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Abstract Background Cervical cancer, although largely preventable, remains the most common cause of cancer mortality among women in low-resource countries. The objective of this study was to assess knowledge and awareness of cervical cancer prevention among Cameroonian healthcare workers. Methods A cross-sectional self-administered questionnaire in 5 parts with 46 items regarding cervical cancer etiology and prevention was addressed to healthcare workers in six hospitals of Yaoundé, Cameroon. The investigators enlisted heads of nursing and midwifery to distribute questionnaires to their staff, recruited doctors individually, in hospitals and during conferences and distributed questionnaires to students in Yaoundé University Hospital and Medical School. Eight hundred and fifty questionnaires were distributed, 401 collected. Data were analyzed with SPSS version 16.0. Chi-square tests were used and P-values < 0.05 were considered significant. Results Mean age of respondents was 38 years (range 20-71 years). Most participants were aware that cervical cancer is a major public health concern (86%), were able to identify the most important etiological factors (58%) and believed that screening may prevent cervical cancer (90%) and may be performed by Pap test (84%). However, less than half considered VIA or HPV tests screening tests (38 and 47%, respectively). Knowledge about cancer etiology and screening was lowest among nurse/midwives. Conclusion Knowledge of cervical cancer and prevention by screening showed several gaps and important misconceptions regarding screening methods. Creating awareness among healthcare workers on risk factors and current methods for cervical cancer screening is a necessary step towards implementing effective prevention programs.

Hypercalcemia, defined as an abnormal elevation of serum calcium, is a common electrolyte anomaly in primary care, affecting almost 1% of the worldwide population. Clinical manifestations concern the neuromuscular, cardiovascular, gastrointestinal, renal and skeletal systems. Among the causes, the main ones are primary hyperparathyroidism, and malignancies. Le initial workup should include the measurement of parathyroid hormone (PTH), and the discontinuation of any medication likely to be involved in iatrogenic hypercalcemia. The chosen treatments and their speed of introduction depend mainly on the severity of hypercalcemia. They include intravenous rehydration, and antiresorptive agents such as bisphosphonates, denosumab or calcitonin., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Steatotic liver disease is the most common liver pathology worldwide, comprises a wide range of liver diseases linked to metabolic dysfunction, excessive alcohol consumption, drug reactions and infectious and genetic origins. Following several years of deliberation, the major liver disease societies have recently adopted a new nomenclature and updated diagnostic criteria for steatotic liver diseases, aimed at better reflecting our evolving understanding of their pathophysiology. This article summarizes these newly adopted designations, explores the basis for these nomenclatures, presents recent epidemiological data and discusses new diagnostic criteria and recent advances in therapeutic approaches for steatotic liver disease., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Thiazide diuretics are an essential part of the treatment of hypertension, which affects nearly a third of the world's population. Hydrochlorothiazide is the most widely used member of this class, due to its long availability on the market and the many combinations available with other substances. Other analogues of this class exist, with notable advantages from a clinical point of view, recognized under the name of thiazide-like. This article reviews some of the considerations in clinical practice concerning the different types of thiazides currently available in Switzerland., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Peripheral facial palsy is a common, often idiopathic and self-limiting mononeuropathy. However, secondary facial palsies require specific management: they are most often of infectious, vascular or dysimmune causes. The presence of red flags in the history, clinical examination or medical follow-up should alert clinicians. Because of the high incidence of Lyme disease in our region, this etiology deserves special attention. The management is based on general measures (eye protection, rehabilitation) and corticosteroid therapy; antivirals may provide additional benefit., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêt en relation avec cet article.

Fusobacterium necrophorum is a Gram-negative anaerobic bacterium that can lead to severe infection in young patients even without immunodeficiency. Due to the length of time for isolation and speciation of this Gram-negative bacillus (typically 5-8 days), and its potential mortality, broad-spectrum antibiotic therapy should be started without delay. With a cervical thrombosis, even on an unusual site and with a standard condition such as tonsillitis, Lemierre syndrome should be considered. We report a case of Lemierre syndrome in a previously healthy young woman., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

The management fever of unknown origin (FUO) is a situation often encountered in internal medicine and remains considered a challenge despite advances in the medical field. Defined as a persisting fever despite extensive investigation, cases of FUO often require hospitalization and invasive diagnostic procedures. The role of PET-CT in FUO has been well described in recent years. However, the literature concerning the role of splenectomy in the diagnostic workup is scarce and no standard protocol has been established. Based on a case report, we describe a situation where splenectomy was key in the investigation of a case of FUO, leading to the diagnosis of a high-grade B cell lymphoma. We performed a non-systematic review of the literature to assess the relevance, utility, and risks of splenectomies in the investigation of fever of unknown origin., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Quinolone's antibiotics, with their excellent biodisponibility, tissular penetration and broad spectrum of activity are commonly used in hospitals and outpatient settings. The properties of this class of antibiotics lead to overuse with inevitable selection of resistance, constantly rising in Switzerland. This article provides a summary of various elements useful to balance benefit/risk when using quinolones in daily clinical practice., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Cephalosporins belong to the betalactam group and are frequently prescribed in both out and inpatient settings. Their broad spectrum of activity allows a varied use in most medical specialties, ranging from preoperative prophylaxis to treatment of febrile agranulocytosis. There are currently five generations of cephalosporins, mainly differentiated according to their structure, spectrum of activity and side-effect profile. So-called siderophore cephalosporins are active against many multiresistant bacteria, especially in cases of complicated urinary tract infections or ventilator-associated pneumonia. This article intends to review some general clinical principles in prescription and monitoring of patients treated with cephalosporins., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Physician well-being has an impact on productivity and quality of care. Residency training is a particularly stressful period., Objective: To assess the well-being of general internal medicine (GIM) residents and its association with personal and work-related factors., Methods: We conducted an anonymous electronic survey among GIM residents from 13 Swiss teaching hospitals. We explored the association between a reduced well-being (&ge;5 points based on the Physician Well-Being Index [PWBI]) and personal and work-related factors using multivariable mixed-effects logistic regression., Results: The response rate was 54% (472/880). Overall, 19% of residents had a reduced well-being, 60% felt burned out (emotional exhaustion), 47% were worried that their work was hardening them emotionally (depersonalisation), and 21% had career choice regret. Age (odds ratio [OR] 1.19, 95% confidence interval [CI] 1.05&ndash;1.34), working hours per week (OR 1.04 per hour, 95% CI 1.01&ndash;1.07) and &lt;2.5 rewarding work hours per day (OR 3.73, 95% CI 2.01&ndash;6.92) were associated with reduced well-being. Administrative workload and satisfaction with the electronic medical record were not. We found significant correlations between PWBI score and job satisfaction (rs = -0.54, p&lt;0.001), medical errors (rs = 0.18, p&lt;0.001), suicidal ideation (rs = 0.12, p = 0.009) and the intention to leave clinical practice (rs = 0.38, p &lt;0.001) CONCLUSIONS: Approximately 20% of Swiss GIM residents appear to have a reduced well-being and many show signs of distress or have career choice regret. Having few hours of rewarding work and a high number of working hours were the most important modifiable predictors of reduced well-being. Healthcare organisations have an ethical responsibility to implement interventions to improve physician well-being.

Proton pump inhibitors (PPI) have long been considered as devoid of any toxicity, but recent studies have uncovered significant potential side effects related to long-term use. In addition, stopping treatment with PPI may cause a symptomatic rebound effect of acid production. This article reviews the current literature on strategies for rationalizing their use, limiting potential adverse effects and progressive discontinuation., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Beta-blockers are very commonly drugs used in clinical practice, but whose mechanisms and clinical impacts are not always well understood, especially in certain specific clinical situations. This article proposes a review of some pharmacology notions over the different generations of β-blockers, as well as a review of indications and side effects in particular clinical situations, such as COPD, portal hypertension with esophageal varices and erectile dysfunction. Finally, an overview of response variability of these treatments is discussed from a genetic point of view., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Antibiotic resistance, good resource management and health care costs drive us to think about our practice. In this update we take into consideration therapeutical guidelines for the most frequently encountered serious infections in a hospital setting, and respective non-inferiority studies supporting early switch to an oral form of antibiotic. This strategy generally leads to a shorter hospital stay, with the same effect in terms of mortality, relapse, complications or treatment failure. Too often still, doctors and patients believe that intravenous antibiotics only are effective enough for severe infections, whereas in many cases, oral antibiotics are as effective., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Rationale: Eosinophilic pleural effusion in elderly patients is most commonly due to malignancies and infections., Patient Concerns: In rare cases, pleural eosinophilia is associated with connective tissue disease., Diagnoses: Presence of Hargraves cells, also called lupus erythematosus (LE) cells (polynuclear cells that have engulfed denatured nuclear material), was a key point of American College of Rheumatology (ACR) classification criteria for systemic lupus erythematosus (SLE) until 1997. Now replaced by serology for autoantibodies, LE cells characterization remains useful in guiding the diagnostic strategy towards autoimmune diseases., Interventions: An 82-year-old woman complained about anorexia, weight loss, fatigue, and mild night fever. Clinical examination disclosed a left pleural effusion without parenchymal lesion on high contrast thoraco-abdomino-pelvic computed tomography scan. A thoracocentesis revealed an exudate with eosinophilia. Direct cytological examination showed LE cells. SLE was rapidly considered. Antinuclear antibodies were subsequently found in the serum and in the pleural effusion. Anti-nucleosome antibodies were also present without antiphospholipid antibodies. Her condition rapidly improved after initiation of prednisone and hydroxychloroquine., Outcomes: Six months later, the patient had no particular complain, clinical examination was strictly normal biological parameter were in normal range., Lessons: The assessment of an eosinophilic pleural effusion allowed to find LE cells, which rapidly suggested the diagnosis of SLE, and early initiation of appropriate treatment. LE cells are no longer a criterion for the diagnosis of SLE, but their presence in serosa is most helpful in guiding the diagnostic strategy, and specifically in atypical forms often seen in older patients.

We report a case of acute kidney injury (AKI) induced by amoxycillin crystalluria suggested by massive amounts of urinary crystals of unusual morphology. This hypothesis was further reinforced by a particular solubility pattern when the urine sample was exposed to various temperatures, alkali, acids and alcohol. We therefore suspended amoxycillin, which produced a rapid and complete recovery of kidney function. Infrared spectroscopy later confirmed the amoxycillin composition of the crystals. Since infrared spectroscopy is not easily available, we propose that these solubility tests of urinary crystals be used as a first-step investigation when amoxycillin crystalluria is suspected.

Development of oncological treatments has progressively and significantly reduced both mortality and morbidity. Chemotherapy and more recently immunotherapy may have short- and long-term side effects among which, renal involvement is one of the most frequent complications, which may alter therapeutic options and quality of life. High cumulative doses of chemotherapy, concomitant administration of nephrotoxic treatment and pre-existing nephropathy are to be carefully considered. This article intends to review some practical considerations concerning therapies from a nephrological point of view., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background & Aims: Hereditary haemorrhagic telangiectasia is characterized by arterio-venous malformations (AVM). It frequently involves the liver without clinical symptoms, but may lead to biliary ischaemia, portal hypertension, or fatal high-output heart failure. The indication of liver transplantation is controversial., Methods: Herein, we report the case of a 65-year-old female patient with a 'double Osler syndrome' consisting of hereditary haemorrhagic telangiectasia (HHT) and type I hereditary angioedema diagnosed at the age of 25 and 22 years respectively., Results: Hereditary angioedema was treated with danazol for several decades until multiple hypoechogenic liver masses were detected. Albeit danazol treatment was replaced by C1 esterase inhibitor infusions, hepatocellular carcinoma was diagnosed at the age of 64 and the patient was listed for liver transplantation. HHT was marked by recurrent epistaxis until the age of 63 when severe intestinal bleeding occurred. At the age of 65, severe dyspnoea (NYHA class IV) developed and rapidly progressive high-output cardiac failure was diagnosed. Despite argon plasma coagulation to control bleeding from intestinal angiodysplasia, and treatment with bevacizumab to inhibit angiogenesis, the patient died from severe gastrointestinal bleeding associated with cardiogenic shock at the age of 66 before being transplanted., Conclusion: The indication to list this patient for liver transplantation was debated several times before the diagnosis of hepatocellular carcinoma because of good general condition and low MELD score. Precise guidelines for screening and management of patients with hepatic HHT need to be better defined., (© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Prevention and management of thromboembolic events are historically based on the use of anti-vitamines K (AVK) and heparins. Since 2009, emerging direct oral anticoagulants (DOAC) with successive validated indications, changed progressively the way of managing oral anticoagulation. The main advantages of this new generation of medication are a better safety profile and the lack of need for monitoring anticoagulation activity. However, a number of situations in clinical practice still require careful use of these DOAC. This article review some practical considerations and specific situations of hospital and ambulatory settings., Competing Interests: les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Daily medical practice triggers reflexes in the use of drugs which must nevertheless always be adapted to new knowledge. Physician assistants and residents in the clinical ward of Internal Medicine of Sion Hospital summarize six recently published clinical treatments to which primary care physicians or in hospital-based internal medicine have to pay a particular attention. Quinolones are widely used but associated with QT interval widening, morphine delays and attenuate ticagrelor action in patients with myocardial infarction, evolocumab, a monoclonal antibody impact in reducing lipids and cardiovascular events, impact of statins on influenza vaccine effectiveness, vitamin D treatment for the prevention of functional decline, high dose dexamethasone for the treatment of immune thrombocytopenia., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: The recently introduced oral direct anticoagulants (ODAs), presumably safer, and with comparable efficacy to the vitamin K antagonists (VKAs), may reshape the world of anticoagulation medicine. This study aimed to assess the prescription appropriateness of ODAs and VKAs at discharge from hospital., Methods: We performed a one year retrospective study between August 2012 and July 2013 in the department of internal medicine of a regional hospital (HVs Sion) using Electronic Medical Records. All patients receiving an ODA were included and matched to a patient treated with a VKA. The appropriateness of prescription at discharge was defined by an adequate indication and dosing, the absence of contraindication, a minimal risk of drug-drug interactions and no major bleeding or venous thromboembolism during the hospitalization. The bleeding risk was evaluated with the HAS-BLED score when the indication was atrial fibrillation (AF)., Results: Out of the 44patients included (22 with an ODA and 22 with a VKA), 38 received an appropriate prescription according to all criteria. Two patients had an inadequate dosing. A potential drug-drug interaction was detected in 3patients receiving a VKA and in 1patient receiving an ODA. No major contraindication was found, but a relative contraindication was discussed in 3cases. The majority of patients receiving an ODA for an AF had a minor bleeding risk., Conclusion: No significant difference was ascertained between the two groups regarding the appropriateness of prescription. Our results suggest that ODAs were cautiously used in our setting., (Copyright © 2015 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.)

Importance: The clinical benefit of adding a macrolide to a β-lactam for empirical treatment of moderately severe community-acquired pneumonia remains controversial., Objective: To test noninferiority of a β-lactam alone compared with a β-lactam and macrolide combination in moderately severe community-acquired pneumonia., Design, Setting, and Participants: Open-label, multicenter, noninferiority, randomized trial conducted from January 13, 2009, through January 31, 2013, in 580 immunocompetent adult patients hospitalized in 6 acute care hospitals in Switzerland for moderately severe community-acquired pneumonia. Follow-up extended to 90 days. Outcome assessors were masked to treatment allocation., Interventions: Patients were treated with a β-lactam and a macrolide (combination arm) or with a β-lactam alone (monotherapy arm). Legionella pneumophila infection was systematically searched and treated by addition of a macrolide to the monotherapy arm., Main Outcomes and Measures: Proportion of patients not reaching clinical stability (heart rate <100/min, systolic blood pressure >90 mm Hg, temperature <38.0°C, respiratory rate <24/min, and oxygen saturation >90% on room air) at day 7., Results: After 7 days of treatment, 120 of 291 patients (41.2%) in the monotherapy arm vs 97 of 289 (33.6%) in the combination arm had not reached clinical stability (7.6% difference, P = .07). The upper limit of the 1-sided 90% CI was 13.0%, exceeding the predefined noninferiority boundary of 8%. Patients infected with atypical pathogens (hazard ratio [HR], 0.33; 95% CI, 0.13-0.85) or with Pneumonia Severity Index (PSI) category IV pneumonia (HR, 0.81; 95% CI, 0.59-1.10) were less likely to reach clinical stability with monotherapy, whereas patients not infected with atypical pathogens (HR, 0.99; 95% CI, 0.80-1.22) or with PSI category I to III pneumonia (HR, 1.06; 95% CI, 0.82-1.36) had equivalent outcomes in the 2 arms. There were more 30-day readmissions in the monotherapy arm (7.9% vs 3.1%, P = .01). Mortality, intensive care unit admission, complications, length of stay, and recurrence of pneumonia within 90 days did not differ between the 2 arms., Conclusions and Relevance: We did not find noninferiority of β-lactam monotherapy in patients hospitalized for moderately severe community-acquired pneumonia. Patients infected with atypical pathogens or with PSI category IV pneumonia had delayed clinical stability with monotherapy., Trial Registration: clinicaltrials.gov Identifier: NCT00818610.

After myocardial infarction (MI), international societies of cardiology recommend an optimal treatment associating four classes of drugs, known as BASI combination (beta-blocker, antiplatelets, statin and inhibitor of the angiotensin converting enzyme). This study shows that the implementation of locally adapted guidelines in a regional hospital (CHCVs, Sion) significantly improve the treatment quality after MI, with a 10% increase of the BASI combination at discharge. Detailed results are discussed. Finally, we provide a table summarizing the optimal treatment strategy with drug examples including doses, which will be helpful to both general practitioners and specialists.

Eosinophilic meningitis is a rare entity, which is a complication of an underlying disease. Its diagnosis and treatment is always a challenge for the hospital practitioner. The aim of this case report and review is to identify the most important aetiologies, and show the diagnostic and therapeutic modalities of Eosinophilic meningitis. The most frequent causes of Eosinophilic meningitis are parasitic and fungal infections. In Europe Eosinophilic meningitis is essentially seen in travellers returning from endemic areas for these agents. The treatment is directed against the underlying disease and can differ depending on the aetiology and severity of the clinical manifestations.

Even though corticoid-induced diabetes is an important clinical finding, there is still a clear lack of investigations in this field. In the last decades research has been conducted on the molecular regulation of the major anti-inflammatory actions of glucocorticoids and their side effects. Currently, insulin still remains the best current management option available to prevent middle and long-term consequences of repeated hyperglycemias. Some therapeutic suggestions are discussed, especially with the type of corticosteroid given, remaining as pragmatic as possible to improve adherence. Our objective is to review the current literature on glucocorticoid-induced hyperglycemia and current treatment strategies.

Positron emission tomography with 18F-fluorodesoxyglucose allows to locate pathological foci expressing a high metabolism. Originally shown in the investigation of neoplasia, this procedure is increasingly used as a new tool to search for inflammatory syndromes. Systemic vasculitis is a complex disorder, often manifested by non specific symptoms. Diagnosis at early stages allows early treatment, which may prevent progression to later complications. Through a case report and a review of the literature, this article describes the important role of PET/CT for the diagnosis when traditional tests remain unsuccessful.

Septic or acute bacterial arthritis is a medical emergency. The primary physician must suspect this condition even when clinical symptoms are non specific or with simultaneous inflammatory arthropathy. Septic arthritis can have serious complications. Optimal care requires hospital admission in general. Synovial fluid aspiration and its correct interpretation, the appropriate choice and timely administration of empiric antibiotic therapy can limit destruction of the joint's cartilage. The adaptation of the antibiotic regimen after reception of microbiological results and the adequate treatment in full length require interdisciplinary collaboration between the hospital physician, including the specialist in infectious diseases, the microbiology laboratory and post-hospital care.

Pneumocystis jirovecii pneumonia is an opportunistic infection affecting not only HIV patient but also patients with others causes of immunosuppression. The reference method for the diagnostic is the direct visualization of the pathogen in induced sputum or in bronchoalveolar lavage with a low sensibility. Direct immunofluorescence does not increase significantly this sensibility on IS. The PCR has been demonstrated to have 100% sensitivity. This gives rise to the problem of falsely positive results in patients, colonized by P. jiroveci (8,9-26,9%) but suffering from a pneumonia due to another pathogen. Use of quantitative PCR or serum beta-D-glucan, might be helpful to distinguish colonization from infection. This paper reviews the literature on the diagnostic of PCP in non HIV patients.

National or international medical societies yearly produce many recommendations i.e., guidelines about patient care, diagnostic or therapeutic procedures or preventive measures. These publications are established according to a level of evidence, based on randomised controlled trials or case studies. The strength of evidence reflects the presence of a good agreement or disagreement between the published trials. The clinician when confronted to these recommendations find them too rigid, poorly adapted to individual patients and depriving him from autonomy. However the use of well established guidelines plays a proven role in improvement of the quality and effectiveness of patient care. Primary care physicians should recognise the good guidelines and follow them to improve their daily practice.

Chronic kidney disease (CKD) prevalence increases with population aging and makes drugs prescription more difficult. Only a few studies have reported drug dosing adjustment in CKD patients, even in the important field of pain management. We propose an algorithm based on the current literature that helps in selecting right analgesic according to the degree of renal failure. Drug dosing adjustment of the most usually used analgesics (acetaminophen, nonsteroidal anti-inflammatory drugs and opioids) is discussed.

In the last fifteen years, procalcitonin measurement has been evaluated as a rapid diagnostic aid for suspected infection. Procalcitonin is now widely used in any febrile patient despite the lack of evidence supporting that practice. Indeed, procalcitonine has proven effective in the intensive care setting, as a diagnostic aid for septic shock, as a prognostic instrument and to tailor the duration of antibiotic treatment. Studies in non intensive care settings are more recent and scarce. Procalcitonin has been assessed in the emergency department in patients with lower respiratory tract infections and in patients admitted for an acute febrile illness. Results are encouraging but preliminary, therefore procalcitonine measurement should be restricted to patients with criteria of severe infection for the time being.

The management of the alcoholic withdrawal syndrome in the intensive care unit is difficult. Clearly, the patient must be sedated, in order to avoid the side-effects of agitation, like trauma. However, a too much enthusiastic sedation has to be avoided, first because it may unmask neurologic important information, and, second, because it can prolong or complicate the ICU stay. In this review, we discuss the actual management of the alcoholic withdrawal syndrome in the ICU.