Marbus SD, Groeneveld GH, van Asten L
… +6 more, van der Hoek W, de Lange MMA, Donker GA, Schneeberger PM, van Dissel JT, van Gageldonk-Lafeber AB
Neth J Med
· 2020 Dec · PMID 33380528
BACKGROUND: Surveillance of acute respiratory infections (ARI) in the Netherlands and other European countries is based mostly on primary care data, with little insight into the severe spectrum of the disease. We compare...BACKGROUND: Surveillance of acute respiratory infections (ARI) in the Netherlands and other European countries is based mostly on primary care data, with little insight into the severe spectrum of the disease. We compared time-trends for ARI in secondary care with influenza-like illness (ILI), ARI and pneumonia in primary care, and crude mortality, in order to assess the value of routinely collected data on respiratory infections in hospitals and the added value of severe acute respiratory infections (SARI) surveillance. METHODS: We calculated incidence of ARI in secondary care, ILI, ARI, and pneumonia in primary care, and crude mortality using five historical databases (2008-2016). RESULTS: Over eight years, seasonal incidence peaks of ARI in secondary care occurred earlier than ILI and ARI incidence peaks in primary care, except during the 2009 influenza A(H1N1) pandemic and post-pandemic season. The median time-lag between ARI in secondary care and ILI, ARI and pneumonia in primary care was 6.5 weeks, 7 weeks, and 1 week, respectively. Crude mortality lagged a median 5 weeks behind ARI in secondary care. CONCLUSION: This observational study demonstrates that routinely collected data can be used for describing trends of ARI in secondary care and may be suitable for near real-time SARI surveillance. In most seasons, the incidence peaks for ARI in secondary care preceded the peaks in primary care and crude mortality with a considerable time-lag. It would be of great value to add microbiological test results to the incidence data to better explain the difference in time-lag between these surveillance systems.
The aetiology of hypotonic polyuria, after excluding solute diuresis, is one of primary polydipsia, central, or nephrogenic diabetes insipidus. Theoretically, these disorders should be relatively easily distinguished bas...The aetiology of hypotonic polyuria, after excluding solute diuresis, is one of primary polydipsia, central, or nephrogenic diabetes insipidus. Theoretically, these disorders should be relatively easily distinguished based on history and the results of an indirect water deprivation test. Practically, however, there is a significant overlap in diagnostic evaluation, potentially leading to an erroneous diagnosis and deleterious management plan. The ability to measure a stimulated copeptin level, either with hypertonic saline or arginine infusion, has led to greater diagnostic accuracy.
van Wonderen K, Jongbloed-de Hoon M, Meinders AJ
… +1 more, Harmsze A
Neth J Med
· 2020 Sep · PMID 33093258
Synthetic cathinones have become popular drugs of abuse. We describe our recent experience with two highly agitated patients following ingestion of the cathinone derivative chloromethcathinone, and cannabis. Both patient...Synthetic cathinones have become popular drugs of abuse. We describe our recent experience with two highly agitated patients following ingestion of the cathinone derivative chloromethcathinone, and cannabis. Both patients suffered from excited delirium syndromes that lasted for over 24 hours. Clinicians should be aware of this phenomenon, especially since routine toxicology screenings do not detect the presence of these agents.
van Boven E, Massolt ET, van Rossum EFC
… +1 more, Kiewiet-Kemper RM
Neth J Med
· 2020 Sep · PMID 33093257
Pituitary apoplexy is an infrequent but life-threatening complication of pituitary adenomas. When apoplexy occurs in a hormonally active adenoma, this may induce spontaneous remission of the clinical syndrome. In these c...Pituitary apoplexy is an infrequent but life-threatening complication of pituitary adenomas. When apoplexy occurs in a hormonally active adenoma, this may induce spontaneous remission of the clinical syndrome. In these cases, clinical suspicion of Cushing's disease or acromegaly may arise at presentation, but due to spontaneous remission of active hormone production, it is not possible to biochemically confirm this diagnosis in retrospect. Resolution of clinical symptoms during follow up retrospectively suggests the diagnosis. However, we describe a patient with Cushing's disease presenting with pituitary apoplexy, who was biochemically in remission at presentation. The diagnosis could be confirmed in retrospect using hair cortisol analysis, thereby enabling clinicians to adequately anticipate remission of Cushing's disease.
Dunbar A, Joosse ME, de Boer F
… +2 more, Eefting M, Rijnders BJA
Neth J Med
· 2020 Sep · PMID 33093256
Bruton's tyrosine kinase (BTK) inhibitors are increasingly used in untreated and previously treated chronic lymphocytic leukaemia (CLL) patients. Invasive fungal infections (IFI) were rarely observed in patients treated...Bruton's tyrosine kinase (BTK) inhibitors are increasingly used in untreated and previously treated chronic lymphocytic leukaemia (CLL) patients. Invasive fungal infections (IFI) were rarely observed in patients treated for CLL in the pre-BTK era. In this article, we describe two patients with CLL who developed an IFI during treatment with the BTK inhibitor ibrutinib. The atypical presentation and the serious course of this complication are described.
van der Voort S, de Graaf J, de Blok K
… +1 more, Sekkat M
Neth J Med
· 2020 Sep · PMID 33093255
The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a known cause of hyponatremia, caused by excessive ADH secretion which, in turn, leads to water retention. SIADH has been associated with multiple e...The syndrome of inappropriate antidiuretic hormone secretion (SIADH) is a known cause of hyponatremia, caused by excessive ADH secretion which, in turn, leads to water retention. SIADH has been associated with multiple etiologies, one of which is traumatic brain injury (TBI). Most cases of SIADH after TBI describe a course in which hyponatraemia develops several days to weeks after the trauma and then resolves within a few weeks. We demonstrate a case of SIADH after TBI, which persisted several years after initial presentation, but eventually did resolve spontaneously after five years.
Boderie MJM, Van Paassen P, Aendekerk JP
… +1 more, Posthouwer D
Neth J Med
· 2020 Sep · PMID 33093254
This case report describes a patient who presented with a debilitating hepatitis C virus-related cryoglobulinaemic vasculitis who was treated with immunosuppression and direct-acting antivirals. After returning symptoms...This case report describes a patient who presented with a debilitating hepatitis C virus-related cryoglobulinaemic vasculitis who was treated with immunosuppression and direct-acting antivirals. After returning symptoms revealed a relapse of the hepatitis C virus infection, treatment with direct-acting antivirals was repeated. Subsequently, he achieved a sustained virological response and his vasculitis subsided.
Jongbloed EM, Hermans MAW, Wabbijn M
… +2 more, van Kampen JJA, van Laar JAM
Neth J Med
· 2020 Sep · PMID 33093253
Haemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory condition that can be triggered by infections, malignancies, or auto-immune diseases. Here, we present a patient with rapidly progressive HLH triggere...Haemophagocytic lymphohistiocytosis (HLH) is a rare hyperinflammatory condition that can be triggered by infections, malignancies, or auto-immune diseases. Here, we present a patient with rapidly progressive HLH triggered by a herpes simplex virus type 2 (HSV-2) primary infection. The patient was successfully treated with intravenous high-dose acyclovir, immunoglobulins, and dexamethasone. This is the first report of HSV-2-associated HLH in an immunocompetent adult patient.
Timmer-Bonte JNH, Ouwerkerk J, Faber LM
… +5 more, Kerkhofs LGM, Laterveer L, Ten Oever D, van Rees BP, van der Linden PW
Neth J Med
· 2020 Sep · PMID 33093252
BACKGROUND: Chemotherapy (CT)-induced neutropenia and febrile neutropenia (FN) can lead to changes in the treatment plan, potentially worsening the cancer outcome. This study evaluated the effect of the glycopegylated gr...BACKGROUND: Chemotherapy (CT)-induced neutropenia and febrile neutropenia (FN) can lead to changes in the treatment plan, potentially worsening the cancer outcome. This study evaluated the effect of the glycopegylated granulocyte-colony stimulating factor lipegfilgrastim, used as primary (PP) or secondary prophylaxis (SP), on treatment modifications in adult patients receiving cytotoxic CT with or without biological/targeted therapy (BT) for solid and haematological tumours. METHODS: This phase 4, prospective, observational study was conducted in eight centres in the Netherlands, in 2015-2017. Other study objectives were to characterise the population of cancer patients receiving lipegfilgrastim, to evaluate the incidence of CT-induced neutropenic events, and to assess safety. RESULTS: Of 142 patients, 73.94% had breast cancer and 55.63% received CT in the adjuvant setting. Most patients received lipegfilgrastim as PP (74.65%) and were at low (34.51%) or high risk (39.44%) of FN. CT dose delays were recorded for 22.64% and 36.11% of patients receiving lipegfilgrastim for PP and SP, respectively. CT dose reductions were recorded for 2.11% of patients; no CT dose omissions and one BT dose omission occurred. FN and grade III/IV neutropenia were reported for 5.63% and 9.86% of patients, respectively; associated hospitalisations were rare. The most frequently lipegfilgrastimrelated adverse events (AE) were myalgia, bone pain, and back pain. Serious AEs (55) were reported for 30 (21.13%) patients. There were two deaths, unrelated to lipegfilgrastim administration. CONCLUSION: Administration of lipegfilgrastim in routine clinical practice in the Netherlands results in limited CT/BT dose modifications and low incidence of neutropenic events, with no new safety concerns.
BACKGROUND: The study aimed to look at alterations in expression of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) and their potential use as biomarkers in the pathogensis of SLE. METHODS: SLE patie...BACKGROUND: The study aimed to look at alterations in expression of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) and their potential use as biomarkers in the pathogensis of SLE. METHODS: SLE patients (n = 41) and healthy controls (n = 50) were recruited. Quantitative RT-PCR/ELISA assays were performed for expression of MMP and TIMP mRNA in whole blood and PBMC; and corresponding serum protein levels. Intracellular levels of MMP-2 and MMP-9 proteins were analysed by flow cytometry. RESULTS: Based on SLEDAI scores patients were grouped into active (SLEDAI ≥ 10) and inactive cases (SLEDAI < 10). In active cases, MMP-2 expression significantly increased and TIMP-2 expression was decreased (p < 0.0001) both at serum secretion (p = 0.0003) and mRNA (p < 0.0001) levels as compared to inactive cases. MMP-9 and TIMP-1 showed significantly reduced serum secretion and mRNA expression (p < 0.0001) in active cases as compared to inactive cases. Intracellular concentration of MMP-9 was reported to be higher in neutrophils, while MMP-2 was mainly found in lymphocytes of SLE patients as compared to controls. MMP/TIMP ratio profile was altered as SLE disease progresses. INTERPRETATION & CONCLUSIONS: Findings suggest disturbed MMP and TIMP levels have a role in the pathogenesis of SLE.
Kremers MNT, Wachelder JJH, Nanayakkara PWB
… +1 more, Haak On Behalf Of The Orca Onderzoeks Consortium Acute Geneeskunde Acute Medicine Research Consortium HR
Neth J Med
· 2020 Sep · PMID 33093250
BACKGROUND: Organisation of the emergency department (ED) is gaining attention due to an increased demand on emergency services, leading to crowding and influencing the quality of care. It is known that the organisation...BACKGROUND: Organisation of the emergency department (ED) is gaining attention due to an increased demand on emergency services, leading to crowding and influencing the quality of care. It is known that the organisation of acute care influences the performance of the ED. In the Netherlands, the organisation of EDs differs between hospitals. However, detailed information about the various organisational structures is lacking. This study aims to determine the organisational structures and the different roles and responsibilities of internists and emergency physicians (EPs) in the EDs. METHODS: We performed a nationwide observational study between January 2018 and February 2019. All hospitals with an ED in the Netherlands were identified, contacted, and surveyed. Requested information was retrieved from internists and complemented with local administrative hospital data. RESULTS: 76 out of 89 EDs responded to the questionnaire (84%); 93% of EDs were operational 24/7. A registered acute internist was present at 47 locations (62%) and an EP at 60 EDs (79%). At 10 locations (13.2%), internists reported not being physically present at the ED. Supervision and working agreements between EPs and internists differed between the hospitals. Collaboration between EPs and internists was graded satisfactory (7.4/10). CONCLUSION: This is the first study providing a detailed overview of the ED organisation in the Netherlands regarding internal medicine patients. This organisation differs in terms of staffing, presence of EPs and internists, and working agreements. The influence of the various organisational structures of EDs on quality of acute care should be the subject of future research.
Schuijt HJ, Oud FMM, Bruns EJR
… +4 more, van Duijvendijk P, Van der Zaag-Loonen HJ, Spies PE, van Munster BC
Neth J Med
· 2020 Sep · PMID 33093249
PURPOSE: Frailty screening in the emergency department may identify frail patients at risk for adverse outcomes. This study investigated if the Dutch Safety Management Program (VMS) screener predicts outcomes in older pa...PURPOSE: Frailty screening in the emergency department may identify frail patients at risk for adverse outcomes. This study investigated if the Dutch Safety Management Program (VMS) screener predicts outcomes in older patients in the emergency department. METHODS: In this prospective cohort study, patients aged 70 years or older presenting to the emergency department were recruited on workdays between 10:00 AM and 7:00 PM from May 2017 until August 2017. Patients were screened in four domains: activities of daily living, malnutrition, risk of delirium, and risk of falling. After 90 days of follow up, mortality, functional decline, living situation, falls, readmission to the emergency department, and readmission to the hospital were recorded. VMS was studied using the total VMS score as a predictor with ROC curve analysis, and using a cut-off point to divide patients into frail and non-frail groups to calculate positive predictive value (PPV) and negative predictive value (NPV). RESULTS: A total of 249 patients were included. Higher VMS score was associated with 90-day mortality (AUC 0.65, 95% CI 0.54-0.76) and falling (AUC 0.67, 95% CI 0.56-0.78). VMS frailty predicted mortality (PPV 0.15, NPV 0.94, p = 0.05) and falling (PPV 0.22, NPV 0.92, p = 0.02), but none of the other outcomes. CONCLUSION: In this selected group of patients, higher VMS score was associated with 90-day mortality and falls. The low positive predictive value shows that the VMS screener is unsuitable for identifying high-risk patients in the ED. The high negative predictive value indicates that the screener can identify patients not at risk for adverse medical outcomes. This could be useful to determine which patients should undergo additional screening.
Jonkers BRP, Cobanoglu G, Blok EJ
… +6 more, Köbben JJ, van der Helm MW, van Hoof IJAM, Tintu AN, Bethlehem C, Versmissen J
Neth J Med
· 2020 Sep · PMID 33093248
A 28-year-old female patient was admitted to our hospital with severe dyspnoea and hypoxemia due to methaemoglobinaemia caused by dapsone. The patient recovered completely after repeated infusions of methylene blue and c...A 28-year-old female patient was admitted to our hospital with severe dyspnoea and hypoxemia due to methaemoglobinaemia caused by dapsone. The patient recovered completely after repeated infusions of methylene blue and cessation of dapsone. However, 12 days after cessation of dapsone, the patient was readmitted due to recurrence of symptoms based on a relapse of methaemoglobinaemia. Toxicological analysis revealed a toxic dapsone level at readmission and no other explanation for methaemoglobinaemia. Several possible mechanisms as explanation for the recurrence of methaemoglobinaemia are listed and additional tests were performed. In addition to supportive care, treatment consisted of methylene blue; furthermore, cimetidine and ascorbic acid were added. An overview of the pathophysiology, diagnostics, treatment, and possible explanations for this relapse of methaemoglobinaemia caused by dapsone are given. This case shows the importance of considering the possibility of a late rebound methaemoglobinaemia after discontinuation of dapsone.
Kurtkulagi O, Aktas G, Bilgin S
… +3 more, Meryem Atak B, Taslamacioglu Duman T, Emin Demirkol M
Neth J Med
· 2020 Sep · PMID 33093247
BACKGROUND: Hypertension (HT) is a chronic condition associated with serious complications. In the present cross-sectional study, we aimed to analyse factors that contribute to blood pressure control in subjects with HT....BACKGROUND: Hypertension (HT) is a chronic condition associated with serious complications. In the present cross-sectional study, we aimed to analyse factors that contribute to blood pressure control in subjects with HT. METHODS: Subjects with HT admitted to outpatient internal medicine clinics of the institution were enrolled in the study. According to the Joint National Committee (JNC) VIII criteria, subjects with a mean blood pressure above target levels were defined as poorly-controlled hypertensive patients and others were grouped as well-controlled hypertensive patients. Clinical and laboratory parameters were compared between study groups. RESULTS: Smokers were more prevalent in the poorly-controlled HT group compared to the well-controlled HT group (p = 0.001). The number of patients who adhered to dietary and exercise recommendations were greater in well-controlled HT group than poorly-controlled HT group (p < 0.001 for both). The rate of combined therapy was greater in well-controlled HT group compared to poorly-controlled HT group (p = 0.04). CONCLUSIONS: We suggest that, in addition to dietary and exercise recommendations and smoking cessation, treatment with combination therapy could be better in reaching blood pressure targets in patients with HT.