Revue medicale suisse最新文献

Switzerland already suffers from the long-predicted shortage of physicians. Moreover, the latter often face long and meandering postgraduate training. At the beginning of their career, most doctors work on internal medicine hospital wards, even though their future may just as well lie in an outpatient or inpatient setting, in general internal medicine or in other disciplines. To help these physicians identify and clarify their hospital trajectory at an early stage, thus optimizing training pathways, the Medicine Department of the CHUV set up its Housestaff. Using a mentorship system and clearly defining a training track (outpatient practice, hospital, academic, or transition), it supports candidates, in close partnership with other departments, regional hospitals and networks, in particular ambulatory ones.

The misuse of pregabalin (Lyrica) has emerged as a common problem in recent years, particularly among vulnerable populations. This reality is reflected in the prison environment, where pregabalin is subject to abuse and trafficking. In this article, we detail the issues surrounding this misuse and our practical strategy for tackling it. It is based on four axes: a) clarification of the indication (or lack thereof); b) support of withdrawal with gabapentin; c) if applicable, management of the symptoms or diseases mentioned (neuropathic pain, epilepsy, etc.) with other treatments, and finally d) addiction counseling.

The cutaneous sclerosis, defined as a pathological increase of the elements composing the dermis or hypodermis, results in thickening and hardening of the skin. This cutaneous manifestation is often associated with systemic sclerosis. However, it is also found in other less well-known syndromes that are highly heterogeneous in their clinical presentations. This article reviews the etiologies, clinical presentations, and possible treatments of these rare pathologies.

Sickle cell anemia is the world's most common monogenic disease, with a steady rise in the number of cases also in Switzerland. It presents as regenerative anemia and recurrent vaso-occlusive episodes, which can impact all organs. Acute and chronic complications increase morbidity and mortality, significantly reducing life expectancy compared to the general population. Optimal and multidisciplinary management of acute events is essential to improve patients' quality of life and overall prognosis. Vaso-occlusive crises and acute chest syndrome are the two most frequent acute complications. Their treatment, described here, is threefold: analgesia, treatment of causative factors and prevention of further complications.

Inhaled treatments are essential for obstructive lung diseases such as asthma and chronic obstructive pulmonary disease (COPD). However, pressurized metered-dose inhalers (pMDI) use propellant gases, contributing to greenhouse gas (GHG) emissions and thereby to climate change. The use of dry powder inhalers (DPI) or soft mist inhalers (SMI) when clinically appropriate is a way to reduce these emissions. It is essential to confirm the diagnosis, promote adherence and therapeutic education, and support effective recycling policies and the development of less polluting treatments. In any case, the right inhaler is the one that suits the patient, is used correctly, and stabilizes of the respiratory condition.