Nederlands tijdschrift voor geneeskunde最新文献

Objective: HIV can be effectively prevented by oral HIV pre-exposure prophylaxis (PrEP). When PrEP was introduced, there was apprehension that condom use would decrease and STIs would increase. The purpose of this study was to investigate sexual behaviour and STI incidence among PrEP users.

Design: Prospective cohort study METHODS: The Amsterdam PrEP demonstration project (AMPrEP) provided oral PrEP to men who have sex with men (MSM) and transgender women from 2015 to 2020. Participants could choose between daily and event-driven PrEP. We tested for HIV and STIs at each quarterly study visit. We examined changes in numbers of sex partners and frequency of condomless anal sex with casual partners (CAS) with negative binomial regression. We examined HIV incidence, and changes in STI incidence using Poisson regression.

Results: 367 participants (365 MSM) initiated PrEP, median duration of participation was 3.9 years (interquartile range[IQR]=3.4-4.0). Median number of sex partners per three months was 13 (IQR=6-26) and decreased with each additional year on PrEP (adjusted rate ratio[aRR]=0.86/year, 95%confidence interval[CI]=0.83-0.88). Frequency of CAS per three months was 10 (IQR=3-20.5) and also decreased (aRR=0.92/year, 95%CI=0.88-0.97). Incidence of any STI was 87/100PY (95%CI=82-92) and did not increase over time. Two HIV infections were diagnosed (incidence=0.2/100PY; 95%CI=0.0-0.6), both during the first year and among daily PrEP users.

Conclusions: In this prospective cohort with an observation period of four years, we observed a low HIV incidence and a decrease in the number of sex partners and CAS over time. Although STI incidence was high, it did not increase.

Night sweats are a common symptom. There is a lack of a uniform definition and a diagnostic guideline. In this article we propose a structural analysis for all levels of healthcare. First, we need to distinguish night sweats with or without fever. We will then discuss the main differential diagnoses (infection, malignancies, sleeping disorders and medication-related) and emphasize the role of diagnostic clues. A screening for infections, sleeping disorders and a medication review are a must for every patient. Furthermore we will explain the role of PET-CT and bone marrow examination.

Many physicians and patients hold the (unconscious) belief that intravenous antibiotic therapy is superior to oral therapy. This belief is also reflected in guidelines, where increasing severity of infection often leads to the recommendation of intravenous options only. But is this belief justified, and where does it come from? Treating with oral antibiotics has many potential advantages, such as fewer hospital admissions and the prevention of related complications. In this era of increasing demand for appropriate and efficient care, oral antibiotic treatment should replace intravenous treatment where possible. Here, we outline the crucial factors that should be considered when deciding between oral and intravenous treatment of infections: pharmacokinetics and dynamics, antibiotic resistance, and specific patient factors.

In the present paper 10 questions regarding gallstones will be answered. The questions relate to the symptoms, diagnostic approach and treatment of gallstones. Additionally, the management of complicated gallstone disease such as cholecystitis, cholangitis or pancreatitis will be discussed. The aim of this work is to provide insight into the multidisciplinary management of gallstone disease including outcomes of treatment. Since the prevalence of gallstones is rising rapidly, it is of importance both in primary as in secondary care to provide our patients with an optimal selection for the most appropriate treatment.

Infections with Corynebacterium diphtheriae were virtually absent among the Dutch population due to vaccination, while in the first half of the 20th century, it was a significant cause of child mortality. However, due to imported infections resulting from migration from countries with low vaccination coverage, infections with Corynebacterium diphtheriae are resurging. Concurrently, the vaccination rates among Dutch children are decreasing, elevating the risk of outbreaks. Severe symptoms are caused by exotoxins from the C. diphtheriae, infections with non-toxigenic strains can occur, which vaccination does not protect against. The bacteria itself is rarely invasive; only the toxin spreads. Non-toxin-producing strains manifest locally with milder symptoms but can become invasive, causing bacteraemia and endocarditis. As infections with non-toxigenic strains are not notifiable, little is known about their epidemiology. Moreover, specific culture media are required for bacterial cultivation, potentially leading to missed diagnoses.

A 74-year-old man, previously healthy, presented at the Dermatology department with an asymptomatic hand lesion persisting for two months. The general practitioner initially treated the lesion with betamethasone and fusidic acid cream. Examination revealed a 3 cm livid plaque with central crusts. A biopsy confirmed cutaneous leishmaniasis tropica. The patient travelled to Greece, Spain, and Southern France before the lesion occurred, which is consistent with the endemicity of leishmaniasis in the Mediterranean. Treatment involved cryotherapy and antimony injections, resulting in lesion resolution after two sessions. This case underscores the importance of considering travel history and endemic diseases in diagnosing and managing dermatological conditions, especially in regions prone to specific infections.

Corticosteroids are often administered locally to prevent systemic exposure and side effects. It is not well known that all forms of locally administered corticosteroids can have systemic side effects. Because doctors are less aware of systemic side effects when using locally administered corticosteroids, these side effects are not always recognized and treated as such. In addition, this means that good incidence figures for systemic side effects of local corticosteroid therapy are lacking. The individual risk of developing systemic side effects varies greatly because it depends on a large number of factors. Knowledge of these risk factors can help to estimate which patients are at risk of systemic side effects. Certain agents, such as fluticasone inhaler or budesonide nasal spray, have an increased risk of systemic side effects. By switching to an alternative, if the case permits it, the risk of systemic side effects can be reduced.

The introduction of cancer screening programs requires solid evidence of a proper balance between health benefits, harms and resources needed. The primary outcome measure in most randomized cancer screening trails so far has been cancer-related mortality. Collecting data on this outcome requires large study groups and adequate follow-up. Alternative primary outcome measures have been proposed, such as a stage shift, which has been selected in the ongoing UK NHS-Galleri trial. Recent commentaries have discussed the limitations of such alternative outcome measures in cancer screening trials.

This study examines, from a legal standpoint, the conditions under which patient data may be shared and processed by clinical quality registries in the Netherlands and investigates the potential impact of the proposed changes of the Healthcare Quality, Complaints and Disputes Act (WKKGZ) on these practices. Healthcare providers in the Netherlands may share patient data with clinical quality registries to measure and improve care quality, provided they have explicit patient consent or a legal basis. While there is general consensus within the field, legal ambiguity remains regarding processing data without explicit consent. Proposed changes to the WKKGZ would create an explicit legal basis for clinical quality registries to collect and process patient data without explicit consent, aiming to improve to improve the quality of care for the greater public interest.

Objective: To compare diagnostic accuracy of artificial intelligence (AI) for cervical spine (C-spine) fracture detection on CT with attending radiologists.

Design: Retrospective, diagnostic accuracy study.

Methods: AI analyzed 2368 scans from patients screened for C-spine fracture with CT (2007-2014, fracture prevalence 9.3%). With the use of a validated reference standard, which includes information on injuries in need of stabilizing therapy (IST), diagnostic accuracy of AI and radiologists was calculated and subsequently compared.

Results: Median age was 48 years. AI detected 158/221 fractures and radiologists 195/221, with a sensitivity of respectively 71.5% and 88.2% (p<0.001). Specificity of the AI and the radiologists was comparable: 98.6% and 99.2% (p=0.07). Of the fractures undetected by AI, 30/63 were an IST versus 4/26 for radiologists. AI detected 22/26 scans with fractures undetected by radiologists.

Conclusion: Compared to attending radiologists, AI has a lower sensitivity and misses more ISTs; however, it detected most fractures undetected by the radiologists, including ISTs.