A contribution to the French validation of the clinical anxiety scale amongst health care workers in Switzerland.

BACKGROUND: Anxiety disorders are frequent but remain often underdiagnosed and undertreated. Hence, valid screening instruments are needed to enhance the diagnostic process. The Clinical Anxiety Scale (CAS) is a 25-item anxiety screening tool derived from the Hamilton Anxiety Scale (HAM-A). However, this scale is not available in French. The General anxiety disorder - 7 (GAD-7) scale, which has been validated in French, is a 7-item instrument with good psychometric properties. This study contributes to the validation of an adapted French version of the CAS, using the GAD-7 as the reference. METHODS: A forward-backward English-French-English translation of the CAS was performed according to standard practice. The French versions of the CAS and GAD-7 were completed by 127 French speaking healthcare professionals. CAS internal consistency was assessed using Crohnbach's alpha, and test-retest reliability was tested after 15 days in a subsample of 30 subjects. Convergent validity with GAD-7 was assessed using Pearson's correlation coefficient. Test-retest reliability was explored using one-way random effects model to calculate the intra-class correlation coefficient (ICC). RESULTS: French CAS showed excellent internal consistency (Cronbach's alpha 0.97), high convergent validity with GAD-7 (Pearson's R 0.81, p < 0.001), and very good test-retest reliability (ICC = 0.97, 95% CI 0.93-0.98). CONCLUSION: The proposed French version of the CAS showed high reliability and validity that need to be further investigated in different populations.

[Geriatrics]. / Gériatrie.

Sleeping enough is associated with a reduced risk of mortality and dementia. New evidence support regular physical exercise, including at home, as a corner stone intervention to prevent falls and fractures. In contrast, supplementation with high doses of vitamin D is ineffective and even deleterious in this indication and a routine screening in asymptomatic adults is not recommended. Several studies illustrate our difficulties in prescribing and deprescribing in frail older patients and a study suggests that statins in cardiovascular primary prevention should considered only when a patient's life expectancy exceeds 2.5 years. Finally, several studies have fueled the debate about screening for hearing impairment.

Dormir ni trop ni trop peu est associé à une réduction du risque de mortalité et de déclin cognitif. De nouvelles études confirment que l'exercice physique régulier, y compris à domicile, constitue la clé de voûte de la prévention des chutes et des fractures. Par contre, la supplémentation par de hautes doses de vitamine D n'est pas efficace, voire délétère, dans cette indication et le dépistage systématique d'un déficit n'est pas recommandé chez les patients adultes asymptomatiques. Plusieurs études illustrent nos difficultés à prescrire et déprescrire, chez les patients âgés fragiles, et une étude suggère qu'un traitement de statines en prévention cardiovasculaire primaire ne se justifie que si l'espérance de vie du patient dépasse 2,5 ans. Finalement, plusieurs études sont venues nourrir le débat sur le dépistage de la presbyacousie.

Inferior vena cava thrombosis as a possible cause of nephrotic-range proteinuria: two case reports.

BACKGROUND: Nephrotic-range proteinuria is a common reason for nephrological consultation in clinical practice. The differential diagnosis is wide, and generally focuses on different forms of glomerulonephritis, but other causes should not be overlooked, as illustrated in this article. CASE PRESENTATIONS: We report two female patients with nephrotic-range proteinuria. In the first case, a 46 year old Caucasian patient who suffered from extreme obesity (Body mass index (BMI) 77 kg/m2), acute kidney injury and nephrotic-range proteinuria were discovered during an emergency consultation for acute abdominal pain. The second patient (aged 52, also Caucasian) developed stage 4 chronic kidney disease and nephrotic proteinuria (protein/creatinine ratio 1821 g/mol) after accidental rupture of the inferior vena cava during a gastric bypass operation. On split-urine collection, both had a much higher degree of proteinuria during the day than during the night, compatible with orthostatic proteinuria. At further work-up, inferior vena cava thrombosis was diagnosed in both patients, whereas renal veins were patent. DISCUSSION: After simple anticoagulation in the first case, and anticoagulation plus endovascular recanalization in the second, there was almost complete resolution of the orthostatic proteinuria and a strong improvement of the estimated glomerular filtration rate in both patients. These cases highlight that nephrotic-range proteinuria can be linked to inferior vena cava thrombosis, and that a split-urine collection may also be very useful in the diagnostic work-up of proteinuria in adults.

[Geriatric medicine: update 2020]. / Gériatrie.

Several studies published in 2020 showed new data supporting the prescription of statins in some old and very old patients. Despite the enthusiasm about SGLT-2 inhibitors, caution must remain in frail and dependent older diabetic patients who are not well represented in most studies. Antihypertensive treatment appears more beneficial when taken at night rather than in the morning but beware of the prescribing cascade of a diuretic when a new prescription of a calcium channel blocker. Biomarkers, including plasmatic biomarkers, are becoming increasingly important in the diagnostic strategy of neurocognitive disorders. Finally, fall prevention studies showed heterogeneous results but multimodal interventions remain mainstream.

Plusieurs études publiées en 2020 ont relancé le débat concernant la prescription de statines chez certaines personnes âgées et très âgées. Malgré l'enthousiasme concernant les inhibiteurs du SGLT2, la prudence reste de mise chez les patients diabétiques âgés vulnérables et, surtout dépendants, peu ou pas représentés dans les études. La prise nocturne d'un traitement antihypertenseur semble plus efficace que diurne, mais attention à la prescription en cascade d'un diurétique de l'anse lorsqu'un traitement anticalcique est initié. La place des biomarqueurs, y compris plasmatiques, dans la stratégie diagnostique se renforce. Si les études de prévention des chutes ont montré des résultats variables, l'approche interventionnelle multimodale reste la référence.

[The internal medicine articles that struck us the most in 2019]. / L'année 2019 mise en perspective par les internistes hospitaliers.

2019 has continued to bring important progress in all areas of internal medicine, impacting our daily practice. From new indications for SGLT2 inhibitors and rivaroxaban, to antibiotic duration for Gram negative bacteriemia, passing by the delay for cardioversion of recent-onset atrial fibrillation or for beginning sacubitril/valsartan after stabilization of a cardiac failure, internal medicine journals are full of novelties. Every year, the chief residents of the CHUV internal medicine ward meet up to share their readings: here is their selection of eleven articles, chosen, summarized and commented for you.

L'année 2019 a vu d'importants progrès dans tous les domaines de la médecine interne, avec un impact important sur notre pratique quotidienne hospitalière. Des nouvelles indications pour les inhibiteurs du SLGT2 et le rivaroxaban, à la durée du traitement des bactériémies à Gram négatif en passant par le délai pour la cardioversion d'une fibrillation auriculaire inaugurale ou celui pour introduire du sacubitril/valsartan après stabilisation d'une insuffisance cardiaque, les nouveautés abondent dans la littérature. Chaque année, les chefs de clinique du Service de médecine interne du Centre Hospitalier Universitaire Vaudois (CHUV) se réunissent pour partager leurs lectures: voici une sélection de onze articles choisis, revus et commentés pour vous.