[New developments and perspectives in outpatient general internal medicine]. / Nouveautés et perspectives en médecine interne générale ambulatoire.

Several studies have been published in 2023, in the field of general internal medicine, addressing various aspects of health and covering topics ranging from hormonal treatment of menopause to the management of chronic and acute diseases. A selection of articles was chosen for this update in outpatient general internal medicine, showing recent studies on outpatient care of patients (treatment, follow-up). The summary of articles is supplemented this year by a table of medical recommendations published in 2023, modestly proposed, and covering various areas. These guidelines, most of them from North America, show advances in the care and monitoring of outpatients, and should be interpreted in light of the various recommendations in Switzerland.

En 2023, plusieurs études ont été publiées dans le champ de la médecine interne générale, abordant divers aspects de la santé et couvrant des sujets allant du traitement hormonal de la ménopause à la gestion de maladies chroniques et aiguës. Un bouquet d'articles a été choisi pour cette mise à jour en médecine interne générale ambulatoire, traitant d'études récentes sur la prise en charge en ambulatoire (traitement, suivi) des patientes et patients. Le résumé d'articles est complété d'un tableau de nouvelles recommandations médicales de 2023, humblement proposé, couvrant divers domaines. Ces guidelines, pour la plupart américaines, montrent les avancées dans la prise en charge et le suivi des patientes et patients en ambulatoire, et sont à interpréter à la lumière des différentes recommandations en Suisse.

[Anemia: new developments and diagnostic and management strategies]. / Anémie: nouveautés et stratégies diagnostiques et de prise en charge.

Anemia is a major public health problem that affects approximately 25% of the world's population. Its prevalence is increased in certain populations: it affects 40% of pregnant women, 42% of children under 5 years old and it increases with age from 50 years old. Anemia can be an emergency in case of hemorrhage or acute hemolysis, but it is most often chronic. Anemia can be constitutional or acquired. In the second case, iron or vitamin deficiencies are the most frequent causes. Anemia can also be a diagnostic pointing to hypothyroidism, inflammatory disease, or cancer. In this article, we provide an update on diagnostic and management strategies for anemia and discuss new scientific developments.

Véritable problème de santé publique, l'anémie touche environ 25% de la population mondiale. Sa prévalence est accrue dans certains groupes: elle concerne 40% des femmes enceintes, 42% des enfants de moins de 5 ans et augmente avec l'âge dès 50 ans. L'anémie peut être une urgence en cas d'hémorragie ou d'hémolyse aiguë mais elle est le plus souvent chronique. Les anémies peuvent être constitutionnelles ou acquises. Dans le 2e cas, les carences martiales ou vitaminiques sont les causes les plus fréquentes. L'anémie peut aussi être un diagnostic orientant vers une hypothyroïdie, une maladie inflammatoire ou un cancer. Dans cet article, nous abordons les nouveautés scientifiques relatives à l'anémie et faisons le point sur les stratégies pour la diagnostiquer et la prendre en charge.

The pandemic toll and post-acute sequelae of SARS-CoV-2 in healthcare workers at a Swiss University Hospital.

Healthcare workers have potentially been among the most exposed to SARS-CoV-2 infection as well as the deleterious toll of the pandemic. This study has the objective to differentiate the pandemic toll from post-acute sequelae of SARS-CoV-2 infection in healthcare workers compared to the general population. The study was conducted between April and July 2021 at the Geneva University Hospitals, Switzerland. Eligible participants were all tested staff, and outpatient individuals tested for SARS-CoV-2 at the same hospital. The primary outcome was the prevalence of symptoms in healthcare workers compared to the general population, with measures of COVID-related symptoms and functional impairment, using prevalence estimates and multivariable logistic regression models. Healthcare workers (n = 3083) suffered mostly from fatigue (25.5 %), headache (10.0 %), difficulty concentrating (7.9 %), exhaustion/burnout (7.1 %), insomnia (6.2 %), myalgia (6.7 %) and arthralgia (6.3 %). Regardless of SARS-CoV-2 infection, all symptoms were significantly higher in healthcare workers than the general population (n = 3556). SARS-CoV-2 infection in healthcare workers was associated with loss or change in smell, loss or change in taste, palpitations, dyspnea, difficulty concentrating, fatigue, and headache. Functional impairment was more significant in healthcare workers compared to the general population (aOR 2.28; 1.76-2.96), with a positive association with SARS-CoV-2 infection (aOR 3.81; 2.59-5.60). Symptoms and functional impairment in healthcare workers were increased compared to the general population, and potentially related to the pandemic toll as well as post-acute sequelae of SARS-CoV-2 infection. These findings are of concern, considering the essential role of healthcare workers in caring for all patients including and beyond COVID-19.

One-year persistent symptoms and functional impairment in SARS-CoV-2 positive and negative individuals.

BACKGROUND: Persistent symptoms of SARS-CoV-2 are prevalent weeks to months following the infection. To date, it is difficult to disentangle the direct from the indirect effects of SARS-CoV-2, including lockdown, social, and economic factors. OBJECTIVE: The study aims to characterize the prevalence of symptoms, functional capacity, and quality of life at 12 months in outpatient symptomatic individuals tested positive for SARS-CoV-2 compared to individuals tested negative. METHODS: From 23 April to 27 July 2021, outpatient symptomatic individuals tested for SARS-CoV-2 at the Geneva University Hospitals were followed up 12 months after their test date. RESULTS: At 12 months, out of the 1447 participants (mean age 45.2 years, 61.2% women), 33.4% reported residual mild to moderate symptoms following SARS-CoV-2 infection compared to 6.5% in the control group. Symptoms included fatigue (16% vs. 3.1%), dyspnea (8.9% vs. 1.1%), headache (9.8% vs. 1.7%), insomnia (8.9% vs. 2.7%), and difficulty concentrating (7.4% vs. 2.5%). When compared to the control group, 30.5% of SARS-CoV-2 positive individuals reported functional impairment at 12 months versus 6.6%. SARS-CoV-2 infection was associated with the persistence of symptoms (adjusted odds ratio [aOR] 4.1; 2.60-6.83) and functional impairment (aOR 3.54; 2.16-5.80) overall, and in subgroups of women, men, individuals younger than 40 years, those between 40-59 years, and in individuals with no past medical or psychiatric history. CONCLUSION: SARS-CoV-2 infection leads to persistent symptoms over several months, including in young healthy individuals, in addition to the pandemic effects, and potentially more than other common respiratory infections. Symptoms impact functional capacity up to 12 months post infection.

Cohort profile: Actionable Register of Geneva Outpatients and inpatients with SARS-CoV-2 (ARGOS).

PURPOSE: The Actionable Register of Geneva Outpatients and inpatients with SARS-CoV-2 (ARGOS) is an ongoing prospective cohort created by the Geneva Directorate of Health. It consists of an operational database compiling all SARS-CoV-2 test results recorded in the Geneva area since late February 2020. This article aims at presenting this comprehensive cohort, in light of some of the varying public health measures in Geneva, Switzerland, since March 2020. PARTICIPANTS: As of 1 June 2021, the database included 360 525 patients, among which 65 475 had at least one positive test result for SARS-CoV-2. Among all positive patients, 37.6% were contacted only once, 10.6% had one follow-up call, 8.5% had two and 27.7% had three or more follow-up calls. Participation rate among positive patients is 94%. Data collection is ongoing. FINDINGS TO DATE: ARGOS data illustrates the magnitude of COVID-19 pandemic in Geneva, Switzerland, and details a variety of population factors and outcomes. The content of the cohort includes demographic data, comorbidities and risk factors for poor clinical outcome, self-reported COVID-19 symptoms, environmental and socioeconomic factors, prospective and retrospective contact tracing data, travel quarantine data and deaths. The registry has already been used in several publications focusing on symptoms and long COVID-19, infection fatality rate and re-infection. FUTURE PLANS: The data of this large real-world registry provides a valuable resource for various types of research, such as clinical research, epidemiological research or policy assessment as it illustrates the impact of public health policies and overall disease burden of COVID-19.

[Harassment: Definition and basic concepts]. / Harcèlement†: définition et notions de base.

Harassment is an insidious form of violence that develops in the intimacy of social relationships. It is likely to emerge in all social contexts, at any age and whatever the cultural levels of the actors. Its high prevalence and its dramatic impact on victims make it a public health problem. Harassment can occur against children at school, children and adults through the internet, workers in the workplace or in the street. Harassment with a sexual connotation frequently acts against women and LGBTQI+ people. In this article, the main types of harassment are presented.

Le harcèlement est une forme insidieuse de violence qui s'inscrit dans l'intimité des relations sociales. Il est susceptible d'émerger dans tous les contextes sociaux, à tout âge et quels que soient les niveaux culturels des acteurs·trices. Sa prévalence élevée et son impact dramatique sur les victimes en font un problème de santé publique. Le harcèlement peut s'exercer contre des enfants dans le cadre scolaire, contre des enfants et des adultes à travers Internet, contre des employé·e·s dans le milieu professionnel ou même dans la rue. Il peut prendre une connotation sexuelle, se dirigeant alors fréquemment contre les femmes ou les personnes LGBTQI+. Dans cet article sont présentés les principaux types de harcèlement.

[New medical demography : challenges for international medical graduates]. / Nouvelle démographie médicale : quels défis pour les médecins formés à l'étranger ?

« International Medical Graduates ¼ (IMGs) are medical doctors practicing abroad, in a country where they have not studied. Their number is increasing at the global level as well as in Switzerland. In this article we describe the challenges faced by IMGs : difficulties related to issues in communication, differences in medical education, variations in clinical practice and difficulties in dealing with specific categories of patients because of local societal values. These challenges demand a process of professional and cultural transition from these foreign medical doctors who constitute a real asset for the host countries. Indeed, they participate in solving the problem of medical shortage and bring to their host country their rich professional experience and recognized clinical skills.

Les « Diplômés Internationaux en Médecine ¼ (DIM), médecins pratiquant leur métier dans un pays dans lequel ils n'ont pas étudié, sont en augmentation à l'échelle globale comme à l'échelle suisse. Dans cet article, nous décrivons les défis rencontrés par les DIM : aspects liés à la communication, différences dans la formation médicale, variations dans la pratique clinique et difficultés de prise en charge de catégories spécifiques de patients en lien avec certaines valeurs sociétales. Ces défis rendent nécessaire un processus de transition professionnelle et culturelle de ces médecins étrangers, qui représentent un réel atout pour les pays d'accueil. En effet, ils participent à résoudre les problèmes de pénurie et de déserts médicaux en apportant leur riche expérience professionnelle et des compétences cliniques reconnues.

Inflammatory Syndrome as the Initial Manifestation of Retroperitoneal Tuberculosis in a Pregnant Woman.

A 20-year-old asylum seeker presented with vomiting and left thigh pain, with a biological inflammatory syndrome. Pregnancy was diagnosed. Investigations revealed a pseudo-cystic, 20-cm-long retroperitoneal abscess, biopsy of which confirmed the diagnosis of tuberculosis. Evolution after cyst drainage and under conventional anti-tuberculosis treatment was favourable. An abdominal location of tuberculosis is rare and its diagnosis is difficult especially in countries with a low incidence of the disease. Unexplained abdominal manifestations and/or persistent biological inflammatory syndrome, especially in high-risk groups, should raise the suspicion of tuberculosis. LEARNING POINTS: Abdominal tuberculosis (TB) is a challenging diagnosis especially in low-incidence countries where the disease is rarely suspected.In low-incidence countries, abdominal TB should be suspected in cases of unexplained abdominal manifestations and/or persistent inflammatory syndrome, especially in high-risk groups.The diagnosis of abdominal TB is based on a range of anamnestic and clinical symptoms and signs, imaging, culture, and invasive procedures for histology.

The incidence of serious adverse events in a tunisian hospital: a retrospective medical record review study.

AIM: To describe the epidemiology of serious adverse events (SAE) reported in the division of internal medicine at the Mongi Slim university hospital in Tunis, to analyze their causes and contributing factors and compare them to that reported in literature so as to establish prevention strategies when these events were deemed preventable. Methods This retrospective study collected the medical records of randomly selected 500 index hospitalizations. Records review was conducted in two stages: a primary review that aimed to detect hospitalizations where a SAE was likely to have occurred then a secondary review which purpose was to confirm the presence of the SAE, to determine its nature and its preventability. RESULTS: SAE were detected in 5.2% of hospitalizations with a preventability of 57.7%. These events were responsible for a prolongation in 27.0% of hospitalizations and disability in 15.4% of cases. They were the cause of admission in 42.9% of hospitalizations in which a SAE occurred. The SAE consisted in adverse drug events in 73.0% of cases, healthcare-associated infections in 19.0% of cases, non-surgical procedures in 4% of cases and pressure ulcers in 4.0% of cases. Age and number of comorbidities were identified as the main risk factors for the occurrence of SAE. CONCLUSION: Awareness of the extent and severity of the problem of iatrogenesis is necessary because it is a prerequisite to establishing a culture of patient safety among caregivers.