the challenging population of individuals who experience PPCS following MTBI.

Considerable progress has been achieved in recent years in treating children affected by bone diseases. Advances in the understanding of the molecular pathophysiology of genetic bone diseases have led to the development of enzyme replacement therapies for various lysosomal storage diseases, following the breakthrough initiated in treating Gaucher disease. Clinical studies are underway with tailored molecules correcting bone fragility and alleviating chronic bone pain and other manifestations of hypophosphatasia, or promoting growth of long bones in achondroplasia patients. We further report our very encouraging experience with intravenous bisphosphonate treatment in children suffering from secondary osteopenia and the high prevalence of calcium and vitamin D deficits in these severely disabled children.

The "Standards, Options: Recommendations" (SOR) project has been undertaken by the French National Federation of Cancer Centers (FNCLCC) and is now part of the French National Cancer Institute. The project involves the development and updating of evidence-based Clinical Practice Guidelines (CPG) in oncology. In order to answer questions related to venous thromboembolic events (VTE) treatment and to central venous catheter thrombosis (CVCT) management in cancer patients, the SOR elaborated national guidelines, here presented in a short report. It results of a collaborative work with members from three learned societies (<< Société nationale française de médecine interne >> : SNFMI, << Société française de médecine vasculaire >> : SFMV and << Société française d'anesthésie-réanimation >> : SFAR).

The Standards, Options: Recommendations (SOR) project has been undertaken by the French National Federation of Cancer Centers (FNCLCC) is now part of the French National Cancer Institute. The project involves the development and updating of evidence-based Clinical Practice Guidelines (CPG) in oncology. In order to answer questions related to venous thromboembolic events(VTE) treatment and to central venous catheter thrombosis (CVCT) management in cancer patients, the SOR elaborated national guidelines, here presented in a short report. It results of a collaborative work with members from three learned societies("société nationale française de médicine interne": SNFMI, "société française de médicine vasculaire": SFMV and "société française dEanesthésie-réanimation:SFAR).