AIMS
The Centor criteria and the FeverPAIN score are recommended for guiding antibiotic prescription for tonsillitis, but they are not validated for this purpose. We aimed to identify risk factors for peritonsillar abscess in group A haemolytic streptococcus-negative tonsillitis and to test the performance of clinical scores and laboratory tests.
METHODSIn a retrospective case-control study at two regional hospitals from January 2015 to June 2018, we identified all cases of peritonsillar abscess and used propensity score matching utilising age and gender to select two controls per case from all patients who had a rapid group A haemolytic streptococcus antigen test in the emergency department. Exclusion criteria were age <18 years, documented refusal and a positive antigen test. We abstracted patient history, physical examination and results of laboratory testing. Logistic regression analysis was used to identify risk factors.
RESULTSWe included 141 cases of peritonsillar abscess, matched with 282 controls. Higher Centor score, C-reactive protein and white blood cell count were significantly associated with peritonsillar abscess, but had a low performance for predicting the latter (area under the receiver operator characteristic curve [ROC AUC] 0.76). The FeverPAIN score was not associated with peritonsillar abscess (ROC AUC 0.51). In the multivariable analysis, difficulty swallowing (odds ratio [OR] 18.4, 95% confidence interval [CI] 6.58–51.2), dyspnoea (OR 10.2, 95% CI 1.18–89.0), tonsillar swelling (OR 4.21, 95% CI 1.39–12.7) and unilateral signs and symptoms (OR 146, 95% CI 40.9–522) were risk factors of peritonsillar abscess.
CONCLUSIONThe Centor criteria, as well as C-reactive protein and white blood cell count, have a low discriminatory performance, and the FeverPAIN score is not useful in identifying patients at risk for peritonsillar abscess in group A haemolytic streptococcus-negative tonsillitis. To guide a rational antibiotic prescription, new decision tools need to be developed. These might include items such as difficulty swallowing, dyspnoea, tonsillar swelling and unilaterality.
AIM OF THE STUDY
In the era of pangenotypic treatment regimens against hepatitis C virus (HCV) infection, data from postmarketing observational studies are crucial to better understand the treatment patterns used in specific countries and treatment outcomes under real-life conditions. We report data from Switzerland from an ongoing, multinational postmarketing observational study on the pangenotypic treatment regimen of glecaprevir (GLE; NS3/4A protease inhibitor) and pibrentasvir (PIB; NS5A inhibitor), coformulated as GLE/PIB.
METHODSAdults infected with chronic HCV genotypes 1–6 were eligible to participate in the postmarketing observational study if they started GLE/PIB at the treating physician’s discretion. The primary objective was to evaluate the effectiveness of GLE/PIB based on sustained virological response 12 weeks after completion of treatment (SVR12); secondary outcomes included patient-reported outcomes (Fatigue Severity Scale, Work Productivity and Activity Impairment Questionnaire, Pictorial Representation of Illness and Self Measure tool) and safety data.
RESULTSIn Switzerland, 109 patients were enrolled, and 107 patients received ≥1 dose GLE/PIB (94.4% non-cirrhotic; 43.9%/14.0%/29.0%/13.1% GT1/GT2/GT3/GT4; 89.7% treatment-naïve; 91.6% assigned to an 8-week GLE/PIB regimen). Overall, 95 of 98 patients with sufficient follow-up data (96.9%) achieved SVR12 (95% confidence interval [CI] 91.4% to 99.0%), and 91.6% in the safety population (including six non-virological failures). The three treatment failures were due to relapse. All three failures were GT3, without cirrhosis and treatment naïve. Patient-reported outcomes improved as well. GLE/PIB was well tolerated with no serious adverse events and no adverse events leading to discontinuation or interruption of GLE/PIB treatment.
CONCLUSIONThese real-world effectiveness and safety data of GLE/PIB in patients from Switzerland were consistent with those seen in the multinational registration trials. (Trial registration number: Clinicaltrials.gov: NCT03303599.)
BACKGROUND
SARS-CoV-2 is a respiratory virus. Transmission occurs by droplets, contact and aerosols. In medical settings, filtering facepiece (FFP) respirators are recommended for use by personnel exposed to aerosol-generating procedures. During the COVID-19 pandemic, the demand for FFP respirators exceeded their supply worldwide and low-quality products appeared on the market, potentially putting healthcare workers at risk.
AIMSTo raise awareness about variations in quality of imported FFP respirators in Switzerland during the COVID-19 pandemic, to draw attention to the current directives regulating the market launch of FFP respirators in Switzerland, to provide practical support in identifying suspicious products or documents and, finally, to offer strategies aimed at reducing the distribution of low-quality FFP respirators in the future.
METHODSThree Swiss laboratories, Spiez Laboratory and Unisanté in partnership with TOXpro SA individually set up testing procedures to evaluate aerosol penetration and fit testing of FFP respirators imported into Switzerland during COVID-19 pandemic. Additionally, Spiez Laboratory visually inspected the products, examined the certification documents and crosschecked the product information with international databases.
RESULTSBetween 31 March and 15 June 2020, 151 FFP respirators were analysed. The initial assessment performed before testing allowed a reduction of up to 35% in the number of FFP respirators sent to Spiez Laboratory for evaluation, for which product information found to be faulty. After filtration efficiency evaluation and fit testing, 52% and 60% of all products tested by Spiez Laboratory and Unisanté-TOXpro SA, respectively, did not meet the minimum performance requirements established independently by the three Swiss laboratories.
CONCLUSIONThe demand for FFP respirators exceeded the supply capacity from established suppliers of the Swiss market. New production and import channels emerged, as did the number of poor-quality FFP respirators. FFP respirators remaining in stocks should be checked for conformity before being used, or eliminated and replaced if quality does not meet standards.
BACKGROUND
The past 25 years have seen the increased use of minimally invasive surgery. The development of these techniques has impacted the domain of liver surgery. This study aimed to describe the safety, feasibility, benefits and results of laparoscopic liver resection in a single tertiary care centre.
METHODSWe reviewed the medical records of all patients who underwent liver surgery between January 2005 and December 2016 at the University Hospital of Basel. We selected all liver resections performed by laparoscopic surgery. To evaluate the results of the laparoscopic liver surgery, we chose the following data: the conversion rate from laparoscopy to open surgery, the median operating time, postoperative complications, the median length of stay following surgery and the median surgical margin in patients with malignant lesions.
RESULTSOf the 274 liver operations, 201 (73%) were performed by open surgery and 73 (27%) by laparoscopy. Sixty-nine laparoscopic liver resections were included in this study. The selected laparoscopic liver resections were performed in 65 patients: 38 men and 27 women. The median age was 59 (range 29–85) years. Forty resections were performed for malignant lesions and 29 (42%) for benign diseases. The median operating time was 112 (range 50–247) minutes. The conversion rate was 19%. The most common cause for conversion was bleeding (69% of all conversions, 13% of all patients). Postoperative complications occurred in 15 patients (22%). The median hospitalisation time was 7.1 (range 2–23) days. Thirty-two patients (46.5% of all patients) had hepatocellular carcinoma. The mean tumour size was 25.6 (range 5–55) mm. The median surgical margin was 9 mm.
CONCLUSIONThis study showed that in our centre laparoscopic liver surgery is a safe and effective treatment option for both benign and malignant liver lesions.
AIM OF THE STUDY
This analysis provides a full national overview of genetic research dossiers pertaining to clinical and nonclinical trials, and to further-use research projects submitted for approval to ethics committees in Switzerland in 2018. It addresses the research type, medical field, number of individuals or datasets involved, diagnostic laboratories and data privacy, as well as the procedures foreseen for obtaining consent, communicating results, and dealing with excess data and incidental findings. The analysis results should constitute a basis for future discussions surrounding regulatory and ethical procedures that govern genetic investigations in biomedical research in Switzerland.
METHODSAll research dossiers approved by ethics committees in 2018 were screened for genetic investigations. A sample of 122 dossiers were analysed in depth, with regards to the frequency of genetic investigations, overall purpose and number of human beings or datasets included, in addition to the diagnostic categories and methodologies that were employed. The number of genes, biosample storage conditions and laboratory types concerned were also recorded. The processes for obtaining informed consent, communicating the results to the participants and predetermined principles for handling incidental findings were analysed.
RESULTSGenetic investigations were retrieved from 9% of all research applications. The focus of most clinical trials was pharmacogenetics, whereas research projects of further use of data and/or biological material were mostly investigator-initiated and focused on basic genetic research and multiple gene analysis. Overall, big datasets (i.e., more than 100 or even 1000 sets) were included, especially in further-use research projects. Nongermline somatic genetic investigations were a large research field in oncology (56%), whereas genetic germline testing was mostly performed in neurology or psychiatry. In most cases, numerous genes were analysed. Modern sequencing techniques were employed, rendering excess genetic information nearly inevitable. Information regarding the storage of genetic data was mostly lacking, whereas information regarding the biosample storage was mostly provided. Data protection and informed consent procedures aligned with legal, regulatory and ethical standards. Procedures for communicating genetic analysis results and incidental findings to research participants were not predetermined in most research protocols, and they were handled differently from informed consent and general consent forms.
CONCLUSIONSThis study overviewed the key dimensions of regulatory and ethical assessments pertaining to genetic investigations that are performed on human beings as part of research projects in Switzerland. The data’s potential impact to shape the Federal Act on Human Genetic Testing and the Human Research Act in the future is also discussed. A direct transfer of standards for quality, consultation and communication of genetic testing within clinical genetic routines to genetic testing of human beings in the research context is neither required nor appropriate. It would bear a high risk of excluding patients and the Swiss health system from seminal innovations in medicine and life-science research.
AIMS OF THE STUDY
Adverse drug reactions (ADRs) are an important cause of hospital admissions. Insufficient data are available about the frequency and characteristics of ADR-related emergency readmissions in Switzerland. The aim of this retrospective study was to characterise ADRs related to short-term emergency readmissions in a large Swiss University Hospital and to assess their reporting frequency.
METHODSElectronic records of all patients discharged from the University Hospital Bern within a 12-month period (1 January to 31 December 2012) and emergency readmission within 30 calendar days were reviewed. Case inclusion required a known ADR. Cases with intentional overdosing, lack of compliance or insufficient documentation were excluded. Identified ADR-related readmission cases were searched in the Swiss ADR reporting system to assess reporting rate.
RESULTSThere were 1294 emergency readmissions among the 4792 readmissions (14% of all admissions) within 30 days after discharge. We identified 270 cases of ADR-related readmissions, corresponding to 21% of emergency readmissions and 6% of all readmissions within 30 days. The most frequent ADRs were gastrointestinal disorders (26%), infections and infestations (19%), and nervous system disorders (10%). The most frequent drug classes leading to ADRs were antineoplastic/immunomodulating (35%) and antithrombotic agents (25%). Only 8 (3%) of the 270 cases were reported to the Swiss ADR reporting system.
CONCLUSIONADR-related readmissions constituted a considerable part of short-term emergency readmissions. Despite being a relevant cause for rehospitalisation, only a minority of the ADRs were reported to the regulatory authorities. Strategies to prevent ADR-related readmissions and to improve reporting rates are needed.
The authors present the case of a 58-year-old man with the unique combination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and, later on, haemophagocytic lymphohistiocytosis admitted to the intensive care unit. During his ICU stay the patient developed a variety of complications including acute respiratory distress syndrome, pulmonary embolism, right heart failure and suspected HLH leading to multiorgan failure and death. Despite the proven diagnosis of haemophagocytic lymphohistiocytosis, the excessively high ferritin levels of the patient did not seem fully explained by this diagnosis. Therefore, the authors want to highlight different causes of hyperferritinaemia in critically ill patients and underline the importance of differential diagnoses when interpreting continuously rising ferritin levels.
