[New developments in the diagnosis and treatment of community-acquired pneumonia]. / Nouveautés dans le diagnostic et le traitement de la pneumonie acquise en communauté.

Community acquired pneumonia is a well-known entity in internal medicine. It represents 1.2 cases per 1000 inhabitants every year, and up to 14 cases per 100 inhabitants in people older than 65 years old. Despite our exposition to the disease almost daily, it is still the leading cause of death related to an infection. In 2019, The American Thoracic Society proposed a revision of its guidelines, especially concerning the diagnosis and the treatment of community acquired pneumonia. It is the latest academic society revision. Further-more, the SARS-CoV-2 pandemia has extended our knowledge of pulmonary infection and brought an adaptation of our practice.

La pneumonie acquise en communauté (PAC) est une entité bien connue de la médecine interne générale. En effet, elle représente 1,2 cas pour 1000 habitants chaque année, et jusqu'à 14 cas pour 1000 habitants chez les plus de 65 ans. Elle reste la première cause de mortalité liée à une infection et est responsable d'une morbidité importante. En 2019, l'American Thoracic Society propose une révision de ses guidelines, notamment sur le diagnostic et les traitements de la PAC. Il s'agit de la dernière revue de société savante. De plus, la pandémie de SARS-CoV-2 a enrichi notre compréhension des infections pulmonaires et a conduit à une adaptation de nos pratiques.

Apple, condom, and cocaine - body stuffing in prison: a case report.

BACKGROUND: Drug dealers and drug users resort to body stuffing to hastily conceal illicit drugs by ingesting their drug packets. This practice represents a medical challenge because rupture of the often insecure packaging can be toxic and even lethal. In an emergency setting, official guidelines are needed to help the medical team decide on the proper treatment. A preliminary observation period is generally accepted but its duration varies from hours to eventual packet expulsion. CASE PRESENTATION: This case involves a 20-year-old white man in detention who claimed to have ingested one cocaine packet wrapped in plastic food-wrap and a condom in anticipation of an impending cell search. He reached out to medical professionals on day 4 after having unsuccessfully tried several methods to expel the drug packet, including swallowing olive oil, natural laxatives, liters of water, and 12 carved apple chunks. An initial computed tomography scan confirmed multiple packet-sized images throughout his stomach and bowel. After 24 hours of observation and normal bowel movements without expelling any packets, a subsequent scan found only one air-lined packet afloat in the gastric content. Due to the prolonged retention of the package there was an increased risk of rupture. The packet was eventually removed by laparoscopic gastrotomy. CONCLUSIONS: This case report illustrates that observation time needs to be adapted to each individual case of body stuffing. Proof of complete drug package evacuation ensures secure patient discharge. Body stuffers should be routinely asked for a detailed history, including how the drug is wrapped, and whether or not they ingested other substances to help expel the packets. The history enables the accurate interpretation of imaging. Repeated imaging can help follow the progress of packets if not all have been expelled during the observation period. Drug packets should be surgically removed in case of prolonged retention. To ensure the best possible outcomes, patients should have access to high-quality, private, and confidential medical care, which is equal to that offered to the general population. This is paramount to earning trust and collaboration from people in detention who resort to body stuffing.