Vitamin D status and its determinants in healthy pregnant women living in Switzerland in the first trimester of pregnancy.

OBJECTIVES: Our study aimed at assessing the prevalence and determinants of vitamin D deficiency (25-hydroxy-vitamin D [25(OH)D] < 20 ng/mL) in pregnant women in the first trimester living in Switzerland. METHODS: From September 2014 through December 2015, 204 pregnant women were conveniently recruited during their first clinical appointment at the Clinic of Obstetrics of the University Hospital Zurich (between week 6 and 12 of pregnancy). Blood samples were collected and a questionnaire focusing on lifestyle and skin colour was completed face-to-face with the responsible physician. Logistic regression analyses were performed with vitamin D status as dependent variable. RESULTS: 63.2% of the participating women were vitamin D deficient, and the median vitamin D concentration in the overall sample was 17.1 ng/mL [Q1, Q3: 9.78, 22.3]. The highest proportions of vitamin D deficiency were detected in women originating from Africa and Middle East (91.4% deficient, median vitamin D concentration of 10.7 ng/mL [Q1, Q3: 6.55, 14.45]) and from South-East Asia/Pacific (88.5% deficient, median vitamin D concentration of 8.4 ng/mL [Q1, Q3: 6.10, 14.88]). Multivariable logistic regression showed that significant risk factors of vitamin D deficiency were country of origin (women born in Switzerland and Germany had a lower risk than women born in other countries), smoking status (lower risk for former smokers) and intake of vitamin D supplements. CONCLUSIONS: Our results confirm a high prevalence of vitamin D deficiency in this Swiss cohort, in particular in women coming from Asian and African countries, and underline the importance of appropriate counseling and vitamin D supplementation in early pregnancy.

Families' experiences with patients who died after assisted suicide: a retrospective interview study in southern Switzerland.

BACKGROUND: In Switzerland, if certain conditions are met, assisted suicide is not prosecuted. International debate suggests that requests for hasten death are often altered by the provision of palliative care. Aims of the study were to explore patients' reasons for choice of assisted suicide and family perceptions of the interactions with health care professionals. PATIENTS AND METHODS: This is a qualitative study upon 11 relatives of 8 patients cared for by a palliative care team, deceased of assisted suicide. RESULTS: Pain and symptom burden were not regarded by patients as key reasons to seek assisted suicide: existential distress and fear of loss of control were the determinants. Most patients had made pre-illness decisions to use assisted suicide. A general need for perceived control and fear of dependency were reported as a common characteristic of these patients. Patients held misunderstandings about the nature and purpose of palliative care, and the interviewed indicated that patients did not regard provision of palliative care services as influential in preventing their decision. CONCLUSIONS: Assisted suicide was preferred despite provision of palliative care. Better understanding of the importance placed on perceived control and anticipated dependency is needed. Further research is needed to develop appropriate support for patients contemplating assisted suicide.

Sitosterolaemia in Switzerland: molecular genetics links the US Amish-Mennonites to their European roots.

Sitosterolaemia is a rare autosomal recessive disease characterized by increased intestinal absorption of plant sterols, decreased hepatic excretion into bile and elevated concentrations in plasma phytosterols. Homozygous or compound heterozygous loss of function mutations in either of the ATP-binding cassette (ABC) proteins ABCG5 and ABCG8 explain the increased absorption of plant sterols. Here we report a Swiss index patient with sitosterolaemia, who presented with the classical symptoms of xanthomas, but also had mitral and aortic valvular heart disease. Her management over the last 20 years included a novel therapeutic approach of high-dose cholesterol feeding that was semi-effective. Mutational and extended haplotype analyses showed that our patient shared this haplotype with that of the Amish-Mennonite sitosterolaemia patients, indicating they are related ancestrally.

[September 11 from the viewpoint of a Swiss trauma fellow in New York]. / Der 11. September aus der Sicht eines Schweizer Trauma Fellows in New York.

This is the report of the events of September 11th seen through the eyes of a Swiss Trauma Fellow. This ill-fated day is described by someone who went down to ground zero with other doctors to help and save lives and came back frustrated because there was so little to be done.

[Acute schistosomiasis or Katayama syndrome: apropos of 2 mini-epidemics]. / La schistosomiase aiguë ou syndrome de Katayama: á propos de deux mini-épidémies.

Schistosomiasis, or bilharziasis, is often oligosymptomatic but there is also an acute form, the Katayama syndrome. Observation of two groups of travelers who swam in the same lake near Banfora in western Burkina Faso, separated by an interval of one year, illustrates the high infection rate of Schistosoma mansoni (100% of swimmers, of whom 82% were symptomatic and 55% presented with fever). The incubation period was 4 to 6 weeks after exposure. 10 of the 11 subjects had eosinophilia (> or = 500/mm3) and IFAT serology was positive in all tested subjects. More than one year after exposure, one traveler (untreated) presented with a neurological deficit due to acute schistosomal myelitis. The diagnosis of schistosomiasis in a patient requires a search for the disease among his fellow travelers, even if they are asymptomatic.

[Cancer mortality among Swiss migrants in France]. / La mortalité par cancer chez les migrants suisses en France.

Using French mortality data for the period 1979 to 1985, risks of death for cancer in Swiss migrants were calculated relative to these in the locally born. In the absence of valid population data for Swiss migrants, risks were estimated using a case-control approach, considering as cases cancer deaths at one specific site, and as controls all other deaths. In order to evaluate the change in risks after migration, death risks in Switzerland, compared to French natives, were calculated using a Poisson regression. For most of the cancer deaths, the risk in Swiss migrants is intermediate between that of their country of origin and that of the host country. Compared with French-born, Swiss migrants maintain however a significantly higher risk for lung cancer, urinary bladder cancer and melanoma in males, for breast cancer in females, and for non-Hodgkin lymphomas in both sexes. In contrast, the risk is significantly lower for liver cancer in male Swiss migrants. The observed differences are interpreted in the light of the available consumption data in both countries.

[Kala-azar imported from Yugoslavia]. / Kala-Azar aus Jugoslawien.

Two months after a vacation in Bosnia and at the Dalmatian coast, a 52-year-old Jugoslav male resident in Switzerland developed slowly progressive fever with arthralgia. Two months later his temperature became septic and his general condition deteriorated. After many wrong diagnostic tracks, six months after onset of the illness kala-azar was finally diagnosed. Treatment with Pentostam cured the disease completely.

[Schistosomiasis. Apropos of 5 cases of Swiss citizens having traveled in endemic countries]. / Schistosomiase. A propos de 5 cas chez des Suisses ayant voyagé en pays d'endémie

Among a series of 35 cases of schistosomiasis diagnosed in Geneva between 1961 and 1975 on biopsies (bladder, rectum and liver), the cases of 5 Swiss citizens who had lived in endemic countries are reported. Since the clinical manifestations are often misleading or hardly typical, the diagnosis rests above all on biopsy. After recall of the epidemiologic and pathologic features, the diagnostic steps are reviewed. The object of this study is to call the practiontitioner's attention to the increasing incidence of imported schistosomiasis among the inhabitants of temperate countries.