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Rev Med Suisse ; 15(661): 1545-1550, 2019 Sep 04.
Artigo em Francês | MEDLINE | ID: mdl-31496187


Pyelonephritis is a frequent infection mostly found in women. Urine must be collected for culture before beginning antibiotherapy. The predominant pathogen identified is E coli. Ciprofloxacin may be used right away if the E. coli susceptibility to this antibiotic is at least 90% in the local population. Otherwise, a dose of ceftriaxone or amikacin (outside pregnancy) should be administered. For inpatient care, initial treatment is different according to clinical severity. In case of complication, specialists of urology and infectiology should be consulted. An antibiotic de-escalation should be considered if permitted by the clinical evolution and the antibiogram; in favor of amoxicillin in women and ciprofloxacin in men. In case of history of ESBL infection or carriage, the empirical treatment should be adapted.

Assistência ao Paciente , Pielonefrite/tratamento farmacológico , Antibacterianos/uso terapêutico , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Escherichia coli/patogenicidade , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Humanos , Testes de Sensibilidade Microbiana , Pielonefrite/microbiologia
Rev Med Suisse ; 15(661): 1558-1562, 2019 Sep 04.
Artigo em Francês | MEDLINE | ID: mdl-31496189


The refeeding syndrome (RS) is a consequence of passing from a catabolic state to an anabolic state triggered by renutrition that is followed by a prolonged period of fasting. Often under-diagnosed in the context of malnutrition or multimorbid patients, RS presents itself through nonspecific symptoms (oedema and tachycardia) that can rapidly progress in the first 72 hours into life threatening states. The internationally recognized NICE guidelines estimate the risk of RS and are based on BMI, weight loss and electrolyte levels. Several recent studies have addressed hypophosphatemia as a predominant marker allowing to better estimate refeeding syndrome gravity and risk. Patients who present a risk should have a progressive renutrition with an electrolyte substitution if required.

Síndrome da Realimentação/diagnóstico , Síndrome da Realimentação/prevenção & controle , Idoso , Índice de Massa Corporal , Edema , Eletrólitos , Jejum , Humanos , Hipofosfatemia , Síndrome da Realimentação/etiologia , Risco , Taquicardia , Perda de Peso
Rev Med Suisse ; 12(502): 125-9, 2016 Jan 20.
Artigo em Francês | MEDLINE | ID: mdl-26946788


The year 2015 gave us many scientific publications, among whom some will have an impact on our daily practice and some will influence our way of considering some well known diseases. Chief residents in the Service of internal medicine of the Lausanne University hospital, gathered like every year, to share their readings together in order to presentyou a small part of the many publications of 2015, which have been considered to have an impact on our future daily practice.

Medicina Interna/educação , Internato e Residência , Editoração , Humanos , Suíça