Diagnosis and management of COVID toes in outpatients: a case report.

BACKGROUND: Since the beginning of the coronavirus disease 2019 pandemic, the most common skin lesions observed due to infection with the severe acute respiratory syndrome coronavirus 2 are pseudochilblains (or coronavirus disease toes). However, this pathology remains infrequent and difficult to diagnose, as no specific test exists. CASE PRESENTATION: Two Caucasian women, 30 and 22 years old, presented to our General Medicine Unit with perniosis lesions on the feet during the first two waves of the coronavirus disease 2019 pandemic. They did not have respiratory or general symptoms of severe acute respiratory syndrome coronavirus 2 infection, the reverse transcription polymerase chain reaction on nasopharyngeal swabs was negative, and the serology was positive only in the first case. The clinical presentation differed for the two cases, as the second patient suffered from swelling and burning after cold application. The diagnosis was based on clinical presentation, temporality, exclusion of other differential diagnoses, and blood test results (positive serology in the first case and high level of CXCL13 and VEGF in the second), supported by current literature. Lesions resolved spontaneously in the first patient. The second case was hospitalized for pain management and received corticosteroid therapy with resolution of the symptoms. CONCLUSION: These two cases with different clinical presentations illustrate the diagnostic approach to coronavirus disease 2019, a challenging disease with diverse manifestations, including, in some cases, coronavirus disease toes. We present a literature review that illustrates the progression of scientific research. Skin lesions associated with coronavirus disease 2019 infection could be the expression of an important interferon type 1 response and should be considered in the differential diagnosis in a primary care setting.

[Practical management of post-COVID-19 condition. Update and illustration by clinical situations]. / Prise en charge pratique de l'affection post-Covid-19. Mise à jour et illustration par des situations cliniques.

Persistent manifestations of COVID-19, known as «long COVID¼ or post-COVID-19 condition (RA02, CIM-11), affect many infected individuals, with a 24-month prevalence depending on the studies context (18 % in a recent Swiss study). The diversity of clinical presentation, the sometimes complex diagnostic methods, and the multidisciplinary management highlight the importance of a holistic approach, with practical advice for assessing work capacity in the outpatient setting. This article offers an update and synthesis of current knowledge concerning post-COVID-19 condition with practical recommendations for primary care medicine, illustrated by real clinical situations.

Les manifestations persistantes du Covid-19, connues sous le nom de « Covid long ¼ ou affection post-Covid-19 (RA02, CIM-11), concernent un nombre significatif de personnes infectées, avec une prévalence à 24 mois de l'infection variant en fonction des études et du contexte (18 % dans une étude suisse récente). La diversité de présentation clinique, les méthodes diagnostiques, parfois complexes, et les approches multidisciplinaires pour la prise en charge soulignent l'importance d'une approche holistique. Cet article propose une mise à jour et une synthèse des connaissances actuelles concernant l'affection post-Covid-19, avec des recommandations pratiques de prise en charge en médecine de premiers recours, illustrées par des situations cliniques réelles et des conseils pratiques pour l'appréciation de la capacité de travail.

[MedEscapeRoom: an innovative learning method at Unisanté. A course offered as part of pre-graduate medical training]. / MedEscapeRoom : méthode d'apprentissage innovante à Unisanté. Un enseignement proposé dans la formation médicale prégraduée.

Teaching methods in the health sciences are evolving with societal changes and the needs of new generations. Gamification in the field of medical education is a fast-growing theme. The use of games in medical training activities engages participants in problem-solving by amplifying their emotional experience and promotes adult learning. At Unisanté (Centre for Primary Care and Public Health of the University of Lausanne), the MedEscapeRoom, an escape game on the outpatient management of acute vertigo, has been developed as a new teaching tool in undergraduate medical education through an exploratory approach and continuous improvement cycles. This article describes the development and evaluation of this pioneering teaching tool.

Les méthodes pédagogiques dans le domaine des sciences de la santé évoluent avec les changements sociétaux et les besoins des nouvelles générations. La ludification dans le domaine de la pédagogie médicale est une thématique en pleine expansion. Le recours au jeu lors des activités de formation médicale permet un engagement des participantes à la résolution de problèmes par l'amplification de l'expérience émotionnelle et favorise l'apprentissage de l'adulte. À Unisanté, Centre universitaire de médecine générale et santé publique à Lausanne, le MedEscapeRoom, un jeu d'évasion sur la prise en charge ambulatoire du vertige aigu, a été développé comme un nouvel outil pédagogique impliquant une démarche exploratoire et des cycles d'amélioration continue. Cet article décrit le développement et l'évaluation de cet enseignement pionnier.

[REVIAC: ten years of advice for populations in vulnerable situations]. / REVIAC : dix ans de conseil pour les populations en situation de vulnérabilité.

The REVIAC device was designed ten years ago, with the aim of advising social workers in their efforts to support and reintegrate people in vulnerable situations. In this article, it will be a question of identifying the current issues and the challenges to be met for the future.

Le dispositif REVIAC a été conçu il y a dix ans dans le but de conseiller les assistants et assistantes sociales dans leurs démarches pour soutenir et réinsérer les personnes en situation de vulnérabilité. Dans cet article, il sera question de repérer les enjeux actuels et les défis à relever pour le futur.

Clinical impact and misdiagnosis of functional ophthalmological symptoms: a case report.

BACKGROUND: There is a high prevalence of somatoform disorders and medically unexplained symptoms. When it comes to deciding whether a patient is able to work, it is essential to differentiate a somatoform disorder from a factitious disorder. The case presented demonstrates the impact on disability benefits and the subsequent psychosocial repercussions of misdiagnosing between a factitious disorder and a somatoform disorder. CASE PRESENTATION: A 42-year-old Caucasian woman worked as a 100% fiduciary accountant until the age of 32 when she was placed on medical leave due to persistent trigeminal neuralgia. Afterward, she developed total blindness, not explained by a physiological process, accompanied by distress in a crucial emotional context. We evaluated the patient for a revision of a disability income after a diagnosis of factitious disorder with severe consequences such as disability income suspension and family conflict. Our psychiatric examination concluded the diagnoses of pain disorders related to psychological factors and a dissociative neurological symptom disorder with visual disturbance. CONCLUSIONS: Blindness not explained by a physiological process may accompany trauma and psychological distress. Differentiating this pathology from factitious disorder or simulation is essential from an insurance medicine point of view, but also for its treatment.

[Neuropsychiatric manifestations of post COVID-19 Syndrome and Disability Insurance (DI)]. / Covid long neuropsychiatrique et assurance invalidité (AI).

Long COVID, frequently associated to neuropsychiatric manifestations, impacts the ability of patients to return to work and often requires adjustments of the previous workstation. Due to the duration of the symptoms and the professional consequences, disability insurance (DI) procedures may be necessary. Because the persistent symptoms of Long COVID are often subjective and unspecific, the medical report to the DI should include a detailed description of the functional impact of these manifestations.

Le Covid long et ses fréquentes manifestations neuropsychiatriques impactent la capacité des patients à retourner au travail et nécessitent souvent des aménagements du poste de travail antérieur. En raison de la durée des symptômes et des conséquences professionnelles, des démarches auprès de l'assurance invalidité (AI) peuvent s'avérer nécessaires. Parce que les symptômes persistants du Covid long sont souvent subjectifs et aspécifiques, le rapport médical à l'AI doit comprendre une description détaillée des répercussions fonctionnelles de ces manifestations.

[Leptospirosis, the diagnostic challenge of an indigenous case]. / Leptospirose, le défi diagnostique d'un cas autochtone.

Leptospirosis is a global widespread zoonosis caused by a Gram-negative bacterium of the genus Leptospira, belonging to the Spirochaetes phylum, favored by unhealthy living conditions and some professional and recreational aquatic activities. Its diagnosis could be very difficult due to the presence of non-specific clinical presentation and biological anomalies common to other infectious diseases. To detect it, the choice of the right diagnostic method is fundamental. We hereby introduce the case of a patient with no classic risk factors for leptospirosis, showing febrile headaches and rapid deterioration of her general conditions with evolution towards septicemia.

La leptospirose est une zoonose causée par une bactérie Gram négatif du genre Leptospira, appartenant au phylum des Spirochaetes. Elle est répandue dans le monde entier, favorisée par des conditions de vie insalubres et certaines activités professionnelles et récréatives en milieu aquatique. Son diagnostic peut s'avérer difficile en raison de sa présentation clinique et de ses anomalies biologiques peu spécifiques et communes à d'autres maladies. Évoquer ce diagnostic et effectuer le test diagnostique approprié demeure, donc, fondamental. Nous présentons l'histoire d'une patiente sans facteurs de risque classiques de leptospirose, présentant des céphalées fébriles et une détérioration rapide de son état avec une évolution vers une septicémie.

[Persistent Postural-Perceptual Dizziness (PPPD) - A clinical case and essentials for the primary care medicine]. / Vertiges posturaux-perceptuels persistants (VPPP) - Cas clinique et notions essentielles pour le généraliste.

Persistent Postural-Perceptual Dizziness (PPPD) is a chronic functional disorder that manifests with symptoms of dizziness, unsteadiness or non-spinning vertigo that lasts for at least three months. These symptoms are exacerbated by upright posture, active or passive motion, and exposure to complex or moving visual stimuli. This -pathology has been known for a long time ago. Still, after an expert's consensus in 2017, this term was born, and some precise diagnostic criteria have been defined based on identifying key symptoms in the patient's clinical history. Treatment is multimodal, incorporating -vestibular rehabilitation, cognitive-behavior therapy, and serotonergic medication.

Les VPPP ou vertiges posturaux-perceptuels persistants (Persistent Postural-Perceptual Dizziness (PPPD)) sont une pathologie fonctionnelle chronique, caractérisée par une sensation de déséquilibre, d'instabilité ou de vertige non rotatoire. Les symptômes peuvent être exacerbés par la position debout, la mobilisation active ou passive et l'exposition à des stimuli visuels complexes ou en mouvement. Si la pathologie est connue de longue date, c'est suite à un consensus d'experts qu'est né ce terme en 2017, et que des critères diagnostiques clairs ont été définis, qui se basent sur l'identification de symptômes clés dans l'histoire ­clinique du patient. Le traitement est multimodal, ­comprenant une réhabilitation vestibulaire, des thérapies cognitivo-comportementales et une médication sérotoninergique.

Randomly controlled drivers using minimally invasive sampling: assessment of drug prevalence in Western Switzerland over two time periods.

BACKGROUND: According to the World Health Organization, road traffic injuries lead to 1.3 million deaths each year and represent the leading cause of death for young adults under 30 years old. The use of psychoactive substances, including alcohol, drugs and pharmaceuticals, is a well-known risk factor for road traffic injuries. Our study aims to assess the prevalence of substances consumed by drivers in western Switzerland. Such studies are pivotal to improving prevention and developing public awareness campaigns. METHODS: To assess the prevalence of psychoactive substances among drivers, roadside controls were performed in collaboration with local police, using their classical sampling procedures to detect drivers under the influence of drugs or alcohol over two time periods (P1: 2006-2008, P2: 2017-2020). When impaired driving was not suspected by the police, minimally invasive sampling strategies (i.e., oral fluids during P1 and dried blood spots during P2) were performed on volunteer drivers after a road safety survey. A posteriori analyses and statistical interpretation were then performed. RESULTS: Among the 1605 drivers included in the study, 1048 volunteers provided an oral fluid sample, while 299 provided a dried blood spot sample. The percentage of drivers testing positive for at least one substance that can impact driving abilities was stable over time, with a rate of 10.5% positivity measured over both periods. Considering the different categories of substances, a slight variation was observed between both periods, with 7.6 and 6.3% of pharmaceuticals and 3.6 and 4.9% of illicit drugs for P1 and P2, respectively. Regarding the consumption of illicit drugs, the highest percentage of positivity was measured in biological fluids of drivers under the age of 35, during nights and week-ends, periods which are considered particularly prone to fatal accidents for this age group. Disturbingly, the road safety survey highlighted that drivers' perception of the risk of getting positively controlled while driving after drug consumption is low (3.3 on a 1-to-10 scale, N = 299). CONCLUSION: The number of positive cases measured in voluntary drivers who passed the preliminary police check demonstrates the importance of systematic biofluid sampling strategies regarding driving under the influence of psychoactive substances. Although the number of fatal road accidents globally has decreased over time, the results of this study reveal the need for both better prevention and deterrent processes that could potentially reduce the risk of fatal road accidents associated with drug consumption.

[Clinical presentation and short-term treatment of pulmonary actinomycosis]. / Manifestations cliniques et traitement de courte durée de l'actinomycose pulmonaire.

Actinomycosis is an uncommon disease caused by Actinomyces, a commensal of the oropharyngeal, digestive, and genital tract. Commonly, it manifests as cervicofacial infection and is often related to poor oral health, smoking, chronic alcoholism or immune deficiency. Pulmonary actinomycosis is a rare disease, characterized by unspecific clinical, biological, and radiological manifestations that may be confused with other diseases. It should always be considered in patients suspected of having tuberculosis, lung abscess or pulmonary neoplasia. We describe a case of pulmonary actinomycosis treated successfully with short-term antibiotic therapy of three months, with a short review of the literature.

L'actinomycose est une infection peu fréquente causée par l'espèce Actinomyces, un commensal du tractus oropharyngé, digestif et génital. Elle se manifeste généralement par une infection cervico-faciale, souvent liée à un mauvais état bucco-dentaire, un tabagisme, un éthylisme chronique, ou un déficit immunitaire. L'actinomycose pulmonaire est une affection peu commune, caractérisée par des manifestations cliniques, biologiques et radiologiques peu spécifiques qui peuvent être confondues avec d'autres maladies. Elle doit être évoquée en cas de suspicion de tuberculose, d'abcès et de néoplasie pulmonaire. Nous décrivons un cas d'actinomycose pulmonaire traitée avec succès par une antibiothérapie de courte durée de 3 mois, avec une revue simplifiée de la littérature.

Risk Perception Related to COVID-19 and Future Affective Responses Among Healthcare Workers in Switzerland: A Mixed-Methods Longitudinal Study.

Objectives: Whereas early findings suggest that risk perceptions related to COVID-19 affect psychological well-being in healthcare workers (HCWs), the temporal associations between these variables need to be clarified and HCWs lived experience further explored. This study proposes a mixed evaluation of COVID-19-related risk perception and affective responses among HCWs. Methods: A longitudinal mixed-method study was conducted. HCWs (N = 138) completed measures of COVID-19 risk perceptions, depression, anxiety, burnout and secondary traumatic stress (STS) at baseline and 6 months later. A subsample (n = 20) participated in semi-structured interviews exploring both risk perceptions and affective responses. Results: Main quantitative findings showed positive associations between worry to contaminate others and depression (IRR = 1.04, p < 0.05), anxiety (IRR = 1.03, p < 0.01), STS (b = 0.3, p < 0.05), and perceptions of lacking protection (IRR = 1.04, p < 0.05) with anxiety scores. Four themes emerged from the thematic content analysis: 1) life was turned upside down; 2) skills were put in quarantine; 3) dealing with patient discomfort; 4) balance to be found between protection and restrictions. Conclusion: These findings emphasize the importance to develop tailored interventions, such as group discussion sessions, to optimize risk perception and help manage uncertainty.

Idiopathic remitting seronegative symmetrical synovitis with pitting edema syndrome mimicking symptoms of polymyalgia rheumatica: a case report.

BACKGROUND: Remitting seronegative symmetrical synovitis with pitting edema is a rare rheumatic condition of the elderly population that is well described but whose mechanisms remain little studied. This syndrome is characterized by symmetrical swelling located mainly on the dorsal part of the hands and the feet. Because of possible heterogeneous clinical presentation, it can easily mimic the onset of other rheumatic diseases or appear associated with them. Here we report a case of a patient who developed remitting seronegative symmetrical synovitis with pitting edema with preexisting shoulder and hip girdle pain associated with progressive fatigue, indicating a possible differential diagnosis of polymyalgia rheumatica. We reviewed and compared classification for remitting seronegative symmetrical synovitis with pitting edema and polymyalgia rheumatica and discussed other differential diagnoses. CASE PRESENTATION: An 84-year-old Caucasian woman presented to our General Medicine Unit with acute onset of symmetrical hands and feet edema, leading to functional limitation due to pain and stiffness. Additionally, she was complaining about neck, shoulder, and pelvic girdle pain present for about 2 months associated with worsening asthenia. Blood tests showed an elevated level of C-reactive protein and erythrocyte sedimentation rate, as well as absence of anti-cyclic citrullinated peptide antibodies and rheumatoid factor. As all criteria of remitting seronegative symmetrical synovitis with pitting edema syndrome were present, the patient was treated with low-dose prednisone, with a rapid and complete resolution of symptoms. She remains asymptomatic without treatment 2 years after the onset of symptoms, without any evident oncologic etiology. CONCLUSIONS: This case is an example of a classic representation of remitting seronegative symmetrical synovitis with pitting edema syndrome with clinical elements suggesting a concomitant existing early stage of polymyalgia rheumatica. These two entities, classified in the group of seronegative arthritis, can coexist (up to 10% of cases), with remitting seronegative symmetrical synovitis with pitting edema appearing as an initial or late manifestation of polymyalgia rheumatica. It is essential to remind that remitting seronegative symmetrical synovitis with pitting edema is associated with a higher risk of cancer (30%). A proper diagnosis allows the clinician to precisely define the appropriate therapy duration to limit its side effects in the elderly and remain aware of the potential risk of underlying malignancy.

Effect of acute iron infusion on insulin secretion: A randomized, double-blind, placebo-controlled trial.

Background: Chronic exposure to high iron levels increases diabetes risk partly by inducing oxidative stress, but the consequences of acute iron administration on beta cells are unknown. We tested whether the acute administration of iron for the correction of iron deficiency influenced insulin secretion and the production of reactive oxygen species. Methods: Single-center, double-blinded, randomized controlled trial conducted between June 2017 and March 2020. 32 women aged 18 to 47 years, displaying symptomatic iron deficiency without anaemia, were recruited from a community setting and randomly allocated (1:1) to a single infusion of 1000 mg intravenous ferric carboxymaltose (iron) or saline (placebo). The primary outcome was the between group mean difference from baseline to day 28 in first and second phase insulin secretion, assessed by a two-step hyperglycaemic clamp. All analyses were performed by intention to treat. This trial was registered in ClinicalTrials.gov NCT03191201. Findings: Iron infusion did not affect first and second phase insulin release. For first phase, the between group mean difference from baseline to day 28 was 0 µU × 10 min/mL [95% CI, -22 to 22, P = 0.99]. For second phase, it was -5 µUx10min/mL [95% CI, -161 to 151; P = 0.95] at the first plateau of the clamp and -249 µUx10min/mL [95% CI, -635 to 137; P = 0.20] at the second plateau. Iron infusion increased serum ascorbyl/ascorbate ratio, a marker of plasma oxidative stress, at day 14, with restoration of normal ratio at day 28 relative to placebo. Finally, high-sensitive C-reactive protein levels remained similar among groups. Interpretation: In iron deficient women without anaemia, intravenous administration of 1000 mg of iron in a single sitting did not impair glucose-induced insulin secretion despite a transient increase in the levels of circulating reactive oxygen species. Funding: The Swiss National Science Foundation, University of Lausanne and Leenaards, Raymond-Berger and Placide Nicod Foundations.

[2021 scientific breakthroughs in ambulatory general internal medicine]. / Avancées scientifiques 2021 en médecine interne générale ambulatoire.

Psychotherapy diminishes depression relapses when antidepressants are reduced or stopped. Delayed antibiotic therapy is effective and safe while treating community-acquired respiratory infection. Physical rehabilitation after hospitalization due to acute cardiac decompensation is useful in frail patients. Six hours of sleep appears to be associated with a higher risk of dementia in people aged 50-70 years. Patients modify healthcare use after losing their referring physician. Screening for atrial fibrillation in healthy patients aged 65 or older is not beneficial. Physicians' ECG reading skills decrease in the absence of regular training. Patients hospitalized with COVID-19 are often clinically, psychologically, and economically impacted.

La psychothérapie diminue les rechutes de dépression lors de la réduction ou de l'arrêt des antidépresseurs. En cas d'infection respiratoire communautaire, l'antibiothérapie retardée est efficace et sûre. La réadaptation physique après une décompensation cardiaque aiguë est utile chez les patients fragiles. Un sommeil de 6 heures semble être associé à un risque plus élevé de démence chez les personnes de 50 à 70 ans. Les patients modifient le recours aux soins de santé après la cessation d'activité de leur médecin référent. La recherche de fibrillation auriculaire chez les patients de 65 ans ou plus en bonne santé n'est pas bénéfique. Les compétences médicales de lecture d'ECG diminuent en l'absence de formation régulière. Les patients hospitalisés pour un Covid-19 sont souvent impactés aux niveaux clinique, psychologique et économique.

[Practical management of long Covid disease in outpatients: illustration by clinical cases]. / Prise en charge des patients avec Covid long : illustration par des cas cliniques.

The SARS-CoV-2 pandemic has caused an unprecedented global public health crisis. The term long Covid is used to describe diverse and heterogeneous symptoms that persist more than 4 weeks after infection with an estimated incidence of 10-40%, which varies between studies. The principal characteristics of long Covid are fluctuating symptoms of prolonged duration affecting multiple organs, such as fatigue, dyspnea, cough, anosmia, dysgeusia, chest pain, palpitations, headache, myalgia, cognitive and gastrointestinal disorders. Contributing factors, possible pathophysiological explanations and international recommendations can help in the management of the disease in the outpatient setting. Biopsychosocial and multidisciplinary management in primary care medicine is essential.

La pandémie due au virus SARS-CoV-2 a provoqué une crise de santé publique sans précédent. Le terme Covid long est utilisé pour décrire les divers symptômes hétérogènes et persistant plus de 4 semaines après l'infection, avec une incidence de 10 à 40 %, qui varie selon les études. Les caractéristiques principales du Covid long sont une atteinte multisystémique et des symptômes fluctuants et prolongés comme la fatigue, la dyspnée, la toux, l'anosmie, la dysgueusie, les douleurs thoraciques, les palpitations, des céphalées, des myalgies, des troubles cognitifs et des troubles gastro-intestinaux. Les facteurs favorisants, les explications physiopathologiques possibles et les recommandations internationales rendent indispensable une prise en charge biopsychosociale et pluridisciplinaire en médecine de premiers recours.

Assessment of cognitive screening tests as predictors of driving cessation: A prospective cohort study of a median 4-year follow-up.

BACKGROUND: Assessing fitness to drive and predicting driving cessation remains a challenge for primary care physicians using standard screening procedures. The objective of this study was to prospectively evaluate the properties of neuropsychological screening tests, including the Trail Making Test (TMT), Clock Drawing Test (CDT), Montreal Cognitive Assessment (MoCA), Useful Field of View (UFOV), and Timed Up and Go (TUG) test, in predicting driving cessation for health reasons in drivers older than 70 years of age. DESIGN AND METHODS: This prospective cohort study, with a median follow-up of 4 years for drivers of 70 years old or older with an active driving license in Switzerland, included 441 participants from a driving refresher course dedicated to volunteer senior drivers. Cases were drivers reported in the national driving registry who lost their license following a health-related accident, who were reported as unfit to drive by their physician or voluntarily ceased driving for health reasons. Survival analysis was used to measure the hazard ratio of driving cessation by adjusting for age and sex and to evaluate the predictive value of combining 3 or more positive tests in predicting driving cessation during a 4-year follow-up. RESULTS: A total of 1738 person-years were followed-up in the cohort, with 19 (4.3%) having ceased driving for health reasons. We found that participants with a TMT-A < 54 sec and TMT-B < 150 sec at baseline had a significantly lower cumulative hazard of driving cessation in 4 years than those with slower performance (adjusted HR 3, 95% CI: 1.16-7.78, p = 0.023). Participants who performed a CDT ≥ 5 had a significantly lower cumulative hazard of driving cessation (adjusted HR 2.89, 95% CI: 1.01-7.71, p = 0.033). Similarly, an MoCA score ≥ 26, TUG test <12 sec or a UFOV of low risk showed a lower but not significant cumulative risk at a median follow-up of 4 years. When using tests as a battery, those with three or more positive tests out of five were 3.46 times more likely to cease driving (95% CI: 1.31-9.13, p = 0.012). CONCLUSIONS: The CDT and the TMT may predict driving cessation in a statistically significant way, with a better performance than the UFOV and MoCA tests during a median 4-year follow-up. Combining tests may increase the predictability of driving cessation. Although our results are consistent with current evidence, they should be interpreted with precaution; more than 95% of the participants above the set threshold were able to continue driving for 4 years without any serious incident.

[Clinical pathway for the physician throughout social insurances : what is worth to know ?] / Itinéraire clinique et assurances sociales : que doit savoir le·la médecin de premier recours ?

Medical practitioners are frequently confronted with social insurance as well as with their patients' health and safety issues. Through the journey of Pierre, an employee, victim of an accident at work, we propose to address some common problems by specifying certain aspects relating to the legal and administrative framework in order to better guide clinical practice on the means of intervention and their limits.

Les médecins praticien·ne·s sont fréquemment confronté·e·s aux assurances sociales ainsi qu'aux enjeux assécurologiques de leur·s patient·e·s. À travers le parcours de Pierre, salarié, victime d'un accident de travail, nous vous proposons d'aborder certaines problématiques courantes en précisant certains aspects relatifs au cadre légal et administratif afin de mieux orienter la pratique clinique sur les moyens d'intervention et leurs limites.

[Mass testing for Covid-19 : what can we learn from real-world implementation ?] / Dépistage de masse du Covid-19 : quelles leçons tirer des récentes expériences ?

While several modelling studies suggest mass testing for SARS-CoV-2 could be effective, real-world attempts at implementation have not been sufficient to evaluate its contribution to controlling the pandemic. To slow the spread of the virus, a mass-testing campaign would need frequent testing over a prolonged period with high rates of participation, all while maintaining public health measures. Screening seems more useful for targeted populations or high-risk events (businesses, teaching facilities, public or private institutions, sporting or cultural events). With their low cost and rapid results, rapid tests should be favored for these interventions.

Bien que des modélisations de dépistage de masse pour le SARS-CoV-2 suggèrent une certaine efficacité, leur réalisation en pratique n'a, à ce jour, pas été confirmée et leur potentiel impact en termes de contrôle sur la pandémie reste à démontrer. Pour espérer endiguer la propagation du virus, il faut réaliser un dépistage fréquent, sur une période prolongée, et atteindre un taux de participation très élevé, cela tout en maintenant les mesures sanitaires. Le dépistage semble toutefois envisageable s'il est ciblé sur une population ou un événement à risque (entreprises, lieux de formation, établissements publics ou privés, manifestations sportives ou culturelles). De par leur faible coût et leur rendu rapide du résultat, les tests rapides sont à favoriser pour de telles stratégies interventionnelles de dépistage.

[2020 scientific breakthroughs in ambulatory general internal medicine]. / Avancées scientifiques de 2020 en médecine interne générale ambulatoire.

Functional weakness of the limbs has an uncertain prognosis and little chance of recovery. Obese people in precarious situations may succeed in losing weight through an intensive lifestyle-based weight loss program. In patients with gonarthrosis, physiotherapy may decrease pain and disability when compared to injected corticosteroids. Patients suffering from an alcohol dependence syndrome can reduce their consumption with short-term consultations conducted by general practitioners. Fatigue and dyspnea are two frequent symptoms that may persist after the acute phase of the SARS-CoV-2 infection. PCR analysis for the detection of SARS-CoV-2 could be performed with the same degree of sensitivity on a nasopharyngeal or salivary swab.

La faiblesse fonctionnelle des membres a un pronostic incertain et peu de probabilité de guérir. Les personnes souffrant d'obésité en situation de précarité peuvent réussir à perdre du poids par un programme intensif de perte pondérale soutenu par des changements du style de vie. Chez les patients atteints de gonarthrose, la physiothérapie peut diminuer la douleur et l'incapacité lorsqu'elle est comparée à des corticostéroïdes injectés. Les patients qui souffrent d'un syndrome de dépendance à l'alcool peuvent réduire leur consommation avec des consultations de courte durée effectuées par des médecins généralistes. La fatigue et la dyspnée sont deux des symptômes parmi les plus fréquents qui peuvent perdurer après la phase aiguë de l'infection par SARS-CoV-2. L'analyse de détection du SARS-CoV-2 par PCR pourrait être effectuée avec le même degré de sensibilité sur un prélèvement nasopharyngé ou salivaire.