Search

Light chain deposit disease (LCDD) is a rare condition caused by deposition of overproduced monoclonal light chains and has been frequently related to multiple myeloma or lymphocytic disorders. LCDD in association with human immunodeficiency virus (HIV) has only been described twice in the literature and is thought to result from HIV direct/indirect effects on B and T-cell populations, leading to chronic immune activation with paraprotein production. We report a renal LCDD case diagnosed at autopsy in a severely immunodepressed HIV patient and analyse renal histopathology of 18 HIV patients who had an autopsy in our department between 2000 and 2010. [ABSTRACT FROM PUBLISHER]

Artificial intelligence (AI) is a rapidly advancing technology in our society. The emergency radiology is an area facing an increase of the number of imaging studies and associated to the necessity to promptly deliver an accurate interpretation. The integration of AI algorithms to assist the clinician in providing analyses of the imaging studies while maintaining adequate diagnostic quality opens up new perspectives. There are numerous potential advantages of the implementation of AI in emergency radiology. However, the use of AI faces new challenges, as the algorithms reliability, data security, responsibility issues, and financial, human and material resources., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Tranexamic acid (TXA) decreases mortality in injured patients and should be administered as soon as possible. Despite international guidelines recommending TXA in the prehospital setting, its use remains low. The aim of this study was to assess the prehospital administration of TXA for injured patients in a Swiss region., Methods: We conducted a retrospective observational study in Switzerland between 2018 and 2021. Inclusion criteria were injured patients ≥18 years for whom an ambulance or helicopter was dispatched. The exclusion criterion was minor injury defined by a National Advisory Committee for Aeronautics score <3. The primary outcome was the proportion of patients treated with TXA according to guidelines. The European guidelines were represented by the risk of death from bleeding (calculated retrospectively using the Bleeding Audit for Trauma and Triage (BATT) score). Factors impacting the likelihood of receiving TXA were assessed by multivariate analysis., Results: Of 13 944 patients included in the study, 2401 (17.2%) were considered at risk of death from bleeding. Among these, 257 (11%) received prehospital TXA. This represented 38% of those meeting US guidelines. For European guidelines, the treatment rate increased with the risk of death from bleeding: 6% (95% CI 4.4% to 7.0%) for low risk (BATT score 3-4); 13% (95% CI 11.1% to 15.9%) for intermediate risk (BATT score 5-7); and 21% (95% CI 17.6% to 25.6%) for high risk (BATT score ≥8) (p<0.01). Women and the elderly were treated less often than men and younger patients, irrespective of the risk of death from bleeding and the mechanism of injury., Conclusion: The proportion of injured patients receiving TXA in the prehospital setting of the State of Vaud in Switzerland was low, with even lower rates for women and older patients. The reasons for this undertreatment are probably multifactorial and would require specific studies to clarify and correct them., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Research in prehospital and in-hospital emergency medicine is essential to the development of this discipline. By calling certain practices into question (thrombolysis for minor strokes, use of coagulation factors for patients with severe polytrauma), providing access to new technologies (video-laryngoscopy, POCT troponins in pre-hospital care) or questioning new practices (double defibrillation, pulmonary US in pneumonia), research enables emergency physicians to adapt their day-to-day practice., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Emergency medicine is facing many challenges, particularly related to the consequences of the pandemic on the pressure of patient flows and the lack of human resources. More than ever, our discipline seeks to offer our patients quality care based on several recent studies, of which the following is a section: a) Gender effect in the administration of tranexamic acid; b) External validation of the Canadian Syncope Risk Score; c) Role of neuro-imaging in psychiatric decompensation; d) Choice of analgesia in renal colic; e) Use of carotid ultrasound for pulse control in cardiac arrest and f) The safetyness of performing simple sutures in non-sterile conditions., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In 2021, emergency medicine has been impacted by the Covid19 pandemic. The repercussions were both on clinical and scientific aspects specific to our discipline. For this special issue, we have chosen not to insist on the pandemic but to return to some fundamentals of our discipline: cardiovascular emergencies remain the leading cause of death in the world and the aspects of risk stratification of pathologies such as acute coronary syndromes or neurovascular attack remain a daily issue within the framework of the strategies of management and investigation in emergency medicine. In addition, the consideration of alternative treatments in the context of pathologies, ranging from cannabis consumption to cardiac arrest and atrial fibrillation, also remains a daily challenge., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

2020 has seen the birth of several relevant studies in emergency medicine of which the following is a selection : 1) conservative treatment for primary spontaneous pneumothorax may be offered ; 2) tranexamic acid does not provide benefit in gastrointestinal bleeding ; 3) the Canadian Syncope Risk Score is validated for the risk stratification of syncopal patients ; 4) early administration of tranexamic acid does not have a significant effect on the neurological prognosis of patients with moderate to severe trauma brain injury ; 5) the notion of frailty seems to be predictive of mortality in the event of intra-hospital cardiac arrest in elderly patients ; 6) a pharmacological cardioversion strategy followed by electrical cardioversion is as effective as initial electrical cardioversion for atrial fibrillation in the emergency room., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Airborne sports are becoming more popular, despite an increased risk of potentially serious accidents. Most accidents are caused by pilot errors, unforeseen climatic conditions or a poor environmental assessment. Cases caused by material defects are rare. Accidents often involve damage to the spine and lower limbs, with impaired functional prognosis. Implementation of safety regulations as well as the promotion of protection material has certainly allowed some reduction in the risk of accident, the emphasis on quality training must however be continued., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Professionalisation of emergency medicine is currently booming. In order to offer the best care, emergency physician can refer to several new studies : 1) in a cerebral stroke, the 0° head position doesn't offer any benefit ; 2) hyperoxygenation in acute patients could raise mortality ; 3) epinephrine in prehospital cardiac arrest favors return of spontaneous circulation but worsens the neurological prognosis ; 4) systematic cross-checking reduces the risk of adverse events in the emergency department ; 5) ultrasensitive troponins better detect myocardic events, but raises the number of unusefull invasive procedures and 6) combined pre-test probability score and D-dimers potentially allows to rule out aortic dissection., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

We confronted some of the most prevalent prehospital misconceptions with the available literature. We found that: the diminution of a retrosternal pain following nitrate administration is not predictive of a cardiac origin of the pain ; survival of traumatic cardiac arrest may not be as bad as usually believed ; peripheral venous administration of vasopressors through proximal catheters during short times may be considered as a safe temporary alternative to central venous access ; using the pulse palpation usually lead to an under-estimation of the systolic blood pressure ; applying a pelvic belt at the level of the iliac crests doesn't aggravate an open-book fracture; there is no 90 mmHg threshold values below which mortality increases in traumatic brain injuries., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Pericarditis is a disease for which clinical criteria can be used to direct ambulatory or hospitalized management. Acute pericarditis is the most frequent form of pericardial disease and recurrence is the most common complication. Current management is largely based on empirical experience but randomized controlled trails are beginning to be appear that have enabled the elaboration of certain recommendations. The use of colchicine is the most recent development in the pharmacological treatment of this affection. Low doses of colchicine, adapted for weight and potential side effects, seem to reduce rates of recurrence. Recommended length of treatment is 3 months for acute pericarditis and 6 months for recurrent pericarditis. Ongoing trials may further clarify the role of this molecule in the management of this condition.