Swiss medical weekly最新文献

Background:  Andrographis paniculata products have gained in popularity for the management of respiratory infections since the COVID-19 pandemic. None of these products holds marketing authorisation and all are sold as herbal food supplements. Current herbal food supplement regulations generally do not impose quality assessments prior to commercialisation, such that the quality of herbal food supplements available to consumers is largely unknown.

Study aim: To assess the quality, purity and labelling accuracy of A. paniculata-containing products, focusing on andrographolide content (the pharmaceutically active component) and the presence of contaminants and residues.

Methods: Forty A. paniculata-containing products were purchased from 13 countries: 13 from pharmacies and 27 from online retailers readily accessible to consumers in Switzerland. Samples were analysed using ultra-high-performance liquid chromatography-ultraviolet (UHPLC-UV) and ultra-high-performance liquid chromatography-mass spectrometry (UHPLC-MS) based on the European Pharmacopoeia method. Contaminants and residues were assessed using inductively coupled plasma mass spectrometry and gas chromatography-mass spectrometry, respectively.

Results: All samples except one contained A. paniculata. The measured daily dose of andrographolide was compared to the labelled dose. Andrographolide content ranged from 29% to 174% of the labelled dose, with only 2 products accurately labelled, while 20 were underdosed and 1 overdosed. Two products contained quercetin, which interfered with UHPLC-UV analysis. Additionally, three online-purchased products contained toxic contaminants, including a heavy metal (mercury) or pesticides (strychnine, butralin).

Conclusion: This study reveals widespread mislabelling and underdosing in A. paniculata-containing food supplements marketed internationally, along with the presence of impurities that pose risks to consumers in products bought online. Regulatory authorities must implement stringent quality controls to ensure consumer safety and product transparency.

Although the medical literature is flooded with case descriptions, it is difficult to dismiss the significant impact that a clinical observation limited to one or two patients can have. Case reports can also play a critical role in other areas such as drug safety by serving as early warning signals for adverse drug reactions. Unlike the aggregated data and statistical abstractions of clinical trials or meta-analyses, case reports reflect the real-world context of medical practice, where decisions are made patient by patient. This alignment with everyday clinical experience makes case reports particularly relatable and valuable to practicing clinicians, offering insights that resonate far beyond the confines of population-based evidence. The "Swiss Medical Weekly" wishes to participate in the dissemination of high-quality case reports. A new section entitled "Clinical reasoning" will provide a dedicated platform for well-structured case reports while upholding the journal's high and very strict editorial standard and its Diamond Open Access model.

NTHL1-associated tumour syndrome, formerly known as NTHL1-associated polyposis, is a rare autosomal recessive tumour predisposition in which biallelic carriers of pathogenic NTHL1 variants develop multiple, predominantly adenomatous, polyps and have an increased risk of colorectal cancer and extracolonic tumour manifestations. The Nth like DNA glycosylase 1 (NTHL1) gene encodes for an enzyme involved in the base excision repair pathway which plays an important role in the maintenance of genomic integrity in the cell. Upon identification of our first Swiss biallelic NTHL1 carrier, we performed a literature survey on mono- and biallelic NTHL1 carriers, followed by genotype-phenotype correlations in order to delineate the clinical manifestations and review current screening recommendations. A comprehensive literature search was conducted to identify all individuals with NTHL1 variants reported since the initial discovery in 2015 to 2022, followed by a genotype-phenotype analysis on a total of 216 individuals, 59 being biallelic and 157 monoallelic NTHL1 carriers. 81.4% of biallelic NTHL1 carriers presented with colon polyps, the majority (69%) exhibiting between 5 and 99 polyps. Interestingly, though not statistically significant, 19% (6/31; p = 0.0766) of carriers homozygous for the recurrent p.Gln90Ter variant displayed a classical (>100 polyps) polyposis phenotype compared to none of the compound heterozygous patients (n = 20); additionally, compound heterozygotes were diagnosed with breast cancer twice as often as homozygous women (75% vs 38.9%, p = 0.0717). Among biallelic carriers, colorectal carcinomas were reported in 50.8% (n = 30; median age at diagnosis: 49 years) and extracolonic malignancies in 55.9% (n = 33), with breast (53.3%), skin (27.1%), endometrial (16.7%) and bladder cancer (8.5%) being the most frequent. Among monoallelic NTHL1 carriers, 15.3% (n = 24) presented with colon polyps and 17.8% (n = 28; median age at diagnosis: 55 years) with colon carcinomas. Timely surveillance measures are essential for early colorectal and breast cancer detection, treatment and prognosis. Prospectively gathered data are needed to further establish and refine clinical guidelines for individuals with NTHL1-associated tumour syndrome.

Can lifesaving be punishable? Performing resuscitation in an emergency places individuals under great pressure. Empirical studies indicate that potential helpers often hesitate to intervene for fear of legal consequences. However, this concern is unfounded. The article examines four scenarios: death despite resuscitation, harmful or unwanted resuscitation, and omission of aid. The conclusion is unequivocal: in case of doubt, initiating resuscitation ("in dubio pro REA") is legally safe. Only in cases where it is clearly established that resuscitation is not desired does the exception apply, meaning that no assistance should be rendered ("no means no"). This article analyses criminal liability risks in resuscitation based on Swiss law. Nevertheless, the findings are broadly transferable to other jurisdictions, as the relevant offences are universally codified.

Introduction: Human childbirth remains a complex and risky process for both mothers and infants, even with modern advancements in medical care. This study investigated the prevalence of obstetric interventions, namely caesarean sections, episiotomies, and forceps deliveries, along with the role of maternal-foetal body size mismatch in influencing delivery outcomes.

Methods: Utilising two datasets from similar archival sources in two Swiss cities (Basel and Lausanne) from the 1920s, we explored the relevance of a mismatch between the body size of the mother and the foetus as a risk factor for obstetrical interventions and the duration of the expulsion phase during delivery.

Results: Over 91% of births (1290/1407 in Basel and 1062/1145 in Lausanne) featured the foetal head in a normal position (either the right or left occiput anterior position). Episiotomies were performed in 8-17% of cases (233/1407 in Basel and 98/1145 in Lausanne) and forceps deliveries in 1-5% (17/1407 in Basel and 54/1145 in Lausanne). Caesarean sections were rare (<1%, 19/1407 in Basel and 6/1145 in Lausanne). Key findings indicated that larger foetal head diameters and narrower pelvic measurements were linked to prolonged expulsion phases and an increased likelihood of intervention. Abnormal head positions and first-time births were also associated with obstetrical interventions. Additionally, rickets was documented in 2% of mothers (23/1145) in Lausanne, correlating with increased forceps use and caesarean section rates.

Conclusion: This research provides insights into obstetric practices and maternal health conditions over a century ago, emphasising the significant impact of maternal-foetal body size mismatches on childbirth complications in a historical context.

Background: In 2018, a hospital-based surveillance system for influenza (CH-SUR) was established in six tertiary care hospitals in Switzerland. From March 2020 onwards, this surveillance system was expanded to include more institutions, as well as COVID-19.

Aim: To quantitatively evaluate the timeliness and completeness of CH-SUR data and to qualitatively assess stakeholder perceptions of the importance, reliability and adaptability of the surveillance system.

Methods: All patients admitted to one of the participating centres for more than 24 hours and who had a laboratory-confirmed influenza virus or SARS-CoV-2 infection were included in CH-SUR. For all cases, we evaluated the timeliness and completeness of reporting to CH-SUR. A qualitative survey among CH-SUR stakeholders assessed perceived importance, understanding, reliability and adaptability of CH-SUR.

Results: Up to 20 centres participated in CH-SUR. Between December 2018 and October 2023, 7375 cases of influenza were reported and between March 2020 and October 2023, 49,235 cases of COVID-19 were reported to CH-SUR. During the COVID-19 pandemic, time to data entry and completeness improved over time; the median delay of data entry in CH-SUR was 5 days (interquartile range [IQR]: 2-23) for COVID-19 and 4 days (IQR: 2-15) for influenza during the period 2018-2023. The completeness of variables was high (99.4%), with the exception of COVID-19 or annual influenza vaccination status (respectively, 15% and 72% "Unknown" responses). Stakeholders perceived the system as important, relevant, understandable and adaptable.

Conclusion: CH-SUR provided critical epidemiological and clinical information on hospitalised influenza and COVID-19 cases across Switzerland during the pandemic. Our evaluation highlighted the importance and relevance of this system among CH-SUR stakeholders, as well as its importance for preparedness and response to future infectious disease outbreaks.

Objectives: The primary objective was to measure the impact of passive exposure to an educational video about Chlamydia trachomatis infection shown in a gynaecology department waiting room on young women's knowledge on the subject. The secondary objective was to explore the participants' interest in improving their knowledge of Chlamydia trachomatis and their opinions on receiving this information during a consultation in the emergency room.

Methods: A prospective, interventional, controlled, non-randomised study. Participants were recruited between January and June 2022. 120 women aged 15-35 years were included. The intervention consisted of passive exposure to a 2-minute cartoon presenting basic foundational points of Chlamydia trachomatis displayed in the waiting room. The control group was not exposed to the video. After the intervention, an in-person knowledge interview was performed with each participant.

Main outcome measures: The main outcome measures were the knowledge scores obtained in the interviews with the exposed and control groups.

Results: Both groups were similar regarding sociodemographic variables. The average knowledge scores from the interview were similar in the two groups. Video exposure was not associated with diminution of lower scores. Participants' baseline knowledge was higher than expected on the basis of a literature review.

Conclusion: The passive learning intervention described in this study did not improve the participants' knowledge about Chlamydia trachomatis. During the one-to-one interview, participants were keen to receive information about Chlamydia trachomatis but the quantitative results show that the short video in the waiting room had no impact on their knowledge. Future studies should focus on pre-assessed, randomised, one-to-one or small-group active interventions.

Background: Psychosocial maturity is one of the key factors for understanding the course of criminal offences in juveniles and young adults. Until recently, forensic-psychiatric assessments to diagnose a severe disorder of personality development remained mostly unguided because validated instruments were not available. A new tool, the Young Adult Personality Development (YAPD) instrument, was introduced in 2021 and consists of three dimensions related to psychosocial maturity: YAPD environmental, YAPD pathology and YAPD developmental tasks failure. The current study tested the reliability (internal consistency, interrater reliability) and concurrent validity of these dimensions.

Methods: We analysed files of a consecutive sample of young adults in the Canton of Zurich (2007 to 2020, n = 234, mean age: 21.33 years, SD: 1.74 years), who were either assigned to specialised institutional treatment for young adults (Swiss Penal Code [SPC] Article 61) or outpatient treatment (SPC Article 63). Intraclass correlation coefficient (ICC) agreements were used to analyse interrater reliability of YAPD dimensions across three independent raters. In the absence of a gold standard, we analysed concurrent validity by measuring the associations of the YAPD dimensions with expert opinion and sample status (judicial decisions on measures) using multiple logistic regressions.

Results: Expert-rated personality development disorder was found to be highly prevalent in both samples. The YAPD dimensions showed adequate-to-good interrater reliability (ICC: 0.74-0.92). In logistic regression models, YAPD developmental tasks failure was related to diagnoses of severe development disorder and juridical decision on a measure for young adults according to SPC Art. 61. YAPD environmental was related to the diagnosis of a severe development disorder. YAPD pathology was found to be unrelated to the diagnosis of severe personality development disorder.

Conclusions: Our findings support the YAPD developmental tasks failure dimension and to a lesser degree the YAPD environmental dimension as valid dimensions to diagnose severe personality development disorder. Structured assessment instruments such as the YAPD may further improve diagnostic decision-making in forensic psychiatry and psychology.