Pub Date : 2020-06-01Epub Date: 2019-03-28DOI: 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。
{"title":"An important problem in an aging country: identifying the frailty via 9 Point Clinical Frailty Scale.","authors":"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","doi":"10.1080/17843286.2019.1597457","DOIUrl":"https://doi.org/10.1080/17843286.2019.1597457","url":null,"abstract":"<p><strong>Objectives: </strong>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.<b>Methods</b>: 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.<b>Results</b>: 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 <i>K</i>: 0.80, <i>p</i> < 0.001).The concordance of CFS and Fried Frailty phenotype was moderate (Cohen's <i>K</i>: 0.514, <i>p</i> < 0.001).CFS inter-rater reliability and test-retest reliability was very strong (Cohen's <i>K</i>: 0.811, <i>p</i> < 0.001 and Cohen's <i>K</i>: 1.0, <i>p</i> < 0.001, respectively).<b>Conclusions</b>: CFS appears to be a quick, reliable and valid frailty screening tool for community-dwelling older adults in the Turkish population.</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/10.1080/17843286.2019.1597457","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37097323","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}
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.
{"title":"The effect of selenium and zinc on CD4(+) count and opportunistic infections in HIV/AIDS patients: a randomized double blind trial.","authors":"Azar Hadadi, Afshin Ostovar, Behnaz Edalat Noor, Mehrnaz Rasoolinejad, Mahboobeh Haji Abdolbaghi, Sahar Yousefi, Hossein Khalili, Gita Manshoori, Patricia Khashayar, Zahra Alipour, Narges Safari","doi":"10.1080/17843286.2019.1590023","DOIUrl":"https://doi.org/10.1080/17843286.2019.1590023","url":null,"abstract":"<p><p><b>Objectives</b>: We assessed the effect of selenium and zinc supplementation on CD4 cell count and the risk of developing opportunistic infections.<b>Methods</b>: 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 3<sup>th</sup>, 6<sup>th</sup> and 9<sup>th</sup> months. The serum selenium and zinc were measured in the 6<sup>th</sup> month. The incidence of opportunistic infection was assessed monthly for 6 months and at the end of the 9<sup>th</sup> month.<b>Results</b>: 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.<b>Conclusion</b>: Development of the opportunistic infections after zinc supplementation significantly decreased; however, significant improvement in CD4 count was not observed in this group.</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/10.1080/17843286.2019.1590023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37070248","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}
Pub Date : 2020-06-01Epub Date: 2019-03-21DOI: 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.
{"title":"Past, present and future of university hospitals.","authors":"Kasper Raus, Eric Mortier, Kristof Eeckloo","doi":"10.1080/17843286.2019.1590024","DOIUrl":"https://doi.org/10.1080/17843286.2019.1590024","url":null,"abstract":"<p><p><b>Objectives</b>: 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.<b>Method</b>: 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.<b>Results</b>: Our current model of academic medicine with its university hospitals finds its origin in the institutionalization of the academic mission in the late 18<sup>th</sup> 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.<b>Conclusion</b>: 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.</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/10.1080/17843286.2019.1590024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37077408","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}
Pub Date : 2020-06-01Epub Date: 2019-03-18DOI: 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.
{"title":"Clinical and biochemical differences between hantavirus infection and leptospirosis: a retrospective analysis of a patient series in Belgium.","authors":"Emma Bakelants, Willy Peetermans, Katrien Lagrou, Wouter Meersseman","doi":"10.1080/17843286.2019.1591654","DOIUrl":"https://doi.org/10.1080/17843286.2019.1591654","url":null,"abstract":"<p><p><b>Objectives</b>: 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.<b>Methods</b>: 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.<b>Results</b>: 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.<b>Conclusion</b>: 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.</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/10.1080/17843286.2019.1591654","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37066462","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}
Pub Date : 2020-06-01Epub Date: 2019-04-22DOI: 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, Amber Werbrouck, Nick Verhaeghe, Elke De Wachter, Steven Simoens, Lieven Annemans, 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}
Pub Date : 2020-04-01Epub Date: 2019-02-26DOI: 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.
{"title":"A practical approach towards the evaluation of aberrant thyroid function tests.","authors":"Barbara Vandendriessche, Bruno Lapauw, Jean Marc Kaufman, 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}
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.
{"title":"Human psittacosis: a review with emphasis on surveillance in Belgium.","authors":"Joanna Rybarczyk, Charlot Versteele, Tinne Lernout, Daisy Vanrompay","doi":"10.1080/17843286.2019.1590889","DOIUrl":"https://doi.org/10.1080/17843286.2019.1590889","url":null,"abstract":"<p><p><i>Chlamydia psittaci</i> 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 <i>C. psittaci</i> diagnostic tools.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2020-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1590889","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37066467","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}
Pub Date : 2019-04-01Epub Date: 2019-02-27DOI: 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.
{"title":"The human microbiome in health and disease: hype or hope.","authors":"Gwen Falony, Doris Vandeputte, Clara Caenepeel, Sara Vieira-Silva, Tanine Daryoush, Séverine Vermeire, Jeroen Raes","doi":"10.1080/17843286.2019.1583782","DOIUrl":"https://doi.org/10.1080/17843286.2019.1583782","url":null,"abstract":"<p><strong>Objectives: </strong>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.</p><p><strong>Methods: </strong>We revisit some recent advances in the field of faecal microbiome analyses with a focus on covariate analyses and ecological interpretation.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Covariate characterization and technical advances increase reproducibility of microbiome research. Targeted in vitro/in vivo intervention studies will accelerate clinical implementation of microbiota findings.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/17843286.2019.1583782","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37178637","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}
Pub Date : 2016-10-01Epub Date: 2016-06-27DOI: 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.
{"title":"Complicated pneumothorax and congenital lung cystic malformation.","authors":"Rachid Attou, Pascal Reper","doi":"10.1179/2295333714Y.0000000023","DOIUrl":"https://doi.org/10.1179/2295333714Y.0000000023","url":null,"abstract":"<p><p>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.</p>","PeriodicalId":48865,"journal":{"name":"Acta Clinica Belgica","volume":null,"pages":null},"PeriodicalIF":1.6,"publicationDate":"2016-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/2295333714Y.0000000023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32229761","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}
Pub Date : 2014-10-01Epub Date: 2014-07-14DOI: 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.
{"title":"Tuberculin skin test versus interferon-gamma release assays for the diagnosis of tuberculosis infection.","authors":"E De Keyser, F De Keyser, 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}