Revue medicale suisse最新文献

Alcohol-associated hepatitis, the new term that has replaced "alcoholic hepatitis", is the most severe form of alcohol-related liver disease, with a 1-month mortality of 30 to 50% in severe cases. The diagnosis is now mainly clinical, with liver biopsy reserved for atypical presentations. The MELD (Model for End-Stage Liver Disease) 3.0 and the Lille score calculated from day 4 allow for dynamic prognostic stratification. In eligible patients, prednisolone at a dose of 40 mg/day for 28 days remains the standard treatment. Nutritional and addiction management are major determinants of survival, while early liver transplantation, without an arbitrary abstinence period, is a rescue option for carefully selected non-responders.

Progressive multifocal leukoencephalopathy (PML) is not limited to HIV. In polymedicated or immunomodulated patients, PML can present with subacute cognitive, language, or motor deficits. For general practitioners, the key is to consider PML, review at-risk medications, arrange urgent brain MRI and lumbar puncture, and refer to neurology. This article provides a practical approach focused on recognition, initial workup, and coordination with hospital teams, illustrated by a case.

In 2025, significant progress has been made in the management of cardiovascular diseases. The introduction of the IMPS (Inflammatory Myopericardial Syndrome) concept has positioned cardiac MRI as a central diagnostic tool. In the management of dyslipidemia, lipoprotein (a) measurement has become a key component of cardiovascular risk assessment, while bempedoic acid is emerging as an effective treatment option for statin-intolerant patients. The Pregnancy Heart Team now provides a structured care pathway for cardiac patients before, during, and after pregnancy. Prevention plays a crucial role, supported by the growing awareness of the close link between mental health and cardiovascular health.

Thrombotic microangiopathy (TMA) is a medical emergency. Recognizing and identifying the pathophysiological mechanism is crucial for quickly initiating appropriate treatment and reducing morbidity and mortality. Thrombotic thrombocytopenic purpura (TTP) should systematically be considered among the causes of TMA. Two scores (French and PLASMIC) can be used upon patient admission. If the probability of TTP is high, the treatment should be initiated without waiting for diagnostic confirmation. This article presents several cases of TMA and their respective management.

Sexual dysfunction is common in primary care and can significantly impair patients' quality of life. However, many general practitioners report difficulties in addressing this topic due to discomfort or a lack of knowledge. This article proposes a management algorithm to guide clinical practice in identifying the most frequent causes and initiating evidence-based treatments without systematically requiring specialist referral.

Primary care medicine is under increasing strain, which limits access to both quality of care and medical information. The confIAnce project, developed by the Division of Primary Care Medicine (SMPR) at Geneva University Hospitals, offers a chatbot providing general information on common chronic diseases. Based on the SMPR strategies (documents), the chatbot delivers medical information to patients and is accessible 24/7. It includes rigorous control systems (matching, groundedness, harmfulness, automated testing, semantic routing) to ensure safety. Tested since February 2025, the chatbot has already answered over 11,000 questions. confIAnce supports both patients and physicians by improving access to information and consultation quality, without replacing the doctor-patient relationship.