[2023 scientific breakthroughs in ambulatory general internal medicine]. / Avancées scientifiques de 2023 en médecine interne générale ambulatoire.

The timing of taking antihypertensive medication does not have an impact on the cardiovascular plan. Geniculate block is an alternative to oral analgesic treatment for knee osteoarthritis. Feedback and audits are ineffective in reducing the inappropriate prescription of antibiotics in Switzerland. The intervention of community health professionals in collaboration with general practitioners allows for the control of arterial hypertension. In the case of peripheral facial paralysis, it is relevant to systematically consider performing magnetic resonance imaging. Aspirin is an alternative to enoxaparin in thromboembolic prophylaxis after surgery for a traumatic fracture. Walking 8,000 steps a few days a week reduces mortality. Opioids are not effective for acute neck and lower back pain.

Le moment de prise des antihypertenseurs n'a pas d'impact sur le plan cardiovasculaire. Le bloc géniculé est une alternative au traitement antalgique oral de la gonarthrose. Le feedback et les audits sont inefficaces dans la diminution de la prescription inappropriée d'antibiotiques en Suisse. L'intervention de professionnelsa de santé communautaire en collaboration avec des généralistes permet de contrôler l'hypertension artérielle. Lors d'une paralysie faciale périphérique, il s'avère pertinent de réfléchir de manière systématique à la réalisation d'une IRM. L'aspirine est une alternative à l'énoxaparine dans la prophylaxie thromboembolique après la chirurgie d'une fracture traumatique. Marcher 8000 pas quelques jours par semaine diminue la mortalité. Les opioïdes ne sont pas efficaces pour les cervicalgies et les lombalgies aiguës.

[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.

Clinical impact and misdiagnosis of functional ophthalmological symptoms: a case report.

BACKGROUND: There is a high prevalence of somatoform disorders and medically unexplained symptoms. When it comes to deciding whether a patient is able to work, it is essential to differentiate a somatoform disorder from a factitious disorder. The case presented demonstrates the impact on disability benefits and the subsequent psychosocial repercussions of misdiagnosing between a factitious disorder and a somatoform disorder. CASE PRESENTATION: A 42-year-old Caucasian woman worked as a 100% fiduciary accountant until the age of 32 when she was placed on medical leave due to persistent trigeminal neuralgia. Afterward, she developed total blindness, not explained by a physiological process, accompanied by distress in a crucial emotional context. We evaluated the patient for a revision of a disability income after a diagnosis of factitious disorder with severe consequences such as disability income suspension and family conflict. Our psychiatric examination concluded the diagnoses of pain disorders related to psychological factors and a dissociative neurological symptom disorder with visual disturbance. CONCLUSIONS: Blindness not explained by a physiological process may accompany trauma and psychological distress. Differentiating this pathology from factitious disorder or simulation is essential from an insurance medicine point of view, but also for its treatment.

[Leptospirosis, the diagnostic challenge of an indigenous case]. / Leptospirose, le défi diagnostique d'un cas autochtone.

Leptospirosis is a global widespread zoonosis caused by a Gram-negative bacterium of the genus Leptospira, belonging to the Spirochaetes phylum, favored by unhealthy living conditions and some professional and recreational aquatic activities. Its diagnosis could be very difficult due to the presence of non-specific clinical presentation and biological anomalies common to other infectious diseases. To detect it, the choice of the right diagnostic method is fundamental. We hereby introduce the case of a patient with no classic risk factors for leptospirosis, showing febrile headaches and rapid deterioration of her general conditions with evolution towards septicemia.

La leptospirose est une zoonose causée par une bactérie Gram négatif du genre Leptospira, appartenant au phylum des Spirochaetes. Elle est répandue dans le monde entier, favorisée par des conditions de vie insalubres et certaines activités professionnelles et récréatives en milieu aquatique. Son diagnostic peut s'avérer difficile en raison de sa présentation clinique et de ses anomalies biologiques peu spécifiques et communes à d'autres maladies. Évoquer ce diagnostic et effectuer le test diagnostique approprié demeure, donc, fondamental. Nous présentons l'histoire d'une patiente sans facteurs de risque classiques de leptospirose, présentant des céphalées fébriles et une détérioration rapide de son état avec une évolution vers une septicémie.

[Neuropsychiatric manifestations of post COVID-19 Syndrome and Disability Insurance (DI)]. / Covid long neuropsychiatrique et assurance invalidité (AI).

Long COVID, frequently associated to neuropsychiatric manifestations, impacts the ability of patients to return to work and often requires adjustments of the previous workstation. Due to the duration of the symptoms and the professional consequences, disability insurance (DI) procedures may be necessary. Because the persistent symptoms of Long COVID are often subjective and unspecific, the medical report to the DI should include a detailed description of the functional impact of these manifestations.

Le Covid long et ses fréquentes manifestations neuropsychiatriques impactent la capacité des patients à retourner au travail et nécessitent souvent des aménagements du poste de travail antérieur. En raison de la durée des symptômes et des conséquences professionnelles, des démarches auprès de l'assurance invalidité (AI) peuvent s'avérer nécessaires. Parce que les symptômes persistants du Covid long sont souvent subjectifs et aspécifiques, le rapport médical à l'AI doit comprendre une description détaillée des répercussions fonctionnelles de ces manifestations.

[2022 scientific breakthroughs in ambulatory general internal medicine]. / Avancées scientifiques de 2022 en médecine interne générale ambulatoire.

In patients aged 65 or older, the risk of dementia decreases with cataract surgery. Mental stress doubles the risk of a cardiac event in patients with stable coronary artery disease. The one-legged stance performance estimates total mortality in patients 50 years or older. Patients with chronic pain benefit from treatment with dronabinol or nabiximols. Salt substitutes are an alternative to regular salt in hypertensive patients aged 60 years or more. The promotion of physical activity in the office is effective in reducing sedentary behavior. Music has a favorable impact on the mental dimensions of quality of life. Colonoscopies performed on patients aged 75 years or more have a higher risk of non-gastrointestinal complications than gastrointestinal complications.

Chez les patients de 65 ans ou plus, le risque de démence diminue après une chirurgie de la cataracte. Le stress mental double le risque d'événements cardiaques chez des patients avec une coronaropathie stable. La station monopodale effectuée au cabinet permet d'estimer la mortalité totale chez les patients de 50 ans ou plus. Ceux souffrant de douleurs chroniques bénéficient d'un traitement par dronabinol ou nabiximols. Les substituts de sel sont une alternative au sel ordinaire chez les hypertendus de 60 ans ou plus. La promotion de l'activité physique au cabinet est efficace dans la diminution de la sédentarité. La musique a un impact favorable sur les dimensions mentales de la qualité de vie. Les coloscopies effectuées chez les patients de 75 ans ou plus présentent un risque supérieur de complications non gastro-intestinales comparativement à celles gastro-intestinales.

[Persistent Postural-Perceptual Dizziness (PPPD) - A clinical case and essentials for the primary care medicine]. / Vertiges posturaux-perceptuels persistants (VPPP) - Cas clinique et notions essentielles pour le généraliste.

Persistent Postural-Perceptual Dizziness (PPPD) is a chronic functional disorder that manifests with symptoms of dizziness, unsteadiness or non-spinning vertigo that lasts for at least three months. These symptoms are exacerbated by upright posture, active or passive motion, and exposure to complex or moving visual stimuli. This -pathology has been known for a long time ago. Still, after an expert's consensus in 2017, this term was born, and some precise diagnostic criteria have been defined based on identifying key symptoms in the patient's clinical history. Treatment is multimodal, incorporating -vestibular rehabilitation, cognitive-behavior therapy, and serotonergic medication.

Les VPPP ou vertiges posturaux-perceptuels persistants (Persistent Postural-Perceptual Dizziness (PPPD)) sont une pathologie fonctionnelle chronique, caractérisée par une sensation de déséquilibre, d'instabilité ou de vertige non rotatoire. Les symptômes peuvent être exacerbés par la position debout, la mobilisation active ou passive et l'exposition à des stimuli visuels complexes ou en mouvement. Si la pathologie est connue de longue date, c'est suite à un consensus d'experts qu'est né ce terme en 2017, et que des critères diagnostiques clairs ont été définis, qui se basent sur l'identification de symptômes clés dans l'histoire ­clinique du patient. Le traitement est multimodal, ­comprenant une réhabilitation vestibulaire, des thérapies cognitivo-comportementales et une médication sérotoninergique.

[Clinical presentation and short-term treatment of pulmonary actinomycosis]. / Manifestations cliniques et traitement de courte durée de l'actinomycose pulmonaire.

Actinomycosis is an uncommon disease caused by Actinomyces, a commensal of the oropharyngeal, digestive, and genital tract. Commonly, it manifests as cervicofacial infection and is often related to poor oral health, smoking, chronic alcoholism or immune deficiency. Pulmonary actinomycosis is a rare disease, characterized by unspecific clinical, biological, and radiological manifestations that may be confused with other diseases. It should always be considered in patients suspected of having tuberculosis, lung abscess or pulmonary neoplasia. We describe a case of pulmonary actinomycosis treated successfully with short-term antibiotic therapy of three months, with a short review of the literature.

L'actinomycose est une infection peu fréquente causée par l'espèce Actinomyces, un commensal du tractus oropharyngé, digestif et génital. Elle se manifeste généralement par une infection cervico-faciale, souvent liée à un mauvais état bucco-dentaire, un tabagisme, un éthylisme chronique, ou un déficit immunitaire. L'actinomycose pulmonaire est une affection peu commune, caractérisée par des manifestations cliniques, biologiques et radiologiques peu spécifiques qui peuvent être confondues avec d'autres maladies. Elle doit être évoquée en cas de suspicion de tuberculose, d'abcès et de néoplasie pulmonaire. Nous décrivons un cas d'actinomycose pulmonaire traitée avec succès par une antibiothérapie de courte durée de 3 mois, avec une revue simplifiée de la littérature.

Risk Perception Related to COVID-19 and Future Affective Responses Among Healthcare Workers in Switzerland: A Mixed-Methods Longitudinal Study.

Objectives: Whereas early findings suggest that risk perceptions related to COVID-19 affect psychological well-being in healthcare workers (HCWs), the temporal associations between these variables need to be clarified and HCWs lived experience further explored. This study proposes a mixed evaluation of COVID-19-related risk perception and affective responses among HCWs. Methods: A longitudinal mixed-method study was conducted. HCWs (N = 138) completed measures of COVID-19 risk perceptions, depression, anxiety, burnout and secondary traumatic stress (STS) at baseline and 6 months later. A subsample (n = 20) participated in semi-structured interviews exploring both risk perceptions and affective responses. Results: Main quantitative findings showed positive associations between worry to contaminate others and depression (IRR = 1.04, p < 0.05), anxiety (IRR = 1.03, p < 0.01), STS (b = 0.3, p < 0.05), and perceptions of lacking protection (IRR = 1.04, p < 0.05) with anxiety scores. Four themes emerged from the thematic content analysis: 1) life was turned upside down; 2) skills were put in quarantine; 3) dealing with patient discomfort; 4) balance to be found between protection and restrictions. Conclusion: These findings emphasize the importance to develop tailored interventions, such as group discussion sessions, to optimize risk perception and help manage uncertainty.

Idiopathic remitting seronegative symmetrical synovitis with pitting edema syndrome mimicking symptoms of polymyalgia rheumatica: a case report.

BACKGROUND: Remitting seronegative symmetrical synovitis with pitting edema is a rare rheumatic condition of the elderly population that is well described but whose mechanisms remain little studied. This syndrome is characterized by symmetrical swelling located mainly on the dorsal part of the hands and the feet. Because of possible heterogeneous clinical presentation, it can easily mimic the onset of other rheumatic diseases or appear associated with them. Here we report a case of a patient who developed remitting seronegative symmetrical synovitis with pitting edema with preexisting shoulder and hip girdle pain associated with progressive fatigue, indicating a possible differential diagnosis of polymyalgia rheumatica. We reviewed and compared classification for remitting seronegative symmetrical synovitis with pitting edema and polymyalgia rheumatica and discussed other differential diagnoses. CASE PRESENTATION: An 84-year-old Caucasian woman presented to our General Medicine Unit with acute onset of symmetrical hands and feet edema, leading to functional limitation due to pain and stiffness. Additionally, she was complaining about neck, shoulder, and pelvic girdle pain present for about 2 months associated with worsening asthenia. Blood tests showed an elevated level of C-reactive protein and erythrocyte sedimentation rate, as well as absence of anti-cyclic citrullinated peptide antibodies and rheumatoid factor. As all criteria of remitting seronegative symmetrical synovitis with pitting edema syndrome were present, the patient was treated with low-dose prednisone, with a rapid and complete resolution of symptoms. She remains asymptomatic without treatment 2 years after the onset of symptoms, without any evident oncologic etiology. CONCLUSIONS: This case is an example of a classic representation of remitting seronegative symmetrical synovitis with pitting edema syndrome with clinical elements suggesting a concomitant existing early stage of polymyalgia rheumatica. These two entities, classified in the group of seronegative arthritis, can coexist (up to 10% of cases), with remitting seronegative symmetrical synovitis with pitting edema appearing as an initial or late manifestation of polymyalgia rheumatica. It is essential to remind that remitting seronegative symmetrical synovitis with pitting edema is associated with a higher risk of cancer (30%). A proper diagnosis allows the clinician to precisely define the appropriate therapy duration to limit its side effects in the elderly and remain aware of the potential risk of underlying malignancy.

[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.

[Occupational dermatoses: management for general practitioners and an interdisciplinary collaboration model]. / Dermatoses professionnelles : démarche diagnostique pluridisciplinaire et outil de dépistage au cabinet.

Dermatoses are among the most frequent diseases related to working conditions. Nevertheless, there is an under-reporting of occupational diseases and the management of patients with either a possible occupational dermatosis or a condition aggravated by work which could be improved. The aim of this article is to present the most common occupational dermatoses, a multidisciplinary diagnostic approach to them and to propose a screening tool for occupational exposures.

Les dermatoses sont parmi les maladies les plus fréquentes en lien avec les conditions de travail. Néanmoins, il existe une sous-déclaration en maladie professionnelle et la prise en charge des patients atteints, soit d'une possible dermatose professionnelle, soit d'une condition aggravée par le travail, qui pourrait être améliorée. L'objectif de cet article est de présenter les dermatoses professionnelles les plus communes et une démarche diagnostique pluridisciplinaire et de proposer un outil de dépistage des expositions professionnelles à risque.

[2021 scientific breakthroughs in ambulatory general internal medicine]. / Avancées scientifiques 2021 en médecine interne générale ambulatoire.

Psychotherapy diminishes depression relapses when antidepressants are reduced or stopped. Delayed antibiotic therapy is effective and safe while treating community-acquired respiratory infection. Physical rehabilitation after hospitalization due to acute cardiac decompensation is useful in frail patients. Six hours of sleep appears to be associated with a higher risk of dementia in people aged 50-70 years. Patients modify healthcare use after losing their referring physician. Screening for atrial fibrillation in healthy patients aged 65 or older is not beneficial. Physicians' ECG reading skills decrease in the absence of regular training. Patients hospitalized with COVID-19 are often clinically, psychologically, and economically impacted.

La psychothérapie diminue les rechutes de dépression lors de la réduction ou de l'arrêt des antidépresseurs. En cas d'infection respiratoire communautaire, l'antibiothérapie retardée est efficace et sûre. La réadaptation physique après une décompensation cardiaque aiguë est utile chez les patients fragiles. Un sommeil de 6 heures semble être associé à un risque plus élevé de démence chez les personnes de 50 à 70 ans. Les patients modifient le recours aux soins de santé après la cessation d'activité de leur médecin référent. La recherche de fibrillation auriculaire chez les patients de 65 ans ou plus en bonne santé n'est pas bénéfique. Les compétences médicales de lecture d'ECG diminuent en l'absence de formation régulière. Les patients hospitalisés pour un Covid-19 sont souvent impactés aux niveaux clinique, psychologique et économique.

[Teaching contact tracing during the SARS-CoV-2 pandemic : experiences from the Swiss canton of Vaud]. / Formation à l'enquête d'entourage durant la pandémie du SARS-CoV-2 - L'exemple du canton de Vaud.

The rapid evolution of the SARS-CoV-2 epidemic required the implementation of contact tracing at an unprecedented scale in the Swiss cantons. Hundreds of contact tracers with different professions, most without medical background, had to be recruited and educated for tasks that usually are carried out by small teams of experts in communicable diseases. Teaching materials and courses about contact tracing, especially in French, were scarce. Thus, the learning team at the contact tracing centre of the canton of Vaud supported by clinicians and epidemiologists developed a method to dynamically create and apply a series of teaching modules. We describe this process and its results. The teaching materials are freely available upon contact with the authors.

L'émergence de l'épidémie liée au SARS-CoV-2 a nécessité la mise en place d'un dispositif d'enquête d'entourage d'une ampleur sans précédent dans les cantons suisses. Des centaines de traceurs, la plupart sans expérience médicale, ont dû être recrutés puis formés pour effectuer des tâches qui sont habituellement pratiquées par des équipes d'experts en maladies infectieuses. La littérature concernant l'enquête d'entourage, notamment francophone, étant rare, l'équipe de formation du centre de traçage a développé des modules d'enseignement dynamiques. Dans cet article, nous décrivons les processus d'élaboration de ces modules et leurs résultats. Le contenu des formations peut être obtenu librement auprès des auteurs.

[Practical management of long Covid disease in outpatients: illustration by clinical cases]. / Prise en charge des patients avec Covid long : illustration par des cas cliniques.

The SARS-CoV-2 pandemic has caused an unprecedented global public health crisis. The term long Covid is used to describe diverse and heterogeneous symptoms that persist more than 4 weeks after infection with an estimated incidence of 10-40%, which varies between studies. The principal characteristics of long Covid are fluctuating symptoms of prolonged duration affecting multiple organs, such as fatigue, dyspnea, cough, anosmia, dysgeusia, chest pain, palpitations, headache, myalgia, cognitive and gastrointestinal disorders. Contributing factors, possible pathophysiological explanations and international recommendations can help in the management of the disease in the outpatient setting. Biopsychosocial and multidisciplinary management in primary care medicine is essential.

La pandémie due au virus SARS-CoV-2 a provoqué une crise de santé publique sans précédent. Le terme Covid long est utilisé pour décrire les divers symptômes hétérogènes et persistant plus de 4 semaines après l'infection, avec une incidence de 10 à 40 %, qui varie selon les études. Les caractéristiques principales du Covid long sont une atteinte multisystémique et des symptômes fluctuants et prolongés comme la fatigue, la dyspnée, la toux, l'anosmie, la dysgueusie, les douleurs thoraciques, les palpitations, des céphalées, des myalgies, des troubles cognitifs et des troubles gastro-intestinaux. Les facteurs favorisants, les explications physiopathologiques possibles et les recommandations internationales rendent indispensable une prise en charge biopsychosociale et pluridisciplinaire en médecine de premiers recours.

Assessment of cognitive screening tests as predictors of driving cessation: A prospective cohort study of a median 4-year follow-up.

BACKGROUND: Assessing fitness to drive and predicting driving cessation remains a challenge for primary care physicians using standard screening procedures. The objective of this study was to prospectively evaluate the properties of neuropsychological screening tests, including the Trail Making Test (TMT), Clock Drawing Test (CDT), Montreal Cognitive Assessment (MoCA), Useful Field of View (UFOV), and Timed Up and Go (TUG) test, in predicting driving cessation for health reasons in drivers older than 70 years of age. DESIGN AND METHODS: This prospective cohort study, with a median follow-up of 4 years for drivers of 70 years old or older with an active driving license in Switzerland, included 441 participants from a driving refresher course dedicated to volunteer senior drivers. Cases were drivers reported in the national driving registry who lost their license following a health-related accident, who were reported as unfit to drive by their physician or voluntarily ceased driving for health reasons. Survival analysis was used to measure the hazard ratio of driving cessation by adjusting for age and sex and to evaluate the predictive value of combining 3 or more positive tests in predicting driving cessation during a 4-year follow-up. RESULTS: A total of 1738 person-years were followed-up in the cohort, with 19 (4.3%) having ceased driving for health reasons. We found that participants with a TMT-A < 54 sec and TMT-B < 150 sec at baseline had a significantly lower cumulative hazard of driving cessation in 4 years than those with slower performance (adjusted HR 3, 95% CI: 1.16-7.78, p = 0.023). Participants who performed a CDT ≥ 5 had a significantly lower cumulative hazard of driving cessation (adjusted HR 2.89, 95% CI: 1.01-7.71, p = 0.033). Similarly, an MoCA score ≥ 26, TUG test <12 sec or a UFOV of low risk showed a lower but not significant cumulative risk at a median follow-up of 4 years. When using tests as a battery, those with three or more positive tests out of five were 3.46 times more likely to cease driving (95% CI: 1.31-9.13, p = 0.012). CONCLUSIONS: The CDT and the TMT may predict driving cessation in a statistically significant way, with a better performance than the UFOV and MoCA tests during a median 4-year follow-up. Combining tests may increase the predictability of driving cessation. Although our results are consistent with current evidence, they should be interpreted with precaution; more than 95% of the participants above the set threshold were able to continue driving for 4 years without any serious incident.