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.

Study aims: In Switzerland, basic health insurance is compulsory. Supplementary or private health insurance may be arranged, providing advantages such as hospital comfort and a free choice of doctors. Since there is limited data on whether insurance status influences the outcome of surgery, this study aimed to investigate the influence of supplementary insurance status on the overall complication occurrence in a group of abdominal, thoracic and vascular surgeries.

Methods: This study is based on surgical patient data prospectively collected between September 2016 and March 2018 from one participating Swiss tertiary referral hospital of the StOP?-trial (NCT02428179), which investigated the effect of structured intraoperative briefings on patient outcomes. First, additional data, including insurance status, demographic and surgical parameters within 30 days was collected. Second, due to endogeneity concerns in the sample driven by selective access to a supplementary insurance, propensity-score matching (PSM) was used to balance samples for the treatment variable (insurance status) by demographic parameters and surgical complexity. The primary outcome was the estimated treatment effect of a supplementary insurance on the occurrence of surgical complications, categorised by the Clavien-Dindo classification (CDC). Finally, multiple logistic regression was used to detect further conditional associations of demographic and surgical variables with the occurrence of complications.

Results: Of all 3173 procedures, 64.3% were elective, 48.2% had a higher surgical complexity (excluding appendectomies, cholecystectomies, hernia surgery and lymph node excision) and 18.6% of all patients had supplementary insurance. The occurrence of complications, including surgical site infection and postoperative complications, was 30.4%. After matching 591 patients with basic insurance to 591 patients with a supplementary insurance, no significant association between insurance status and complications could be found (crude odds ratio [OR] [95% CI]: 0.97 [0.77-1.23]). In contrast to insurance status, multiple logistic regression identified that variables such as surgical complexity (adjusted OR [95% CI]: 1.80 [1.27-2.56]), contamination (adjusted OR [95% CI]: 1.90 [1.41-2.56]) and duration of surgery (adjusted OR [95% CI]: 1.008 [1.006-1.009]) were associated with the occurrence of complications.

Conclusion: Despite the different cost-liable insurance levels, there were no significant differences and, therefore, no disadvantages for basic insured patients regarding the complication rate in this Swiss cohort undergoing abdominal, thoracic or vascular surgery.

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.

With the use of combined antiretroviral therapy (cART), it has become possible to completely and permanently suppress human immunodeficiency virus (HIV) replication. Successful treatment with combined antiretroviral therapy not only makes HIV infection a treatable chronic disease with a near-normal life expectancy, but also reliably prevents horizontal and also vertical virus transmission. In principle, this allows us to dispense with certain preventive measures from the pre-cART era. However, HIV prevention recommendations tend not to be adjusted until it has been proven beyond any doubt that there is no associated risk. This zero-risk strategy still makes HIV infection a special case and contradicts standard medical practice, which almost always also entails some acceptable risk. This hesitant attitude delays adaptations of care and contributes to the stigmatisation of those affected. In addition, it might even violate the ethical principles of beneficence and justice. In this context, there is still an ongoing debate as to whether the credo "U = U" (undetectable = untransmittable) applies to all aspects of vertical transmission. While there is consensus about the safety of vaginal delivery in case of an undetectable maternal viral load, Switzerland is still the only country that has also refrained from providing post-exposure prophylaxis to newborns since 2016 in such cases. Furthermore, when we last revised our Swiss recommendations for the prevention of vertical transmission in 2018, we assumed a balance (equipoise) between the benefits and potential risks of breastfeeding with HIV under optimal conditions. We proposed a shared decision-making process to allow the expectant mother to make her own well-considered decision which is then unconditionally supported by the care team. However, the decision and the associated responsibility is basically left to the woman. Most high-income countries have meanwhile adopted this procedure. Based on a literature review summarised in this article, the question arises as to whether this approach is still justified. We came to the conclusion that the potential risks of breastfeeding with HIV are being overemphasised, as benefits of breastfeeding, including reductions in morbidity and mortality for both mother and child appear to clearly outweigh these apparently very low risks, even in high-income settings. We therefore believe that breastfeeding with HIV should be favoured and encouraged and not just supported under optimal circumstances and that the care teams should take a clear position in this regard. This will facilitate decision-making for affected women, reduce stigma, relieve the parent(s) of taking on primary responsibility for the decision and further "normalise" HIV infection.

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.