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Mesures du glucose non invasives : où en est-on ?
No full textLes technologies utilisées pour mesurer les glycémies des personnes présentant un diabète ont beaucoup évolué ces dernières années, avec notamment l’introduction des mesures interstitielles en continu, rendant le contrôle glycémique plus aisé. Depuis peu, il y a un intérêt croissant, notamment dans les médias, autour de potentielles méthodes révolutionnaires via des montres intelligentes, la sueur, la salive et même les larmes. Dans cet article, nous répertorions les différentes technologies en cours d’investigation et notons que plusieurs d’entre elles restent imprécises, empêchant leur utilisation pour nos patients diabétiques, chez qui des mesures incorrectes peuvent avoir de graves conséquences. Néanmoins, ces nouveautés sont prometteuses et ont le potentiel de changer le quotidien des personnes présentant un diabète dans le futur.The technologies used to measure blood glucose have significantly evolved the past few years, especially with the introduction of continuous interstitial glucose measurements, simplifying the management of the disease. More recently, there has been a lot of interest regarding some potential revolutionary methods, such as smartwatches, and glucose measurements in sweat, saliva, and even tears. In this article, we review the different technologies that are under development, and notice that although promising, they rest imprecise. False measurements can have fatal consequences for our patients. Nevertheless, these innovations are promising and have the potential to change the daily life of people with diabetes in the future.</p
Prise en charge de la maladie rénale chronique en médecine de premier recours. Nouveautés dans la néphroprotection en pratique clinique
No full textLa maladie rénale chronique est fréquemment rencontrée en pratique clinique et touche 8 à 16 % de la population mondiale. Son dépistage représente un enjeu considérable pour les patients du fait de l’augmentation de la morbidité et de la mortalité qui y sont liées, ainsi qu’un enjeu de santé publique dans le ralentissement de la progression vers l’insuffisance rénale terminale nécessitant des traitements substitutifs coûteux (dialyse, transplantation). Les nouvelles guidelines KDIGO proposent de viser un contrôle optimal des facteurs de risque cardiovasculaire associés à la maladie rénale chronique, notamment à l’aide de traitements émergents tels que les inhibiteurs du SGLT2. Cet article propose une synthèse des dernières recommandations dans la néphroprotection à l’intention des médecins de premier recours.Chronic kidney disease is often encountered in clinical practice, affecting between 8 and 16% of the world's population. Screening for CKD represents a major challenge for patients, given the increase in morbidity and mortality associated with the disease, as well as a public health issue in terms of slowing the progression to end-stage renal failure, which requires costly replacement treatments (dialysis and transplantation). The new KDIGO guidelines suggest aiming for optimal control of the cardiovascular risk factors associated with chronic kidney disease, in particular with the help of emerging treatments such as SGLT2 inhibitors. This article summarises the latest nephroprotection recommendations for primary care physicians
Douleur monoarticulaire aiguë non traumatique
No full textLes principales causes non traumatiques de la douleur monoarticulaire aiguë sont les arthrites microcristallines, dégénératives, réactives et septiques. Cette dernière doit être exclue rapidement avec une ponction de l’épanchement articulaire. En l’absence de sepsis, un drainage chirurgical peut être réalisé dans un délai de 24 heures après l’admission aux urgences. Concernant la goutte, les recommandations conseillent l’utilisation de l’imagerie pour la pose du diagnostic en cas de ponction articulaire non réalisable et l’introduction d’un traitement hypo-uricémiant pendant la crise aiguë. À propos de l’arthrite réactive, la présence d’éléments microbiens dans les articulations touchées améliore la compréhension de sa physiopathologie. Enfin, pour la prise en charge de l’arthrose, les guidelines soulignent l’importance de programmes d’autogestion des crises douloureuses.The main non-traumatic causes of acute single-joint pain are microcrystalline, degenerative, reactive and septic arthritis. Septic arthritis must be excluded quickly with puncture of the joint effusion. In the absence of sepsis, surgical drainage can be performed within 24 hours after admission to the emergency unit. Concerning gout, recommendations advise the use of imaging for diagnosis in case of joint puncture not feasible and the introduction of urate-lowering treatment during the acute attack. Regarding reactive arthritis, the presence of microbial elements in the affected joints improves the understanding of its pathophysiology. Finally, osteoarthritis guidelines emphasize the importance of self-management programs for painful crises
Advancing intracranial aneurysm wall characterization and vascular imaging for instability prediction
No full textIntracranial aneurysms (IAs), affecting 2 to 5% of the adult population, present a significant health problem due to their risk of rupture. IA rupture, leading to subarachnoid hemorrhage, may be avoided by a preventive surgical or endovascular treatment. However, the majority of IAs remain stable, and treatments would then pose an unnecessary risk to patients. Balancing the risk of IA rupture against treatment risks is critical. Current clinical scores used for this decision-making process lack sensitivity and specificity and do not consider the crucial aspect of IA wall composition, which undergoes significant changes before rupture. IA imaging plays a pivotal role in managing IA disease by providing essential information on IA location, size, morphology, and potential growth. Improving angiography with innovative tools providing high-quality visualization of IAs, such as advanced contrast agents (CAs), is of paramount importance. Thus, the goal of my thesis work was to improve the prediction of IA stability through a better characterization of the unstable IA wall and to improve vessel imaging
Addictions : ce qui a changé en 2023
No full textL’addictologie est actuellement confrontée à des nouveaux défis, tels que des épidémies de consommation et des scènes de drogues ouvertes. Elle répond à ces défis par différentes innovations. 1. La commercialisation du traitement assisté par opioïdes (TAO) en dépôt est une avancée majeure. 2. À Genève, un projet communautaire de maraudes, impliquant des pairs praticiens en santé mentale, cible la scène de consommation de crack émergente, montrant son efficacité pour orienter cette population marginalisée vers les soins. 3. En Suisse, deux projets romands testent des modèles hybrides de régulation du cannabis. L’évaluation de ces projets guidera la meilleure approche pour la régulation du cannabis.Addiction medicine is currently facing new challenges, such as drug epidemics and open drug scenes. It is responding to these challenges with a range of innovations: 1. The commercialization of opioid-assisted treatment (OAT) is a major step forward. 2. In Geneva, a community outreach project involving mental health peer practitioners targets the emerging crack scene, demonstrating its effectiveness in directing this marginalized population towards care. 3. In Switzerland, two projects in French-speaking Switzerland are testing hybrid models of cannabis regulation. Evaluation of these projects will guide the best approach to cannabis regulation
Public health responses to the burden of NCDs among adolescents in Europe: insights, strengths, and limitations of the Global Burden of Disease
No full textAdolescence is a critical life stage marked by rapid physical, psychological, and social changes with long-term implications for health and wellbeing. Despite growing recognition within global frameworks—such as the Global Strategy for Women’s, Children’s and Adolescents’ Health and the Countdown to 2030—adolescents remain underrepresented in health data systems and policy agendas, particularly regarding non-communicable diseases (NCDs). This thesis investigates the burden of NCDs among adolescents in Europe, focusing on the utility, strengths, and limitations of the Global Burden of Disease (GBD) Study estimates for informing public health strategies and planning.
The research involved a comprehensive assessment of adolescents’ health status across 28 European Union Member States using GBD 2019 estimates, disaggregated by age, sex, location, and cause, over a 30-year period. Diabetes mellitus (both type 1 and type 2) was identified as the highest rising NCD in terms of disability-adjusted life years (DALYs) among adolescents. Additionally, an in-depth analysis examined diabetes trends across Western Europe, with also a specific case study on type 1 diabetes estimates in Finland, and a comparative evaluation between GBD 2021 subnational estimates and primary data from the Piemonte Regional Diabetes Registry in Italy.
The findings, presented in four research papers, reveal rising disability burdens and persistent data gaps—particularly for type 2 diabetes. This PhD thesis provides critical insights into the burden of NCDs among adolescents in Europe through the lens of the GBD framework, highlighting both its utility and its limitations. The research underscores the urgent need for improved primary data—especially for diabetes mellitus—to enhance the accuracy and policy relevance of health estimates and inform effective public health responses. Moreover, the thesis evaluates the GBD framework’s strengths—such as universality, comparability, and transparency—while also identifying inherent limitations, including challenges in accurately estimating type-specific diabetes and a lack of data granularity to capture local health disparities. These findings call for enhanced data infrastructure and better integration of local data sources to complement global models.
By addressing the complex challenges of adolescent health—from disease prevention and care delivery to data infrastructure—this work contributes to the foundation for comprehensive, age- and gender-sensitive interventions. It emphasizes the need to invest in robust health information systems, improved modelling techniques, and disaggregated data to support evidence-based policymaking. A harmonized approach to data collection, analysis, and dissemination will enable more effective decision-making, strengthen health system efficiency, and ensure high-quality care for adolescents—ultimately promoting healthier future generations.</p
Reply : Antibody-mediated rejection in liver transplantation following immune checkpoint inhibitors treatment
No full textReply to : Wang P, Zhong L. Letter to the editor: Antibody-mediated rejection in liver transplantation following immune checkpoint inhibitors treatment. Hepatology. 2025 May 1. doi: 10.1097/HEP.0000000000001373. Epub ahead of print. PMID: 40310648, which was a comment on : Moeckli B, Wassmer CH, El Hajji S, Kumar R, Rodrigues Ribeiro J, Tabrizian P, Feng H, Schnickel G, Kulkarni AV, Allaire M, Asthana S, Karvellas CJ, Meeberg G, Wei L, Chouik Y, Kumar P, Gartrell RD, Martinez M, Kang E, Sogbe M, Sangro B, Schwacha-Eipper B, Schmiderer A, Krendl FJ, Goossens N, Lacotte S, Compagnon P, Toso C. Determining safe washout period for immune checkpoint inhibitors prior to liver transplantation: An international retrospective cohort study. Hepatology. 2025 Mar 5. doi: 10.1097/HEP.0000000000001289. Epub ahead of print. PMID: 40042053.</a
Electronic and structural studies of perovskite and infinite layer nickelates
No full textThis thesis explores the electronic and structural properties of rare-earth nickelates, a family of transition metal oxides that exhibit complex and rich phase transitions. When synthesized as epitaxial thin films, these materials provide an ideal platform to study emergent physical properties, such as metal-insulator transitions, coupled magnetic orders, and, more recently, superconductivity in the so-called "infinite-layer" phases.
The work begins with an introduction to transition metal oxides, their perovskite structures, and the oxygen octahedral distortions that impact the physical properties of these systems. Special attention is given to the physics of transition metal d-orbitals, which drive unconventional electronic behaviors. The potential of thin films and heterostructures to access novel quantum states is also discussed. A significant part of this thesis is dedicated to the growth and characterization of thin films obtained by RF magnetron sputtering, using topotactic solid-state reduction to access reduced phases. Structural characterizations are carried out by X-ray diffraction and reciprocal space mapping, while electronic properties are investigated by transport measurements and electron microscopy (both scanning and transmission). The studied systems include solid solutions such as Nd₁₋ₓSmₓNiO₃, which allow investigation of the effect of the ionic radius on the separation between electronic and magnetic transitions. Artificial superlattices combining NdNiO₃, SmNiO₃, and LaAlO₃ are also fabricated to tune interfacial couplings, with original observations on the decoupling of order parameters. Special emphasis is placed on artificial superlattices combining Nd₁₋ₓLaₓNiO₃ and SmNiO₃ layers, where careful control of periodicity and interface nature allows direct manipulation of the competition between metallic and insulating phases. It is demonstrated that a configuration usually metallic can become insulating due to the combined effect of interfaces and superlattice architecture, revealing the crucial role of phase boundaries in stabilizing new electronic states. The second part of the thesis focuses on infinite-layer phases, with the synthesis of NdNiO₂ via reduction of NdNiO₃, and the study of Eu doping effects. These investigations follow the direction first envisaged in the early days of high-temperature superconductivity research. In their 1987 Nobel lecture, Bednorz and Müller already mentioned LaNiO₃ as their starting point in searching for high-Tc superconductivity in oxides, owing to its metallic character and absence of Jahn-Teller distortion. In our infinite-layer nickelate samples, we observe superconductivity. Furthermore, our measurements reveal a spectacular re-entrant superconducting behavior under perpendicular magnetic fields, reminiscent of a mechanism predicted in 1962 by Jaccarino and Peter. The results presented here highlight the central role of structural and chemical engineering in controlling electronic phases. They also showcase the richness of nickelates as a platform for the development of "by design" functional materials, opening avenues for future research in correlated oxides and unconventional superconductivity.</p