[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.

[Work-related contact dermatitis: interest of an occupational medicine approach in the clinical pathway]. / Eczéma professionnel : intérêt d'une approche de médecine du travail dans l'itinéraire clinique.

Work-related contact dermatitis is frequent and might reduce the professional activity. Through the presentation of a clinical situation and its handling, this article shows the added value of an occupational medicine intervention. This procedure integrating a field observation has shown useful solutions after the medical handling and the maintenance of employment, although they were not always where we expected them.

Les eczémas professionnels sont fréquents et peuvent parfois limiter l'exercice de l'activité professionnelle. Au travers de la présentation d'une situation clinique et de sa prise en charge, cet article montre la plus-value d'une intervention de médecine du travail. Cette démarche intégrant une approche de terrain a révélé des leviers utiles à la suite de la prise en charge et au maintien en emploi, même s'ils n'étaient pas toujours là où on les attendait.

[Return to work: challenges and opportunities for the primary care physician]. / Retour au travail : défis et opportunités pour le médecin de premier recours.

Return to work is at the crossroads of complex medical, legal, economic and social concepts and involves a multitude of stakeholders who are often far removed from the reality of care in the medical practice. This article presents some basic concepts on return to work and explores some good practice guidelines. It also describes the role and limits of the occupational physician in the company and mentions possible areas of collaboration with social insurers and employers. It aims to provide concrete elements for the practice of the primary care physician.

Le retour au travail est au croisement de notions médicales, juridiques, économiques et sociales complexes et implique une multitude de parties prenantes qui restent souvent éloignées de la réalité de la prise en charge au cabinet médical. Cet article présente quelques notions de base sur le retour au travail et explore certaines orientations de bonnes pratiques. Il décrit également le rôle et les limites du médecin du travail en entreprise et mentionne les champs de collaboration possible avec les assureurs sociaux et les employeurs. Il vise à fournir des éléments concrets pour la pratique du médecin de premier recours.

[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.

[Detection and treatment of burnout by physicians of Unisanté]. / Repérage et prise en charge des patients en burnout par les médecins d'Unisanté.

Lacking diagnostic standards, the prevalence of Occupational Burnout (OB) remains uncertain. Unisanté aimed to evaluate its magnitude in its patients and to evaluate the medical practices related to OB in two of its departments, the Department of the Policlinics (DDP) and the Department of Occupational and Environmental Health (DSTE). An online survey has shown that 43/55 of the physicians participating in the survey have already diagnosed patients with OB in their practice. Two focus groups allowed to evaluate the interest and usefulness of a standardized diagnostic tool for physicians of the DDP and the DSTE. The tool turned out not to be appropriate in its present form, but this work allowed to sensitize physicians to OB and to clarify the recommendations for the screening and treatment of OB patients at Unisanté.

Faute de standard diagnostique, la prévalence de burnout professionnel (BP) reste incertaine. Unisanté a souhaité évaluer son ampleur dans sa patientèle et décrire les pratiques médicales en rapport au BP dans 2 de ses départements, le Département des policliniques (DDP) et le Département santé, travail et environnement (DSTE). Une enquête en ligne a montré que 43/55 médecins participant à l'étude ont déjà diagnostiqué des patients en BP dans leur pratique. Deux focus groups ont permis d'évaluer l'intérêt et l'utilité d'un outil diagnostique standardisé pour les médecins du DDP et du DSTE. L'outil s'est avéré peu adapté sous sa forme actuelle, mais ce travail a permis de sensibiliser les médecins au BP et de clarifier les recommandations de dépistage et de prise en charge des patients en BP à Unisanté.

Exposure to Amosite-Containing Ceiling Boards in a Public School in Switzerland: A Case Study.

The measurement of an airborne concentration in Amosite fibers above 5035 F/m3 in a school prompted a retrospective quantitative health risk assessment. Dose estimates were built using air measurements, laboratory experiments, previous exposure data, and interviews. A dose response model was adapted for amosite-only exposure and adjusted for the life expectancy and lung cancer incidence in the Swiss population. The average yearly concentrations found were 52-320 F/m3. The high concentration previously observed was not representative of the average exposure in the building. Overall, the risk estimates for the different populations of the school were low and in the range of 2 × 10-6 to 3 × 10-5 for mesothelioma and 4 × 10-7 to 8 × 10-6 for lung cancer. The results evidenced however that children have to be considered at higher risk when exposed to asbestos, and that the current reference method and target values are of limited use for amphibole-only exposures. This study confirmed that quantitative health risk assessments and participatory approaches are powerful tools to support public decisions and build constructive communication between exposed people, experts, and policy-makers.

[Occupational health: which place for the primary care physician?]. / Santé au travail, burnout, troubles musculosquelettiques. Quelle place pour le médecin de premier recours?

Primary care physicians are among the specialists who most often have to deal with work-related health problems. Musculoskeletal (including the spine and limbs) and psychological problems are the most frequently encountered work-related diseases. In that context, it is essential for the primary care physician to identify the link between a disease and the occupational environment of the patient, in order to deliver appropriate care. This article deals with two clinical cases to illustrate the semiology and therapeutic aspects of burnout, and musculoskeletal disorders of the upper limb, respectively. It gives some clues to the primary care physician, about how to guide his practice in a multimodal way, oriented toward the patient himself, but also toward his occupational environment.

Renal hemodynamic and natriuretic effects of concomitant Angiotensin-converting enzyme and neutral endopeptidase inhibition in men.

This double-blind placebo-controlled study was designed to investigate the acute and sustained hormonal, renal hemodynamic, and tubular effects of concomitant ACE and neutral endopeptidase (NEP) inhibition by omapatrilat, a vasopeptidase inhibitor, in men. Thirty-two normotensive subjects were randomized to receive a placebo, omapatrilat (40 or 80 mg), or the fosinopril/hydrochlorothiazide (FOS/HCTZ; 20 and 12.5 mg, respectively) fixed combination for 1 week. Blood pressure, renal hemodynamics, urinary electrolytes and atrial natriuretic peptide excretion, and several components of the renin-angiotensin system were measured for 6 hours on days 1 and 7 of drug administration. When compared with the placebo and the FOS/HCTZ combination, omapatrilat induced a significant decrease in plasma angiotensin II levels (P<0.001 versus placebo; P<0.05 versus FOS/HCTZ) and an increase in urinary atrial natriuretic peptide excretion (P<0.01). These hormonal effects were associated with a significant fall in blood pressure (P<0.01) and a marked renal vasodilatation, but with no significant changes in glomerular filtration rate. The FOS/HCTZ markedly increased urinary sodium excretion (P<0.001). The acute natriuretic response to FOS/HCTZ was significantly greater than that observed with omapatrilat (P<0.01). Over 1 week, however, the cumulative sodium excretion induced by both doses of omapatrilat (P<0.01 versus placebo) was at least as great as that induced by the dose of FOS/HCTZ (P=NS versus FOS/HCTZ). In conclusion, the results of the present study in normal subjects demonstrate that omapatrilat has favorable renal hemodynamic effects. Omapatrilat combines potent ACE inhibition with a sustained natriuresis, which explains its well-documented potent antihypertensive efficacy.