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An important problem in an aging country: identifying the frailty via 9 Point Clinical Frailty Scale. 一个老龄化国家的一个重要问题:通过9点临床虚弱量表来识别虚弱。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2020-06-01 Epub Date: 2019-03-28 DOI: 10.1080/17843286.2019.1597457
Cemile Özsürekci, Cafer Balcı, M Cemal Kızılarslanoğlu, Hatice Çalışkan, Rana Tuna Doğrul, Gözde Şengül Ayçiçek, Fatih Sümer, Erdem Karabulut, Burcu Balam Yavuz, Mustafa Cankurtaran, Meltem Gülhan Halil

Objectives: Frailty is a geriatric syndrome which develops as a result of cumulative decline in many physiological systems and results in an increased vulnerability and risk of adverse outcomes. The Clinical Frailty Scale (CFS) was validated as a predictor of adverse outcomes in community-dwelling older people and evaluates items such as comorbidity, cognitive impairment and disability. We aimed to study the concurrent and construct validity and reliability of the 9 point CFS in Turkish Population.Methods: This study was designed as a cross-sectional study. Participants, who were admitted to a geriatric medicine outpatient clinic, were included. Validity of 9 point CFS was tested by its correlation with the assessment and opinion of an experienced geriatric medicine specialist and Fried frailty phenotype. Test-retest and inter-rater reliability analyses were also performed.Results: Median age of the 118 patients was 74.5 years (min: 65 max: 88) and 64.4 % were female. The concordance of CFS and experienced geriatric medicine specialist's opinion was excellent (Cohen's K: 0.80, p < 0.001).The concordance of CFS and Fried Frailty phenotype was moderate (Cohen's K: 0.514, p < 0.001).CFS inter-rater reliability and test-retest reliability was very strong (Cohen's K: 0.811, p < 0.001 and Cohen's K: 1.0, p < 0.001, respectively).Conclusions: CFS appears to be a quick, reliable and valid frailty screening tool for community-dwelling older adults in the Turkish population.

目的:虚弱是一种老年综合征,它是许多生理系统累积衰退的结果,导致脆弱性增加和不良后果的风险。临床虚弱量表(CFS)被验证为社区居住老年人不良结果的预测因子,并评估合并症、认知障碍和残疾等项目。我们的目的是研究9点CFS在土耳其人群中的并发性和结构效度和信度。方法:本研究设计为横断面研究。参与者,谁是承认老年医学门诊诊所,包括。通过与经验丰富的老年医学专家的评估和意见以及Fried虚弱表型的相关性来检验9点CFS的有效性。测试-重测和评估间信度分析也进行了。结果:118例患者中位年龄为74.5岁(最小65岁,最大88岁),64.4%为女性。CFS与经验丰富的老年医学专家意见的一致性非常好(Cohen’s K: 0.80, p K: 0.514, p K: 0.811, p K: 1.0, p)结论:CFS似乎是土耳其社区居住老年人快速、可靠和有效的虚弱筛查工具。
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引用次数: 31
The effect of selenium and zinc on CD4(+) count and opportunistic infections in HIV/AIDS patients: a randomized double blind trial. 硒和锌对HIV/AIDS患者CD4(+)计数和机会性感染的影响:一项随机双盲试验
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2020-06-01 Epub Date: 2019-03-19 DOI: 10.1080/17843286.2019.1590023
Azar Hadadi, Afshin Ostovar, Behnaz Edalat Noor, Mehrnaz Rasoolinejad, Mahboobeh Haji Abdolbaghi, Sahar Yousefi, Hossein Khalili, Gita Manshoori, Patricia Khashayar, Zahra Alipour, Narges Safari

Objectives: We assessed the effect of selenium and zinc supplementation on CD4 cell count and the risk of developing opportunistic infections.Methods: In a double blind clinical trial, 146 HIV(+) patients receiving combination antiretroviral therapy with CD4(+) >200/cubic millimeter were screened for comorbidities and opportunistic infections, and randomized to receive daily selenium (200 µg), zinc (50 mg) or placebo for 6 months, before a 3-month follow-up period. CD4 cell counts were measured in the 3th, 6th and 9th months. The serum selenium and zinc were measured in the 6th month. The incidence of opportunistic infection was assessed monthly for 6 months and at the end of the 9th month.Results: The final incidence of supplement deficiency for placebo, zinc and selenium were 46.7%, 44.7% and 50.0%, respectively. Overall compliance with supplementation was 99.42%. Although the changes from baseline were not statistically significant, zinc supplementation was significantly associated with reduced risk of opportunistic infections.Conclusion: Development of the opportunistic infections after zinc supplementation significantly decreased; however, significant improvement in CD4 count was not observed in this group.

目的:我们评估硒和锌补充对CD4细胞计数和发生机会性感染的风险的影响。方法:在一项双盲临床试验中,筛选146例接受CD4(+) >200/立方毫米联合抗逆转录病毒治疗的HIV(+)患者的合并症和机会性感染,随机分为每日服用硒(200µg)、锌(50 mg)或安慰剂,为期6个月,随访3个月。分别于第3、6、9个月检测CD4细胞计数。第6个月测定血清硒、锌含量。在第6个月和第9个月末每月评估机会性感染的发生率。结果:安慰剂组、锌组和硒组最终缺乏率分别为46.7%、44.7%和50.0%。总体依从性为99.42%。虽然从基线的变化没有统计学意义,但补充锌与降低机会性感染的风险显著相关。结论:补锌后机会性感染发生率明显降低;然而,在该组中,CD4计数没有明显改善。
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引用次数: 8
Past, present and future of university hospitals. 大学医院的过去、现在和未来。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2020-06-01 Epub Date: 2019-03-21 DOI: 10.1080/17843286.2019.1590024
Kasper Raus, Eric Mortier, Kristof Eeckloo

Objectives: Health care systems worldwide are changing and taking new forms. The old, more hierarchically oriented, model with individual institutional and bilateral interactions between primary, secondary, tertiary and quaternary care is being replaced by an integrated and dynamic network model. We aim to look at what role university hospitals will play in this future organization of health care.Method: In this paper, we look at the relevant literature on the history of academic medicine and university hospitals. Subsequently, we look at the challenges university hospitals are facing according to contemporary literature on the topic.Results: Our current model of academic medicine with its university hospitals finds its origin in the institutionalization of the academic mission in the late 18th century. Currently, the sustainability of the model is under immense pressure. University hospitals are facing economic challenges, teaching challenges and research challenges. However, there is reason to believe that they can continue to play a role of importance in tomorrow's medicine. The organization of health care is undergoing two important changes. The first is the evolution towards a more dynamic and integrated network model. University hospitals can become an important hub within this network. The second change is an evolution towards evidence based medicine and translational research.Conclusion: Due to their unique tripartite mission, we argue that university hospitals can continue to play an important and critical role in promoting evidence-based medicine and speedy translation of new evidence.

目标:世界各地的卫生保健系统正在发生变化并采取新的形式。在初级、二级、三级和四级保健之间进行个人机构和双边互动的旧的、更注重等级的模式正在被一个综合的、动态的网络模式所取代。我们的目标是研究大学医院在未来的医疗保健组织中扮演什么角色。方法:查阅学术医学史和大学医院史的相关文献。随后,我们根据有关该主题的当代文献,看看大学医院面临的挑战。结果:我们目前的学术医学模式及其大学医院的起源是18世纪后期学术使命的制度化。目前,该模式的可持续性面临巨大压力。大学医院面临着经济挑战、教学挑战和科研挑战。然而,我们有理由相信它们将继续在未来的医学中发挥重要作用。卫生保健的组织正在经历两个重要的变化。首先是向更加动态和集成的网络模型的演变。大学医院可以成为这一网络的重要枢纽。第二个变化是向循证医学和转化研究的演变。结论:由于其独特的三方使命,我们认为大学医院可以继续在促进循证医学和快速转化新证据方面发挥重要而关键的作用。
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引用次数: 2
Clinical and biochemical differences between hantavirus infection and leptospirosis: a retrospective analysis of a patient series in Belgium. 汉坦病毒感染和钩端螺旋体病的临床和生化差异:对比利时患者系列的回顾性分析。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2020-06-01 Epub Date: 2019-03-18 DOI: 10.1080/17843286.2019.1591654
Emma Bakelants, Willy Peetermans, Katrien Lagrou, Wouter Meersseman

Objectives: Hantavirus infection and leptospirosis are infectious diseases transmitted by rodents. The clinical picture is nonspecific, often involving the kidneys but other organs can be affected too. Clinical and biochemical clues to make a difference between these two entities will be described.Methods: A retrospective analysis was performed on a database of patients presenting between January 2012 and September 2017 at the emergency department of the university hospital Leuven, Belgium. Patients were selected on the basis of a compatible clinical picture, biochemistry, and microbiological evidence. Presenting complaints and clinical examination were compared. Blood, taken at presentation, was used for hematological and biochemical analysis.Results: Sixteen patients with hantavirus infection and eight patients with leptospirosis were identified. All patients complained about general malaise and fever. Other frequent complaints were myalgia and a headache. Patients with leptospirosis often experienced photo- or sonophobia.Looking for neck stiffness and eye lesions might help to diagnose leptospirosis.Differences in biochemistry between viral and bacterial disease could be recognized; high C-reactive protein (CRP) and leukocytosis with left shift favor leptospirosis, elevated lactate dehydrogenase (LDH) favors viral infection. Abnormal liver function with raised total bilirubin is often seen in cases with leptospirosis.Conclusion: This study demonstrates some subtle clues that may help to differentiate between hantavirus infection and leptospirosis in patients presenting to a hospital in a nonendemic region of the world. Because of small number of patients, we could not identify significant clinical or biochemical tests. Serology remains the gold standard.

目的:汉坦病毒感染和钩端螺旋体病是由啮齿动物传播的传染病。临床表现无特异性,常累及肾脏,但也可累及其他器官。临床和生化的线索,使这两个实体之间的区别将被描述。方法:对2012年1月至2017年9月在比利时鲁汶大学医院急诊科就诊的患者数据库进行回顾性分析。患者的选择是基于相容的临床表现、生物化学和微生物学证据。比较两组患者的主诉和临床检查结果。就诊时取血,用于血液学和生化分析。结果:共检出汉坦病毒感染16例,钩端螺旋体病8例。所有病人都有全身不适和发热。其他常见的症状还有肌痛和头痛。钩端螺旋体病患者通常有恐光症或恐声症。寻找颈部僵硬和眼部病变可能有助于诊断钩端螺旋体病。可以识别病毒性和细菌性疾病在生物化学上的差异;高c反应蛋白(CRP)和白细胞左移倾向于钩端螺旋体病,乳酸脱氢酶(LDH)升高倾向于病毒感染。肝功能异常伴总胆红素升高常见于钩端螺旋体病。结论:本研究显示了一些微妙的线索,可能有助于区分汉坦病毒感染和钩端螺旋体病的患者呈现到医院在世界非流行地区。由于患者数量少,我们无法确定重要的临床或生化检查。血清学仍然是金标准。
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引用次数: 4
A model-based economic evaluation of four newborn screening strategies for cystic fibrosis in Flanders, Belgium. 一个基于模型的经济评估四个新生儿筛查策略的囊性纤维化法兰德斯,比利时。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2020-06-01 Epub Date: 2019-04-22 DOI: 10.1080/17843286.2019.1604472
Masja Schmidt, Amber Werbrouck, Nick Verhaeghe, Elke De Wachter, Steven Simoens, Lieven Annemans, Koen Putman

Objectives: The most cost-effective newborn screening strategy for cystic fibrosis (CF) for Flanders, Belgium, is unknown. The aim of this study was to assess the cost-effectiveness of four existing newborn screening strategies for CF: IRT-DNA (immunoreactive trypsinogen, cystic fibrosis transmembrane conductance regulator (CFTR) gene mutation analysis), IRT-PAP (pancreatitis-associated protein), IRT-PAP-DNA, and IRT-PAP-DNA-EGA (extended CFTR gene analysis).Methods: Using data from published literature, the cost-effectiveness of the screening strategies was calculated for a hypothetical cohort of 65,606 newborns in Flanders, Belgium. A healthcare payer perspective was used, and the direct medical costs associated with screening were taken into account. The robustness of the model outcomes was assessed in sensitivity analyses.Results: The IRT-PAP strategy was the most cost-effective strategy in terms of costs per CF case detected (€9314 per CF case detected). The IRT-DNA strategy was more costly (€13,966 per CF case detected), but with an expected sensitivity of 93.4% also the most effective strategy, and was expected to detect 2.2 more cases of CF than the IRT-PAP strategy. The incremental cost-effectiveness ratio of IRT-DNA vs. IRT-PAP was €54,180/extra CF case detected. The IRT-PAP-DNA strategy and the IRT-PAP-DNA-EGA strategy were both strongly dominated by the IRT-PAP strategy.Conclusion: The IRT-PAP strategy was the most cost-effective strategy in terms of costs per CF case detected. However, the strategy did not fulfil the European Cystic Fibrosis Society guidelines for sensitivity and positive predictive value. Therefore, the more costly and more effective IRT-DNA strategy may be the most appropriate newborn screening strategy for Flanders.

目的:比利时法兰德斯最具成本效益的新生儿囊性纤维化(CF)筛查策略尚不清楚。本研究的目的是评估现有的四种新生儿CF筛查策略的成本效益:IRT-DNA(免疫反应性胰蛋白酶原,囊性纤维化跨膜传导调节因子(CFTR)基因突变分析),IRT-PAP(胰腺炎相关蛋白),IRT-PAP- dna和IRT-PAP- dna - ega(扩展CFTR基因分析)。方法:利用已发表文献的数据,对比利时法兰德斯65606名新生儿的假设队列进行筛查策略的成本效益计算。采用了医疗保健付款人的观点,并考虑了与筛查相关的直接医疗费用。在敏感性分析中评估模型结果的稳健性。结果:就每例检测到的CF病例的成本而言,IRT-PAP策略是最具成本效益的策略(每例检测到的CF病例为9314欧元)。IRT-DNA策略更昂贵(每检测到CF病例13,966欧元),但预期灵敏度为93.4%,也是最有效的策略,预计比IRT-PAP策略多检测2.2例CF。IRT-DNA与IRT-PAP的增量成本-效果比为54180欧元/额外检测的CF病例。IRT-PAP- dna策略和IRT-PAP- dna - ega策略均受IRT-PAP策略的强烈支配。结论:就每个CF病例的检测成本而言,IRT-PAP策略是最具成本效益的策略。然而,该策略不符合欧洲囊性纤维化协会的敏感性和阳性预测值指南。因此,更昂贵和更有效的IRT-DNA策略可能是最适合弗兰德斯的新生儿筛查策略。
{"title":"A model-based economic evaluation of four newborn screening strategies for cystic fibrosis in Flanders, Belgium.","authors":"Masja Schmidt,&nbsp;Amber Werbrouck,&nbsp;Nick Verhaeghe,&nbsp;Elke De Wachter,&nbsp;Steven Simoens,&nbsp;Lieven Annemans,&nbsp;Koen Putman","doi":"10.1080/17843286.2019.1604472","DOIUrl":"https://doi.org/10.1080/17843286.2019.1604472","url":null,"abstract":"<p><p><b>Objectives</b>: The most cost-effective newborn screening strategy for cystic fibrosis (CF) for Flanders, Belgium, is unknown. The aim of this study was to assess the cost-effectiveness of four existing newborn screening strategies for CF: IRT-DNA (immunoreactive trypsinogen, cystic fibrosis transmembrane conductance regulator (<i>CFTR</i>) gene mutation analysis), IRT-PAP (pancreatitis-associated protein), IRT-PAP-DNA, and IRT-PAP-DNA-EGA (extended <i>CFTR</i> gene analysis).<b>Methods</b>: Using data from published literature, the cost-effectiveness of the screening strategies was calculated for a hypothetical cohort of 65,606 newborns in Flanders, Belgium. A healthcare payer perspective was used, and the direct medical costs associated with screening were taken into account. The robustness of the model outcomes was assessed in sensitivity analyses.<b>Results</b>: The IRT-PAP strategy was the most cost-effective strategy in terms of costs per CF case detected (€9314 per CF case detected). The IRT-DNA strategy was more costly (€13,966 per CF case detected), but with an expected sensitivity of 93.4% also the most effective strategy, and was expected to detect 2.2 more cases of CF than the IRT-PAP strategy. The incremental cost-effectiveness ratio of IRT-DNA vs. IRT-PAP was €54,180/extra CF case detected. The IRT-PAP-DNA strategy and the IRT-PAP-DNA-EGA strategy were both strongly dominated by the IRT-PAP strategy.<b>Conclusion</b>: The IRT-PAP strategy was the most cost-effective strategy in terms of costs per CF case detected. However, the strategy did not fulfil the European Cystic Fibrosis Society guidelines for sensitivity and positive predictive value. Therefore, the more costly and more effective IRT-DNA strategy may be the most appropriate newborn screening strategy for Flanders.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2020-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1604472","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37170355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 8
A practical approach towards the evaluation of aberrant thyroid function tests. 一种评估甲状腺功能异常的实用方法。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2020-04-01 Epub Date: 2019-02-26 DOI: 10.1080/17843286.2019.1577531
Barbara Vandendriessche, Bruno Lapauw, Jean Marc Kaufman, Tom Fiers

Objective: To provide insight in patterns and causes of aberrant thyroid function tests (TFT) and to propose a practical approach for clinicians.Methods: Starting from an illustrative case report, an extensive literature search was performed, resulting in a narrative literature review.Results: TFT that cannot be explained by the negative feedback principle of the hypothalamo-pituitary-thyroid axis are a challenge for every clinician. Various alternative explanations for these TFT should be considered before drawing the conclusion of thyroid disorder, since incorrect diagnosis and treatment can have severe consequences for the patient.For example, the combination of elevated or normal TSH with elevated free T4 or T3 levels may result from the use of certain drugs or lab interference, while low or normal TSH with low T3 or T4 can often be explained by non-thyroidal illness or central hypothyroidism due to pituitary failure. Correct identification of these clinical situations requires understanding thyroid hormone metabolism and action, knowledge of some laboratory techniques, and a multistep evaluation process.Conclusion: To avoid incorrect diagnosis and thus treatment, clinicians should be aware of the existence of aberrant TFT and know how to decipher them.

目的:了解甲状腺功能异常(TFT)的类型和原因,并为临床医生提供实用的方法。方法:从一个说明性的病例报告开始,进行广泛的文献检索,形成一个叙述性的文献综述。结果:不能用下丘脑-垂体-甲状腺轴负反馈原理解释的TFT是每个临床医生都面临的挑战。在得出甲状腺疾病的结论之前,应该考虑对这些TFT的各种替代解释,因为不正确的诊断和治疗可能对患者造成严重后果。例如,TSH升高或正常与游离T4或T3水平升高的结合可能是由于使用某些药物或实验室干扰,而TSH低或正常与低T3或T4通常可以解释为非甲状腺疾病或垂体功能衰竭引起的中枢性甲状腺功能减退。正确识别这些临床情况需要了解甲状腺激素的代谢和作用,一些实验室技术的知识,以及多步骤的评估过程。结论:临床医生应意识到TFT异常的存在,并了解如何识别异常,以避免误诊和治疗。
{"title":"A practical approach towards the evaluation of aberrant thyroid function tests.","authors":"Barbara Vandendriessche,&nbsp;Bruno Lapauw,&nbsp;Jean Marc Kaufman,&nbsp;Tom Fiers","doi":"10.1080/17843286.2019.1577531","DOIUrl":"https://doi.org/10.1080/17843286.2019.1577531","url":null,"abstract":"<p><p><b>Objective</b>: To provide insight in patterns and causes of aberrant thyroid function tests (TFT) and to propose a practical approach for clinicians.<b>Methods</b>: Starting from an illustrative case report, an extensive literature search was performed, resulting in a narrative literature review.<b>Results</b>: TFT that cannot be explained by the negative feedback principle of the hypothalamo-pituitary-thyroid axis are a challenge for every clinician. Various alternative explanations for these TFT should be considered before drawing the conclusion of thyroid disorder, since incorrect diagnosis and treatment can have severe consequences for the patient.For example, the combination of elevated or normal TSH with elevated free T4 or T3 levels may result from the use of certain drugs or lab interference, while low or normal TSH with low T3 or T4 can often be explained by non-thyroidal illness or central hypothyroidism due to pituitary failure. Correct identification of these clinical situations requires understanding thyroid hormone metabolism and action, knowledge of some laboratory techniques, and a multistep evaluation process.<b>Conclusion</b>: To avoid incorrect diagnosis and thus treatment, clinicians should be aware of the existence of aberrant TFT and know how to decipher them.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2020-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1577531","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37000978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Human psittacosis: a review with emphasis on surveillance in Belgium. 比利时人鹦鹉热监测综述。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2020-02-01 Epub Date: 2019-03-18 DOI: 10.1080/17843286.2019.1590889
Joanna Rybarczyk, Charlot Versteele, Tinne Lernout, Daisy Vanrompay

Chlamydia psittaci causes psittacosis in humans, mainly in persons in contact with birds in either the setting of occupational or companion bird exposure. Infection is associated with a range of clinical manifestations from asymptomatic infection to severe atypical pneumonia and systemic disease. This paper reviews new knowledge on psittacosis, its legal and regulatory aspects and presents epidemiological data on psittacosis in Belgium. In Belgium, the number of reported positive laboratory results increased slowly since 2010, and in 2017, the number almost doubled compared to the two previous years. The number of psittacosis cases in Belgium, as in other countries, is probably highly underestimated, because of underdiagnoses and underreporting. Over the 3-year period, the mandatory notification system registered 24% only of all reported positive laboratory result. Therefore, increased awareness among general and occupational physicians, clinicians and the public is needed. Policies aimed at reducing psittacosis disease burden are justified, nevertheless national health authorities should provide more legal and financial support to implement more adequate C. psittaci diagnostic tools.

鹦鹉热衣原体在人类中引起鹦鹉热病,主要是在职业性或伴禽接触环境中与鸟类接触的人。感染与一系列临床表现相关,从无症状感染到严重非典型肺炎和全身性疾病。本文综述了关于鹦鹉热的新知识,其法律和监管方面,并介绍了比利时鹦鹉热的流行病学数据。在比利时,自2010年以来报告的阳性实验室结果数量缓慢增加,2017年,这一数字几乎是前两年的两倍。与其他国家一样,比利时的鹦鹉热病例数可能被严重低估,原因是诊断不足和报告不足。在3年期间,强制性通报系统仅登记了所有报告阳性实验室结果的24%。因此,需要提高普通和职业医生、临床医生和公众的认识。旨在减少鹦鹉热疾病负担的政策是合理的,然而,国家卫生当局应提供更多的法律和财政支持,以实施更充分的鹦鹉热诊断工具。
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引用次数: 31
The human microbiome in health and disease: hype or hope. 人类微生物群在健康和疾病中的作用:炒作还是希望。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2019-04-01 Epub Date: 2019-02-27 DOI: 10.1080/17843286.2019.1583782
Gwen Falony, Doris Vandeputte, Clara Caenepeel, Sara Vieira-Silva, Tanine Daryoush, Séverine Vermeire, Jeroen Raes

Objectives: The prognostic, diagnostic, and therapeutic potential of the human gut microbiota is widely recognised. However, translation of microbiome findings to clinical practice is challenging. Here, we discuss current knowledge and applications in the field.

Methods: We revisit some recent advances in the field of faecal microbiome analyses with a focus on covariate analyses and ecological interpretation.

Results: Population-level characterization of gut microbiota variation among healthy volunteers has allowed identifying microbiome covariates required for clinical studies. Currently, microbiome research is moving from relative to quantitative approaches that will shed a new light on microbiota-host interactions in health and disease.

Conclusions: Covariate characterization and technical advances increase reproducibility of microbiome research. Targeted in vitro/in vivo intervention studies will accelerate clinical implementation of microbiota findings.

目的:人类肠道菌群的预后、诊断和治疗潜力已得到广泛认可。然而,将微生物组的发现转化为临床实践是具有挑战性的。在这里,我们将讨论该领域的当前知识和应用。方法:我们回顾了粪便微生物组分析领域的一些最新进展,重点是协变量分析和生态学解释。结果:健康志愿者肠道微生物群变异的人群水平表征允许确定临床研究所需的微生物组协变量。目前,微生物组研究正从相对方法转向定量方法,这将为健康和疾病中的微生物-宿主相互作用提供新的线索。结论:协变量表征和技术进步提高了微生物组研究的可重复性。有针对性的体外/体内干预研究将加速微生物群研究结果的临床应用。
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引用次数: 35
Complicated pneumothorax and congenital lung cystic malformation. 并发气胸及先天性肺囊性畸形。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2016-10-01 Epub Date: 2016-06-27 DOI: 10.1179/2295333714Y.0000000023
Rachid Attou, Pascal Reper

Congenital cystic adenomatoid malformation, also named congenital pulmonary airway malformation (CPAM), is a congenital lung abnormality which is uncommon in adults. The usual radiological appearance of CPAM is a cystic space-occupying lesion. We present one case of CPAM with unusual clinical and radiological findings, a complicated spontaneous pneumothorax with intracystic haemorrhage with successful conservative initial treatment, despite acute haemodynamic instability.

先天性囊性腺瘤样畸形,又称先天性肺气道畸形(CPAM),是一种少见的成人先天性肺异常。CPAM的放射学表现为囊性占位性病变。我们报告了一例临床和影像学表现不寻常的CPAM病例,这是一例复杂的自发性气胸合并囊内出血,尽管急性血流动力学不稳定,但初步保守治疗成功。
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引用次数: 2
Tuberculin skin test versus interferon-gamma release assays for the diagnosis of tuberculosis infection. 结核菌素皮试与干扰素释放试验诊断结核感染的比较。
IF 1.6 4区 医学 Q2 Medicine Pub Date : 2014-10-01 Epub Date: 2014-07-14 DOI: 10.1179/2295333714Y.0000000043
E De Keyser, F De Keyser, F De Baets

Objective: Accurate detection of latent tuberculosis infection (LTBI) is becoming increasingly important due to the increasing use of immunosuppressive medications and the human immunodeficiency epidemic, which have increased the risk for reactivation to active tuberculosis (TB) infection. LTBI is detected by tuberculin skin test (TST) and interferon-gamma release assays (IGRAs). The latter include T-SPOT(®).TB (Oxford Immunotec) and QuantiFERON(®)-TB Gold In-Tube (QFT-GIT; Cellestis). We examined the value of TST versus IGRAs in the diagnosis of TB infection by meta-analysis based on data derived from a systematic literature review.

Methods: PubMed was searched for articles in English published between January 2010 and July 2012 in which TST and IGRA were performed simultaneously in individuals with and without active TB infection. A random effect model meta-analysis was performed to determine pooled sensitivity and specificity values for TST, T-SPOT.TB, and QFT-GIT. Owing to the absence of a gold standard for the diagnosis of LTBI, active TB infection was used as a surrogate for LTBI.

Results: Nineteen studies were included. T-SPOT.TB was significantly more sensitive [90% (95% confidence interval: 85-95) versus 64% (46-81)] than TST. The specificity of T-SPOT.TB was higher than the specificity of TST, but there was overlap between confidence intervals [77% (68-85) versus 57% (41-72)]. QFT-GIT seemed to be more sensitive than TST [75% (61-86) versus 64% (48-78)] but similarly specific [71% (62-86) versus 70% (57-81)].

Conclusions: IGRAs, especially T-SPOT.TB, are more effective at detecting TB infection than TST. Despite their higher cost, they have added value and can be requested in addition to TST.

目的:由于免疫抑制药物的使用增加和人类免疫缺陷的流行,增加了活动性结核病(TB)感染再激活的风险,因此准确检测潜伏性结核病感染(LTBI)变得越来越重要。通过结核菌素皮肤试验(TST)和干扰素释放试验(IGRAs)检测LTBI。后者包括T-SPOT(®)。TB (Oxford immunnotec)和QuantiFERON(®)-TB金管(QFT-GIT);Cellestis)。基于系统文献综述的数据,我们通过荟萃分析检验了TST与IGRAs在结核病感染诊断中的价值。方法:在PubMed检索2010年1月至2012年7月期间发表的在结核病患者和非活动性结核病患者中同时进行TST和IGRA的英文文章。随机效应模型荟萃分析确定TST、T-SPOT的敏感性和特异性。TB和QFT-GIT。由于缺乏诊断LTBI的金标准,活动性结核感染被用作LTBI的替代指标。结果:共纳入19项研究。T-SPOT。TB明显比TST更敏感[90%(95%可信区间:85-95)vs 64%(46-81)]。T-SPOT的特异性。TB的特异性高于TST,但置信区间之间存在重叠[77%(68-85)对57%(41-72)]。QFT-GIT似乎比TST更敏感[75%(61-86)对64%(48-78)],但特异性相似[71%(62-86)对70%(57-81)]。结论:IGRAs,尤其是T-SPOT。在检测结核感染方面比TST更有效。尽管它们的成本较高,但它们具有附加值,并且可以在TST之外要求。
{"title":"Tuberculin skin test versus interferon-gamma release assays for the diagnosis of tuberculosis infection.","authors":"E De Keyser,&nbsp;F De Keyser,&nbsp;F De Baets","doi":"10.1179/2295333714Y.0000000043","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000043","url":null,"abstract":"<p><strong>Objective: </strong>Accurate detection of latent tuberculosis infection (LTBI) is becoming increasingly important due to the increasing use of immunosuppressive medications and the human immunodeficiency epidemic, which have increased the risk for reactivation to active tuberculosis (TB) infection. LTBI is detected by tuberculin skin test (TST) and interferon-gamma release assays (IGRAs). The latter include T-SPOT(®).TB (Oxford Immunotec) and QuantiFERON(®)-TB Gold In-Tube (QFT-GIT; Cellestis). We examined the value of TST versus IGRAs in the diagnosis of TB infection by meta-analysis based on data derived from a systematic literature review.</p><p><strong>Methods: </strong>PubMed was searched for articles in English published between January 2010 and July 2012 in which TST and IGRA were performed simultaneously in individuals with and without active TB infection. A random effect model meta-analysis was performed to determine pooled sensitivity and specificity values for TST, T-SPOT.TB, and QFT-GIT. Owing to the absence of a gold standard for the diagnosis of LTBI, active TB infection was used as a surrogate for LTBI.</p><p><strong>Results: </strong>Nineteen studies were included. T-SPOT.TB was significantly more sensitive [90% (95% confidence interval: 85-95) versus 64% (46-81)] than TST. The specificity of T-SPOT.TB was higher than the specificity of TST, but there was overlap between confidence intervals [77% (68-85) versus 57% (41-72)]. QFT-GIT seemed to be more sensitive than TST [75% (61-86) versus 64% (48-78)] but similarly specific [71% (62-86) versus 70% (57-81)].</p><p><strong>Conclusions: </strong>IGRAs, especially T-SPOT.TB, are more effective at detecting TB infection than TST. Despite their higher cost, they have added value and can be requested in addition to TST.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2014-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32498326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
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Acta Clinica Belgica
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