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BACKGROUND Hepatitis C virus (HCV) treatment reduces hepatic and extrahepatic morbidity and mortality and prevents further transmissions. Since October 2017, direct-acting antivirals (DAAs) have been reimbursed in Switzerland for all patients. Intravenous drug use accounts for the majority of HCV infections in Switzerland. Between July 2013 and July 2015, 205 of the 631 opioid agonist therapy (OAT) patients in the Swiss canton Aargau were enrolled into a cohort study, the Argovian OAT cohort study. In March 2019, the Federal Office of Public Health (FOPH) published guidelines for the HCV management in drug users. AIM To describe current HCV management in OAT patients of the Swiss canton Aargau in view of the FOPH guidelines and to compare the management of patients within and outside the cohort study. METHODS Between July 2013 and August 2018, 330 patients were enrolled into the Argovian OAT cohort study offering human immunodeficiency virus (HIV)/HCV antibody rapid testing, noninvasive liver fibrosis assessment (Fibroscan®) and, since August 2017, capillary HCV RNA rapid testing with the GeneXpert®. To assess HCV management, all information available before 1 September 2018 was considered. In September 2018, 592 of the then 809 OAT patients were not yet enrolled into the cohort study. For them, the cantonal physician sent a questionnaire regarding HCV, HIV, and hepatitis A and B viruses (HAV and HBV) to the OAT prescriber. Up to September 2019, we had received 182 (31%) questionnaires; 160 were eligible for analysis. RESULTS In the HCV cascade, the four diagnostic gaps, but not the two treatment-related gaps, were significantly larger in non-cohort compared with cohort patients: (1) never HCV antibody screened: 14% (22/160) versus 0.3% (1/330); (2) no HCV RNA test, if HCV antibody positive: 36% (21/58) versus 11% (19/167) if ever chronically infected; (3) liver fibrosis stage unknown: 51% (19/37) versus 3% (4/120); (4) HCV genotype unknown: 41% (15/37) versus 18% (21/120); (5) never received HCV treatment: 24% (9/37) versus 30% (36/120); (6) no treatment success, if treated and outcome known: 7% (1/14) versus 6% (5/84). HCV treatment outcome was unknown by the OAT prescriber in 50% of non-cohort patients. Adequate HCV management (HCV antibody test ≤1 year ago if HCV antibody negative or last HCV RNA test negative, and ≤1 year ago if HCV antibody positive) was less frequent in non-cohort than in cohort patients: 28% (44/160) versus 69% (229/330). CONCLUSION With regard to HCV elimination in OAT patients by 2030, case finding and regular screening for new and re-infections remain a challenge, especially for non-cohort patients in a decentralised setting. Documentation of the HCV sero- and RNA status of each OAT patient by the cantonal physician and a yearly HCV screening reminder sent to the OAT prescriber combined with capillary HCV antibody and HCV RNA testing by the OAT prescriber, general practitioner or the pharmacy might facilitate the implementation of the FOPH guidelines. DAA prescription directly by the OAT prescriber could increase awareness and improve linkage to care.

BACKGROUND In Switzerland, intravenous drug use accounts for the majority of hepatitis C virus (HCV) infections. Early HCV treatment prevents further transmissions and reduces morbidity and mortality due to decompensated liver cirrhosis and hepatocellular carcinoma. Nevertheless, patients in drug substitution programmes are often insufficiently screened and treated. AIM The aim was to compare the current state of HCV management in centralised and decentralised drug substitution programmes of the canton Aargau. Objectives were human immunodeficiency virus (HIV) and HCV prevalence, compliance with guidelines and gaps in the HCV cascade, as well as feasibility/acceptance/validity of HIV/HCV rapid tests on finger-prick blood and noninvasive liver fibrosis assessment with Fibroscan®. METHODS For the cross-sectional study, in June 2013, questionnaires and free rapid tests for HIV (Determine®) and HCV (OraQuick®) that used capillary blood (finger-stick) were sent to 161 physicians providing drug substitution treatment for 631 patients. Free liver fibrosis assessment with Fibroscan® by a member of the study team was offered to all patients. Additionally, patients were directly recruited by the study team in the heroin substitution programme and several addiction clinics visited every 4-6 months, as well as in the Infectious Diseases Outpatient Clinic (questionnaire, rapid tests and Fibroscan® in the same session). RESULTS Between July 2013 and July 2015, 205 (32.5%) of the 631 patients receiving opioid substitution in the canton Aargau were enrolled, 192 (93.7%) with HIV/HCV rapid tests and 167 (81.5%) with Fibroscan®. Acceptance of Fibroscan® was higher when offered in the same session (94.1 vs 69.2%). Overall, 77.8% had ever used intravenous drugs. HCV seroprevalence was 53.7% (109/203), HCV RNA prevalence 27.8%. Overall, 7.4% (15/202) were HIV infected, all of whom were HCV co-infected and under antiretroviral treatment. Of the 205 patients included, 104 (50.7%) were recruited in a decentralised setting (family practice / pharmacy) and 101 (49.3%) in a centralised setting (heroin programme, addiction clinic, Infectious Diseases Outpatient Clinic). Compliance with guidelines (regular HIV/HCV screening, workup of HCV-positive patients, availability of HAV/HBV serology) was consistently lower in the decentralised setting, characterised by a higher proportion of females, longer median time in the programme, lower percentage of daily attendance, ever-use of intravenous drugs and HIV and HCV infections. We identified several gaps in the HCV cascade: 23.9% (49/205) had never been HCV screened; 18.9% (18/95) of the HCV positive patients had no HCV RNA test. Of the 61 patients developing chronic HCV infection, 19.7% (12) were not HCV genotyped, 52.5% (32) had no liver fibrosis assessment (liver biopsy) and 54.1% (33) never received treatment; 25.0% (7/28) did not achieve a sustained virological response with interferon-based treatment. The 192 HCV rapid tests showed a sensitivity of 90.4% (94/104; 95% confidence interval 84.7-96.1%) and a specificity of 100% (88/88), and provided 14 new HCV diagnoses. Eight of ten patients with a false-negative HCV rapid test were HCV RNA negative (2 unknown). Among the 88.6% (39/44) currently HCV RNA-positive individuals with valid Fibroscan® results, 24 (61.5%) had a liver stiffness

The histological parameters of Helicobacter pylori (H. pylori) gastritis are dependent on the virulence factor profile of the microbe, which includes the cytotoxins vacA (vacuolating cytotoxin A) and cagA (cytotoxin-associated gene A) as well as the duration of infection. The virulence factor genotypes vacA and cagA were assessed by the line probe reverse hybridization assay INNO-LiPA and correlated with the histological parameters of H. pylori infection, in particular intestinal metaplasia (IM) as well as with the patient's age. A total of 120 patients were analyzed; 47 patients with IM in the antrum and 73 control patients without this alteration. The vacA s1 cagA+ genotype (high virulence) correlated with the presence of antral IM, a more intense acute inflammation in both antrum and corpus and the formation of ulcer. The vacA m1 genotype (high virulence) correlated with a more intense acute inflammation in only the corpus as well as more prominent Russell bodies in the antrum. H. pylori strains with the vacA s2 m2 cagA- genotype (low virulence) were rarely found in these conditions (all P0.05). No correlation with the virulence status was found for the type and extent of IM, the intensity of chronic inflammation, the formation of lymphoid follicles and the microbial density. Furthermore, patients with IM were 7 years older than their counterparts without (P0.05). Finally, there was a trend for more virulent vacA s1 m1 cagA+ strains to be found in younger individuals (P0.05). The virulence genotype of the microbe is an important determinant for the severity of the gastritis and the formation of antral IM. Age is an additional factor for the development of IM.

Background Jumping from heights is a readily available and lethal method of suicide. This study examined the effectiveness of a minimal structural intervention in preventing suicide jumps at a Swiss general teaching hospital. Following a series of suicide jumps out of the hospital’s windows, a metal guard rail was installed at each window of the high-rise building. Results In the 114 months prior to the installation of the metal guard rail, 10 suicides by jumping out of the hospital’s windows occurred among 119,269 inpatients. This figure was significantly reduced to 2 fatal incidents among 104,435 inpatients treated during the 78 months immediately following the installation of the rails at the hospital’s windows (χ 2 = 4.34, df = 1, p = .037). Conclusions Even a minimal structural intervention might prevent suicide jumps in a general hospital. Further work is needed to examine the effectiveness of minimal structural interventions in preventing suicide jumps.

We describe the clinicopathological features of six patients, two with rheumatoid arthritis and four with osteoarthritis, in whom intake of sustained-release diclofenac for one or more years was associated with ulceration and or stricture of the ascending colon. All were referred for further evaluation of anemia and changes in bowel habits. Three had chronic watery diarrhea, one suffered from progressive constipation and subsequently needed a right hemicolectomy because of complete intestinal obstruction. In five patients, colonoscopy revealed single to multiple semilunar ulcers, predominantly localized on the crest of the haustra of the ascending colon. In five of six cases the lumen was narrowed, from slight accentuation of the haustrum to almost pinhole-like concentric stenosis. All except one patient had multiple diaphragm-like strictures. The macroscopic and microscopic appearances closely resembled those of similar lesions previously described in the terminal ileum in patients treated with nonsteroidal anti-inflammatory drugs. It appears that the slow-release form of a nonsteroidal anti-inflammatory drug, such as sustained-release diclofenac, predisposes to manifestations of such lesions in the ascending colon.

To retrospectively compare the dynamic contrast enhancement of the small bowel segments with and without active Crohn's disease at 3D MR enterography (MRE).Thirteen patients (five men, eight women; mean age 41.2 years; range 29-56) were imaged on a 1.5-T MR scanner (Sonata, Siemens Medical) with standard MR sequences after having ingested 1000 ml of a 3% mannitol solution. Subsequently, high resolution 3D gradient-echo (volumetric interpolated breath-hold examination=VIBE) data sets were obtained pre-contrast and 20-40s, 60-80s, and 120-140 s after i.v. Gd-DOTA administration (0.2 mmol/kg). Signal enhancement was measured on single slices both in normal and histologically confirmed (12/13) inflamed small bowel wall segments as well as in the aorta, the psoas muscle, and the background to calculate signal-to-noise (SNR) and contrast-to-noise ratios (CNR).Small bowel wall enhancement was significantly higher (p0.05) in inflamed compared to normal segments at 20-40s (SNR inflamed: 58.7+/-33.8 vs normal: 36.0+/-19.8; p=0.048; CNR inflamed: 34.8+/-23.4 vs normal: 16.3+/-11.2; p=0.017) and at 60-80s (SNR: 60.3+/-25.1 vs 41.9+/-20.0; p=0.049; CNR: 34.9+/-15.1 vs 19.3+/-13.2; p=0.01) after i.v. contrast administration, respectively. Even at 120-140 s CNR was still increased in inflamed segments (33.7+/-16.0 vs 18.1+/-13.2; p=0.04), while differences in SNR did not attain statistical significance (63.0+/-26.2 vs 45.3+/-23.3; p=0.15).In active Crohn's disease, histologically confirmed inflamed small bowel wall segments demonstrate a significantly increased early uptake of gadolinium on 3D VIBE sequences compared to normal small bowel segments.