Acute flaccid myelitis in Switzerland - association with enterovirus D68.

Poliomyelitis-like acute flaccid myelitis associated with enterovirus D68 (EV-D68) has emerged globally during the past decade. Here we describe the first documented case reported from Switzerland, and a second, suspected case occurring in temporal association. AFM occurs primarily in children, is usually heralded by a febrile, respiratory prodrome followed by acute-onset, usually asymmetrical, limb weakness with some predilection for the upper extremities, and respiratory muscle compromise in one third of reported cases. There is no specific therapy and the majority of cases result in permanent neurological sequelae. A comprehensive diagnostic workup and timely reporting to the health authorities are essential. Surveillance of respiratory and stool samples for EV-D68 and other neurotropic enteroviruses is in place in several European countries and warrants consideration in Switzerland. This could entail the extension of the poliomyelitis surveillance program of the Federal Office of Public Health by monitoring and enteroviral typing of respiratory samples from patients with acute flaccid paralysis.

Doping mit Anabolika - auch ein Thema für den Hausarzt!

BACKGROUND: Over the last years, various revelations demonstrated that the doping problem is far from being solved. These included the American cyclist Lance Armstrong's disclosure and subsequent conviction for doping abuse over a period of many years. Furthermore, these revelations underlined the importance of strong and independent national antidoping agencies (NADA). During the current revision process of the World Anti-Doping Programme (WADP), Antidoping Switzerland is campaigning for national anti-doping agencies to have the same rights, the same authority and the same degree of responsibility as international sports associations. Further, the newly revised Federal Act on the Promotion of Sport and Exercise (Sport Promotion Act), which entered into force on 1 October 2012, establishes the framework for cooperation with customs officers when suspected doping substances are seized. By the end of 2012 Antidoping Switzerland received about 50 reports from the customs authorities, and in 24 cases an administrative ruling for the seizure and destruction of these doping substances was issued. In addition, there was also a greater cooperation between customs and the Swiss Agency for Therapeutic Products Swissmedic. Two athletes have already been sanctioned under private law for importing doping substances. CONTROLS: Antidoping Switzerland carried out 2'551 controls in 2012. Of these, 1'752 were urine tests, of which 1'089 were conducted out of competition and 663 in competition. The majority of the 799 blood controls were conducted out of competition. In 2012 Antidoping Switzerland lodged about 20 applications on violations of the anti-doping provisions with Swiss Olympic's Disciplinary Chamber for Doping Cases (DC). In numbers, four athletes were banned for two years for using anabolic steroids. A trainer was also suspended for two years for having given an athlete a stimulant before a competition. 2012 was the first year in which two athletes were convicted of import of doping substances (EPO and an anabolic drug respectively) on information provided by customs officers. Both athletes were banned from competition for two years. Legal basis: Of importance to all the physicians looking after athletes is to know the actual legal basis: The international law basis of the Swiss fight against doping are the Council of Europe Convention against Doping of 16 November 1989 and the International Convention against Doping in Sport of the General Conference of the United Nations Educational, Scientific and Cultural Organization (UNESCO) of 19 October 2005. The basis in public law of the Swiss fight against doping is the Federal Act on the Promotion of Gymnastics and Sport of 17 March 1972. Article 11e, paragraph 1 states that "national sport organisations, the relevant umbrella bodies and bodies responsible for sporting events that are supported in the framework of this act […] are required to ensure that the necessary doping controls are carried out in their area of responsibility". Article 11 f, paragraph 1 of the Federal Act also states that "whoever produces, introduces, transfers, sells, prescribes or provides substances for doping purposes or who uses methods for doping purposes for third persons will be liable to a prison sentence or to a fine of up to 100'000 francs". The civil law basis of the Swiss fight against doping consists of the norms established by various actors in the sporting world. These actors are in most cases clubs, associations and foundations in accordance with the stipulations of the Swiss civil code. The Swiss Olympic Association's revised Doping Statute was approved by the Sports Parliament on 15 November 2008. The statute implements the code of the World Anti-Doping Agency (WADA) in Switzerland. In the introduction it defines the anti-doping agencies in our country: Antidoping Switzerland and the Disciplinary Chamber for Doping Offences of the Swiss Olympic Association. The revised Statute entered into force on 1 January 2009. Finally, it is well known that the use of anabolic steroids and other doping substances is a phenomenon not restricted to professional sport only. Also in popular sport, in particular in fitness, the use of anabolic steroids to increase physical performance is very common. To summarize, doping is a widespread phenomenon not only in athletes. In these situations physicians involved have to know not only the medical but also the legal side of prescribing, applying substances to persons actively involved in sport activities. Otherwise it might happen that wittingly or unwittingly the doctor runs into serious problems. All the most valuable information are published at http://www.antidoping.ch.

Children's and adolescent's self - assessment of metabolic control versus professional judgment: a cross-sectional retrospective and prospective cohort study.

BACKGROUND: Morbidity and mortality in T1DM depend on metabolic control, which is assessed by HbA1c measurements every 3-4 months. Patients' self-perception of glycemic control depends on daily blood glucose monitoring. Little is known about the congruence of patients' and professionals' perception of metabolic control in T1DM. OBJECTIVE: To assess the actual patients' self-perception and objective assessment (HbA1c) of metabolic control in T1DM children and adolescents and to investigate the possible factors involved in any difference. METHODS: Patients with T1DM aged 8 - 18 years were recruited in a cross-sectional, retrospective and prospective cohort study. Data collection consisted of clinical details, measured HbA1c, self-monitored blood glucose values and questionnaires assessing self and professionals' judgment of metabolic control. RESULTS: 91 patients participated. Mean HbA1c was 8.03%. HbA1c was higher in patients with a diabetes duration > 2 years (p = 0.025) and in patients of lower socioeconomic level (p = 0.032). No significant correlation was found for self-perception of metabolic control in well and poorly controlled patients. We found a trend towards false-positive memory of the last HbA1c in patients with a HbA1c > 8.5% (p = 0.069) but no difference in patients' knowledge on target HbA1c between well and poorly controlled patients. CONCLUSIONS: T1DM patients are aware of a target HbA1c representing good metabolic control. Ill controlled patients appear to have a poorer recollection of their HbA1c. Self-perception of actual metabolic control is similar in well and poorly controlled T1DM children and adolescents. Therefore, professionals should pay special attention that ill controlled T1DM patients perceive their HbA1c correctly.

Transient Neonatal Zinc Deficiency Caused by a Heterozygous G87R Mutation in the Zinc Transporter ZnT-2 (SLC30A2) Gene in the Mother Highlighting the Importance of Zn (2+) for Normal Growth and Development.

Suboptimal dietary zinc (Zn(2+)) intake is increasingly appreciated as an important public health issue. Zn(2+) is an essential mineral, and infants are particularly vulnerable to Zn(2+) deficiency, as they require large amounts of Zn(2+) for their normal growth and development. Although term infants are born with an important hepatic Zn(2+) storage, adequate Zn(2+) nutrition of infants mostly depends on breast milk or formula feeding, which contains an adequate amount of Zn(2+) to meet the infants' requirements. An exclusively breast-fed 6 months old infant suffering from Zn(2+) deficiency caused by an autosomal dominant negative G87R mutation in the Slc30a2 gene (encoding for the zinc transporter 2 (ZnT-2)) in the mother is reported. More than 20 zinc transporters characterized up to date, classified into two families (Slc30a/ZnT and Slc39a/Zip), reflect the complexity and importance of maintaining cellular Zn(2+) homeostasis and dynamics. The role of ZnTs is to reduce intracellular Zn(2+) by transporting it from the cytoplasm into various intracellular organelles and by moving Zn(2+) into extracellular space. Zips increase intracellular Zn(2+) by transporting it in the opposite direction. Thus the coordinated action of both is essential for the maintenance of Zn(2+) homeostasis in the cytoplasm, and accumulating evidence suggests that this is also true for the secretory pathway of growth hormone.