[The year 2022 placed in perspective by hospital internists]. / Année 2022 mise en perspective par les internistes hospitaliers.

According to PubMed statistics when writing this review, the year 2022 is expected to mark the first dip in the number of articles published in relation to the Covid-19 pandemic. This review, without any mention to Sars-CoV-2, highlight this transition and addresses many topics in internal medicine: gastroenterology, cardiology, endocrinology, respiratory medicine, infectious diseases and venous access. Each year, the chief residents of the internal medicine ward in Lausanne university hospital (CHUV) in Switzerland meet up to share their readings: here is a selection of ten articles that have caught our attention, summarized and commented for you, which should change our daily practice.

D'après les statistiques PubMed au moment de la rédaction de cette revue, l'année 2022 devrait marquer le premier infléchissement du nombre d'articles publiés en relation avec la pandémie de Covid-19. Cette revue d'articles, sans écho au Sars-CoV-2, souligne cette transition et aborde de nombreux sujets de la médecine interne : gastroentérologie, cardiologie, endocrinologie, pneumologie, infectiologie et accès veineux. Chaque année, les cheffes et chefs de clinique du Service de médecine interne du CHUV se réunissent pour partager leurs lectures : voici une sélection de dix articles ayant retenu notre attention, revus et commentés pour vous, et qui devraient faire évoluer notre pratique quotidienne.

[The Internal medicine articles that struck us the most in 2021]. / Année 2021 mise en perspective par les internistes hospitaliers.

The year 2021 has seen many breakthroughs in general internal medicine, despite the ongoing COVID-19 pandemic, with multiple implications in our daily clinical practice. From shorter antibiotic treatment duration in community-acquired pneumonia, to new indications for colchicine treatment, without forgetting better targets of hemoglobin for transfusion, questioning of the interest of high dose vitamin D substitution when preventing falls in older patients and finally disappointing hopes for new indications of albumin substitution in cirrhosis, the literature is full of new evidence. Each year, the chief residents of the internal medicine ward in Lausanne university hospital (CHUV) in Switzerland meet up to share their readings: here is a selection of ten articles, chosen, summarized, and commented for you.

L'année 2021, malgré la pandémie de Covid-19, a vu de nombreux progrès en médecine interne générale, avec de multiples implications pour notre pratique quotidienne. D'une durée diminuée d'antibiothérapie pour le traitement de la pneumonie communautaire à de nouvelles indications au traitement de colchicine, en passant par des précisions sur les cibles de transfusion érythrocytaire, ainsi qu'une remise en question de l'intérêt de la vitamine D à haute dose dans la prévention des chutes chez la personne âgée, et pour finir des espoirs déçus de nouvelle indication à la substitution d'albumine dans la cirrhose, les nouveautés abondent dans la littérature. Chaque année, les cheffes et chefs de clinique du Service de médecine interne du CHUV se réunissent pour partager leurs lectures : voici une sélection de dix articles choisis, revus et commentés pour vous.

[Focus on tizanidine in primary care medecine]. / Le point sur la tizanidine en médecine de premier recours.

Tizanidine is an alpha2 agonist with central action whose myorelaxant effects are often used off-label against primary backpain in clinical practice. It is mainly metabolized by the liver. The concomitant use of CYP1A2 inhibitor drugs increases the plasmatic concentration and thus can cause serious adverse effects. Severe hypotension is the most memorable example. Its narrow therapeutic range and the interindividual different sensitivity to the molecule justify using it wisely. A clinical case is reported as illustration.

La tizanidine est un agoniste alpha-2-adrénergique d'action centrale dont l'effet myorelaxant est utilisé « hors indication ¼ en pratique médicale pour les lombalgies primaires. Elle est principalement métabolisée au niveau hépatique. Lorsqu'elle est administrée de manière concomitante à un inhibiteur du CYP1A2, sa concentration plasmatique augmente, entraînant potentiellement plusieurs effets indésirables. L'hypotension sévère en est l'exemple le plus probant. Sa marge thérapeutique étroite et la sensibilité variable des sujets à la molécule justifient son utilisation judicieuse. Un cas clinique illustratif est rapporté.

[Strategy diagnostic and therapeutic of an hypophosphatemia]. / Stratégie diagnostique et thérapeutique d'une hypophosphatémie.

Hypophosphatemia is an electrolyte disorder frequently faced in inpatient and outpatient practice. Associated symptoms are very variable but are often nonspecific. The consequence is that it might be overlooked. Yet, when severe, hypophosphatemia is associated with a significant morbi-mortality and, therefore, needs to be identified and treated appropriately. Treatment goes from identifying the cause to substitution according to whether it is symptomatic or not and its severity. Mild to moderate hypophosphatemia needs substitution only when symptomatic which will be administrated orally, while severe hypophosphatemia requires an intravenous substitution. We review here situations at risk of hypophosphatemia, its clinical manifestations and its management in terms of diagnostic and treatment.

L'hypophosphatémie est un désordre électrolytique fréquemment rencontré, tant en milieu hospitalier qu'ambulatoire. Sa symptomatologie est très variable et souvent aspécifique. De ce fait, elle peut parfois être manquée. Pourtant, lorsque sévère, elle est grevée d'une morbimortalité non négligeable. Le traitement passe par l'identification de sa cause, puis une substitution en fonction de la présentation clinique et de sa sévérité. Une hypophosphatémie légère à modérée nécessite une supplémentation en cas de symptômes et sera administrée par voie orale, tandis qu'une hypophosphatémie sévère justifie une supplémentation intraveineuse. Cet article intègre un rappel du métabolisme du phosphate, les situations associées à un risque d'hypophosphatémie, ses manifestations cliniques et sa gestion tant sur le plan diagnostique que thérapeutique.

How much do combined affective and cognitive impairments worsen rehabilitation outcomes after hip fracture ?

BACKGROUND: To investigate the association between isolated and combined affective and cognitive impairments with functional outcomes and discharge destination in older patients admitted to rehabilitation after a hip fracture. METHODS: Prospective study in 612 community-dwelling patients aged 65 years and over, admitted to rehabilitation after surgery for hip fracture. Information on socio-demographics, medical, functional, affective, and cognitive status was systematically collected at admission. Functional status, length of stay and destination were assessed at discharge. Functional improvement was defined as any gain on the Barthel Index score between admission and discharge from rehabilitation. RESULTS: At admission, 8.2% of the patients had isolated affective impairment, 27.5% had cognitive impairment only, and 7.5% had combined impairments. Rate of functional improvement steadily decreased from 91.2% in patients with no cognitive nor affective impairment to 73.8% in those with combined impairments. Compared to patients without any impairment, those with combined impairments had lower odds of functional improvement, even after adjustment for age, gender, health and functional status at admission (adjOR: 0.40; 95%CI: 0.16-1.0; p = .049). The proportion of patients discharged back home gradually decreased from 82.8% among patients without any impairment to only 45.6% in patients with combined impairments. In multivariate analysis, the odds of returning home remained significantly reduced in these latter patients (adjOR: 0.31; 95%CI:0.15-0.66; p = .002). CONCLUSIONS: Affective and cognitive impairments had both independent, and synergistic negative association with functional outcome and discharge destination in patients admitted to rehabilitation after a hip fracture. Nevertheless, patients with combined affective and cognitive impairments still achieved significant functional improvement, even though its magnitude was reduced. Further studies should investigate whether these patients would benefit from better targeted, longer, or more intensive rehabilitation interventions to optimize their functional recovery.