[Brittle bones]. / 5 minutes pour apprendre. Des os fragiles.

The use of corticosteroids is common in our clinical practice. Cortico-induced osteoporosis should be taken into consideration when using a dosage higher than 7.5 mg/d of prednisone or equivalent for a minimum of 3 months. We describe the case of a 69-year-old female patient who received long-term corticosteroid treatment for low back pain and developed secondary vertebral compression fractures. This case illustrates the importance of assessing fracture risk when prescribing corticosteroids, in order to offer preventive measures and introduce (in subjects with high risk) prophylactic treatments aiming to reduce the risk of irreversible consequences.

Comparison of five different risk scores to predict incident type 2 diabetes in the Swiss HIV cohort study.

OBJECTIVE: People with HIV (PWH) have a higher risk of type 2 diabetes (T2D) than HIV-negative individuals. In the general population, diabetes risk scores are used to identify persons at risk of developing T2D, but little is known regarding their performance in PWH. DESIGN: Assessment of the capacity of five diabetes risk scores to predict T2D in PWH. METHODS: A prospective study including all Swiss HIV cohort study (SHCS) participants followed between 2009 and 2019. Five diabetes risk scores were assessed: FINDRISC versions 1 and 2, Balkau, Swiss Diabetes Association (SDA), and Kraege. RESULTS: Three thousand eight hundred fifty-three T2D-free PWH (78.5% men, 39.9 ±â€Š11.3 years) were included. After a median follow-up of 4.8 years (interquartile range 2.2-7.8), 62 participants (1.6%) developed T2D, corresponding to an incidence rate of 3.18 per 1000 person-years (95% confidence interval = 2.47-4.08). Participants who developed T2D were older (48.7 ±â€Š12.4 vs. 39.8 ±â€Š11.2 years), more likely to be obese (22.6% vs. 7.4%), abdominally obese (9.7% vs. 1.5%), and to have a family history of diabetes (32.3% vs. 19.1%) than those without T2D. The AUC for incident T2D ranged between 0.72 (Kraege 16) and 0.81 (SDA, FINDRISC2 and Balkau). Sensitivity ranged between 3.2% (Balkau) and 67.7% (FINDRISC1) and specificity between 80.9% (FINDRISC1) and 98.3% (Balkau). Positive predictive values of all scores were below 20%, while negative predictive values were above 98%. CONCLUSION: Our study shows that the performance of conventional diabetes risk scores in PWH is promising, especially for Balkau and FINDRISC2, which showed good discriminatory power. These scores may help identify patients at a low risk of T2D in whom careful assessment of modifiable T2D risk factors can be spared.

SARS-CoV-2 neutralizing antibody response in vaccinated and non-vaccinated hospital healthcare workers with or without history of infection.

Between March 2021 and February 2022, SARS-CoV-2 neutralizing antibodies dynamics was investigated in a prospective observational study in 903 healthcare workers of a hospital in Switzerland. A surrogate neutralization assay measuring the competitive inhibition of the angiotensin converting enzyme 2 (ACE2) binding to the spike protein (S) of the SARS-CoV-2 wild type virus and to five variants of concern (Alpha, Beta, Gamma, Delta, Omicron) was used. We observed a broad distribution of neutralization activity among participants and substantial differences in neutralizing titers against variants. Participants were grouped based on combinations of vaccination status (1, 2 or 3 doses) and/or prior or subsequent SARS-CoV-2 infection/reinfection. Triple vaccination resulted in the highest neutralization response, as did double vaccination with prior or subsequent infection. Double vaccination without infection showed an intermediate neutralization response while SARS-CoV-2 infection in non-vaccinated participants resulted in poor neutralization response. After triple vaccination or double vaccination plus infection, additional vaccination and/or reinfection had no impact on neutralizing antibody titers over the observed period. These results strongly support the booster dose strategy, while additional booster doses within short time intervals might not improve immunization. However, dynamics of neutralizing antibodies titers needs to be monitored individually, over time and include newly emerging variants.

SARS-CoV-2 seroprevalence in hospital healthcare workers in Western Switzerland at the end of the second pandemic wave.

Introduction. In early January 2020, the pandemic of COVID-19 (coronavirus disease 2019) rapidly spread from China and caused a worldwide pandemic.Hypothesis. Healthcare workers represent a high-risk group for acquiring COVID-19 and for nosocomial transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2).Aim. We aimed to investigate over a 1 year period, across two pandemic waves, the SARS-CoV-2 seroprevalence in employees at a Western Switzerland public hospital.Methodology. A prospective observational SARS-CoV-2 seroprevalence study was proposed to all hospital employees who enrolled on a voluntary basis.Results. Out of 594 participants recruited on a voluntary basis, 269 volunteers (45.3 %) had anti-SARS-CoV-2 antibodies: this seroprevalence was twice higher than that reported in the local community. Healthcare workers with prolonged exposure to patients with COVID-19 showed a significantly higher odds ratio (OR) of having a positive SARS-CoV-2 serology [OR 3.19, 95 % confidence interval (CI) 2.16-4.74]. Symptoms showing the highest association with a positive serology were anosmia (OR 11.9, 95 % CI 5.58-30.9) and ageusia (OR 10.3, 95 % CI 4.8-26.3). A total of 17.1 % (95 % CI 12.2-21.1 %) of SARS-CoV-2 seropositive volunteers did not report a suspicion of COVID-19 in their personal history.Conclusion. Overall, we observed that the impact of the second SARS-CoV-2 pandemic wave was considerable and significantly affected healthcare workers with prolonged exposure to patients with COVID-19.

[Infectious diseases: Achievements, new Developments and Perspectives in 2021]. / Maladies infectieuses - Acquis, nouveautés et perspectives en 2021.

The substantial progresses during the last decades in the field of infectious diseases have significantly improved their prevention, diagnosis and treatment. Basic and medical sciences have efficiently dealt with the challenges of emerging infections, infectious complications related to the increasing complexity of medical practices and marked slow-down in the development of new antimicrobial agents. During the worldwide crisis related to the COVID-19 pandemic, the « medical normality ¼ has been put in stand-by, but medical advances have fortunately continued. In the present article we present new knowledge in the field of bacterial, viral and fungal infections, which may modify hospital and ambulatory practices. Significant achievements in the field of COVID-19 will be presented in a future article.

Les progrès spectaculaires des dernières décennies dans le domaine des maladies infectieuses ont sensiblement amélioré leurs prévention, diagnostic et traitement. Les sciences de base et cliniques ont répondu présent face à de multiples défis: infections émergentes, complications infectieuses de pratiques médicales de plus en plus complexes, ralentissement préoccupant du développement de nouveaux agents antimicrobiens. Pendant la crise mondiale liée à la pandémie de Covid-19, la « normalité médicale ¼ a dû être mise entre parenthèses, mais les progrès médicaux se sont ­ fort heureusement ­ poursuivis. Dans cet article, nous vous présentons de nouvelles connaissances en matière d'infections bactériennes, virales ou fongiques qui pourraient faire évoluer nos pratiques hospitalières et ambulatoires. Les acquis marquants dans le domaine du Covid-19 feront l'objet d'un article à venir.

[How to fight against overtreatment ? Example of neuroleptic prescriptions for acute delirium]. / Comment lutter contre la surmédicalisation à l'hôpital ? - Exemple des neuroleptiques dans l'état confusionnel aigu.

Since 2014, the Swiss Smarter medicine - choosing wisely campaign has established lists of recommendations, with an emphasis on futile treatments and tests where risks may outweigh benefits. Ultimately this initiative aims to develop, disseminate and implement educational programs to improve quality of care. Literature shows a positive impact of this initiative on clinical practice. Hence, we developed several guidelines based on this initiative in our internal medicine department. This article describes the multimodal and interprofessional strategy aiming to reduce neuroleptic prescriptions in acute delirium. After the implementation of this recommendation in our clinical practice, we noted positive effects, both qualitative and quantitative, confirming the potential benefit of such changes.

Depuis 2014, la campagne Smarter Medicine a établi des recommandations, afin de cibler des thérapies ou des examens considérés comme futiles ou représentant un risque plus grand que le bénéfice apporté au patient. In fine, cette initiative vise à développer, diffuser et implémenter des programmes d'éducation permettant une amélioration de la qualité des soins. La littérature montre un impact positif de cette initiative sur les pratiques cliniques. C'est pourquoi, dans notre service de médecine interne, nous avons développé un certain nombre de recommandations basées sur cette initiative. Cet article décrit une intervention multimodale et interprofessionnelle visant à diminuer la prescription des neuroleptiques lors d'états confusionnels aigus et son impact sur les pratiques.

[The internal medicine articles that struck us the most in 2017]. / L'année 2017 mise en perspective par les internistes hospitaliers.

2017 has continued to bring important progress in all areas of internal medicine, impacting our daily practice. From bedside screening for beta-lactam allergies, to statins as primary prevention in the elderly, SGLT2 inhibitors in heart failure, azithromycin in severe asthmatics and tofacitinib in ulcero-haemorrhagic recto-colitis, internal medicine journals are full of novelties. Every year, the chief residents of the CHUV internal medicine ward meet up to share their readings: here is their selection of eleven articles, chosen, summarized and commented for you.

L'année 2017 a vu d'importants progrès dans tous les domaines de la médecine interne, avec un impact important sur notre pratique quotidienne. Du dépistage au lit du patient des allergies aux bêta-lactames, aux statines en prévention primaire chez les personnes âgées, en passant par l'utilisation des inhibiteurs SGLT2 dans l'insuffisance cardiaque, de l'azithromycine chez les asthmatiques sévères et du tofacitinib en cas de rectocolite ulcéro-hémorragique (RCUH), les nouveautés abondent dans la littérature. Chaque année, les chefs de clinique du Service de médecine interne du Centre hospitalier universitaire vaudois (CHUV) se réunissent pour partager leurs lectures : voici une sélection de onze articles choisis, revus et commentés pour vous.