Hunger strike among detainees: guidance for good medical practice

Hunger strike is a regularly reported problem in prison. Although clinical situations are rarely severe, hospitalisation is often considered. In consequence, it is not only physicians working in prisons, but also hospital medical teams who face challenges related to hunger strike, involving somatic, psychological, legal and human rights aspects. Furthermore, deontological rules must be strictly respected when delivering care, particularly in prison setting. Starvation involves metabolic changes and can cause severe, and sometimes even irreversible or fatal complications. Moreover, the phase of re-alimentation should not be trivialised, as re-feeding syndrome is a potentially fatal phenomenon. This article provides guidance for monitoring and management of patients on hunger strike

Cas importés d'histoptasmose

Histoplasmosis is a fungal infection that may be opportunistic in the context of HIV. Rare in Europe, it is always imported. The two variants of histoplasmosis are encountered in defined geographic areas: var. capsulatum in Americas, Africa and Asia; and var duboisii in Africa only. In immuno-competent patients, acute infection is often asymptomatic, or it may cause a pulmonary syndrome of variable severity. Among immuno-compromised patients, histoplasmosis is disseminated and life-threatening. Diagnosis is typically made by cultures. The treatment of the disseminated form must be started immediately with anti-fungal therapy and highly active anti-retroviral treatment. In a globalized world, one has to remember the importation of unusual exotic diseases

Médecine interne générale ambulatoire : quelques enseignements de la littérature

Critique du dépistage de l’infection génitale à Chlamydia, évaluation du risque de cancer lié à la contraception orale, indication et efficacité du vaccin contre le Papillomavirus, outils diagnostiques de la maladie coeliaque chez l’adulte, voilà une sélection de thèmes de médecine ambulatoire traités en 2007, faite par des internes et des chefs de clinique du Service de médecine de premier recours de Genève. Résumés, commentés, et à destination de tous nos collègues, ils sont leur contribution à la base de données de littérature initiée en 2005 par les chefs de clinique de Lausanne

Coupling radiative, conductive and convective heat-transfers in a single Monte Carlo algorithm: A general theoretical framework for linear situations

It was recently shown that radiation, conduction and convection can be combined within a single Monte Carlo algorithm and that such an algorithm immediately benefits from state-of-the-art computer-graphics advances when dealing with complex geometries. The theoretical foundations that make this coupling possible are fully exposed for the first time, supporting the intuitive pictures of continuous thermal paths that run through the different physics at work. First, the theoretical frameworks of propagators and Green’s functions are used to demonstrate that a coupled model involving different physical phenomena can be probabilized. Second, they are extended and made operational using the Feynman-Kac theory and stochastic processes. Finally, the theoretical framework is supported by a new proposal for an approximation of coupled Brownian trajectories compatible with the algorithmic design required by ray-tracing acceleration techniques in highly refined geometry