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Zusammenfassung. Untersuchungen in der Schweiz, Deutschland und Österreich haben gezeigt, dass Dooring-Unfälle (Unfälle von Radfahrenden, die von einer geöffneten Tür eines Kraftfahrzeugs erfasst werden) entgegen der weitläufigen Meinung zu den häufigen Fahrradunfällen zählen. Die resultierenden Verletzungen sind häufig schwerwiegend und führen oft zur Vorstellung und Behandlung in einem Krankenhaus. Es wurden retrospektiv alle Dooring-Unfälle des universitären Notfallzentrums des Inselspitals Bern der Jahre 2012 bis 2021 identifiziert und ausgewertet. Die Daten wurden aus der Datenbank des Managementsystems des Universitätsspitals Bern mittels einer Suchabfrage mit den Keywords auf Deutsch: «Autotüre», «Autotuere», «Dooring» generiert und anonymisiert. Die meisten Verunfallten waren weiblichen Geschlechts und durchschnittlich 34 Jahre alt; Verletzungen fanden sich vor allem an Kopf und Extremitäten. Die Behandlung konnte meist ambulant erfolgen. Der ISS (Injury Severity Score) betrug durchschnittlich 3,5. Ein Patient musste notoperiert werden. Dies ist die erste Schweizer Studie, die Dooring-Unfälle systematisch erfasst und auswertet. Da Radfahren vor allem im städtischen Raum im Trend liegt und folglich die Zahl der Radfahrenden stetig steigt, ist davon auszugehen, dass auch die Anzahl an Dooring-Verletzten zunehmen wird und entsprechende Präventionsmassnahmen getroffen werden müssen. Die gegenwärtige COVID-19-Pandemie verschärft die Problematik, da im Rahmen des Infektionsschutzes die Anzahl an Radfahrenden und folglich auch an Unfällen insbesondere im städtischen Raum zunimmt. Diesbezüglich sind beispielweise Kenntnisse über die Unfallzeit und die verunfallten Personen durch entsprechende Studien besonders wichtig, um passende Gegen- und Schutzmassnahmen ergreifen zu können.

E-scooters have gained popularity worldwide in the last few years. Due to the increase in users, more accidents related to e-scooters can be observed. The present study aimed to analyse epidemiological data, characteristics, and severity of injuries in patients admitted to a Level I trauma centre in Switzerland (Inselspital Bern, University Hospital Bern) after accidents associated with e-scooters. This retrospective case series evaluated 23 patients who presented to the University Hospital of Bern between 1 of May 2019 and 31 of October 2021 after an e-scooter accident. Data were collected on patient demographics, time and cause of the accident, speed, alcohol consumption, helmet use, type and localisation of injury, number of injuries per patient, and outcome. Men were most frequently affected (61.9%). The mean age was 35.8 (STD 14.8) years. Slightly more than half (52.2%) of all accidents were self-inflicted. Most accidents were reported during the night (7 p.m. to 7 a.m., 60.9%) and in summer (43.5%). Alcohol consumption was reported in 43.5% of cases, with a mean blood alcohol level of 1.4 g/l. Most injuries were observed in the face (25.3%) and head/neck area (20.25%). Skin abrasions (56.5%) and traumatic brain injury (43.5%) were the most common types of traumata in terms of total number of patients. Only in one case it was reported that a protective helmet had been worn. Five patients required hospitalisation and four patients underwent surgery. Three patients underwent emergency orthopaedic surgery, and one patient underwent emergency neurosurgery. E-scooter accidents result in a significant number of facial and head/neck injuries. E-scooter riders would potentially benefit from a helmet to protect them in the event of an accident. Additionally, the results of this study indicate that a significant number of e-scooter accidents in Switzerland occurred under the influence of alcohol. Prevention campaigns to raise awareness of the risks of driving e-scooters under the influence of alcohol could help prevent future accidents.

Zusammenfassung. Die Zahl der Gewaltdelikte im Bereich häuslicher Gewalt steigt seit 2011 in der Schweiz kontinuierlich an. Das Universitäre Notfallzentrum Bern UNZ etablierte im November 2018 eine standardisierte Betreuung von Betroffenen von häuslicher Gewalt mit einer integrierten Nachkontrolle. In der vorliegenden retrospektiven Studie sind die Resultate sowie Herausforderungen ein Jahr nach der Einrichtung der Spezialsprechstunde zusammengetragen. Von den 53 primär im Notfallzentrum aufgrund HG behandelten Personen wurde 69,8 % (n = 37) ein Nachkontrolltermin angeboten. Spezifischen Subgruppen wurden weniger oft Nachkontrolltermine angeboten. Es zeigte sich, dass trotz Handlungsanleitung und Schulungen nicht alle Betroffenen gleich wahrgenommen werden.

Background: Adolescents aged sixteen to eighteen years are mostly treated in adult emergency departments. In a study at our tertiary adult emergency department (ED) at the University Hospital in Bern (Inselspital), Switzerland, we found that adolescents significantly more often present with psychiatric problems than adults. The study at hand aimed to characterise those adolescents presenting to the ED triaged with a chief complaint regarding mental health. Furthermore, the goal was to assess sex differences in terms of diagnosis, suicidal ideation, substance use, as well as social impact. Methods: We conducted a single-centre, retrospective review of presentations to our adult ED related to the mental health of adolescents aged 16 to 18 years, covering the period from January 2013 to July 2017. Anonymised data were extracted from medical reports referring to the ED visits that were triaged as mental-health-related, and we assessed these for diagnosis, acute and previous suicidal ideation, history of self-harm, external aggression, substance use and social problems. We focused on patient characterisation and defining sex differences. Results: Data were analysed for a total of 612 consultations by adolescents who presented to our ED with problems related to mental health. Women accounted for 61.1% of cases. The most frequent diagnoses were reactions to severe stress and adjustment disorders (19.1%), followed by alcohol use disorders (17.6%), intentional self-harm (17.3%), and affective disorders (13.7%). Males had lower odds for intentional self-harm (OR 0.10, 95% 0.05–0.21, p < 0.001) as well as disorders of personality and behaviour (OR 0.09, 95% 0.21–0.37, p < 0.001), whereas they had higher odds of being admitted due to use of alcohol (OR 2.51, 95% 1.65–3.83, p < 0.001). Of all cases, 31.7% reported acute suicidal ideation, with a significantly lower odds ratio in males (OR 0.58, 95% 0.41–0.84, p = 0.004). The most common source for referral to the ED was family members (25.2%). Males had twice the odds of reporting alcohol consumption as well as use of cannabis (in both cases p < 0.001). In 27.9% of all cases, familial problems were reported, with males having significantly lower odds of being exposed to these (OR 0.64, 95% 0.44–0.94, p = 0.021), whereas they had higher odds of reporting educational problems (OR 1.68, 95% 1.04–2.72, p = 0.035). Conclusions: Adolescents aged sixteen to eighteen years presenting to the ED with problems related to mental health are an important subgroup of ED presentations and should be thoroughly assessed for suicidal ideation, substance use, as well as familial and educational problems. Assessment and establishment of post-ED care are of particular importance in this vulnerable patient group.

Dooring Bicycle Accidents with Severe Injury Patterns: 10-Year Study of a Level 1 Trauma Center

Background Anaphylaxis is a medical emergency and requires prompt treatment to prevent life threatening conditions. Epinephrine considered as the first-line drug is often not administered. We aimed first to analyze the use of epinephrine in patients with anaphylaxis in the emergency department of a University Hospital and secondly to identify factors that influence the use of epinephrine. Methods We performed a retrospective analysis of all patients who were admitted with moderate or severe anaphylaxis to the emergency department between 1 January 2013 to 31 December 2018. Patient characteristics and treatment information were extracted from the electronic medical database or manually of the full emergency department discharge report. Results A total of 531 (0.2%) patients with moderate or severe anaphylaxis out of 260'485 patients admitted to the emergency department were included. Epinephrine was administered in 252 patients (47.3%). In a multivariate logistic regression cardiovascular (ORCARD = 2.94, CI 1.96–4.46, p RESP=3.14, CI 1.95–5.14, p INTEGU = 0.98, CI 0.54–1.81, p = 0.961) and gastrointestinal symptoms (ORGAST=0.62, CI 0.39–1.00, p = 0.053). Conclusions Less than half of the patients with moderate and severe anaphylaxis received epinephrine according to guidelines. In particular, gastrointestinal symptoms seem to be misrecognized as serious symptoms of anaphylaxis. Training of the rescue service and emergency department medical staff and further awareness are crucial to increase the administration rate of epinephrine in anaphylaxis.

Zusammenfassung. Feuerwerkskörper werden häufig zum Feiern von nationalen, kulturellen oder religiösen Anlässen verwendet. Trotz strenger gesetzlicher Regelungen geschehen immer wieder Unfälle im Zusammenhang mit Feuerwerk. Besonders die unvorsichtige Handhabung von Sprengkörpern stellt ein grosses Verletzungsrisiko dar. Methode: Dies ist eine retrospektive Studie basierend auf Daten des UNZ Inselspital Bern im Zeitraum 1. Januar 2013 bis 31. Dezember 2019. Es wurden unter anderem folgende Parameter analysiert: Geschlecht, Alter, Verletzungsmuster und Therapie. Resultate: Es konnten 59 Patientinnen und Patienten in die Studie eingeschlossen werden. Davon waren 81,4 % männlich, das Durchschnittsalter betrug 31 Jahre (Range 16–73; SD = 11,3). Ein Grossteil der Fälle (83,6 %) betraf den Kopf mit Beeinträchtigung der Ohren/des Gehörs sowie Verletzungen der Augen und des Gesichts. Die meisten Verletzungen waren Monotraumata, nur 6,8 % der Verletzungen betrafen mehrere Körperregionen. Insgesamt mussten neun Patienten aufgrund schwerwiegender Verletzungen hospitalisiert werden. Hiervon betraf eine Verletzung die Augen, die restlichen acht Verletzungen betrafen die Hände. Ausschliesslich bei diesen acht Patienten war eine operative Versorgung der Verletzungen nötig. Schlussfolgerung: Feuerwerkskörper sind mit einem beträchtlichen Verletzungsrisiko verbunden, vor allem bei unsicherer Handhabung. Unsere Studie zeigte, dass schwere Verletzungen vor allem die Hände betreffen. Zur Vermeidung solcher Verletzungen wäre eine systematische Datenerhebung von Verletzungen mit Feuerwerkskörpern nötig, da viele Verletzte in kleineren, peripheren Krankenhäusern oder gar nicht vorstellig werden. Anhand dieser Daten liessen sich umfassendere und detaillierte Präventionsstrategien entwickeln, die Verletzungen durch Feuerwerkskörper vorbeugen könnten.

Four decades of civil war, violence, and destabilisation have forced millions of Afghans to flee their homes and to move to other countries worldwide. This increasing phenomenon may challenge physicians unfamiliar with the health status of this population, which may be markedly different from that of the host country. Moreover, several factors during their migration, such as transport in closed containers, accidental injuries, malnutrition, and accommodation in detention centres and refugee camps have a major influence on the health of refugees. By taking into account the variety of the specific diseases among migrant groups, the diversity of the origins of refugees and asylum seekers, and the increasing numbers of Afghan refugees, in this review we focus on the population of Afghans and describe their health status with the aim of optimising our medical approach and management. Our literature review shows that the most prevalent reported infections are tuberculosis and other respiratory tract infections and parasitic diseases, for example leishmaniasis, malaria, and intestinal parasitic infections. Anaemia, hyperlipidaemia, arterial hypertension, diabetes, smoking, overweight, malnutrition, low socioeconomic status, and poor access to healthcare facilities are additional risk factors for non-communicable diseases among Afghan refugees. With regards mental health issues, depression and post-traumatic stress disorder (PTSD) are the most common diagnoses and culture shock and the feeling of being uprooted modulate their persistence. Further research is needed in order to provide us with extensive, high-quality data about the health status of Afghan refugees. The main objective of this review is to identify protective factors which could ensure key health concepts and good clinical practice.

Purpose: Only a few studies have been conducted on trampoline-associated injuries in adults, especially in Switzerland. The aim of the present study was to describe the characteristics of trampoline-related injuries in patients older than 16 years of age and track their development over time by comparing two different time periods. Methods and Materials: Data were gathered from the emergency department (ED) of Bern University Hospital. A retrospective design was chosen to allow analysis of changes in trampolining accidents between 2003–2020. Results: A total of 144 patients were enrolled. The number of ED presentations due to trampoline-related injury rose significantly over time. The most common injuries were sprains to the extremities (age group 31–62: 58.4% and age group 16–30: 50.8%), followed by fractures (age group 31–62: 33.3% and age group 16–30: 32.5%). Lower extremities appeared to be the most frequently injured body region (age group 31–62: 20.8% and age group 16–30: 10.0%), although the differences were not statistically significant, p = 0.363. BMI was significantly higher for older than for younger patients (p = 0.004). Conclusion: Over the last two decades, trampoline-related injuries have become more common in patients older than 16 years of age. These are most common in the lower extremities. While most of the patients in the present study only suffered minor injuries, the occasional severe injury might result in long-term disability. As trampoline-related injuries in adults are becoming more common, prevention strategies in public education and safety instructions must be optimised.

Occupational injuries are one of the main causes of Emergency Department visits and represent a substantial source of disability or even death. However, the published studies and reports on construction–occupational accidents in Switzerland are limited. We aimed to investigate the epidemiology of fatal and non-fatal injuries among construction workers older than 16 years of age over a 5-year period. Data were gathered from the emergency department (ED) of Bern University Hospital. A retrospective design was chosen to allow analysis of changes in construction accidents between 2016–2020. A total of 397 patients were enrolled. Compared to studies in other countries, we also showed that the upper extremity and falling from height is the most common injured body part and mechanism of injury. Furthermore, we were able to show that the most common age group representing was 26–35 years and the second common body part injured was the head, which is a difference from studies in other countries. Wound lacerations were the most common type of injury, followed by joint distortions. By stratifying according to the season, occupational injuries among construction workers were found to be significant higher during summer and autumn. As work-related injuries among construction workers are becoming more common, prevention strategies and safety instructions must be optimized.

Lessons Learned - Observational Study After One Year of 'Domestic Violence Consultation' at the University Emergency Department Bern

Background: In many large hospitals in Switzerland, adolescents 16 years and older are treated in adult emergency departments (ED). There have been few publications about this specific patient population, especially in Switzerland. This study aims to provide an overview of emergency presentations of adolescents between 16–18 years of age when compared to adults and focuses on their principle complaints. Methods: We conducted a single-centre, retrospective, cross-sectional study of all patients aged 16 years and older presenting to the adult ED at the University Hospital (Inselspital) in Bern, Switzerland, from 2013 to 2017. This analysis gives an overview of emergency presentations of adolescents between 16–18 years of age in this time period and compares their consultation characteristics to those of adult patients. Results: Data of a total of 203,817 patients who presented to our adult ED between 2013 and 2017 were analysed. Adolescents account for 2.5% of all emergency presentations. The number of ED presentations in the reviewed time period rose for adults (+2368, 95% CI: 1695, 3041, p = 0.002 consultations more per year, +25% comparing 2013 with 2017), while adolescent presentations did not significantly increase (p = 0.420). In comparison to adult patients, adolescents presented significantly more often during the night (39.1% vs. 31.5%, p &lt, 0.001), as walk-ins (54.2% vs. 44.9%, p &lt, 0.001), or with less highly acute complaints at triage (21% vs. 31%, p &lt, 0.001). They were more likely to be discharged (70.8% vs. 52.2%, p &lt, 0.001). We found a significant association between the two age groups and principle complaints. In comparison to adults, trauma and psychiatric problems were significantly more common among adolescents. Conclusions: Our data showed that complaints in adolescent patients under 18 years of age significantly differ from those in older patients. The artificial age cut-off therefore puts this vulnerable population at risk of receiving inadequate diagnostic testing and treatment adapted only for adults. Additional studies are needed on the reasons adolescents and young adults seek ED care, as this could lead to improvements in the care processes for this vulnerable population.

Zusammenfassung. Gartenarbeit ist eine beliebte Freizeitaktivität in der Schweiz. Pro Jahr werden ungefähr eine Million Nichtberufsunfälle registriert, davon ereignen sich etwa 600 000 zu Hause oder während der Ausübung eines Hobbies, einschliesslich 16 000 Unfällen bei der Gartenarbeit. Ziel dieser retrospektiven Analyse ist die Untersuchung von Gartenarbeitsunfällen. Die Daten wurden aus der elektronischen Datenbank des Universitären Notfallzentrums des Inselspitals Bern gesammelt und retrospektiv ausgewertet. Patienten im Alter von 16 Jahren oder älter, die einen Unfall während der Gartenarbeit als Freizeitaktivität erlitten, wurden in die Analyse eingeschlossen. Jüngere Patienten wurden in einem separaten Notfallzentrum für Kinder und Jugendliche behandelt und somit nicht ausgewertet. Anschliessend wurden die Daten nach Alter, Geschlecht, Triagekategorie, Unfallmechanismus, unfallverursachendem Objekt, betroffenen Körperregionen, Diagnosen, Schweregrad der Verletzung (monotraumatisch, kombiniert mit mehr als einer betroffenen Körperregion oder Polytrauma) und ambulanter oder stationärer Behandlung analysiert. Unfälle bei der privaten Gartenarbeit ereigneten sich vorwiegend bei Erwachsenen im Alter von 40–69 Jahren. Dabei waren Männer häufiger als Frauen betroffen. Die Patienten zogen sich vorwiegend Augenverletzungen und Hautwunden zu. Exponierte Körperstellen wie Augen, Finger, Kopf und Gesicht waren am häufigsten betroffen. Es handelte sich vorwiegend um monotraumatische Verletzungen, die ambulant behandelt werden konnten. Stürze und ähnliche Ereignisse wie Stolpern führten häufig zu Unfällen. Unfälle wurden hauptsächlich durch organisches Material oder durch die fehlerhafte und nachlässige Anwendung von Werkzeugen verursacht. Die Datenanalyse zeigte, dass ein Grossteil der Unfälle durch einfache Präventionsmassnahmen verhindert werden könnten.

Obesity, as a major risk factor of metabolic syndrome (MetS), represents a pandemic, especially in Western societies, and is considered a risk factor for malignancies. Helicobacter pylori (Hp), is a definite carcinogen with global distribution. We aimed to investigate, for the first time in Switzerland, the main gastric mucosa premalignant histological lesions of bariatric patients in correlation with MetS components and Hp Infection (Hp-I). By reviewing retrospectively 94304 patient cases, a total of 116 eligible patients having undergone bariatric surgery were identified. The mean patient age was 48.66 years. Hp(+) patients were 24% (28/116). Presence of gastric mucosa atrophy was documented in 8/28 Hp(+) patients (29%) and (2/88) Hp(−) ones (2%) (p = 0.006). Gastric mucosa intestinal metaplasia was observed in 14/28 (50%) Hp(+) patients versus 3/88 (3.4%) of Hp(-) group (p &lt, 0.0001). Hp(+) patients exhibited statistically higher arterial hypertension (p = 0.033). The homeostatic model of assessment insulin resistance was also statistically significantly higher for the Hp(+) group (p &lt, 0.001). In a multivariate analysis, including arterial hypertension, gastric mucosa atrophy, and intestinal metaplasia as variables, statistical significance remained only for intestinal metaplasia (p = 0.001). In conclusion, Hp-I is associated with premalignant gastric mucosa histologic lesions and MetS components, including arterial hypertension and IR. Further large-scale prospective studies are required to confirm these findings.

Hazard or Harmless Fun? Injuries Caused by Fireworks -Study at the University Emergency Department (2013-2019)We conducted a retrospective study based on data from the Emergency Department of the University Hospital in Bern between January 1st 2013 and December 31st 2019. Among others, the following parameters were analyzed: gender, age, type of injury and therapy.We were able to include 59 patients in our study. 81.4 % were men, the mean age was 31 years (range 16-73; SD = 11.3). In a majority of all cases (83.6 %) the ears, eyes and face were affected. Most injuries were monotraumatic, only 6.8 % of all patients suffered from injuries on multiple body regions. A total of nine patients had to be hospitalised due to serious injuries. Of these, one injury concerned the eyes, the remaining eight injuries concerned the hands. Only these eight patients required surgical treatment of their injuries.Fireworks are associated with a substantial risk for injuries, especially when used uncautiously. Our study showed that serious injuries mainly affect the hands. To prevent such injuries, systematic data collection on injuries caused by fireworks would be necessary, as many injured patients are hospitalised in smaller, peripheral hospitals or not at all. These data would allow for the development of more comprehensive and detailed prevention strategies that could prevent fireworks injuries.

Background: As more and more people are travelling abroad, there are also increasing numbers who fall ill or have accidents in foreign countries. Some patients must be repatriated. While it has been reported that the number of repatriations is rising steadily, little is known about patients’ characteristics, calling for in depth investigations of this patient group. Methods: We have conducted a retrospective study including 447 patients repatriated to the Emergency Department at the University Hospital (Inselspital) in Bern, Switzerland from 2013–2018. Results: Between 2013 and 2018, the number of repatriated patients increased by 42.6%, from 54 to 77 cases. In total, 59% of these patients were male and the median age was 60 years. Overall, 79% of patients were repatriated from European countries, with the top five countries being Italy, France, Spain, Germany and Austria. About half the cases (51.9%) were caused by illness, the other half by accidents. In total, 127 patients had to undergo surgical intervention abroad, another 194 patients underwent surgery after repatriation. The hospitalization rate was 81.4%, with a median length of in-hospital stay of 9 days (IQR 5–14) at the Inselspital. The mortality rate of at the Inselspital hospitalized patients was 4.4%, with 16 patients dying within the first 30 days after repatriation. The median cost per case was 12,005.79 CHF (IQR 4717.66–24,462.79). A multiple regression analysis showed a significant association of total costs with hospitalization (p = 0.001), surgical intervention (p = 0.001), as well as treatment in the intensive care unit (p = 0.001). Conclusions: The number of repatriations has been continuously increasing in recent years and reached a mean value of more than one case per week at the Inselspital (77 cases per year in 2018). The 30 day-mortality rate of 4.4% and the median cost per case are relatively high, demonstrating a neglected Public Health concern. These findings may provide impetus—not only for further research into repatriations but also for Public Health Promotion strategies.

Background: The popularity of floorball has surged throughout Switzerland in the last 20 years. However, epidemiological studies are still scarce. Objective: To collect information on floorball-related injuries, their severity and approximate cost in adults who presented to our emergency department from 2013–2019. Moreover, to use this information to suggest possible strategies to prevent injuries. Materials and Methods: The study population includes all patients who suffered injuries related to floorball and were then seen at the University Hospital in Bern during a 7-year period. Bern University Hospital, Switzerland, has a comprehensive management system (Ecare) that was used to generate the data for this study. The data were then used to create an injury profile of all cases presented during the said period. Results: A total of 263 injures were recorded from 2013 to 2019. The most common locations for injuries were to the eyes (43.73%), followed by the lower extremities (25.48%). The mean cost per case was CHF 1191.43. However, the vast majority of admissions could be sent home (93.16%) and did not cost more than 500 CHF/case (57.41%). Of the 22 cases that cost more than CHF 2000, 10 were located around the torso and 6 affected one or both eyes. Significant differences were observed between the age groups and treatment area (p = 0.008), costs (p = 0.008), route of discharge (p = 0.023) and type of trauma (p = 0.020). Conclusion: Although floorball is still a relatively minor sport, its impact on sport-related injuries must not be underestimated. Injuries to the eyes are particularly common. In our opinion, our findings provide strong evidence that all floorball players (not only children and adolescents) should wear protective eyewear. We conclude that the Swiss Floorball Association (Swiss Unihockey) should mandate the use of protective eyewear.

Nonalcoholic fatty liver disease (NAFLD) emerges as an important global burden and Helicobacter pylori infection (Hp-I) has been suggested as a risk factor of NAFLD, although controversy exists. This retrospective study aimed to investigate a potential impact of active Hp-I on NAFLD severity in morbidly obese patients, subjected to bariatric surgery and gastric biopsy for documentation of Hp-I. Of 64 eligible participants, 15 (23.4%) were diagnosed with active Hp-I, showing higher rates of nonalcoholic steatohepatitis (NASH) than those without Hp-I (86.7% vs. 26.5%, respectively, p &lt, 0.001). Concerning histological lesions, steatosis grade (p = 0.027), ballooning (p &lt, 0.001), lobular inflammation (p = 0.003), and fibrosis stage (p &lt, 0.001) were also more severe in Hp-I positive patients. Likewise, liver function tests, insulin resistance, dyslipidemia, and arterial hypertension were significantly higher in Hp-I positive patients. Hp-I was independently positively associated with NASH (beta = 3.27, p = 0.002), severe NASH (beta = 2.37, p = 0.018), and the presence of fibrosis (beta = 3.86, p = 0.001) in a binary regression model, after adjustment for potential confounders. In conclusion, active Hp-&Iota, was independently associated with NASH and fibrosis, findings offering potential clinical implication.

Nonalcoholic fatty liver disease (NAFLD) emerges as an important global burden and Helicobacter pylori infection (Hp-I) has been suggested as a risk factor of NAFLD, although controversy exists. This retrospective study aimed to investigate a potential impact of active Hp-I on NAFLD severity in morbidly obese patients, subjected to bariatric surgery and gastric biopsy for documentation of Hp-I. Of 64 eligible participants, 15 (23.4%) were diagnosed with active Hp-I, showing higher rates of nonalcoholic steatohepatitis (NASH) than those without Hp-I (86.7% vs. 26.5%, respectively; p < 0.001). Concerning histological lesions, steatosis grade (p = 0.027), ballooning (p < 0.001), lobular inflammation (p = 0.003), and fibrosis stage (p < 0.001) were also more severe in Hp-I positive patients. Likewise, liver function tests, insulin resistance, dyslipidemia, and arterial hypertension were significantly higher in Hp-I positive patients. Hp-I was independently positively associated with NASH (beta = 3.27; p = 0.002), severe NASH (beta = 2.37; p = 0.018), and the presence of fibrosis (beta = 3.86; p = 0.001) in a binary regression model, after adjustment for potential confounders. In conclusion, active Hp-Ι was independently associated with NASH and fibrosis, findings offering potential clinical implication.

ObjectivesOutdoor rock climbing has become popular in recent years. However, few data have been published on climbing accidents in Switzerland, even though the Swiss Alps are a major climbing resort.To analyse data on accidents related to outdoor climbing treated in the Emergency Department (ED) of University Hospital Bern, Switzerland.MethodsA retrospective database search for accidents related to outdoor climbing was conducted in the clinical reporting system E.care of the ED of University Hospital Bern for the period April 2012–December 2018.Results78 patients were treated after an accident related to outdoor climbing, which accounted for 1 per 3571 (0.028%) of all ED visits during this period. Mean age was 35.8±10.4 years. 76% of patients were male. Falls were the most common mechanism of injury (64%), followed by rock or ice falling on the climber (21%). Injuries affected multiple body regions (38%) or only the lower limbs (22%). Most injuries were fractures (68%). Mean ISS was 7.5 (1–38), and grade 3 UIAA MedCom injuries were most common (45%). 11 cases of polytrauma occurred and one fatality. 44 patients needed inpatient admission. Mean duration of inpatient stay was 7 days. Mean costs per patient were 12 283 CHF.ConclusionsAccidents related to outdoor climbing accounted for a small number of patients seen in the University ED Bern. Further research should be on a nationwide basis, with collection of specific climbing data like use of a helmet and experience of climbing to inform injury prevention strategies. This should shed further light on this topic, as would a prospective study using the International Alpine Trauma Register.

In the recent years, particular attention was given to the research aimed at optimizing the use of tumour epigenetic markers. One of the best known epigenetic changes associated with the process of carcinogenesis is aberrant DNA methylation. The aim of the present research was to evaluate the methylation profile of genes potentially important in the diagnosis and/or prognosis of equine sarcoids, the most commonly detected skin tumours in Equidae. The methylation status of potential promoter sequences of nine genes: APC, CCND2, CDKN2B, DCC, RARβ, RASSF1, RASSF5, THBS1 and TRPM1, was determined using bisulfite sequencing polymerase chain reaction (BSP-CR). The results of this study did not reveal any changes in the level of DNA methylation in the analysed group of candidate genes between the tumour and healthy tissues. Despite numerous reports describing the aberrant methylation of the promoters of the analysed genes in human cancers, the data obtained did not confirm the existence of such relationships in the examined tumour tissues, which excludes the possibility of using these genes for the diagnosis of the equine sarcoid.

OBJECTIVE: In this study, for the first time we report the genome-wide DNA methylation profile of skin tumour in horses and describe differentially methylated genomic regions (DMRs) with respect to healthy skin. MATERIALS & METHODS: The comparative analysis of DNA methylation patterns detected using Reduced Representation Bisulfite Sequencing (RRBS) technique, allowed identification of 136 regions showing differential methylation between sarcoid and normal skin tissue. RESULTS: Most of the identified DMRs were short fragments, less than 1 kb in size, located in the intergenic regions. Among identified DMRs there were also regions located within genes directly or indirectly related with oncogenesis. We additionally validated 9 CpG sites showing hypomethylation and 9 CpG sites that were hypermethylated in lesional sample, confirming the identified changes in the DNA methylation. CONCLUSION: Knowledge on the changes taking place in the process of DNA methylation may provide a basis for the development of new alternative diagnostic or therapeutic approaches to equine sarcoids.

Diving Accidents in Lakes - a Retrospective Study of a Level-1 Emergency Centre in Switzerland

Medulloblastoma (MB) is a common and highly aggressive pediatric brain tumor of a heterogeneous nature. According to transcriptome-based profiling, four molecular subgroups of MB have been revealed, namely WNT, SHH, Group 3 and Group 4. High MYC mRNA expression and MYC gene amplification in MB have been considered as indicators of poor prognosis. However, the role of c-Myc in MB biology is still not well established. In the present study, the effects of c-Myc activation in UW228-MycER MB cell line were investigated using 4-hydroxytamoxifen (4-OHT) induction system. Upon 4-OHT stimulation, an increase in metabolic activity, large-cell/anaplastic (LC/A) phenotype and oxidative stress-mediated DNA damage were observed. However, 53BP1 foci were not implicated in DNA damage response. Instead, cofilin nuclear translocation, changes in F-actin cytoskeleton and the levels of cytoskeletal proteins were shown. Moreover, the telomere length was found to be unaffected that may be associated with the upregulation of TRF proteins. Transcription of nascent RNA (synthesis of new rRNA) and the expression of RNA polymerase I-specific transcription initiation factor RRN3/TIF-IA were also elevated. Moreover, increased levels of DNMT2, a modulator of stress responses, were observed. A small fraction of cells responded differently as oncogene-induced senescence was also noticed. We postulate that c-Myc-mediated modulation of genetic stability of MB cells may trigger cellular heterogeneity and affect adaptive responses to changing environment., Highlights • c-Myc activation stimulates different reprogramming modes in medulloblastoma cells. • c-Myc activation promotes oxidant-induced DNA damage. • TRF1-TRF2-based DNA damage response protects against telomere erosion. • c-Myc activation results in cofilin-mediated F-actin cytoskeleton remodeling. • Oncogene-induced cellular senescence is also observed.

AIMS OF THE STUDY To describe the characteristics of cases presenting at the emergency department due to (suspected) poisoning for which consultation on patient management with the national Poisons Information Centre was required. METHODS Retrospective study at the emergency department of Bern University Hospital, Switzerland, from May 2012 to December 2017. Cases were identified in the electronic patient database using appropriate full-text search terms. Cases were excluded if the contact with the National Poisons Information Centre was through an external hospital or directly by the patient. Cases in which the poison centre was not contacted and cases without the patient’s general consent to use their medical data for research purposes were also excluded. RESULTS Overall, 667 cases from the study period were included. The median age was 32 years (range 16–94); 405 patients (61%) were female and 262 (39%) male. In most cases, the poisoning was acute (n = 631, 95%) and intentional (n = 505, 76%). The most common route of exposure was ingestion (n = 587, 88%) and the most commonly involved substances were sedatives (n = 185, 28%), antidepressants (n = 162, 24%) and non-opioid analgesics (n = 161, 24%). Impaired consciousness was documented in 299 cases (45%). Approximately half of the cases (n = 359, 54%) were of minor severity as assessed using the Poisoning Severity Score, 142 (21%) were of moderate severity, 110 (16%) were asymptomatic and 56 (8%) were severe. There were no fatalities. In most cases (n = 599, 90%), immediate therapeutic or diagnostic measures were undertaken prior to contact with the poison centre. Decontamination measures and specific antidotes undertaken or administered only after contacting the poison centre included whole bowel irrigation, haemodialysis, fomepizole, biperiden, silibinin, deferoxamine, leucovorin, dimercaptopropanesulfonic acid and hydroxocobalamin. Administration of a specific antidote/therapeutic agent was recommended in 87 cases (13%). In 70 of these 87 cases (80%), the specific agents were administered as recommended by the poison centre. In 17 cases (20%), the specific antidotes were not administered as recommended because of either clinical improvement (n = 11), termination of therapy based on laboratory results (n = 3), therapy refused by the patient (n = 2), or identification of a mushroom as non-poisonous (n = 1). In 109 cases (16%), there was no change in patient management after contacting the poison centre. CONCLUSIONS For patients presenting at the emergency department with severe poisoning, contact with the poison information centre can help to implement specific treatment and avoid fatalities. In less severe cases involving more common agents (e.g. paracetamol, benzodiazepines), contact can help to avoid unnecessary treatment and serve as a source of information and/or confirmation.

Aim. To investigate the characteristics of Emergency Department (ED) presentations due to acute paracetamol intoxication. Methods. Retrospective observational study of patients presenting to the ED of Bern University Hospital between May 1, 2012, and October 31, 2018, due to a paracetamol overdose (defined as intake of >4 g/24 h). Cases were identified using the full-text search of the electronic patient database and were grouped into intentional (suicidal/parasuicidal) and unintentional intoxications (e.g., patient unaware of maximal daily dose). Results. During the study period, 181 cases were included and 143 (79%) of those were intentional. Compared to the patients in the unintentional group, patients in the intentional group were more often female (85% vs 45%, p<0.001) and younger (median age 23.0 vs 43.5 years, p<0.001), more frequently suffered from psychiatric comorbidities (93%, (including 49% with borderline personality disorder) vs 24%, p<0.001), and paracetamol was more often taken as a single dose (80% vs 13%, p<0.001). Although the median daily ingested dose was lower in the unintentional than in the intentional group (8.2 g vs 12.9 g, p<0.001), patients in the unintentional group presented later (29% vs 84% within 24 h of ingestion, p<0.001), included more cases of acute liver failure (nine (24%) vs six (4%), p<0.001), and were more often hospitalised (24% vs 52% treated as outpatients, p=0.002). There were no significant differences between the groups regarding drug-induced liver injury (seven cases (5%) in the intentional and one (3%) in the unintentional group) or fatalities (one in each group). Conclusions. The majority of presentations due to paracetamol poisoning were intentional, most commonly in female patients with borderline personality disorder. Patients with unintentional paracetamol intoxication had worse outcomes with respect to acute liver failure and hospitalisation. Future preventive measures should raise awareness of paracetamol toxicity in the general population and encourage particular attention and frequent follow-ups when prescribing paracetamol for vulnerable groups.

Preventive strategies can be developed by gathering more information about oral and maxillofacial injuries and oral pathologies in immigrants from low- to middle-income countries (LMIC). Additional information on the quality of care can also improve the allocation of clinical resources for the management of these patients. We studied immigrants from LMIC who presented in the emergency department (ED) at Berne University Hospital with dental problems or oral or maxillofacial injuries. The patient data included age, gender, nationality, the etiology and type of trauma and infection in the oral-maxillofacial area, and overall costs. The greatest incidence of maxillofacial injuries was observed in the age group of 16&ndash, 35 years (n = 128, 63.6%, p = 0.009), with males outnumbering females in all age groups. Trauma cases were most frequent in the late evening and were mostly associated with violence (n = 82, 55.4%, p = 0.001). The most common fracture was fracture of the nose (n = 31). The mean costs were approximately the same for men (mean = 2466.02 Swiss francs) and women (mean = 2117.95 Swiss francs) with maxillofacial injuries but were greater than for isolated dental problems. In conclusion, the etiology of dental and maxillofacial injuries in immigrants in Switzerland requires better support in the prevention of violence and continued promotion of oral health education.

The consequences of mushroom poisoning range from mild, mostly gastrointestinal, disturbances to organ failure or even death. This retrospective study describes presentations related to mushroom poisoning at an emergency department in Bern (Switzerland) from January 2001 to October 2017. Gastrointestinal disturbances were reported in 86% of the 51 cases. The National Poisons Information Centre and mycologists were involved in 69% and 61% of the cases, respectively. Identification of the mushroom type/family was possible in 43% of the cases. The most common mushroom family was Boletaceae (n = 21) and the most common mushrooms Xerocomus chrysenteron (n = 7, four being part of a cluster), Clitocybe nebularis, Lepista nuda and Lactarius semisanguifluus (n = 5 each, four being part of a cluster). Poisonous mushrooms included Amanita phalloides (n = 3, all analytically confirmed), Boletus satanas (n = 3), Amanita muscaria (n = 2) and Amanita pantherina (n = 2). There were no fatalities and 80% of the patients were discharged within 24 h. Mushroom poisoning does not appear to be a common reason for emergency consultation and most presentations were of minor severity and related to edible species (e.g., due to incorrect processing). Nevertheless, poisonous mushrooms and severe complications were also recorded. Collaboration with a poison centre and/or mycologists is of great importance, especially in high risk cases.

Giorgos Papoutsis,1 Sylvana Papoutsi,2 Jolanta Klukowska-Rötzler,1 Benoît Schaller,3 Aristomenis K Exadaktylos1 1Department of Emergency Medicine, 2Department of Visceral Surgery and Medicine, 3Department of Cranio-Maxillofacial Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland Purpose: Temporomandibular joint (TMJ) dislocation is an uncommon and debilitating condition of the facial skeleton. The condition may be traumatic or nontraumatic, in an acute or chronic form, and with bilateral or monolateral expression. Patients and methods: In this study, conducted from May 2012 to July 2016, we ­retrospectivelyanalyzed TMJ dislocations treated in the Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, by focusing on the following parameters: age, gender, reason, localization, frequency, and therapy. Results: Thirty-two patients were included. The mean age was 42.06 years and there was no predominant gender. Most cases of TMJ dislocation were nontraumatic (93.7%). Dislocations were mostly bilateral (59.4%) and appeared in a chronic situation and with repetitive events (62.5%). Thirty-one patients received conservative treatment, which consists of reposition of the TMJ with (38.7%) or without (61.3%) analgosedation. Only one patient needed surgical reposition due to previous surgical treatment. Conclusion: This is the first attempt to evaluate TMJ dislocations in Switzerland in an acute hospital setting. To our knowledge, there are no other studies that systematically analyze these injuries by focusing on the patients’ characteristics. Surgical reposition is only indicated in complicated and very rare situations. Conservative approaches are commonly used and should be exhausted before any surgery. Keywords: temporomandibular joint, emergency medicine, dislocations