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Introduction: Currently, approved disease-specific therapies for patients with immunoglobulin (Ig) A nephropathy in Switzerland are scarce. According to the 2024 KDIGO guidelines, current treatments focus on reducing proteinuria and nephron loss using nephroprotective regimens consisting of renin-angiotensin system blockade, the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors, and the dual endothelin angiotensin receptor antagonist sparsentan. Systemic glucocorticoids and a targeted-release formulation of budesonide are other therapeutic options to reduce IgA nephropathy-specific drivers of nephron loss. However, their use has been associated with adverse effects, even with targeted-release budesonide, and the benefit of these therapies remains to be weighed against the risk of treatment-emergent toxicity. This highlights the ongoing need to identify more effective and safer therapies for the treatment of IgA nephropathy. In the last few years, increasing understanding of the pathogenetic role of alternative complement pathway dysregulation in the onset and progression of IgA nephropathy has led to the development of new complement-targeting therapies. Iptacopan is an oral inhibitor of complement factor B that effectively blocks the alternative complement pathway.

Case presentation: We report the successful treatment of a 40-year-old female patient suffering from IgA nephropathy with iptacopan. In this patient, despite maximum tolerated renin-angiotensin system blockade and fully dosed SGLT-2 inhibitor administration, we failed to achieve the desired reduction in proteinuria to <0.5 g/day. Proteinuria persisted at a level of >1 g/day despite the goal of blood pressure ≤120/70 mm Hg being achieved. Impressively, within just two months after the initiation of iptacopan, we noted a reduction in proteinuria to 0.5 g/day, and after nearly six months, we reached our goal, with proteinuria at <0.3 g/day, a value continuing to the present day. Further, the medication was well-tolerated.

Conclusion: To the best of our knowledge, our case report is the first in Switzerland to show that selective inhibition of the alternative complement pathway in IgA nephropathy results in significant and ongoing reduction of proteinuria after six months of therapy, supporting the innovative concept of targeting the alternative complement pathway with iptacopan to treat IgA nephropathy.

Background: Information on severely injured patients transported by helicopter emergency medical services (HEMS) in Switzerland is scarce. This study, with a special focus on sex differences, aimed to gain insights into the demographics, injury characteristics and outcomes of these patients and to provide data that could help improve prehospital trauma care.

Methods: This is a retrospective multicentre cohort study analysing data collected by the Swiss Trauma Registry. Patients aged 16 or older, who were admitted by helicopter emergency medical services to a level 1 trauma centre in Switzerland between 2018 and 2022, with an Injury Severity Score (ISS) of ≥16, were included.

Results: Overall, 2714 trauma patients were analysed in the present study. The majority of these patients were male (73.7%). Blunt trauma was the main cause of injury (93.6%), with traffic accidents (43.5%) and falls (43.3%) being the most common accident mechanisms. A greater percentage of male patients than female patients were involved in motorcycle crashes (16.5% vs 6.9%, p <0.001). Female patients were more frequently involved in accidents as pedestrians (6% vs 2.7%, p <0.001) and experienced more falls below 3 metres of height (22.9% vs 14.7%, p <0.001). The median ISS of our cohort was 24 (interquartile range [IQR]: 19-30). The most common injuries were thoracic trauma (67%), head trauma (66.7%) and spine trauma (50.3%). Men suffered more thoracic injuries (68.9% vs 61.9%, p = 0.001) and their median Abbreviated Injury Score (AIS) Thorax was significantly higher (3.0 [IQR: 0-3] vs 2.0 [IQR: 0-3], p <0.001). Women had a higher prevalence of pelvic fractures (29.3% vs 21.5%, p <0.001) and suffered more fractures of long bones in their upper extremities (22.2% vs 15.7%, p <0.001). There was no significant difference in in-hospital mortality between women and men (15.7% vs 14.6%, p = 0.493), nor in other outcome parameters.

Conclusion: To our knowledge, this is the first analysis of data on severely injured trauma patients transported by helicopter emergency medical services in Switzerland. While there were notable differences between women and men in terms of accident mechanisms and injury characteristics, no significant differences in outcome parameters were observed.

Introduction: Inappropriate antibiotic prescribing drives antimicrobial resistance. Although the Swiss Society of Infectious Diseases has introduced national guidelines for common infectious diseases starting from 2019, it remains unclear whether family physicians and paediatricians adhere to them and what factors influence their prescriptions. The aims of this study were to assess whether Swiss family physicians and paediatricians make appropriate antibiotic choices in accordance with national guidelines and to identify physician- and patient-related factors associated with the prescribing of not-recommended antibiotic choices for specific indications.

Methods: A cross-sectional study analysed the choice of antibiotics (2017-2022) by indication from a sentinel physician surveillance network, comparing them to adult (16+) and paediatric national guidelines. Indications included pharyngitis, sinusitis, otitis media, pneumonia, chronic obstructive pulmonary disease exacerbation (adults only) and upper and lower urinary tract infections (adult females only). Descriptive analysis and pre- and post-guideline comparisons were conducted. A multilevel logistic regression model assessed factors influencing prescribing of not-recommended antibiotics across several clinical indications.

Results: A total of 52,098 observations were analysed. The overall proportion of not-recommended antibiotic prescriptions was 18% for adults and 19% for children. The proportion of not-recommended antibiotics ranged from 8% (lower urinary tract infection) to 39% (sinusitis) in adults, and from 5% (sinusitis) to 38% (pharyngitis) in children. The proportion of not-recommended antibiotics decreased following guideline implementation for all indications for children and for sinusitis (48% vs 39%) and pneumonia (19% vs 15%) for adults. A multilevel model revealed that certain clinical indications - such as pharyngitis - were associated with higher odds of prescribing not-recommended antibiotics. Additionally, family physicians (compared to paediatricians), older physician age and physicians' perception of a favourable patient attitude to the antibiotic were also linked to increased prescribing of not-recommended antibiotics.

Conclusions: Swiss family physicians and paediatricians show high levels of non-adherence to national guidelines across several indications, with limited change post-guideline implementation. Certain demographic characteristics of physicians and patient behaviour exacerbate these inappropriate prescribing habits. These insights indicate the need to enhance guideline dissemination and adoption by considering physicians' needs.

Background: Due to persistent organ shortage, the selection criteria for living kidney donors have broadened to include elderly donors and those with co-morbidities. As little is known about metabolic health after living kidney donation, this prospective, multicentre cohort study explored metabolic changes among living kidney donors, with a particular focus on weight trajectories.

Methods: We analysed metabolic and cardiovascular parameters before and after living kidney donation in 466 consecutive living kidney donors recorded in the Swiss Organ Living-Donor Health Registry between January 2018 and August 2022. Outcomes included weight, blood pressure, haemoglobin A1c (HbA1c) levels, and the occurrence of new-onset type 2 diabetes mellitus, arterial hypertension and cardiovascular diseases. Donors were stratified by predonation body mass index (BMI) and by postdonation weight change.

Results: Obese donors (BMI ≥30 kg/m²) more frequently had pre-existing hypertension at baseline than non-obese donors (31.6% vs 18.3%, p = 0.03). During follow-up (median 2.9 years), 6% of living kidney donors developed arterial hypertension, 2.6% developed cardiovascular diseases and 1.1% developed type 2 diabetes mellitus. Obese donors had a higher incidence of postdonation type 2 diabetes mellitus than non-obese donors (p = 0.01). Changes in BMI postdonation were not correlated with age or predonation BMI. Donors with postdonation weight gain had slightly higher follow-up blood pressure, but no clear differences in rates of new-onset hypertension or type 2 diabetes mellitus were observed between weight-change groups.

Conclusions: This exploratory analysis suggests that living kidney donation is generally metabolically safe. While metabolic changes were modest overall, obesity at the time of donation was associated with a slightly higher frequency of postdonation type 2 diabetes mellitus, underscoring the importance of counselling on lifestyle modification before donation.

The ultrasound examination in the first trimester is a crucial tool in prenatal diagnostics. Its primary aim is the early detection of fetal structural anomalies with the option to assess the risk for the common fetal trisomies (in Switzerland: "Ersttrimestertest"). The latter is achieved by combining ultrasound data with biochemical blood tests. In addition to chromosomal diagnostics, the first-trimester ultrasound plays an essential role in evaluating pregnancy risks as well as the overall health of the fetus. This method is non-invasive, safe and effective, offering invaluable information to both healthcare professionals and expectant parents that is critical for further pregnancy care. The introduction and wide-spread use of another, molecular test, NIPT ("non-invasive prenatal testing") should be seen as a useful additional option to, not a substitute for first trimester ultrasound. NIPT has high detection rates for "the common trisomies", but, in isolation, is insufficient for comprehensive early fetal assessment.

The Swiss expert group published revised guidelines on the prevention and antibiotic prophylaxis against infective endocarditis in 2021. In this viewpoint article, the group reports on their experiences two years after implementing the new prevention concept, which included information flyers and antimicrobial prophylaxis cards. Challenges included communicating the concept and indications for antimicrobial prophylaxis to both high-risk patients and providers.

Background: Opioid-containing antitussives are used to symptomatically treat a dry, irritative cough but bring a risk of misuse as recreational drugs. Since the update of the Swiss Therapeutic Products Act in 2019, opioid-containing antitussives are regulated more strictly, being available only on prescription and no longer over the counter.

Aim: This study aimed to describe the sales trends of opioid-containing antitussives in Switzerland between 2011 and 2022 to assess the impact of the regulation change.

Methods: We descriptively analysed cross-sectional data of opioid sales from wholesalers to pharmacies and self-dispensing physicians as an indicator of community use.

Main findings: An estimated 369 million standard units of opioid-containing antitussives were sold over the whole observation period, of which 59% contained dextromethorphan as the active ingredient. Sales decreased slowly between 2011 and 2019, then dropped substantially in 2020 (-30.4% compared to previous year) and 2021 (-15.2%), then partially recovered in 2022. The sales of codeine-containing antitussives did not recover until the end of the study period (quarter 3 of 2022) and remained 37.3% lower than before the rescheduling (quarter 4 of 2018).

Discussion: It is likely that repeated media attention on cases of misuse of opioid-containing antitussives led to more cautious dispensing in Switzerland leading up to the revision of the Therapeutic Products Act in 2019. The substantial decrease in sales in 2020 and 2021 was likely related to the COVID-19 pandemic rather than the rescheduling of opioid-containing antitussives. Longer data collection will be needed to assess the impact of the regulation change post-pandemic.

As patient and public involvement (PPI) in academic clinical research, especially clinical trials, is gaining recognition, including acceptance and implementation, questions arise about how to establish an effective "basic framework for PPI in academic clinical research" for all stakeholders in Switzerland. In this Viewpoint, the authors focus on one aspect of the survey and interview results reported by Eberle and colleagues from PPI contributors, researchers, academic research infrastructure staff, and representatives of regulatory and funding bodies to identify a possible direction for a basic PPI framework in Switzerland. Specifically, they describe how they prepare two groups of stakeholders - clinical researchers and PPI contributors - for collaboration. They present clear definitional distinctions to help clinical researchers prepare for the 2025 call for proposals from the Swiss National Science Foundation (SNSF) for Investigator-Initiated Clinical Trials (IICT) and provide important background information that is essential for understanding the fundamentals of PPI.

Study aims: This study aimed to deepen the understanding of endometriosis symptoms, types, and therapy recommendations for Swiss endometriosis patients in Swiss-certified endometriosis centres in 2022.

Methods: In this exploratory retrospective multicentre cohort study, data from 3538 women who had their first consultation at a certified endometriosis centre in Switzerland in 2022 were analysed retrospectively. Data were collected by using questionnaires that were filled out by the patient and the physician at the first consultation, to evaluate parameters that included the main reason for consultation, visual analogue scale (VAS) scores for pain, clinical findings and therapy recommendations.

Results: This study analysed all patients who had provided consent and were diagnosed with endometriosis (n = 3403, 96.2%) during their first consultation at a Swiss-certified endometriosis centre in 2022. The median age was 33.0 years (11-66 years). Of 812 documented VAS scores, 71.6% of the patients felt general pain, resulting in a median VAS score for dysmenorrhoea of 8 (0-10). After the first examination, peritoneal endometriosis (n = 1453, 54.8%) was diagnosed most often, followed by adenomyosis (n = 1366, 51.5%), deep infiltrating endometriosis (n = 857, 32.3%) and cystic/ovarian endometriosis (n = 643, 24.2%). In 46.2% of the patients, more than one working hypothesis, with regard to their condition, was identified - in most cases, a combination of peritoneal endometriosis and adenomyosis (15.6%). Endocrine therapy was the most frequent treatment recommended (60.6%), followed by recommendations for medical pain therapy (57%), surgery (34.4%), complementary procedures (23.5%), reproductive therapy (5.7%) and multimodal pain therapy (5.6%). Analysis of correlations between symptoms, diagnosis and treatment recommendations showed only a few notable findings such as correlations between peritoneal endometriosis and hormonal-/medical treatment as well as correlations between deep infiltrating endometriosis and treatment recommendation for surgery.

Conclusion: The high VAS scores in dysmenorrhoea underline the degree of suffering of patients with endometriosis seeking consultation at a certified endometriosis centre. Most patients presented multiple phenotypes with uncorrelated symptoms and diverse as well as multimodal treatment options were indicated, underlining the complexity and individuality of the disease.