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Hyperammoniemic encephalopathy is part of the differential -diagnosis in the presence of an acute confusional state. Although associated with liver dysfunction in the majority of cases, it can be observed in many other clinical situations. Often not investigated, the dosage of ammonium in the blood should be integrated in the biological work-up of encephalopathy of unknown origin. Mana-gement focused on etiology is paramount and usually allows for the rapid normalization of ammonium levels and resolution of the clinical syndrome., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The PartnerREC network at the Geneva University Hospitals aims to facilitate the collaboration between researchers and patient partners in any type of clinical research, mainly those led at the HUG. It is the result of a coconstruction process initiated in 2019 by physicians, research professionals, cantonal research ethics committee members, a lawyer, and patient partners. The network implemented four initiatives: a) a website providing information to researchers and patients participating to research projects; b) personalized counseling for researchers to explore partnership opportunities in their own research projects; c) a training program related to patient partnership in research developed together with different partners in French-speaking Switzerland and d) its own research program on partnership in clinical research., Competing Interests: Les auteures font toutes partie du réseau PartnerREC.

Infectious diseases played a key role in public health development during the 20th century and well-known western comics such as Asterix, The Adventures of Tintin and Lucky Luke are of major significance to the local collective imagination. The purpose of the present review is to establish how infectious diseases were addressed in Goscinny, Hergé and Morris's comics by systematically gathering all references to infectiology throughout the series. It emerged that many allusions to transmittable diseases could be found in The Adventures of Tintin whereas Asterix and Lucky Luke, whose historical frameworks differ from the ones of the authors, rarely mention any contagious diseases., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêt en relation avec cet article.

This article examines the risk of infective endocarditis (IE) linked to various bacterial species causing bacteremia. While the European Society of Cardiology (ESC) and the American Heart Association (AHA) guidelines do not specify the diagnostic workup to perform based on bacterial species, certain bacteria are acknowledged to pose a higher IE risk. Community-acquired bacteremia has a higher IE risk than nosocomial bacteremia. Implantable electronic cardiovascular devices (IECD) and a history of IE or valve surgery also increase this risk. Several risk stratification systems (RSS) have been developed to guide clinicians on the necessity of echocardiography in patients with Gram-positive bacteremia, particularly S. aureus, streptococci, and enterococci. An evaluation algorithm based on these RSS is proposed to assist clinical investigations., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

A 78-year-old smoker patient with COPD (GOLD 3E) is admitted for COPD exacerbation. The initial examination shows abnormal fingers and nails. The hyponychial angle is 195 degrees and there is a positive Schamroth sign. A diagnosis of nail clubbing is made. Because the association of nail clubbing and COPD is rare, the history is completed and reveals significant weight loss over the past few months. A -pulmonary CT-scan shows a peri-hilar mass, and biopsy confirms small cell lung cancer.

Elevated liver enzymes are a common finding in primary care medicine, with an estimated prevalence of 8 %. Steatotic liver diseases are the most frequently encountered etiologies and r-epresent the main cause of liver-related morbidity and mortality. This article looks at the latest developments in these diseases, with a particular focus on MASLD (Metabolic dysfunction associated steatotic liver disease). Recommendations include biological monitoring every 1-3 years in the presence of risk factors, and the use of the FIB-4 score to detect fibrosis in cases of MASLD. Therapeutic management aims to improve metabolic function by treating risk factors and through lifestyle and dietary measures., Competing Interests: Les auteur-ices n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Community acquired pneumonia is a well-known entity in internal medicine. It represents 1.2 cases per 1000 inhabitants every year, and up to 14 cases per 100 inhabitants in people older than 65 years old. Despite our exposition to the disease almost daily, it is still the leading cause of death related to an infection. In 2019, The American Thoracic Society proposed a revision of its guidelines, especially concerning the diagnosis and the treatment of community acquired pneumonia. It is the latest academic society revision. Further-more, the SARS-CoV-2 pandemia has extended our knowledge of pulmonary infection and brought an adaptation of our practice., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Microscopic hematuria (MH) is a frequent biological finding. In most cases, the etiology is benign, symptomatic and reversible. The diagnostic approach allows classifying hematuria as glomerular or non-glomerular. For non-glomerular hematuria, the risk of urinary tract neoplasia is 5% and should always be evaluated1. To use resources efficiently, patients requiring additional and invasive exam must be identified and distinguished from those who will only require a follow up. This article reviews the diagnostics approach of MH by integrating the new recommendations of the American urology association published in 2020., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The management of acute pain focuses on a multimodal approach integrating both pharmacological and non-pharmacological treatments. In recent years, caution towards opioids has increased, with several studies showing that they are not necessarily more effective than non opioid analgesics for pain relief for musculoskeletal pain, which is the most common painful symptom in outpatient settings, and have the disadvantages of more side effects and a risk of dependence. Adjuvant and non-pharmacological treatments (e.g. manual medicine, acupuncture, hypnosis) are gaining importance to reduce therapeutic escalation and improve pain management. This approach which can be more personalized, aims to minimize risks while ensuring effective relief of acute pain., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Hypertensive patients are frequently affected by erectile dysfunction (20-25%). This is often a manifestation of atherosclerosis, a systemic disease that itself requires management. Dietary measures and physical activity are beneficial for these patients. Regarding pharmacological options, these include modifying the antihypertensive treatment or using a phosphodiesterase type 5 inhibitor (PDE5 inhibitor) in males. The preferred antihypertensive treatments are angiotensin 2 receptor antagonists, ACE inhibitors, calcium channel blockers, and if necessary, a vasodilating beta-blocker (nébivolol). Thiazide and thiazide-like diuretics (with the exception of indapamide), traditional beta-blockers, and central antihypertensive agents should be avoided., Competing Interests: Le Pr Ehret a des liens d’intérêts avec Servier et Novartis (mineur). Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Dolodoc is a mobile application aimed at improving autonomy and quality of life for individuals living with chronic pain. Designed as a virtual coach, it offers counseling according to 7 important dimensions of quality of life. Activities, pain and fulfillment of the 7 dimensions of quality of life can be recorded in the application. Moreover, a report can be exported to enhance patient monitoring during clinical interactions. Dolodoc was developed with a user-centered approach and is based on scientific evidence related to the self-management of chronic pain. Indeed, counseling by the coach is based on a multimodal strategy, incorporating elements of physical activity, pacing, positive psychology, and relaxation, among others. Overall, Dolodoc is an innovation that can be used in various clinical settings with an individualized approach., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article. Le développement de Dolodoc a été possible grâce au soutien de la Fondation des HUG.

Vasospastic angina (VSA) was first described in 1959 by Myron Prinzmetal as "the variant form of angina pectoris" on the sole basis of medical history and ECG. This condition is currently categorized as an endotype of myocardial infarction without coronary obstruction (Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA)). Diagnostic criteria have been suggested by expert consensus. Provocative testing during coronary angiography is the gold standard test but is rarely used. The clinical presentation is often neglected, and the diagnosis is missed. However, VSA may lead to life-threatening arrhythmias. There are simple and effective therapies that are markedly different from those for the atherosclerotic coronary artery disease., Competing Interests: Le Pr Marco Roffi déclare des fonds de recherche institutionnels de la part de Biotronik, Medtronic, Cordis, Boston Scientific et Terumo, sans lien avec l’article publié. Le Dr Juan F. Iglesias déclare des fonds de recherche institutionnels de la part de Abbott Vascular, Astra Zeneca, Biosensors, Biotronik, Concept Medical, Philips, and Terumo Corp., sans lien avec l’article publié, ainsi que des honoraires personnels et d’orateur de la part de Astra Zeneca, Biosensors, Biotronik, Bristol Myers Squibb, Cordis, Concept Medical, Medalliance, Medtronic, Novartis, Terumo Corp., Pfizer, and Philips, sans lien avec l’article publié. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

SGLT2 inhibitors (gliflozins) have proven their efficacy in reducing complications due to atherosclerotic cardiovascular disease, heart failure and chronic kidney disease both in placebo-controlled clinical trials and in real-life studies versus other glucose-lowering agents (except GLP-1 analogues) in patients with type 2 diabetes. Hence, observational studies demonstrate that they are poorly used in -clinical practice, including in patients at high cardiorenal risk. -Reasons are multiple and involve physicians, patients and health care system with restricted criteria for prescription and reimbursement in many countries. Bridging the gap between scientific proves from evidence-based medicine and clinical practice represents a major health-care issue., Competing Interests: L’auteur a reçu des honoraires comme conférencier, conseiller scientifique et/ou investigateur clinicien des firmes pharmaceutiques AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Menarini et NovoNordisk. Il a été investigateur clinicien dans les grands essais TECOS, EMPA-REG OUTCOME, CANVAS-R, DECLARE-TIMI 58, LEADER et HARMONY Outcomes.

The development of liver fibrosis is the consequence of histological remodeling of the liver parenchyma, reflecting chronic inflammatory liver disease or hepatocyte necrosis. These tissue modifications result in structural changes to the extracellular matrix, predisposing to progression to cirrhosis and hepatocellular carcinoma, whatever the underlying etiology. Recent data demonstrate the potential benefits of screening for hepatic fibrosis, in particular in order to detect and treat the cause of the underlying liver disease as early as possible, which could ultimately lead to the many known complications in cirrhotic patients. Early identification of the population at risk of hepatic fibrosis should precede screening, which may be initiated in the primary care physician's office and continued at a later stage by the specialist., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Both glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve cardiorenal -prognosis of at-risk patients with type 2 diabetes thanks to pleiotropic effects that are either common or specific. This article discusses the clinical efficacy of a combined therapy with the two medications. Data were obtained from post hoc analyses of subgroups of participants to cardiovascular outcome trials and from real-life observational retro-spective cohort studies. The reported superiority of the combination versus either monotherapy should be confirmed in an ongoing large prospective trial (PRECIDENTD). The extra-cost of such a combined therapy as well as the common underuse of each pharmacological class in daily clinical practice deserve attention., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Gastroparesis is a pathology associating upper digestive symptoms, such as nausea and vomiting, with impaired gastric emptying in the absence of mechanical gastric or duodenal obstruction. It has a major impact on patients' quality of life, can lead to undernutrition, and -increases overall mortality. Several schools of thought converge on the hypothesis of a clinico--pathological spectrum of gastric neuro-muscular dysfunction encompassing gastroparesis and functional dyspepsia, in particular the subtype known as "postprandial distress syndrome". Its management includes non--pharmacological interventions, such as hygienic--dietary measures, pharmacological interventions using prokinetic, antiemetic or neuromodulatory treatments, and endoscopic interventions., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Gastroesophageal reflux disease is the most frequent gastroente-rological diagnosis, with a high prevalence of symptoms impacting patients' quality of life and causing high economic costs. It has a -complex pathophysiology that encompasses different mechanisms and an overlap with functional disorders that cause similar symptoms. Hence, an accurate diagnosis and phenotyping of patients is crucial to individualize therapy and limit health costs. Nowadays, therapy is personalized and encompasses lifestyle interventions, proton pump inhibitors, surgery, neuromodulation, diaphragmatic breathing as well as, in the future, new drugs and endoscopic interventions., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Incidents involving ionizing radiation pose a risk of immediate and long-term clinical consequences for both victims and responders in the event of secondary contamination. Rapid identification of the problem and a coordinated response are crucial. This article summarizes the key challenges related to the emergency management of a single patient or multiple victims, addressing the importance of recognizing such a case, radioprotection measures, decontamination, and available treatments., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Exercise addiction, although not yet officially recognized, can be defined as the harmful practice of physical exercise, described as a compulsive need, where damage take precedence over the benefits of this practice, with a continuation of this behavior despite the negative consequences. A number of risk factors have been identified, including psychopathological conditions such as eating disorders or other addictions. It is possible to detect this addiction and assess its intensity using multidimensional questionnaires, even the clinical relevance and thresholds of which are still debated. Despite the absence of validated treatments, motivational approaches and cognitive-behavioural therapies can be useful, combined with nutritional management if necessary, as well as management of concomitant disorders., Competing Interests: Les auteur-es n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), is a neurological disorder involving multiple pathophysiological mechanisms and etiologies. Symptoms include asthenia, myalgia, post-exertional malaise and neurocognitive disorders. While the numerous patient complaints pose a diagnostic challenge, the advent of new technologies paves the way for innovative methods to reveal ME. The heterogeneity of the disease's mechanisms complicates the search for effective treatments but also offers the prospect of numerous beneficial molecules. Combining treatments targeting mitochondrial dysfunction, oxidative stress, inflammation and immunological disorders appears to be the current optimal therapeutic approach., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Sexual violence constitutes a form of gender-based violence, to the extent that the victims are mainly women. Other groups of vulnerable people are also more affected, in particular gender and sexual diversity persons. Sexual and gender-based violence can also occur in healthcare. To respect the legal framework and people's rights, but also to promote safety and quality in healthcare, it is essential to obtain and respect consent. Consent must be informed, explicit, freely given, and reiterated throughout the consultation. This article reviews the concept of consent and offers practical tools for its application in healthcare., Competing Interests: Les auteures n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Medicine is evolving with increasing feminization and the rise of part-time work. Women now outnumber men among graduates but are underrepresented in leadership roles and in the highest-paid specialties. To meet these economic and organisational challenges, this article proposes a number of courses of action. In addition to an overall increase in the number of medical training places to compensate for retirement and the development of interprofessional integrated care structures, support for academic promotion and management positions for women, as well as an increase in the financial value of professional and non-remunerated activities, are all solutions to be considered. These changes will ensure that medicine is inclusive, efficient and of high quality., Competing Interests: A. Gayet-Ageron, S. Arsever, S. De Lucia, C. Bleeker et M. Schellongova sont membres du groupe facultaire Médecine, genre & équité pouvant représenter un conflit d’intérêts mais celui-ci est non problématique. N. Jaunin-Stalder n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Transgender people are at risk of being in worse health than the cisgender population. On the one hand, they encounter specific health problems, mostly related to the impact of minority stress on their mental and somatic health. On the other hand, the preventive recommendations usually do not account for gender-affirming hormonal or surgical treatments that can alter their biologic or anatomic risk profile. The health of transgender people is an area in which research is yet sparse, professionals seldom trained, and where uncertainty remains. The aim of this review article is to summarize the current state of knowledge and propose recommendations for clinical practice., Competing Interests: Les auteur-trices n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Although the initial management of heart failure is essentially pharmacological, the use of mechanical circulatory support may become necessary in advanced forms. In cardiogenic shock, temporary mechanical circulatory support should be considered, while in more stable forms of advanced heart failure, implantation of a long-term left ventricular assist device (LVAD) can prolong survival and improve patient's quality of life. Recent improvements in LVAD technology have reduced post-implant complications, but the procedure is not without risk and requires close clinical follow-up., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Precision medicine makes it possible to classify patients into groups on the basis of molecular and genetic biomarkers, as well as clinical characteristics, in order to optimize therapeutic response. For example, several types of type 2 diabetes seem to coexist with classic insulin-dependent, autoimmune type 1 diabetes : diabetes with insulinopenia (generally severe), diabetes linked to aging or obesity (less severe), and diabetes with insulin resistance, whose patients will be those with the most numerous complications, notably macrovascular. In this article, we examine the possibilities offered by this new classification of diabetes with a view to personalized medicine., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

With the increasing prevalence of diabetes, we are more frequently confronted to treat pregnant women with pre-existing type 2 diabetes. Thereby, we need to take several factors into account such as glycemic control before and during pregnancy, comorbidities such as overweight/obesity and hypertension, as well as existing complications and the need for changes in diabetes treatment. Pregnancy leads to increased insulin requirements, particularly from the second trimester onwards. In this context, a healthy lifestyle and control of weight gain are also necessary. This article provides an overview of the interdisciplinary management of type 2 diabetes before and during pregnancy and in the postpartum period., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Skin disorders are common in diabetes, affecting both patients with type 1 and type 2 diabetes. These cutaneous manifestations can be classified into three categories: dermatoses associated with the presence of diabetes, cutaneous complications of diabetes (acute and chronic) and dermatoses linked to antidiabetic treatments. These conditions vary considerably in terms of severity (from insignificant cosmetic problems to life-threatening) and prevalence (from relatively frequent to rare). Despite the high prevalence of diabetes and associated skin disorders, the dermatological manifestations of diabetes are generally neglected and often under-diagnosed. Failure to diagnose and treat skin disorders at an early stage can lead to clinical worsening, whereas early detection and treatment can reduce the risk of serious complications., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

C-peptide measurement allows an estimation of the residual endogenous insulin secretion in diabetic patients. Nowadays plasmatic testing is convenient and unexpensive, but we lack standardized tests. Therefore, there are no official recommendation regarding its use. As an indication, in some circumstances, C-peptide measurement could be used to specify the type of diabetes, help guide the treatment strategy and potentially assess the risk for complications. Its use is still limited and not recommended on a routine base for all patients living with diabetes, but in the future, tests standardization and establishment of reference ranges could give more insight on the clinical relevance of C-peptide measurement., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

For the first time, the European Society of Cardiology has drafted guidelines which encompass the management of the entire spectrum of patients with acute coronary syndrome, ranging from cardiogenic shock or cardiac arrest to ST-segment as well as non-ST-segment elevation myocardial infarction, to unstable angina. Some of the modified, as well as new recommendations include cardiac arrest, cardiogenic shock, diagnostic workup, antithrombotic therapy, timing of invasive strategy, intravascular imaging and revascularization in multivessel coronary artery disease. In addition, and for the first time, one entire section is dedicated to the patient's perspective and shared decision., Competing Interests: Le Pr M. Roffi déclare des fonds de recherche en faveur de l’institution de la part de Cordis, Terumo, Medtronic, Boston Scientific et Biotronik sans lien avec l’article publié. Le Dr J. F. Iglesias déclare des fonds de recherche en faveur de l’institution de la part de Abbott Vascular, Astra Zeneca, Biosensors, Biotronik, Concept Medical, Philips, and Terumo Corporation sans lien avec l’article publié ainsi que des honoraires d’orateurs de la part de AstraZeneca, Biosensors, Biotronik, Bristol Myers Squibb, Cordis, Concept Medical, Medalliance, Medtronic, Novartis, Terumo Corporation, Pfizer, et Philips, sans lien avec l’article publié. La Dre S. Degrauwe déclare des fonds de recherche en faveur de l’institution de la part de Biotronik et Abbott sans lien avec l’article publié ainsi que des honoraires d’orateurs de la part de Biotronik, Medalliance, Medtronic, SIS Medical, Vascular Medical, Cordis, Shockwave, Orbus Neich, Boston Scientific, sans lien avec l’article publié.

Heart failure with preserved ejection fraction (HFpEF), defined as ≥50 %, affects 1 to 3 % of the population and represents a diagnostic challenge. Clinical scores have been developed to facilitate the diagnosis of affected patients, who can now benefit from new treatments. Recent studies have shown a reduction in cardiovascular morbidity and mortality with sodium-glucose cotransporter-2 (SGLT-2) inhibitors in this population. Other promising drugs, currently in the study phase, could potentially change the management approach in the near future. Finally, controlling symptoms, signs of congestion and the frequently encountered comorbidities in this population remain crucial., Competing Interests: P. Meyer a activement participé à des conseils consultatifs et des séminaires organisés par Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Novartis, Pfizer, Servier et Vifor. Les honoraires perçus pour ces engagements ont été entièrement versés depuis 2015 à la fondation GEcor, fondation pour la recherche de la cardiologie universitaire de Genève. V. Valiton a participé à des conseils consultatifs organisés par AstraZeneca et des frais d’orateurs de Vifor et Pfizor. Les honoraires perçus pour ces engagements ont été entièrement versés à la fondation GEcor. N. K. Poku a activement participé à des séminaires organisés par Abbott, AstraZeneca, Boehringer Ingelheim, Pfizer, Servier et Vifor. Les honoraires perçus pour ces engagements ont été entièrement versés à la fondation GEcor. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In up to 30-40% of the cases acute coronary syndrome (ACS) is complicated by cardiac arrhythmias. The latter can be benign or malignant and mainly occur during the first 24 hours after myocardial infarction. Ischemia time being the key factor, arrythmias decreased dramatically since the implementation of accelerated reperfusion strategies. Bradyarrhythmias are often benign and self-limiting and are less frequent than tachyarrhythmias but can sometimes require specific treatment. The objective of this article is to provide an update on bradycardia and conduction system disorders occurring during ACS and their management., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

This is a selection of some important studies recently published and dealing with several key organization and functioning features of family medicine. This year, the articles focus on organizational responses to emergencies in family medicine. In this field, the use of primary care professionals other than physicians is an interesting solution. One article examines direct access to a physiotherapist, with very positive results, while a second explores the wide-ranging skills of advanced practice nurses in the emergency field. In some countries, such as Belgium, the use of teleconsultation in primary care is also being considered to avoid inappropriate use of hospital emergencies. Finally, more macroscopic organizational aspects of the healthcare system and the role of primary care in health emergencies will be considered in the last article., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Family doctors have to provide the geriatric cares needed by an aging population. In particular, the increased complexity of care needs in the population living in long term care facilities (LCTF) raises several challenges. One of these challenges is the adequate training of physicians working in LCTF as well as the next generation. Residency programs in LTCFs for future general practioners has demonstrated their value abroad. We describe here the creation of a residency program in LTCF for family doctors in Canton Vaud. Since its beginning in 2020, the program has not only trained young physicians but has also improved interprofessionality and strengthened the training of other healthcare professionals., Competing Interests: Les auteurs de cet article sont liés et impliqués dans le projet d’assistanat en EMS et, à ce titre, intéressés à son devenir.

Breast cancer claims fewer lives in Switzerland, but it profoundly impacts the quality of life, with various treatments carrying significant side effects. Cancer treatments include physiotherapy as soon as possible. Physiotherapist, movement expert, using physical activity, enhances survival rates, reduces treatment-related side effects, and improves quality of life. After surgery, it addresses pain, functional limitations, and lymphatic issues. In the long term, it not only reduces the risk of recurrence of cancer but also enhances post-treatment quality of life and aids in the reintegration with one's "new" body. It empowers patients to actively engage in their treatment, illness, and recovery., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Marburg virus disease (MVD) is a dreadful but exceptional disease. Formerly mainly identified in Uganda, Angola and the Democratic Republic of Congo, it has recently appeared in the Republic of Guinea, Ghana, Equatorial Guinea and Tanzania, adding West Africa to the affected regions. Humans become infected through exposure to bats Roussettus aegyptiacus or during unprotected care of infected people. Five cases are linked to travellers, the last one dates to 2008 and involved a visit to caves colonized by bats. At present, there is no specific treatment or vaccine. Despite its rarity, adventurous travelers should be aware of the risks of exposure and avoid entering places inhabited by bats., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Immunosuppressed persons are a heterogeneous population that represents approximately 3 % of the adult population. They are more vulnerable to infectious agents, such as SARS-CoV-2. This is reflected by a reduced response to vaccination, a higher rate of progression towards a severe form of the disease, and recurrent or persistent infections associated with intra-host viral evolution. This review summarizes the evidence regarding vaccine efficacy, clinical and virological singularities, and the management in immunosuppressed patients., Competing Interests: La Pre Calmy est l’investigatrice principale de l’étude OPTICOV. Le Pr Hentzien est le co-président du conseil scientifique de l’essai OPTICOV. La Pre Eckerle et la Dre Fedeli participent à l’étude OPTICOV. La première auteure n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Antibiotic resistance is a public health emergency requiring a concerted approach and motivating the implementation of antibiotic stewardship programmes. As part of an institutional project at the Centre hospitalier universitaire vaudois, we collected data on the appropriateness of antimicrobial prescriptions in various medical and surgical departments in order to identify areas for improvement. The results show that there is room for improvement and that there are differences between departments, particularly regarding surgical prophylaxis administered beyond the operating time, adaptation of the spectrum and duration. Prescribing appropriateness data is an essential complement to consumption data for adapting effective intervention strategies., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

The number of elderly people is constantly increasing in Switzerland. This population is often at higher risk of infections and concomitant decompensation of underlying comorbidities, in particular cardiac or respiratory diseases. Vaccines are some of the most effective preventive measures for limiting morbidity and mortality related to some of those infections, such as influenza or shingles. In order to improve vaccination coverage, it is essential to inform the patients of the benefits of vaccination, and to plan a catch-up vaccination consultation. The goal of this article is to offer a practical guide for the general practitioner detailing vaccines for the elderly recommended in Switzerland., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

HIV pre-exposure prophylaxis (PrEP) is an effective tool in HIV prevention but is rarely prescribed by primary care physicians. A survey conducted among 147 physicians to assess their knowledge and interest in prescribing PrEP shows that 97% stated they have already heard of PrEP, but their knowledge of its indications, dosage, price, and side-effects is often incomplete or incorrect. For 69% of them, the main obstacle to prescribing PrEP is the lack of training on the subject. However, 70% of physicians express interest in receiving training to confidently prescribe PrEP to their patients. To address this demand, the clinical recommendations of the SwissPrEPared program are summarized., Competing Interests: L’institution du Pr M. Cavassini a reçu des fonds de recherche et des dédommagements financier pour avis d’expert de Gilead, MSD et Viiv. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Since its first description in 1855, our understanding of primary adrenal insufficiency has greatly evolved. However, diagnosis is often delayed, as symptoms are frequently nonspecific in the early stages of the disease. In this article, we review the classical manifestations, associated diseases, as well as the diagnostic algorithm for primary adrenal insufficiency, aiming to enable earlier diagnosis., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.