[Infectious disease: what's new in 2022]. / Maladies infectieuses : ce qui a changé en 2022.

While recent epidemics have generated particular interest in viral infections, it should be noted that diagnostic, prophylactic or therapeutic innovations concerning other pathogens are not lacking. New vaccines (malaria, shingles) but new viruses (Lengya, child hepatitis), new therapeutic options against disabling parasitic diseases and bacteria becoming more and more resistant, including tuberculosis, shortening of treatment durations (tuberculosis, endocarditis), new diagnostic tests (borreliosis) are, among others, some notable recent innovations.

Si les récentes épidémies ont généré un intérêt particulier pour les infections virales, il faut constater que les innovations diagnostiques, prophylactiques ou thérapeutiques, concernant d'autres pathogènes, ne manquent pas. Nouveaux vaccins (malaria, zona), nouveaux virus (Lengya, hépatite infantile), nouvelles options thérapeutiques contre des parasitoses invalidantes et des bactéries devenant de plus en plus résistantes, y compris la tuberculose, raccourcissement des durées de traitement (tuberculose, endocardite), nouveaux tests diagnostiques (borréliose) constituent, parmi d'autres, quelques-unes des innovations récentes notables.

[The flu in its worse forms]. / La grippe sous ses pires facettes.

Influenza A and B infections are marred with variable morbidity and, in some cases, develop into severe or even fatal respiratory, circulatory and neurologic complications. Respiratory complications are most common and involve primary-Influenza pneumonia and pneumonia from bacterial or fungal superinfections. Nonrespiratory complications can affect several organs/systems, namely the heart (myocarditis, type 1 and 2 myocardial infarction) and the nervous system (stroke, encephalitis, Guillain-Barré Syndrome). This article provides an overview of the basic pathophysiological aspects of Influenza virus infection, reviews the main severe respiratory and nonrespiratory complications and discusses the different treatments with their respective indications, contraindications and limitations.

L'infection par les virus de la grippe de types A et B (influenza A et B) est grevée d'une morbidité variable, pouvant évoluer en diverses complications respiratoires, circulatoires et neurologiques sévères, voire fatales. Les complications pulmonaires sont les plus fréquentes et l'on distingue parmi elles les pneumonies dues au virus de celles par surinfection bactérienne ou fongique. Les complications extrapulmonaires, plus rares, peuvent toucher divers organes, dont le cœur (myocardite, infarctus du myocarde de types 1 et 2) et le système nerveux (AVC, encéphalite, syndrome de Guillain-Barré). Cet article aborde les aspects physiopatho logiques de base de la grippe, passe en revue les principales complications sévères pulmonaires et extrapulmonaires, et discute les indications, contre-indications et limites des différents traitements disponibles.

[Antiretrovirals: drug and food interactions]. / Antirétroviraux†: interactions médicamenteuses et alimentaires.

As with antibiotics, antiretroviral drugs used in the treatment of human immunodeficiency virus infection are subject to multiple drug interactions. Although less well known than those of antibiotics, these interactions can sometimes have very severe consequences. The main objective of this article is therefore to make practitioners in the ambulatory practice or in the hospital aware of the main inter actions of antiretroviral therapies with drugs frequently used in daily clinical practice, but also to discuss the influence of food.

À l'instar des antibiotiques, les médicaments antirétroviraux utilisés dans le traitement contre l'infection par le virus de l'immunodéficience humaine sont sujets à de multiples interactions médicamenteuses. Bien que moins connues que celles des antibiotiques, ces interactions peuvent avoir des conséquences parfois très sévères. L'objectif principal de cet article est donc de sensibiliser les praticiens en charge de ces patients au cabinet ou à l'hôpital aux principales interactions des thérapies antirétrovirales avec les médicaments fréquemment utilisés dans la pratique clinique quotidienne, mais également de discuter l'influence des aliments.

Impact of drugs on hypoglycaemia in hospitalised patients.

OBJECTIVES: Hospital admission rates for hypoglycaemia now exceed those for hyperglycaemias among older adults. A growing number of reports associating hypoglycaemia with non-antidiabetic drugs have been published. Clinical pharmacists are often faced with hypoglycaemia in patients taking multiple medications. This study assessed the potential relationship between prescribed drugs and episodes of hypoglycaemia during hospitalisation. METHODS: Point-of-care blood glucose values and prescribed drugs were analysed in patients admitted to a regional hospital. Hypoglycaemia cases were defined as patients with at least one hypoglycaemic event (random glucose value ≤3.9 mmol/L), and normoglycaemic cases as those with random glucose concentrations within the range of 4.5-5.8 mmol/L. Analyses were carried out using multivariate logistic regressions and Cox proportional hazard models. RESULTS: 373 patients (53% males; median age=74 years) were included in the analysis and of these, 64 (17%) had at least one hypoglycaemic event. Patients who experienced a hypoglycaemic event had a longer length of stay (median=10 vs 7 days, p<0.01) and a higher rate of antidiabetic drugs prescription (83% vs 37%, p<0.01). The number of non-antidiabetic drugs was associated with an increased risk of hypoglycaemia during hospitalisation (HR 2.3, 95% CI 1.4 to 4, p<0.01). After adjusting by confounders, heparin and pantoprazole were found to be associated with hypoglycaemia. CONCLUSIONS: The relationship between hypoglycaemia and polypharmacy reinforces the advice to limit polymedication as much as possible, especially in elderly patients. This result underlines the potential involvement of clinical pharmacists with the aim to reduce the risk of hypoglycaemia during hospitalisation.

Endoscopic removal of a gastric pharmacobezoar induced by clomipramine, lorazepam, and domperidone overdose: a case report.

INTRODUCTION: Gastric pharmacobezoars are a rare entity that can induce mechanical gastric outlet obstructions and sometimes prolong toxic pharmacological effects. Certain medications, such as sustained-release forms, contain cellulose derivatives that may contribute to the adhesion between pills and lead to the creation of an aggregate resulting in a pharmacobezoar. Case reports are rare, and official guidelines are needed to help medical teams choose proper treatment options. CASE PRESENTATION: Our patient was a 40-year-old Caucasian woman with borderline personality disorder and active suicidal thoughts who was found unconscious after a massive drug consumption of slow-release clomipramine, lorazepam, and domperidone. On her arrival in the emergency room, endotracheal intubation was preformed to protect her airway, and a chest x-ray revealed multiple coffee grain-sized opaque masses in the stomach. She was treated with activated charcoal followed by two endoscopic gastric decontaminations 12 h apart in order to extract a massive gastric pharmacobezoar by manual removal of the tablets. CONCLUSION: This case demonstrates that in the case of a massive drug consumption, a pharmacobezoar should be suspected, particularly when cellulose-coated pills are ingested. Severe poisoning due to delayed drug release from the gastric aggregate is a potential complication. Detection by x-ray is crucial, and treatment is centered on removal of the aggregate. The technique of decontamination varies among experts, and no formal recommendations exist to date. It seems reasonable that endoscopic evaluation should be performed in order to determine the appropriate technique of decontamination. Care should be patient-oriented and take into account the clinical presentation and any organ failure, and it should not be determined solely by the suspected medication ingested. Thus, serum levels are not sufficient to guide management of tricyclic antidepressant intoxication.

[Vancomycine-resistant enterocci (VRE) : a new reality in our hospitals]. / Entérocoque résistant à la vancomycine (ERV) : une nouvelle réalité dans nos hôpitaux.

Limiting the emergence and spread of multi-resistant bacteria is a global concern and the management of colonized patient represents a real challenge, especially in the hospital setting, where risks of acquisition and transmission are increased. Switzerland is not protected from undesirable trends : for instance, recent outbreaks of vancomycin-resistant enterococci (VRE) have been reported in several hospitals in western Switzerland. Since 2011, more than 250 patients have been tested positive during these outbreak episodes and the molecular analysis of the documented strains shows an unexpected diversity, including both sporadic and epidemic strains. This emerging threat requires strict monitoring, prevention and infection control strategies in our healthcare facilities.

Limiter l'émergence et la diffusion des bactéries multirésistantes (BMR) est une urgence mondiale et la gestion des patients porteurs représente un véritable défi, notamment en milieu hospitalier, où les risques d'acquisition et de transmission de ces germes sont multipliés. La Suisse n'est pas épargnée par ce phénomène. En témoignent les épidémies récentes à entérocoques résistant à la vancomycine (ERV) dans plusieurs hôpitaux de Suisse romande. Depuis 2011, plus de 250 patients ont été dépistés positifs durant ces épisodes et l'analyse moléculaire par séquençage complet de génome montre une diversité inattendue des souches, qu'elles soient sporadiques ou à potentiel épidémique. Cette menace émergente, bien réelle, implique une stratégie de surveillance, prévention et contrôle de l'infection stricte dans nos établissements de soins.

[Candida in urine: colonization ? Infection ? When and how to treat ?] / Candidurie ­ colonisation ? Infection ? Quand et comment traiter ?

Candida is frequently found in urine cultures. Deciding whether this represents simple colonization or true infection is often difficult since Candida is a normal genital and urinary tract commensal. Urinary tract colonization is facilitated by well identified risk factors. The diagnostic of a true infection relies upon the identification of the usual clinical signs which cannot be attributed to another pathogen ; also, plasma level of beta-D-glucan can contribute to confirm the diagnostic. Treatment success depends upon the possibility to correct the risk factors and appropriate anti-fungal therapy according to in vitro susceptibility testing.

Candida sp. est fréquemment isolé lors de cultures d'urine. L'interprétation de ce résultat est souvent difficile, car ce germe est un commensal des muqueuses génito-urinaires. La colonisation des voies urinaires est favorisée par des facteurs prédisposants bien identifiés. L'évolution d'une colonisation vers une véritable infection est difficile à diagnostiquer et repose sur l'identification de signes généraux d'infection non attribuables à un autre germe ; l'élévation du taux plasmatique de bêta-D-glucane peut conforter ce diagnostic. Le succès du traitement dépend de la possibilité de corriger les facteurs prédisposants et la susceptibilité du germe aux antifongiques.

[Hospital pathway of complex patients in a medical service of a local Hospital]. / Trajectoire hospitalière des patients complexes dans un service de médecine d'un hôpital régional.

In the current Swiss medical system, hospital care is provided by both university hospitals and so-called « peripheral ¼ hospitals. While university hospitals offer advanced technology and a wide range of medical specialists, how is care organized within the smaller, less complex structure of a peripheral hospital ? In emergencies, although patients usually go to their local hospital, they should not be exposed to lower quality care. Quality treatment is guaranteed by a well-organized structure, supported by a competent team of general doctors and specialists who have access to advanced technology. This article illustrates the journey of a typical patient presenting several common problems that make his case complex to manage, and also illustrates how the internal medicine department of a peripheral hospital operates.

En Suisse, les soins hospitaliers sont dispensés par des centres universitaires et des hôpitaux dits «périphériques¼. Alors qu'un hôpital universitaire offre un plateau technique avancé et dispose d'un panel de médecins spécialistes, comment s'organisent les soins au sein d'un hôpital périphérique ? Les patients se présentent généralement dans l'hôpital le plus proche de leur domicile, et cela ne devrait pas les exposer à des soins de moindre qualité. L'organisation associant les généralistes hospitaliers aux spécialistes disponibles et la collaboration avec les hôpitaux universitaires garantit des soins de qualité. Cet article illustre le parcours d'un patient ordinaire avec plusieurs problèmes courants rendant la prise en charge complexe, ainsi que l'activité d'un service de médecine interne hospitalier d'un hôpital périphérique.

[Foodborne diseases]. / Toxi-infections alimentaires aujourd'hui.

Foodborne diseases are frequent, even though food safety has never been so high in industrialized countries. The epidemics of previous centuries, such the cholera, disappeared from our everyday public health concerns. The persistence of foodborne diseases depends largely upon poor compliance with the rules of proper food hygiene, especially with storage and preparation of food items. While these processes are subjected to strict controls when food items are industrially processed, it is not so with everyone's food basket or kitchen. Feeding behavior also tends to change, with an increasingly popular trend to consume raw food, to consume exotic meals and to adopt exotic recipes. Altogether these factors compromise food safety. A good knowledge of foodborne diseases, whether native or imported is thus relevant to today's general practice.

Major depressive disorder in the general hospital: adaptation of clinical practice guidelines.

Major Depressive Disorder is particularly frequent among physically ill inpatients. Despite the considerable human burden and financial costs, Major Depressive Disorder remains under-detected and under-treated. To improve this situation, clinical practice guidelines for the management of Major Depressive Disorder were developed for patients in the general hospital. They were adapted from existing good quality guidelines. A literature search has been conducted to identify guidelines and systematic reviews about the management of Major Depressive Disorder. The quality of the existing guidelines was evaluated by means of the AGREE instrument (Appraisal of Guidelines for Research and Evaluation). Complementary literature searches were necessary to answer questions such as "depression and physical illness" or "antidepressants and somatic medication". The guidelines were discussed by a multidisciplinary internal panel. The final version was reviewed by an external panel. This paper presents the development process and a summary of these guidelines for the management of Major Depressive Disorder. The adaptation of good quality guidelines to local needs requires much time, effort and skills. Easier ways for the adaptation and use of high quality guidelines at the local level may result from better coordination, organization and updating of guidelines at a national or supranational level.