Nederlands tijdschrift voor geneeskunde最新文献

Objective: To describe the association between suspected physical abuse in an index child and the risk of abuse among contact children, and to translate the recent international consensus on recommended screening protocols for contact children into clinical practice.

Results: There is strong evidence of a link between abuse in an index child and risk to other children in close contact - such as siblings or those cared for by the same caregiver - especially children under 2 years and twins. The consensus recommends the following radiological screening protocol: All contact children: top-to-toe physical examination and clinical history intake. Age <  12 months: top-to-toe exam, full skeletal survey, and neuroimaging (preferably MRI and myelum). Age 12-24 months: top-to-toe exam and full skeletal survey. Age > 24 months: no routine imaging indicated unless clinically warranted. Expert evaluation by a pediatric forensic radiologist is advised; re-evaluation by a LECK radiologist is recommended.

Conclusion: Contact children of a physical abused index child are at heightened risk and require proactive radiological screening according to the international consensus protocol. Interpretation of imaging should involve specialists in forensic pediatric radiology to ensure diagnostic accuracy and safeguard vulnerable children.

Post-acute infection syndromes (PAIS) are conditions characterized by persistent symptoms following an infectious disease. Although these syndromes share similarities in symptom burden and impact on daily functioning, they vary significantly in aetiology, clinical course, and treatment options. Postcovid is currently the most recognized example, but the phenomenon is not new: prolonged symptoms have also been observed after infections with Epstein-Barr virus, Borrelia burgdorferi, Coxiella burnetii, poliovirus, and after sepsis. The increasing attention to PAIS raises key questions in clinical practice: When do residual symptoms constitute a distinct syndrome? What do we know about underlying mechanisms and treatment strategies? How can we adequately diagnose and support patients? And what role does the biopsychosocial model play in understanding and managing these complaints? In this Discussion article, we review recent scientific findings and offer a perspective on these discussion points, with the aim of improving recognition, insight, and patient-centred care in PAIS.

A 45 year old male presents to our outpatient clinic with anemia. On physical examination, the finger nails are abnormal with a striking concave shape. Laboratory testing shows a microcytic anemia. What is the diagnosis?

The end of life is part of our lives and dying is more than just a physical event. End-of-life conversations are therefore essential in providing good quality care and to improve the quality -of-life for both patients in their last phase of life as well as their loved ones. Advance care planning should thus form an integral part of care for patients being confronted with their end of life either through illness or old age.

Objective: Surgery and corticosteroid injections are established treatments for carpal tunnel syndrome (CTS), but the optimal treatment strategy remains unclear. The DISTRICTS aimed to compare the efficacy of surgery with injection.

Design: Open-label, randomised controlled trial in the Netherlands.

Method: CTS patients were randomly assigned to start treatment with either surgery or an injection. Additional treatments were allowed. The primary outcome was the proportion of patients who recovered-defined as a score of fewer than eight points on the 6-item CTS scale at 18 months.

Results & conclusion: 934 participants were enrolled. The recovery rate in the surgery group was 61% and significantly higher than the 45% recovery rate in the injection group. In patients with CTS, initiating treatment with surgery offers a higher chance of recovery after 18 months compared to starting with a corticosteroid injection.

A skincare routine refers to the regular use of products and steps aimed at cleansing, hydrating, protecting, or rejuvenating the skin. What began as a basic regimen has evolved into a widely popular, often elaborate practice, driven by social media and commercial influence. While skincare can benefit skin health, extensive routines may also lead to dermatological complications. These include irritant and allergic contact dermatitis, perioral dermatitis, and photosensitivity. Contributing factors are cumulative exposure to active and allergenic ingredients, product misuse for certain skin types, and unrealistic expectations shaped by influencer content. Extra caution is warranted in children, given their more vulnerable skin barrier and greater susceptibility to marketing influences. Nonetheless, benefits such as UV protection and emollient use in dermatologic care are acknowledged. Given the high prevalence of skin-related complaints in primary care, the current skincare trend warrants critical evaluation and medically informed guidance.

In the Netherlands, all pregnant persons are screened for hiv, hepatitis B and syphilis at 10 weeks' gestation. Treatment of these infections both promote maternal health and prevent perinatal transmission. Other viral infections may also impair maternal and fetal health, but screening for these infections is not a routine in pregnancy. Sometimes opportunistic screening is done in presumed high-risk groups such as in child- and healthcare workers or viral diagnostic tests are done in case of illness or in the presence of fetal anomalies. We aim to discuss these viral illnesses with maternal and fetal consequences.

Pain relief during labor is a critical aspect of obstetric care, balancing maternal comfort with neonatal safety. With the increasing use, questions arise regarding the available pharmaceutical pain relief options and their obstetric, anesthetic, and neonatal implications. This article discusses two cases involving epidural analgesia and briefly reviews remifentanil and nitrous oxide, including their mechanisms, side effects, and implications. Epidural analgesia remains the gold standard for labor pain management due to its effectiveness and safety. Although it generally causes only mild and well-manageable side effects without clinical consequences, it remains an invasive technique that can, in rare cases, lead to (serious) complications. Remifentanil offers an alternative but with reduced efficacy and risks like respiratory depression. Nitrous oxide provides rapid pain relief but is less effective and limited by its short duration, environmental impact, healthcare personal exposure risks and uncertain neonatal effects.

Multi-cancer early detection (MCED) is a new development within cancer screening. A blood test combined with analysis of circulating tumor DNA could lead to early detection of multiple cancer types simultaneously, potentially reducing cancer-related mortality. While this sounds promising, a proactive ethical reflection on the possibilities and potential consequences of MCED in population screening is essential for its responsible implementation. In this article, we explore the ethics of MCED offered as population screening using the bioethical principles of beneficence and maleficence (proportionality), autonomy and justice. Proportionality of MCED screening requires that benefits outweigh harms. To respect autonomy, meaningful choices and understandable information need to be offered. Distributive justice requires at a minimum fairness in both the implementation and costs of screening. MCED screening does not currently meet these requirements, due to limited validity of MCED tests and potential harmful consequences of MCED introduction on both the individual and societal level.

Inguinal hernias are a common finding in young children. In female patients, these hernias may contain the ovary in some cases, particularly in early childhood. In very rare instances, the uterus may also be found. We present the case of a 3-year-old girl with a left-sided inguinal hernia. During herniotomy, both the left ovary and the uterus were found to be adherent to the hernia sac. For this reason, a laparoscopic approach was chosen for safe evaluation and reduction. Awareness of the potential herniation of internal reproductive organs in young girls is essential, particularly in case of signs of incarceration. Early surgical intervention is recommended to prevent ischemic damage. This case highlights the importance of prompt recognition, careful intraoperative assessment and the consideration of minimally invasive techniques.