K. Moehlig, A. De Lamper, E. Dierckx, L. Vandeputte, W. Van Peer, B. Van Rompaey, L. Peremans
The family physician shortage: does it start at the university? Well-developed primary care results in a better preventive healthcare, cost-reduction and better health outcomes. Despite this importance, there is a growing shortage of family physicians in Belgium and internationally. A promising approach is to increase the number of entry-level students in advanced training to become family physicians. This study used a mixed-methods design. The quantitative component included an exploratory questionnaire administered to medical students from all years at Flemish universities. In the qualitative part, focus group discussions with master students went deeper into the different influencing factors. The results were compiled in the final phase. For statistical analysis, 423 completed questionnaires were included. Interest in long-term relationships with patients, conducting psychological interviews, commitment to prevention, a shorter training time, flexible working hours, a higher year of study and constancy in the choice of family medicine explain 68.7% of the choice of family medicine after multivariate analysis. Students from the focus group interviews (n = 26) cite similar elements. Only 1/5 of medical students completely rule out family medicine. The following recommendations are formulated for Flemish universities to increase the interest in family medicine: involve more family physicians in basic training, organise compulsory internships in general medicine and provide sufficient information regarding advanced training.
{"title":"Begint het huisartsentekort bij de opleiding?","authors":"K. Moehlig, A. De Lamper, E. Dierckx, L. Vandeputte, W. Van Peer, B. Van Rompaey, L. Peremans","doi":"10.47671/tvg.80.24.074","DOIUrl":"https://doi.org/10.47671/tvg.80.24.074","url":null,"abstract":"The family physician shortage: does it start at the university?\u0000\u0000 \u0000\u0000Well-developed primary care results in a better preventive healthcare, cost-reduction and better health outcomes. Despite this importance, there is a growing shortage of family physicians in Belgium and internationally. A promising approach is to increase the number of entry-level students in advanced training to become family physicians.\u0000\u0000 \u0000\u0000This study used a mixed-methods design. The quantitative component included an exploratory questionnaire administered to medical students from all years at Flemish universities. In the qualitative part, focus group discussions with master students went deeper into the different influencing factors. The results were compiled in the final phase.\u0000\u0000 \u0000\u0000For statistical analysis, 423 completed questionnaires were included. Interest in long-term relationships with patients, conducting psychological interviews, commitment to prevention, a shorter training time, flexible working hours, a higher year of study and constancy in the choice of family medicine explain 68.7% of the choice of family medicine after multivariate analysis. Students from the focus group interviews (n = 26) cite similar elements.\u0000\u0000 \u0000\u0000Only 1/5 of medical students completely rule out family medicine. The following recommendations are formulated for Flemish universities to increase the interest in family medicine: involve more family physicians in basic training, organise compulsory internships in general medicine and provide sufficient information regarding advanced training.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"48 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141919147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Moehlig, A. De Lamper, E. Dierckx, L. Vandeputte, W. Van Peer, B. Van Rompaey, L. Peremans
The family physician shortage: does it start at the university? Well-developed primary care results in a better preventive healthcare, cost-reduction and better health outcomes. Despite this importance, there is a growing shortage of family physicians in Belgium and internationally. A promising approach is to increase the number of entry-level students in advanced training to become family physicians. This study used a mixed-methods design. The quantitative component included an exploratory questionnaire administered to medical students from all years at Flemish universities. In the qualitative part, focus group discussions with master students went deeper into the different influencing factors. The results were compiled in the final phase. For statistical analysis, 423 completed questionnaires were included. Interest in long-term relationships with patients, conducting psychological interviews, commitment to prevention, a shorter training time, flexible working hours, a higher year of study and constancy in the choice of family medicine explain 68.7% of the choice of family medicine after multivariate analysis. Students from the focus group interviews (n = 26) cite similar elements. Only 1/5 of medical students completely rule out family medicine. The following recommendations are formulated for Flemish universities to increase the interest in family medicine: involve more family physicians in basic training, organise compulsory internships in general medicine and provide sufficient information regarding advanced training.
{"title":"Begint het huisartsentekort bij de opleiding?","authors":"K. Moehlig, A. De Lamper, E. Dierckx, L. Vandeputte, W. Van Peer, B. Van Rompaey, L. Peremans","doi":"10.47671/tvg.80.24.074","DOIUrl":"https://doi.org/10.47671/tvg.80.24.074","url":null,"abstract":"The family physician shortage: does it start at the university?\u0000\u0000 \u0000\u0000Well-developed primary care results in a better preventive healthcare, cost-reduction and better health outcomes. Despite this importance, there is a growing shortage of family physicians in Belgium and internationally. A promising approach is to increase the number of entry-level students in advanced training to become family physicians.\u0000\u0000 \u0000\u0000This study used a mixed-methods design. The quantitative component included an exploratory questionnaire administered to medical students from all years at Flemish universities. In the qualitative part, focus group discussions with master students went deeper into the different influencing factors. The results were compiled in the final phase.\u0000\u0000 \u0000\u0000For statistical analysis, 423 completed questionnaires were included. Interest in long-term relationships with patients, conducting psychological interviews, commitment to prevention, a shorter training time, flexible working hours, a higher year of study and constancy in the choice of family medicine explain 68.7% of the choice of family medicine after multivariate analysis. Students from the focus group interviews (n = 26) cite similar elements.\u0000\u0000 \u0000\u0000Only 1/5 of medical students completely rule out family medicine. The following recommendations are formulated for Flemish universities to increase the interest in family medicine: involve more family physicians in basic training, organise compulsory internships in general medicine and provide sufficient information regarding advanced training.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"13 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141919633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A study on the use of the Pediatric Sleep Questionnaire as a screening tool for obstructive sleep apnea syndrome in children with ADHD Background: Obstructive sleep apnea syndrome (OSAS) is a common childhood sleep disorder in which sleep is disrupted by complete or partial obstruction of the upper airway. An increased presence of OSAS in children with attention deficit hyperactivity disorder (ADHD) (25-30%) has been reported in the literature. Detection and treatment are not only important for good sleep but can also reduce the symptoms of ADHD and avoid metabolic risks later in life, such as cardiovascular disease. Given the high prevalence and serious consequences of OSAS, early diagnosis is crucial. However, a screening tool for OSAS that has been validated in a population of children with ADHD is not known. Objective: To investigate whether an existing screening questionnaire for OSAS (PSQ – Pediatric Sleep Questionnaire) is also suitable for screening for OSAS in children with ADHD. Method: In a first small-scale study, the PSQ was administered to children with ADHD, after which the data were analyzed. Results: A shortage of participants, a high number of missing data, and a lack of variation in the data did not allow us to deduce whether the PSQ is suitable as a screening tool for OSAS in children with ADHD. Descriptive analysis of the answers to the questionnaire and the score on the PSQ showed a possible influence of the intake of ADHD medication and the presence of one or more comorbidities. The underlying mechanisms are still unclear and need to be further investigated in future research.
将儿童睡眠问卷作为多动症儿童阻塞性睡眠呼吸暂停综合征筛查工具的研究 背景：阻塞性睡眠呼吸暂停综合征（OSAS）是一种常见的儿童睡眠障碍，由于上气道完全或部分阻塞而影响睡眠。据文献报道，患有注意力缺陷多动障碍（ADHD）的儿童中，阻塞性睡眠呼吸暂停综合征的发病率较高（25%-30%）。检测和治疗不仅对良好的睡眠非常重要，还能减轻多动症的症状，避免日后的代谢风险，如心血管疾病。鉴于 OSAS 的高发病率和严重后果，早期诊断至关重要。然而，目前还不知道有什么筛查工具能在多动症儿童群体中得到验证。研究目的调查现有的 OSAS 筛查问卷（PSQ - 儿童睡眠问卷）是否也适用于筛查多动症儿童的 OSAS。方法：首次小规模研究在首次小规模研究中，对患有多动症的儿童进行了 PSQ 问卷调查，之后对数据进行了分析。结果：参加者人数不足、参与人数较多：由于参与人数不足、数据缺失较多以及数据缺乏变化，我们无法推断 PSQ 是否适合作为多动症儿童 OSAS 的筛查工具。对问卷答案和 PSQ 分数的描述性分析表明，服用 ADHD 药物和存在一种或多种并发症可能会对其产生影响。其潜在机制尚不清楚，需要在今后的研究中进一步探讨。
{"title":"Een onderzoek naar het gebruik van de Pediatric Sleep Questionnaire als screeningstool voor obstructief slaapapneusyndroom bij kinderen met ADHD","authors":"H. Bens, E. Campforts","doi":"10.47671/tvg.80.24.014","DOIUrl":"https://doi.org/10.47671/tvg.80.24.014","url":null,"abstract":"A study on the use of the Pediatric Sleep Questionnaire as a screening tool for obstructive sleep apnea syndrome in children with ADHD\u0000\u0000 \u0000\u0000Background: Obstructive sleep apnea syndrome (OSAS) is a common childhood sleep disorder in which sleep is disrupted by complete or partial obstruction of the upper airway. An increased presence of OSAS in children with attention deficit hyperactivity disorder (ADHD) (25-30%) has been reported in the literature. Detection and treatment are not only important for good sleep but can also reduce the symptoms of ADHD and avoid metabolic risks later in life, such as cardiovascular disease. Given the high prevalence and serious consequences of OSAS, early diagnosis is crucial. However, a screening tool for OSAS that has been validated in a population of children with ADHD is not known.\u0000\u0000 \u0000\u0000Objective: To investigate whether an existing screening questionnaire for OSAS (PSQ – Pediatric Sleep Questionnaire) is also suitable for screening for OSAS in children with ADHD.\u0000\u0000 \u0000\u0000Method: In a first small-scale study, the PSQ was administered to children with ADHD, after which the data were analyzed.\u0000\u0000 \u0000\u0000Results: A shortage of participants, a high number of missing data, and a lack of variation in the data did not allow us to deduce whether the PSQ is suitable as a screening tool for OSAS in children with ADHD. Descriptive analysis of the answers to the questionnaire and the score on the PSQ showed a possible influence of the intake of ADHD medication and the presence of one or more comorbidities. The underlying mechanisms are still unclear and need to be further investigated in future research.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141919273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A study on the use of the Pediatric Sleep Questionnaire as a screening tool for obstructive sleep apnea syndrome in children with ADHD Background: Obstructive sleep apnea syndrome (OSAS) is a common childhood sleep disorder in which sleep is disrupted by complete or partial obstruction of the upper airway. An increased presence of OSAS in children with attention deficit hyperactivity disorder (ADHD) (25-30%) has been reported in the literature. Detection and treatment are not only important for good sleep but can also reduce the symptoms of ADHD and avoid metabolic risks later in life, such as cardiovascular disease. Given the high prevalence and serious consequences of OSAS, early diagnosis is crucial. However, a screening tool for OSAS that has been validated in a population of children with ADHD is not known. Objective: To investigate whether an existing screening questionnaire for OSAS (PSQ – Pediatric Sleep Questionnaire) is also suitable for screening for OSAS in children with ADHD. Method: In a first small-scale study, the PSQ was administered to children with ADHD, after which the data were analyzed. Results: A shortage of participants, a high number of missing data, and a lack of variation in the data did not allow us to deduce whether the PSQ is suitable as a screening tool for OSAS in children with ADHD. Descriptive analysis of the answers to the questionnaire and the score on the PSQ showed a possible influence of the intake of ADHD medication and the presence of one or more comorbidities. The underlying mechanisms are still unclear and need to be further investigated in future research.
将儿童睡眠问卷作为多动症儿童阻塞性睡眠呼吸暂停综合征筛查工具的研究 背景：阻塞性睡眠呼吸暂停综合征（OSAS）是一种常见的儿童睡眠障碍，由于上气道完全或部分阻塞而影响睡眠。据文献报道，患有注意力缺陷多动障碍（ADHD）的儿童中，阻塞性睡眠呼吸暂停综合征的发病率较高（25%-30%）。检测和治疗不仅对良好的睡眠非常重要，还能减轻多动症的症状，避免日后的代谢风险，如心血管疾病。鉴于 OSAS 的高发病率和严重后果，早期诊断至关重要。然而，目前还不知道有什么筛查工具能在多动症儿童群体中得到验证。研究目的调查现有的 OSAS 筛查问卷（PSQ - 儿童睡眠问卷）是否也适用于筛查多动症儿童的 OSAS。方法：首次小规模研究在首次小规模研究中，对患有多动症的儿童进行了 PSQ 问卷调查，之后对数据进行了分析。结果：参加者人数不足、参与人数较多：由于参与人数不足、数据缺失较多以及数据缺乏变化，我们无法推断 PSQ 是否适合作为多动症儿童 OSAS 的筛查工具。对问卷答案和 PSQ 分数的描述性分析表明，服用 ADHD 药物和存在一种或多种并发症可能会对其产生影响。其潜在机制尚不清楚，需要在今后的研究中进一步探讨。
{"title":"Een onderzoek naar het gebruik van de Pediatric Sleep Questionnaire als screeningstool voor obstructief slaapapneusyndroom bij kinderen met ADHD","authors":"H. Bens, E. Campforts","doi":"10.47671/tvg.80.24.014","DOIUrl":"https://doi.org/10.47671/tvg.80.24.014","url":null,"abstract":"A study on the use of the Pediatric Sleep Questionnaire as a screening tool for obstructive sleep apnea syndrome in children with ADHD\u0000\u0000 \u0000\u0000Background: Obstructive sleep apnea syndrome (OSAS) is a common childhood sleep disorder in which sleep is disrupted by complete or partial obstruction of the upper airway. An increased presence of OSAS in children with attention deficit hyperactivity disorder (ADHD) (25-30%) has been reported in the literature. Detection and treatment are not only important for good sleep but can also reduce the symptoms of ADHD and avoid metabolic risks later in life, such as cardiovascular disease. Given the high prevalence and serious consequences of OSAS, early diagnosis is crucial. However, a screening tool for OSAS that has been validated in a population of children with ADHD is not known.\u0000\u0000 \u0000\u0000Objective: To investigate whether an existing screening questionnaire for OSAS (PSQ – Pediatric Sleep Questionnaire) is also suitable for screening for OSAS in children with ADHD.\u0000\u0000 \u0000\u0000Method: In a first small-scale study, the PSQ was administered to children with ADHD, after which the data were analyzed.\u0000\u0000 \u0000\u0000Results: A shortage of participants, a high number of missing data, and a lack of variation in the data did not allow us to deduce whether the PSQ is suitable as a screening tool for OSAS in children with ADHD. Descriptive analysis of the answers to the questionnaire and the score on the PSQ showed a possible influence of the intake of ADHD medication and the presence of one or more comorbidities. The underlying mechanisms are still unclear and need to be further investigated in future research.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"11 45","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141919448","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Methylphenidate as a treatment for hypersomnolence due to a thalamic infarction Fatigue after a stroke can persist for a long time and has consequences for the patient’s rehabilitation. Fatigue is also associated with a higher mortality and a reduced quality of life. Hypersomnia (or hypersomnolence) is much less common after a stroke, but can seriously hinder a person’s recovery and treatment. In this article, 2 cases of severely disabling hypersomnolence after an ischemic stroke in the thalamus are presented and the typical features and treatment options are discussed. The clinical course of thalamic lesions, as well as the contribution of the electroencephalogram and medical imaging are reported. The stimulating effect of methylphenidate on the central nervous system explains the beneficial influence on the hypersomnolence in the 2 cases described here. Treatment of hypersomnia improves a patient’s recovery and quality of life after a stroke.
{"title":"Methylfenidaat als behandeling voor hypersomnolentie als gevolg van een thalamusinfarct","authors":"N. Geurs, K. Hoffbauer, L. Baisier, H. De Cauwer","doi":"10.47671/tvg.80.24.062","DOIUrl":"https://doi.org/10.47671/tvg.80.24.062","url":null,"abstract":"Methylphenidate as a treatment for hypersomnolence due to a thalamic infarction\u0000\u0000 \u0000\u0000Fatigue after a stroke can persist for a long time and has consequences for the patient’s rehabilitation. Fatigue is also associated with a higher mortality and a reduced quality of life. Hypersomnia (or hypersomnolence) is much less common after a stroke, but can seriously hinder a person’s recovery and treatment.\u0000\u0000 \u0000\u0000In this article, 2 cases of severely disabling hypersomnolence after an ischemic stroke in the thalamus are presented and the typical features and treatment options are discussed. The clinical course of thalamic lesions, as well as the contribution of the electroencephalogram and medical imaging are reported. The stimulating effect of methylphenidate on the central nervous system explains the beneficial influence on the hypersomnolence in the 2 cases described here. Treatment of hypersomnia improves a patient’s recovery and quality of life after a stroke.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"57 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141923564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Deleeck, S. Schevenels, T. Jaspers, M. Danckaerts
Alice in Wonderland syndrome and psychotic experiences: a challenging differential diagnosis Alice in Wonderland syndrome (AIWS) is an understudied condition associated with a variety of symptoms, from visual and somesthetic perceptual distortions to disturbances in time perception and symptoms in the psychotic spectrum. The syndrome is pathophysiologically associated with cortical dysfunction in sensory brain areas. When AIWS symptoms occur, possible underlying neurological conditions should be investigated as they may be amenable to treatment. From a psychiatric perspective, distinguishing it from disorders within the psychotic spectrum poses a challenge. This article aims to clearly describe the phenomenology and definition of AIWS and to explore whether a strict differential diagnosis with psychotic experiences is possible. To the best of the authors’ knowledge, psychiatric disorders have to this date only been associated with AIWS in adults. A case of a 14-year-old girl with depression and subclinical psychotic symptoms with an unclear origin of AIWS is presented. Presumably, there was a looping effect and the subclinical psychotic symptoms were mistakenly identified as AIWS symptoms. Due to substantial differences in prognosis and treatment, the authors want to emphasize the importance of differentiating AIWS from a (subclinical) psychotic syndrome. It is crucial to thoroughly examine each individual AIWS symptom phenomenologically in all its facets. Additionally, clinicians should be aware of the influence of the looping effect.
{"title":"Het Alice in Wonderland-syndroom en psychotische ervaringen: een differentiaaldiagnostische uitdaging","authors":"N. Deleeck, S. Schevenels, T. Jaspers, M. Danckaerts","doi":"10.47671/tvg.80.24.044","DOIUrl":"https://doi.org/10.47671/tvg.80.24.044","url":null,"abstract":"Alice in Wonderland syndrome and psychotic experiences: a challenging differential diagnosis\u0000\u0000 \u0000\u0000Alice in Wonderland syndrome (AIWS) is an understudied condition associated with a variety of symptoms, from visual and somesthetic perceptual distortions to disturbances in time perception and symptoms in the psychotic spectrum. The syndrome is pathophysiologically associated with cortical dysfunction in sensory brain areas. When AIWS symptoms occur, possible underlying neurological conditions should be investigated as they may be amenable to treatment. From a psychiatric perspective, distinguishing it from disorders within the psychotic spectrum poses a challenge.\u0000\u0000 \u0000\u0000This article aims to clearly describe the phenomenology and definition of AIWS and to explore whether a strict differential diagnosis with psychotic experiences is possible.\u0000\u0000 \u0000\u0000To the best of the authors’ knowledge, psychiatric disorders have to this date only been associated with AIWS in adults. A case of a 14-year-old girl with depression and subclinical psychotic symptoms with an unclear origin of AIWS is presented. Presumably, there was a looping effect and the subclinical psychotic symptoms were mistakenly identified as AIWS symptoms.\u0000\u0000 \u0000\u0000Due to substantial differences in prognosis and treatment, the authors want to emphasize the importance of differentiating AIWS from a (subclinical) psychotic syndrome. It is crucial to thoroughly examine each individual AIWS symptom phenomenologically in all its facets. Additionally, clinicians should be aware of the influence of the looping effect.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"26 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141355396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Vermeulen, V. Reynaert, M. Willemsen, S. Daelemans
Fever and necrotising skin lesions in an 8-month-old boy The authors present the case of an 8-month-old infant who was brought to the emergency department with a persistent fever, diarrhoea and skin lesions. The initial treatment with intravenous ceftriaxone resulted in fever resolution within 24 hours, but persistent skin lesions prompted further investigation. Secondary cultures revealed Pseudomonas aeruginosa and the skin biopsy showed characteristic histopathological features supporting the diagnosis of ecthyma gangrenosum (EG). The treatment was adjusted based on susceptibility testing. Three weeks of antibiotic therapy (2 weeks of intravenous ceftazidim and 1 week of oral ciprofloxacin) along with intensive wound care resulted in a progressive improvement of the lesions. The immunological screening was normal. This case illustrates the importance of repeated cultures and skin biopsies to confirm the diagnosis. Next, it is crucial to initiate a prompt and accurate antibiotic treatment considering the potential for rapid fatality in untreated septicemic EG cases.
{"title":"Necrotiserende huidletsels en koorts bij een 8 maanden oude jongen","authors":"H. Vermeulen, V. Reynaert, M. Willemsen, S. Daelemans","doi":"10.47671/tvg.80.24.041","DOIUrl":"https://doi.org/10.47671/tvg.80.24.041","url":null,"abstract":"Fever and necrotising skin lesions in an 8-month-old boy\u0000\u0000 \u0000\u0000The authors present the case of an 8-month-old infant who was brought to the emergency department with a persistent fever, diarrhoea and skin lesions. The initial treatment with intravenous ceftriaxone resulted in fever resolution within 24 hours, but persistent skin lesions prompted further investigation. Secondary cultures revealed Pseudomonas aeruginosa and the skin biopsy showed characteristic histopathological features supporting the diagnosis of ecthyma gangrenosum (EG). The treatment was adjusted based on susceptibility testing. Three weeks of antibiotic therapy (2 weeks of intravenous ceftazidim and 1 week of oral ciprofloxacin) along with intensive wound care resulted in a progressive improvement of the lesions. The immunological screening was normal. This case illustrates the importance of repeated cultures and skin biopsies to confirm the diagnosis. Next, it is crucial to initiate a prompt and accurate antibiotic treatment considering the potential for rapid fatality in untreated septicemic EG cases.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":" 17","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141371197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Treatment of focal spasticity using Extra-corporeal Shock Wave Therapy (ESWT) as an adjuvans on Botulinum Toxin: a review of literature Background: Spasticity is a complex problem with an impact on bodily functions, activities and participation. Botulinum toxin (BTX) is commonly known as an effective and safe therapy for focal spasticity, but needs frequent repetition with risk of tolerance. Extracorporeal Shock Wave Therapy (ESWT) is a treatment already known for its positive temporary effect on focal spasticity in monotherapy. This literature review wishes to evaluate the potential of ESWT as an adjuvant therapy to Botulinum toxin based on the hypothesis that it may prolong and enhance the therapeutic effect since ESWT influences the rheological properties of the spastic muscle, where Botulinum toxin rather affects the neural mechanisms of spasticity. Methods: review of literature. Results: 6 studies were found, with a moderate methodological quality and strongly varying protocol for the use of Botulinum toxin and ESWT, reporting of outcome variables and follow-up. Outcome variables mainly consisted of technical investigations and measurements on the level of bodily structure and functions (in accordance with the International Classification of Functioning, Disability and Health (ICF)). Side effects were described only briefly. Short term effects were mostly positive. Follow-up longer than 3 months remained unreported. Conclusion: ESWT may be an adjuvant therapy when combined with Botulinum toxin, at least in the short term. Further research is necessary, preferably set up as randomised, double-blind controlled trials with a clear and uniform protocol concerning ESWT and Botulinum toxin, with a longer lasting follow-up. Reporting on side effects and usage of quality assessments that fit the ICF framework, as well as correct usage of biostatistics herein are required.
{"title":"Behandeling van focale spasticiteit d.m.v. ESWT als adjuvans op Botulinetoxine: nazicht van de literatuur","authors":"L. Verschuere, K. Oostra","doi":"10.47671/tvg.80.24.003","DOIUrl":"https://doi.org/10.47671/tvg.80.24.003","url":null,"abstract":"Treatment of focal spasticity using Extra-corporeal Shock Wave Therapy (ESWT) as an adjuvans on Botulinum Toxin: a review of literature\u0000\u0000 \u0000\u0000 \u0000\u0000 \u0000\u0000Background: Spasticity is a complex problem with an impact on bodily functions, activities and participation. Botulinum toxin (BTX) is commonly known as an effective and safe therapy for focal spasticity, but needs frequent repetition with risk of tolerance. Extracorporeal Shock Wave Therapy (ESWT) is a treatment already known for its positive temporary effect on focal spasticity in monotherapy. This literature review wishes to evaluate the potential of ESWT as an adjuvant therapy to Botulinum toxin based on the hypothesis that it may prolong and enhance the therapeutic effect since ESWT influences the rheological properties of the spastic muscle, where Botulinum toxin rather affects the neural mechanisms of spasticity.\u0000\u0000 \u0000\u0000Methods: review of literature.\u0000\u0000 \u0000\u0000Results: 6 studies were found, with a moderate methodological quality and strongly varying protocol for the use of Botulinum toxin and ESWT, reporting of outcome variables and follow-up. Outcome variables mainly consisted of technical investigations and measurements on the level of bodily structure and functions (in accordance with the International Classification of Functioning, Disability and Health (ICF)). Side effects were described only briefly. Short term effects were mostly positive. Follow-up longer than 3 months remained unreported.\u0000\u0000 \u0000\u0000Conclusion: ESWT may be an adjuvant therapy when combined with Botulinum toxin, at least in the short term. Further research is necessary, preferably set up as randomised, double-blind controlled trials with a clear and uniform protocol concerning ESWT and Botulinum toxin, with a longer lasting follow-up. Reporting on side effects and usage of quality assessments that fit the ICF framework, as well as correct usage of biostatistics herein are required.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":" 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141374131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Recurrent testicular torsion 27 years after previous orchidopexy: a case report A recurrent testicular torsion after a previous orchidopexy is a rare phenomenon that requires a high index of suspicion to avoid misdiagnosis and delayed treatment. This case intends to emphasize the importance of considering a recurrent testicular torsion in the differential diagnosis of acute scrotal pain, regardless of the patient’s age. The case involves a 45-year-old man with a history of a bilateral testicular fixation for a testicular torsion at the age of 18. The patient presented with recurrent testicular pain, despite the fact that both testes previously had been fixed to the scrotal wall. This case illustrates that a recurrent testicular torsion can manifest even when the testis is fixed to the scrotal wall. This emphasizes the importance of including a recurrent testicular torsion in the differential diagnosis of acute scrotal pain. Furthermore, during the surgical intervention particular attention should be given to ensuring a proper fixation of both testes using non-absorbable sutures at a minimum of 2 points to reduce the risk of a recurrent torsion. A recurrent testicular torsion following a previous orchidopexy is a rare condition that requires vigilance in case of acute scrotal pain. This case report reinforces the need for a thorough examination and emphasizes the importance of safe testicular fixation during surgery to minimize the risk of recurrence. The threshold for surgical exploration should always be kept low, even after a previous orchidopexy.
{"title":"Recidiverende testiculaire torsie 27 jaar na eerdere orchidopexie: casusbespreking","authors":"G. Nougon, G. Lefebvre, M. Duesberg","doi":"10.47671/tvg.80.24.040","DOIUrl":"https://doi.org/10.47671/tvg.80.24.040","url":null,"abstract":"Recurrent testicular torsion 27 years after previous orchidopexy: a case report\u0000\u0000 \u0000\u0000A recurrent testicular torsion after a previous orchidopexy is a rare phenomenon that requires a high index of suspicion to avoid misdiagnosis and delayed treatment. This case intends to emphasize the importance of considering a recurrent testicular torsion in the differential diagnosis of acute scrotal pain, regardless of the patient’s age.\u0000\u0000 \u0000\u0000The case involves a 45-year-old man with a history of a bilateral testicular fixation for a testicular torsion at the age of 18. The patient presented with recurrent testicular pain, despite the fact that both testes previously had been fixed to the scrotal wall.\u0000\u0000 \u0000\u0000This case illustrates that a recurrent testicular torsion can manifest even when the testis is fixed to the scrotal wall. This emphasizes the importance of including a recurrent testicular torsion in the differential diagnosis of acute scrotal pain. Furthermore, during the surgical intervention particular attention should be given to ensuring a proper fixation of both testes using non-absorbable sutures at a minimum of 2 points to reduce the risk of a recurrent torsion.\u0000\u0000 \u0000\u0000A recurrent testicular torsion following a previous orchidopexy is a rare condition that requires vigilance in case of acute scrotal pain. This case report reinforces the need for a thorough examination and emphasizes the importance of safe testicular fixation during surgery to minimize the risk of recurrence. The threshold for surgical exploration should always be kept low, even after a previous orchidopexy.","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"7 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141265768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Op weg naar een transdisciplinair TvGG","authors":"A. Buelens-Terryn","doi":"10.47671/tvg.80.24.055","DOIUrl":"https://doi.org/10.47671/tvg.80.24.055","url":null,"abstract":"","PeriodicalId":23124,"journal":{"name":"Tijdschrift Voor Geneeskunde","volume":"85 22","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141230995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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