GZO Spital Wetzikon

The COVID-19 pandemic significantly impacted the mental health of the Swiss population. This study analyzed data from the Collaborative Outcome study on Health and Functioning during Infection Times (COH-FIT) across three pandemic waves: T1 (April-June 2020), T2 (July-December 2020) or T3 (January-June 2021). Each participant participated only once, during one of these three waves. Participants reported their subjective well-being and mental health status for the two weeks prior to the pandemic (pre-pandemic baseline) and during their respective pandemic wave. Subjective well-being was assessed using the World Health Organization Well-Being Index (WHO-5) from 4,037 participants, while mental health was measured via the P-score, completed by 3,375 participants. The WHO-5 ranges from 0 to 100, with higher scores indicating better well-being, while the P-score also ranges from 0 to 100 whereas higher scores represent greater levels of perceived burden across five domains of mental health. Pre- and intra-pandemic differences were analyzed using Wilcoxon tests and ANOVA, with subgroup analyses across seven Swiss regions utilizing the Kruskal-Wallis test. Participants had a mean age of 45.6 years (61.9% female). Results showed a substantial decline in well-being during the pandemic, with average WHO-5 scores decreasing from 75.3 pre-pandemic, to 66.5 during the first wave, 69.1 during the second, and 65.1 during the third, representing relative reductions of 11.7%, 8.2%, and 13.5%. The percentage of participants at risk for depression (WHO-5 <50) peaked during the third wave at 19.8%, up from 10.0% pre-pandemic. Mental health burden, as measured by the P-score, increased significantly during the first wave (from 20.6 to 27.3, +32.5%), and remained elevated across the two subsequent waves, with no significant recovery observed. Wilcoxon tests indicated significant differences between pre-pandemic and intra-pandemic WHO-5 and P-scores, with the largest effect sizes during the third wave (r = 0.652 for WHO-5; r = 0.487 for P-score). ANOVA showed significant intra-pandemic differences in WHO-5 across waves (p < 0.001), with improvements noted in the second wave. However, no intra-pandemic differences in P-scores were found (p = 0.298). Regional analyses revealed that Ticino, the Lake Geneva region, and Northwestern Switzerland experienced the most pronounced declines in well-being and increases in mental health burden. In contrast, Espace Mittelland and Eastern Switzerland experienced a less severe impact. Overall, these findings highlight the considerable and lasting impact of COVID-19 on mental health in Switzerland, emphasizing the need for targeted interventions, particularly in the most affected regions.

Knowledge about the impact of smoking in Celiac disease is limited. We aimed to assess clinical differences between smoking and non-smoking patients with celiac disease. We conducted a cross-sectional questionnaire-based study among patients with Celiac disease distributed through a common interest group. Patients answered questions regarding the clinical manifestation of disease, adherence to a gluten-free diet and symptom development over time. Patients were asked whether they smoked at the time of diagnosis. Comparisons to the Swiss General Population were performed using data from the Swiss federal statistic office with data from the health survey 2012. Data on smoking status was available from 1537 individuals. We found a significantly lower proportion of smokers among questionnaire respondents compared to the Swiss general population in the same time frame (8.5% vs 28.2%, p < 0.01). Compared to non-smokers, smokers had a higher age at diagnosis (39 years vs 32 years, p < 0.01) and more frequently reported diarrhea as an initial symptom (67% vs 56%, p =0.013). Smokers tended to adhere less strictly to a gluten-free diet than non-smokers (69% strict adherence vs. 77% p =0.052). Six and twelve months after diagnosis, the proportion of patients with symptomatic improvement was not different between smokers and non-smokers. We found a lower rate of smokers in this large group of celiac disease patients compared to the general population. Differences in presenting symptoms and higher age at diagnosis suggest that smoking might influence disease onset and/or presentation in an early phase.

Anastomotic leakage is a severe complication after colorectal surgery that can significantly affect clinical outcomes and patient prognosis. Although multiple risk factors for anastomotic leakage have been identified, predicting the incidence of anastomotic leakage remains difficult. To develop a machine learning predictive model that combines logits from different base models to predict the incidence of anastomotic leakage more accurately. This retrospective prognostic study was conducted across 13 centers in Europe and North America between January 1, 2012, and December 31, 2020, and with data from the European Society of Coloproctology (ESCP). The study population included patients 18 years or older who underwent colon resection with anastomosis and had a follow-up of at least 6 months. Patients with metastatic disease and insufficient follow-up were excluded. A total of 6079 patients from 13 centers across different countries were included in the analysis with an additional 3041 patients from the ESCP. Data analysis was conducted from October 2024 to January 2025. Colon anastomosis for various reasons, including neoplasia, diverticulitis, ischemia, iatrogenic or traumatic perforation, or inflammatory bowel disease. The primary outcome of this study was to predict anastomotic leakage using a cross-attention-based meta-model, which integrated predictions from base models and patient-level clinical features. The F1 score was used to assess the prediction performance of the models. A total of 9120 patients (mean [SD] age, 61.26 [15.71] years; 4636 [50.8%] male) from the 513 centers and the ESCP were included in the analysis. There was no difference in distribution between the 13 centers and the ESCP dataset. The model's predictive performance achieved overall F1 scores of 87% (95% CI, 78%-95%) and 70% across tests using a cross-validation process and external validation test set, respectively. The meta-model's performance was better than that of its component parts (eg, CatBoost: cross-validation F1 score, 87% [95% CI, 78%-95%]; external validation F1 score, 70%). In this prognostic study of patients who underwent colon resection with anastomosis, a meta-model was found to improve predictive accuracy. Additional prospective studies are needed to assess the clinical utility of the model in real-time settings and its integration into surgical workflows.

Zusammenfassung Am Beispiel des in verschiedenen lokalen Traditionen genutzten Blutwurz, auch Tormentill (Potentilla erecta L.), wird exemplarisch eine offensichtliche Kluft zwischen üblichen indikationsgetriebenen Zulassungsverfahren und der empirischen Realität sowie dem Potential vieler Heilpflanzen aufgezeigt. Für Tormentillae rhizoma ist ein breites Spektrum an Inhaltsstoffen und das mit dem Vielstoffgemisch einhergehende Wirkprofil einer u.a. vielfältig antiinflammatorisch wirkenden systemischen Droge experimentell belegt. Die traditionelle Empirie der dämpfenden Effekte im Entzündungsgeschehen wird dadurch plausibilisiert. Die moderne Forschung liefert also Daten für einen sinnvollen Einsatz einer gut verträglichen Heilpflanze mit vielfältigen Anwendungsmöglichkeiten für Haut und Schleimhaut (innerlich und äusserlich). Auf dem Markt gibt es aber, abgesehen von vereinzelten topischen Spezialitäten und Arzneitees, kaum Zubereitungen als zugelassene Arzneispezialität. Denn die derzeitige Praxis der Arzneimittelzulassung bevorzugt die spezifischen und organbezogenen Wirkungen und übersieht dabei das systemische Potential, die Modulationsfähigkeit dieser natürlichen Stoffgemische, wie sie durch traditionelle und empirische Belege angezeigt wird. Systemische Wirkungen zeigen ihre Stärke gerade im Zusammenspiel mit anderen Therapien insbesondere beim additiven Einsatz mit Spezifika, indem sie bestimmte Wirkungen verstärken bzw. abschwächen oder die Verträglichkeit der Spezifika erhöhen bzw. deren Nebenwirkungen abmildern. Die Kombination von spezifisch wirkenden Arzneimitteln mit solchen Systemmitteln (wie z.B. Blutwurz/Tormentill) stellt damit eine weitere Therapieoption dar, die als sinnvolle Ergänzung, wenn nicht sogar als Grundlage bei Prävention, Therapie und Lebensgestaltung zu werten ist.

Swallowed topical corticosteroids (STCs) are effective in treating patients with eosinophilic esophagitis. However, real-world data about loss of response to STC are limited and whether patients with off-label STC (olSTC) failure may achieve histologic remission after a switch to budesonide orodispersible tablets (BOT) is unknown. We analyzed prospectively collected data between 2015 and 2023 from the Swiss Eosinophilic Esophagitis Cohort Study and compared patients with prior histologic olSTC-failure (≥15 eosinophils per high-power field), histologic remission after olSTC (<15 eosinophils per high-power field), and STC-naïve patients before BOT treatment. Furthermore, we evaluated the course of olSTC-failure patients after a switch to BOT and used logistic regression to explore potential associations between patients with olSTC-failure and clinical factors. A total of 340 patients (76% male, median age = 43 years) with BOT were analyzed. Twenty-six percent had prior olSTC nonresponse, 16% were in remission with prior olSTC, and 58% were STC-naïve. In the multivariable logistic regression, olSTC treatment duration in years (OR 1.37, 95% CI 1.12-1.67, P = 0.002), off-label STC adherence <80% in the last 2 years before BOT (6.30; 1.19-33.29, P = 0.03), and age <30 years (6.57; 1.85-23.37, P = 0.004) were independently associated with histologic nonresponse to olSTC. Histologic or combined remission to BOT was not different in patients with prior olSTC response (n = 44) compared to patients nonresponded to olSTC (n = 66) (77.3% vs 62.1%, P = 0.095 and 61.4% vs 42.4%, P = 0.052). Most patients nonresponding to olSTC are not true corticosteroid-refractory but respond to an esophageal-targeted budesonide formulation. Age below 30 years, longer treatment duration and low adherence are associated with olSTC-failure.

The interpretation of the surface electrocardiogram and intracardiac recordings is key for the appropriate diagnosis and interventional treatment of cardiac arrhythmias.This report describes a patient with both a focal atrial tachycardia (AT) and an atypical atrioventricular-nodal reentrant tachycardia that were repeatedly induced and terminated by atrial ectopic beats.Radiofrequency ablation of the slow pathway, as well as targeted ablation of the specific AT focus effectively eliminated both tachycardias.

Group A Streptococcus (GAS, aka Streptococcus pyogenes) poses a significant public health concern, causing a diverse spectrum of infections with high mortality rates. Following the COVID-19 pandemic, a resurgence of invasive GAS (iGAS) infections has been documented, necessitating efficient outbreak detection methods. Whole genome sequencing (WGS) serves as the gold standard for GAS molecular typing, albeit constrained by time and costs. This study aimed to characterize the post-pandemic increased prevalence of iGAS on the molecular epidemiological level in order to assess whether new, more virulent variants have emerged. A total of 66 iGAS strains isolated from nine Swiss hospitals during the COVID-19 post-pandemic increased GAS prevalence were evaluated and compared to 15 strains collected before and 12 during the COVID-19 pandemic. FT-IR measurements and WGS were conducted for network analysis. Demographic, clinical, and epidemiological data were collected. Skin and soft tissue infection was the most common diagnosis, followed by primary bacteremia and pneumonia. Viral co-infections were found in 25% of cases and were significantly associated with more severe disease requiring intensive care unit admission. WGS analysis did not reveal emerging GAS genetic distinct variants after the COVID-19 pandemic, indicating the absence of a pandemic-induced shift. FT-IR spectroscopy exhibited limitations in differentiating genetically distant GAS strains, yielding poor overlap with WGS-derived clusters. The emm1/ST28 genotype was predominant in our cohort and was associated with five of the seven deaths recorded, in accordance with the molecular epidemiological data before the pandemic. Additionally, no notable shift in antibiotic susceptibility patterns was observed. Our data suggest that mainly non-pathogen related factors contributed to the recent increased prevalence of iGAS.