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Atopic dermatitis as well as psoriasis are characterized as common, chronic, often long lasting disorders of the cutis. In case of (a) a refractory out-patient therapy, (b) an acute severe exacerbation of skin lesions, (c) functional impairment of hands and feet, (d) suberythroderma or erythroderma, (e) complex topical as well as systemic treatment modalities, (f) complicating somatic or psychological comorbidity, a referral to in-patient treatment at high altitude must be considered. The therapy at the Hoch-gebirgsklinik Davos (1'560 m above see level) is characterized by application of natural-borne UV radiation all year round, missing house dust mite allergen, massive reduction of pollens and mycotic spores, improvement of skin perfusion as well as a reduction in itching (as compared to low altitude regions). Last but not least, silence and distance from home and company may show benefits for psychological an cutaneous well-being the 24-hour daily presence of dermatology experts, a broad armamentarium of topical an systemic treatment modalities as well as wide range of up-to-date diagnostic and therapeutic tools have to be further mentioned. [ABSTRACT FROM AUTHOR]

This multicentre, prospective cohort study measured the effect of romosozumab for 12 months on bone mineral density, taking into account prior therapies. Prior antiresorptive therapy blunted the BMD response to romosozumab, and the duration was correlated with BMD changes at both the lumbar spine and total hip., Introduction: In Switzerland, romosozumab is administered to high-risk osteoporosis patients. Our study aimed to assess the effect of romosozumab on bone mineral density (BMD), taking into account prior therapies., Methods: This multicentre, prospective cohort study measured the effect of romosozumab for 12 months in patients in a nationwide Swiss osteoporosis registry. BMD and bone turnover marker (P1NP and CTX) changes were measured and compared between pre-treated and treatment naïve patients., Results: Ninety-nine patients (92 women and 7 men, median age 71 years [65, 76]) were enrolled from January 2021 to December 2023. Among them, 22 had no prior treatment before romosozumab, while 77 had previous therapy (including 23 with a history of prior teriparatide therapy), with a median duration of 6 years [4, 11] of cumulative antiresorptive treatment. Over 12 months, romosozumab led to BMD changes of 10.3% [7.5, 15.5] at the lumbar spine, 3.1% [1.1, 5.8] at the total hip and 3.1% [0.5, 5.3] at the femoral neck, indicating notable variability. Significantly lower BMD responses were observed in pre-treated patients, with the duration of prior antiresorptive therapy inversely associated with BMD increases at the lumbar spine and hip. Other predictors of BMD changes at the total hip included baseline T-scores at the hip, body mass index and baseline CTX level, while the BMD response at the lumbar spine was associated with the lumbar spine T-score at baseline, age and baseline CTX level., Conclusion: Prior antiresorptive therapy blunted the BMD response to romosozumab, and the duration was correlated with BMD changes at both the lumbar spine and total hip., (© 2024. The Author(s).)

Objective: To provide the first update on drug safety profiles and adverse drug reactions (ADRs) associated with fetal disorders from the Swiss national ADR database., Methods: We conducted a retrospective study using data from 202 pharmacovigilance reports on drug-associated fetal disorders from the Swiss national ADR database from 1990 to 2009. Evaluated aspects included administrative information on the report, drug exposure, and disorders., Results: The ADR reporting frequency on the topic of fetal disorders has increased during the last 20 years, from only 1 report in 1991 to a maximum of 31 reports in 2008. Nervous system drugs were the most frequently reported drug group (40.2%) above all antidepressants and antiepileptics. The highest level of overall drug intake could be observed for the 1st trimester (85.4%), especially for the first 6 weeks of pregnancy. The most frequently reported types of fetal disorders were malformations (68.8%), especially those of the musculoskeletal and circulatory systems. A positive association was discovered between antiepileptics and malformations in general and in particular of the circulatory system and the eye, ear, face, and neck., Conclusions: The results suggest that the nervous system drug group bears an especially high risk for malformations. The most commonly identified drug exposures can help focus pharmacoepidemiologic efforts in drug-induced birth defects.

Atopic dermatitis as well as psoriasis are characterized as common, chronic, often long lasting disorders of the cutis. In case of (a) a refractory out-patient therapy, (b) an acute severe exacerbation of skin lesions, (c) functional impairment of hands and feet, (d) suberythroderma or erythroderma, (e) complex topical as well as systemic treatment modalities, (f) complicating somatic or psychological co-morbidity, a referral to in-patient treatment at high altitude must be considered. The therapy at the Hochgebirgsklinik Davos (1,560 m above sea level) is characterized by application of natural-borne UV radiation all year round, missing house dust mite allergen, massive reduction of pollens and mycotic spores, improvement of skin perfusion as well as a reduction in itching (as compared to low altitude regions). Last but not least, silence and distance from home and company may show benefits for psychological and cutaneous well-being the 24-hour daily presence of dermatology experts, a broad armamentarium of topical and systemic treatment modalities as well as wide range of up-to-date diagnostic and therapeutic tools have to be further mentioned.

Since 1991, 6 years after the recommendation of universal childhood vaccination against measles, mumps, and rubella (MMR triple vaccine), Switzerland is confronted with a large number of mumps cases affecting both vaccinated and unvaccinated children. Up to 80% of the children suffering from mumps between 1991 and 1995 had previously been vaccinated, the majority with the Rubini vaccine strain. On the basis of a case-control study including 102 patients and 92 controls from the same pediatric population, a study of the humoral immune-response following vaccination with the Rubini vaccine in 6 young adult volunteers, and two different genetic studies, we investigated the complex problem of large scale vaccine failure in Switzerland. We conclude that the recently reported large number of Swiss mumps cases was caused by at least four interacting factors: 1. A vaccine coverage of 90-95% at the age of 2 years is necessary to interrupt mumps wild virus circulation. The nationwide vaccine coverage in Switzerland of some 80% in 27-36 month-old children is too low. 2. Primary vaccine failures (absence of seroconversion or unprotective low levels of neutralizing antibodies), as well as secondary vaccine failures due to the rapid decline of antibodies to mumps virus in our volunteers and controls, seem to be frequent after vaccination with the Rubini strain. 3. Despite its reported Swiss origin, the Rubini strain does not belong to the mumps virus lineages recently circulating in this area but is closely related to American mumps virus strains. 4. Differences in protein structure between the vaccine strain and the circulating wild type strains, and in particular a different neutralization epitope in the hemagglutinin neuraminidase protein, may additionally contribute to the lack of protection in vaccinated individuals.

Since 1991, 6 years after the recommendation of universal childhood triple vaccination against measles, mumps and rubella (M + M + R), Switzerland has been confronted with an increasing number of mumps cases affecting both vaccinated and unvaccinated children. The M + M + R vaccine mainly used in the Swiss population after 1986 contains the highly attenuated Rubini strain of mumps virus. We analysed an outbreak of 102 suspected mumps cases by virus isolation, determination of IgM antibodies to mumps virus in 27 acute phase sera, and verification of vaccination histories. Mumps was confirmed by virus isolation in 88 patients, of whom 72 had previously received the Rubini vaccine strain. IgM antibodies to mumps virus were detected in 24/27 acute phase serum samples. A group of 92 subjects from the same geographic area without signs of mumps virus infection served as controls. IgG antibodies to mumps virus and vaccination status were assessed in these children. The vaccination rate in these controls was 61%, with equal seropositivity for unvaccinated and Rubini-vaccinated subjects. These data support other recent reports which indicate an insufficient protective efficacy of current mumps vaccines.

Two studies are presented. The first one concerns a mumps outbreak in a kindergarten in Geneva in June 1991. Of 26 children, nine (34.6%) got mumps. Of nine children vaccinated with the Rubini vaccine strain, seven had the disease as opposed to only one of 14 children vaccinated with the Urabe strain. The vaccine efficacy of the Rubini strain was estimated at 22% with a 95% confidence interval of -10% to 45%. The second study concerns a cluster of 112 mumps patients seen by a pediatrician in the Bernese Jura region between September 1992 and May 1993. A case-control study was carried out resulting in a vaccine efficacy estimate of 50% with a 95% confidence interval of -19% to 81%. Of the cases, 51 (45.5%) had been vaccinated against mumps, 50 of them (98%) with the Rubini vaccine strain. Of the controls, 30 (61.2%) had been vaccinated, 86.7% of them with Rubini. Methodological problems of case selection and their possible effects on the estimated vaccine efficacy are discussed. The results of these two studies have been confirmed by more recent investigations. In retrospect, we therefore conclude that small studies can serve as early indicators for epidemiological evidence and that they can be finally integrated into a more complete picture.