ABSTRACT
This article has been brought to you by clinicians in general internal medicine passionate about ultrasound, using it for many years daily and having long been committed to training in abdominal ultrasound. The term POCUS, Point-Of-Care Ultrasound or targeted ultrasonography, has appeared in recent years, quickly establishing itself as an essential tool in certain specialties, such as emergency medicine. Since 2018, the Swiss Institute for Medical postgraduate and continues Education (ISFM) delegates training and accreditation of POCUS in various specialties to the Swiss Society of Ultrasound in Medicine (SSUM). However, we did not wait for the term POCUS to use it, our daily medical life leading us to regularly use this tool in a very targeted manner, depending on the requirements of our patients.
Cet article vous est proposé par des médecins internistes généralistes passionnés d'échographie, l'utilisant dans leur pratique quotidienne et engagés de longue date dans la formation des médecins en échographie abdominale. Le POCUS (Point-of-care ultrasonography ou ultrasonographie ciblée), est apparu ces dernières années et s'est rapidement imposé comme un outil incontournable dans certaines spécialités comme la médecine d'urgence. Dès 2018, l'Institut suisse pour la formation médicale postgraduée et continue (ISFM) délègue à la Société suisse d'ultrasons en médecine (SSUM) les formations et l'accréditation du POCUS dans diverses spécialisations. Or, nous n'avons pas attendu l'apparition des POCUS pour en faire, étant régulièrement amenés à utiliser cet outil de manière très ciblée, en fonction de la clinique de nos patients.
Subject(s)
Emergency Medicine , General Practitioners , Humans , Internal Medicine , Point-of-Care Systems , UltrasonographyABSTRACT
Severe bacterial infection requires prompt diagnosis and treatment. Point-of-care ultrasonography (POCUS) can significantly reduce time to diagnosis. In this article we discuss the diagnostic performance of POCUS through the illustration of four common infectious clinical situations: pneumonia, complicated pleural effusion, cholecystitis and obstructive pyelonephritis.
L'infection bactérienne sévère nécessite un diagnostic et un traitement rapides. L'échographie ciblée, aussi appelée Point-of-care ultrasonography (POCUS), permet de réduire sensiblement les délais jusqu'au diagnostic. Dans cet article, nous discutons des performances diagnostiques de l'échographie ciblée à travers l'illustration de quatre situations cliniques fréquentes de problématiques infectieusesâ : la pneumonie, l'épanchement parapneumonique compliqué, la cholécystite et la pyélonéphrite obstructive.
Subject(s)
Bacterial Infections , Pleural Effusion , Pneumonia , Humans , Pleural Effusion/diagnostic imaging , Point-of-Care Systems , UltrasonographyABSTRACT
Background: Mountain guides work daily in remote areas and high-altitude locations where specific hypoxia-related and common medical problems may occur. Arrival of rescue teams can be delayed, so mountain guides often have to rely on their own capabilities to provide first aid. Therefore, IFMGA-recognized Swiss mountain guides receive a specific medical education and are equipped with a dedicated medical kit. This specific education has never been evaluated. Methods: A questionnaire was sent to all Swiss mountain guides through their national association. This questionnaire evaluates guides' activity, type, and frequency of medical events encountered, medical education, and use of the medical kit. Furthermore, clinical vignettes were used to evaluate their subjective and objective knowledge about prevention and treatment of specific altitude-related diseases. Results: A total of 467 guides completed the questionnaire, 54 (11.6%) of them were identified as high-altitude guides (HA-guides), because they spent ≥10 nights above 4000 meters each year. Mountain guides are more exposed to altitude-specific pathologies, such as Acute Mountain Sickness (AMS), High-Altitude Pulmonary Edema (HAPE), and High-Altitude Cerebral Edema (HACE) than to general medical conditions. A majority of participants (in particular HA-guides) considered altitude-related medical knowledge essential but judged their own education as insufficient. A majority of mountain guides were aware of nonpharmacological preventive measures and able to recognize altitude-related diseases. Mountain guides declared themselves as very confident in treating altitude-related diseases. Objective assessment of their knowledge showed some gaps, in particular related to the use of specific medications like nifedipine and dexamethasone. Conclusions: Swiss mountain guides' education in altitude medicine may be improved, in particular concerning the recognition and treatment of severe conditions such as HAPE and HACE. Better knowledge may be especially important for HA-guides. These data have induced experts in the field to adapt the guides teaching curriculum and medical kit.
Subject(s)
Education, Professional , Health Knowledge, Attitudes, Practice , Mountaineering , Wilderness Medicine/education , Altitude , Altitude Sickness/diagnosis , Altitude Sickness/therapy , Brain Edema/diagnosis , Brain Edema/therapy , Emergency Treatment , Female , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/therapy , Male , Middle Aged , Surveys and Questionnaires , SwitzerlandABSTRACT
Micro-electro-mechanical systems (MEMS)-based heating holders offer exceptional control of temperature and heating/cooling rates for transmission electron microscopy experiments. The use of such devices is relatively straightforward for nano-particulate samples, but the preparation of specimens from bulk samples by focused ion beam (FIB) milling presents significant challenges. These include: poor mechanical integrity and site selectivity of the specimen, ion beam damage to the specimen and/or MEMS device during thinning, and difficulties in transferring the specimen onto the MEMS device. Here, we describe a novel FIB protocol for the preparation and transfer of specimens from bulk samples, which involves a specimen geometry that provides mechanical support to the electron-transparent region, while maximizing the area of that region and the contact area with the heater plate on the MEMS chip. The method utilizes an inclined stage block that minimizes exposure of the chip to the ion beam during milling. This block also allows for accurate and gentle placement of the FIB-cut specimen onto the chip by using simultaneous electron and ion beam imaging during transfer. Preliminary data from Si and Ag on Si samples are presented to demonstrate the quality of the specimens that can be obtained and their stability during in situ heating experiments.
ABSTRACT
2013 was full of significant advances in all areas of medicine, which may have an impact on daily practice in general internal medicine. From salt and water restriction in heart failure to transfusion threshold in upper gastrointestinal bleeding and fecal infusion in Clostridium difficile colitis; from new data in resuscitation and persistent questions in palliative care and intensive care medicine, through pneumology, nephrology and endocrinology, the literature has been rich in new considerations. Each year, the residents of the Department of internal medicine of the University hospital of Vaud (CHUV) meet to share their most interesting readings. Thirteen of them are reviewed and commented here.
Subject(s)
General Practice/trends , Internal Medicine/trends , Internship and Residency , Hospitals, University , Humans , SwitzerlandABSTRACT
The glycoprotein 130 (gp130) is the common signal transducing receptor chain of the interleukin-6 family of cytokines. Here we investigated the requirements for transfer of the information given by ligand binding to the cytoplasmic domain of gp130. It is demonstrated that the box 1/2 region has to be located membrane-proximally in order to bind and activate Janus kinases. To test the possible requirement of an alpha-helical orientation, we inserted 1-4 alanine residues into this juxtamembrane intracellular region. The insertion of one alanine results in a strongly reduced activation of STAT1 and STAT3, whereas insertion of three alanine residues leads to a stronger STAT activation. These results suggest that gp130-mediated activation of STATs is sensitive to rotational changes around the receptor axis perpendicular to the membrane. Surprisingly, insertion of 1, 2, 3, or 4 alanine residues into this juxtamembrane region leads to successive impairment but not abolishment of Janus kinase and receptor phosphorylation, supporting the finding of sensitivity of Janus kinases toward changes in distance of box 1/2 from the plasma membrane. We suggest a new model concerning the gp130 activation mode in which the relative orientation of the cytoplasmic regions seems to be critical for further signal transduction.
