Hôpital intercantonal de la Broye

Adnexal torsion is a gynaecological emergency in which timely diagnosis is critical to preserve ovarian function. This review examines the emerging roles of D-dimer and ischemia-modified albumin (IMA) as diagnostic biomarkers in ovarian (adnexal) torsion. A systematic search of recent literature (2015–2025) identified both animal experiments and clinical studies evaluating these markers. D-dimer, a fibrin degradation product, rises significantly in ovarian torsion due to thrombosis and tissue necrosis, while IMA increases in response to ischemia-induced albumin modification. Key studies show that D-dimer and IMA levels are significantly elevated in torsion versus controls, with diagnostic sensitivities and specificities reaching 67–82% and 78–100% for D-dimer, and ~90% each for IMA. Both markers demonstrate strong positive likelihood ratios (>10) for torsion. IMA levels also correlate with the severity of ovarian ischemic damage, suggesting a prognostic value. However, their accuracy can be influenced by confounders such as pregnancy and inflammatory conditions. In practice, these biomarkers could complement imaging (e.g. ultrasound) to improve early detection of torsion and guide urgent intervention. Further large-scale studies are needed to validate their clinical utility and to determine whether combining markers in a diagnostic panel could reliably distinguish torsion from other acute pelvic pathologies.

Chronic Kidney Disease Associated-Pruritus (CKD-aP) is frequent among hemodialysis patients. Its associations with hemodiafiltration or conventional hemodialysis and clinical characteristics are inconsistent in observational studies. This study aimed to assess the prevalence, severity and factors associated with CKD-aP among patients on hemodialysis in the French-speaking part of Switzerland, where hemodiafiltration is widely used. A cross-sectional design was used. Adults on hemodialysis for ≥ 6 months and free of cognitive impairment were recruited from 15 dialysis centers. A research nurse collected sociodemographic, clinical, laboratory data and assessed CKD-aP using the Visual Analogue Scale (VAS) and Verbal Rating Scale (VRS). A multilevel mixed-effects model with maximum likelihood estimation was performed to investigate associations. A total of 413 participants, mean age was 69.68 years (SD 13.52), were included; 66% were men, 73% on hemodiafiltration. CKD-aP prevalence was 25%. VAS average itch score of participants with CKD-aP was 4.74 ± 1.99, versus 6.62 ± 2.18 for the worst intensity itch. According to VRS, most participants with CKD-aP suffered moderate (61.4%) to severe (22%) itch within the past 24 h. Higher phosphorus levels were significantly associated with increased CKD-aP severity, but not prevalence. Depression, smoking, and polypharmacy were associated with increased CKD-aP severity, whereas hemodialysis modality, volume substitution, filter or access type were not. Despite high dialysis standards, CKD-aP remains a frequent symptom in Switzerland. Depression is associated with CKD-aP and its severity while hemodialysis modality is not. These results suggest that effective management of CKD-aP requires not only optimal dialysis prescription but also a holistic approach. Registered at ClinicalTrials.gov (NCT05524467) on 10.06.2022.

Prescribing medication is a routine part of an emergency physician's clinical practice. However, it carries significant risks that must not be overlooked. Many of the pathologies seen in the emergency department require patients to fast or make oral administration impossible. In such cases, it is critical to evaluate which medications should be continued or stopped, as inappropriate management can lead to clinical deterioration or serious adverse effects. Similarly, every new prescription introduces the potential for drug interactions with the patient's existing treatment regimen, while discontinuing a medication can also destabilize previously well-managed interactions. This underscores the importance of thorough medication reconciliation.

Pneumothorax (PTX) is a potentially life-threatening condition that affects neonates, with an incidence of 0.05 to 2%. Its management includes conservative treatment, chest tube (CT) drainage, and needle aspiration (NA). Aims were to evaluate the incidence of PTX in a 10-hospital perinatal network, its clinical characteristics and risk factors, and to compare the different treatment options. All neonates diagnosed with PTX and hospitalized in the network were included in this retrospective observational trial over a period of 30 months. Primary outcome was the incidence of PTX. Secondary outcomes were the treatment modality, the length of stay (LOS), and the number of chest X-rays. Among the 173 neonates included, the overall incidence of PTX was 0.56 per 100 births with a large range among the hospitals (0.12-1.24). Thirty-nine percent of pneumothoraces were treated conservatively, 41% by CT drainage, 13% by NA, and 7% by combined treatment. Failure rate was higher for NA (37%) than for CT drainage (9%). However, the number of X-rays was lower for patients treated by NA, with a median of 6 (interquartile range [IQR] 4-6.25), than by CT drainage, with a median of 9 (IQR 7-12). LOS was shorter for NA than for CT drainage, with a median of 2 (IQR 1-4.25) and 6 days (IQR 3-15), respectively. Complications, including apnea and urinary retention, occurred in 28% of patients managed with CT drainage, whereas none was observed with NA. High variability of PTX incidence was observed among the hospitals within the network, but these values correspond to the literature. NA showed to reduce the number of X-rays, the LOS, and complications compared with CT drainage, but it carries a high failure rate. This study helped provide a new decisional management algorithm to harmonize and improve PTX treatment within our network. · Neonatal PTX is a frequent pathology with a high incidence requiring urgent management.. · We report a large variability of PTX incidence between different hospitals of the same network.. · Needle aspiration carries higher failure rate, shorter hospital stay duration without complications reported..

Abstract Lateral flow antigen tests have been widely used in the Covid-19 pandemic, allowing faster diagnostic test results and preventing further viral spread through isolation of infected individuals. Accomplishment of this screening must be performed with tests that show satisfactory sensitivity in order to successfully detect the target protein and avoid false negatives. The aim of this study was to create a lateral flow test that could detect SARS-CoV-2 nucleocapsid protein in low concentrations that were comparable to the limits of detection claimed by existing tests from the market. To do so, several adjustments were necessary during research and development of the prototypes until they were consistent with these criteria. The proposed alternatives of increasing the test line antibody concentration and addition of an intermembrane between the conjugate pad and the nitrocellulose membrane were able to increase the sensitivity four-fold and generate a new rapid test prototype called “lateral flow intermembrane immunoassay test” (LFIIT). This prototype showed an adequate limit of detection (2.0 ng mL− 1) while maintaining affordability and simplicity in manufacturing processes.

In Switzerland, sex work has been legal under certain conditions since 1942, and the number of sex workers in 2011 was estimated at between 14'000 and 20'000 throughout the country, 96% of whom were migrants. These people are exposed to a wide range of vulnerabilities, both because of their profession and because of structural and institutional shortcomings. The complexity of their care has led over time to the creation of specialised structures and units, which are often unknown to healthcare professionals. The aim of this article is to shed light on these facilities and to offer healthcare professionals appropriate advice on how to improve the care provided to patients in the emergency department.

BACKGROUND: The aim of this study was to assess diagnosis severity, perioperative management and outcomes of two common urgent general surgery situations, appendicitis and cholecystitis, during the COVID-19 outbreak in a region with a high incidence of COVID. METHODS: Retrospective analysis of all appendicitis and cholecystitis cases in a region of western Switzerland (population 850,000) during the first pandemic peak. Primary endpoints were delay after first symptoms to consultation and delay to surgery. Secondary endpoints were disease severity and postoperative outcome compared with the same period in 2019. RESULTS: 214 patients were included: 99 during the 2020 pandemic and 115 in 2019. Median time to consultation for appendicitis was 48 hours (interquartile range [IQR] 24–96) in 2020 and 24 hours (12–36) in 2019 (p = 0.004); for cholecystitis, it was 48 hours (24–96) in 2020 and 36 hours (24–72) in 2019 (p = 0.28). Median time to surgery after consultation for appendicitis was 6.5 hours (IQR 4–18) in 2020 and 7.3 hours (5–9) in 2019 (p = 0.68), for cholecystitis 20 hours (12–48) in 2020 and 23 hours (14–39) in 2019 (p = 0.91). More antibiotics were prescribed after appendectomy in 2020 (46 vs 31%, p = 0.026). Significantly more perforations/abscesses related to appendicitis and cholecystitis were observed in 2020 during the COVID-19 outbreak (p = 0.007 and p = 0.044, respectively). No differences were found for postoperative complications and length of stay. CONCLUSIONS: A delay in patients’ arrival at the emergency room was observed for appendicitis. No delay to surgery during the pandemic was observed. A higher rate of perforations and abscesses associated with appendicitis and cholecystitis was observed during the pandemic period. Morbidity and reoperation rate did not change.

Smoking is still the most preventable cause of disease and premature death in Switzerland, as elsewhere. We aimed to assess the main determinants of smoking cessation in the population-based cohort of SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults). The SAPALDIA study was initiated in 1991 with 9651 participants aged 18 to 60 years from eight areas (S1). Follow-up assessments were conducted in 2002 (S2; 8047 participants) and 2010/11 (S3; 6088 participants). At each survey, detailed information on health and potential health-related factors was collected and lung function measured. Using logistic regression, we assessed predictors of smoking cessation between S1 and S2 and between S2 and S3. In both periods, highest educational level (summary odds ratio [OR] 1.49, 95% confidence interval [CI] 1.08-2.06; ref. lowest level), FEV1/FVC <0.5 (OR 6.19, 95% CI 2.44-15.7, ref. FEV1/FVC ≥0.7), higher age in men (OR 1.02, 95% CI 1.01-1.03, per year) and overweight (OR 1.38, 95% CI 1.16-1.64) were significant predictors of smoking cessation. Nicotine dependence (OR 0.97, 95% CI 0.96-0.98, per cigarette smoked a day) and female sex between age 45 and 60 (e.g., OR 0.74, 95% CI 0.61-0.91, at age 50) were negatively associated with smoking cessation. Moreover, smokers at S2 reporting a diagnosis of depression were less likely to quit smoking by S3 (OR 0.53, 95% CI 0.30-0.93). Prospective tobacco control policies in Switzerland should be addressed to women, younger persons and persons of lower education.