OBJECTIVES: Rheumatoid arthritis (RA) is an independent risk factor for cardiovascular disease (CVD). Glucocorticoids are often used in the management of RA and might also contribute to the increased risk of metabolic sy...OBJECTIVES: Rheumatoid arthritis (RA) is an independent risk factor for cardiovascular disease (CVD). Glucocorticoids are often used in the management of RA and might also contribute to the increased risk of metabolic syndrome (metS). Identifying metabolic alterations earlier and treating them together with disease-modifying therapy may be associated with better outcomes. Here, we aimed to investigate the frequency of metS and its components in treatment-naïve RA patients. METHODS: Fifty-three newly diagnosed treatment-naïve RA patients and 55 control subjects were enrolled. MetS was diagnosed using Adult Treatment Panel III report-defined criteria. We evaluated the metS-related metabolic and anthropometric alterations between the groups. RA patients were subdivided and those with and without metS were also compared with respect to disease-related parameters. RESULTS: MetS was more common in treatment-naïve newly diagnosed RA patients compared to controls (25 of 53 (47.1%) vs 9 of 55 (16.4%), respectively (p = 0.001; OR, 4.56; 95% CI 1.86-11.16). All evaluated anthropometric and metabolic parameters were similar in both groups. However, there was a trend to lower LDL and HDL cholesterol levels in RA patients. Furthermore, among those with metS, the number of fulfilled metS criteria items were higher in RA patients, compared to controls (p < 0.001). Interestingly, more RA patients fulfilled metS criteria with a glucose measurements item compared to controls (p < 0.001). CONCLUSION: MetS was more common in newly diagnosed and treatment-naïve RA patients compared to controls. MetS, along with tendency to present paradoxical and atherogenic lipid profiles in RA patients, may be among the underlying mechanisms of increased CVD.
Dimmendaal M, Kracht PAM, Dijkstra S
… +3 more, Arends JE, Woonink F, Behalf Of The Reach Working Group O
Neth J Med
· 2019 Aug · PMID 31391325
BACKGROUND: In the Netherlands, approximately 200 patients die annually from a chronic hepatitis B (CHB) infection, even though effective antiviral treatment is available. There are an estimated 49,000 Dutch CHB patients...BACKGROUND: In the Netherlands, approximately 200 patients die annually from a chronic hepatitis B (CHB) infection, even though effective antiviral treatment is available. There are an estimated 49,000 Dutch CHB patients. Many of these patients have been lost to follow-up (LFU) over time. The study aimed to trace LFU CHB patients in the province of Utrecht and bring them back into care. METHODS: Positive hepatitis B surface antigen (HBsAg) tests from 2001-2015 were collected from the four hospitals in the Utrecht province and linked to medical records. The general practitioners (GPs) were requested in writing to evaluate LFU CHB patients and to refer patients when needed. In addition, GPs were asked to fill out a questionnaire on the patients' characteristics and to indicate reasons for not being able to perform an evaluation. RESULTS: A total of 2,242 chronic CHB patients were identified based on HBsAg-positive serology. After review of their medical records, 599 (27%) patients were eligible for retrieval. Of those, the GP response rate was 49% (n = 292) and 62 patients (10%) of the eligible CHB patients could be evaluated. Of these, 20 patients (3%) were referred to a hospital and 42 patients (7%) did not have an indication for referral. CONCLUSION: Lost to follow-up CHB patients can be traced through screening of past positive HBsAg tests. There was willingness among GPs to participate in the retrieval of CHB patients. This may contribute to the reduction of the CHB-related burden of disease.
Olgers TJ, Azizi N, Blans MJ
… +3 more, Bosch FH, Gans ROB, Ter Maaten JC
Neth J Med
· 2019 Jun · PMID 31264587
The use of Point-of-care Ultrasound (PoCUS) is rapidly increasing in internal medicine as it is useful in the primary assessment of acutely ill internal medicine patients for enhanced diagnostics and resuscitation. PoCUS...The use of Point-of-care Ultrasound (PoCUS) is rapidly increasing in internal medicine as it is useful in the primary assessment of acutely ill internal medicine patients for enhanced diagnostics and resuscitation. PoCUS can be taught in a modular fashion including basic core applications and advanced applications which can be combined for a symptom-based approach. Several PoCUS curriculum guidelines, especially for emergency medicine, exist throughout the world but a clear Dutch guideline for internists has not been developed. In this review we propose 'core' ultrasound competencies for internists that may also be incorporated into the European Training Requirements Internal Medicine. We suggest the use of an Entrustable Professional Activities (EPA) competencybased training system with EPAs specifically designed for ultrasound.
BACKGROUND: Familial Mediterranean Fever (FMF) is the earliest described and most prevalent hereditary auto-inflammatory disease. Its clinical presentation is diverse, leading to possible delay in diagnosis and treatment...BACKGROUND: Familial Mediterranean Fever (FMF) is the earliest described and most prevalent hereditary auto-inflammatory disease. Its clinical presentation is diverse, leading to possible delay in diagnosis and treatment. Due to immigration, FMF became common in non-Mediterranean European regions. In the present single centre retrospective study, the clinical, demographic, and genetic characteristics of patients with FMF of different ancestry in Amsterdam are described. METHODS: Case records of patients with FMF, who met the Tel-Hashomer diagnostic criteria, were retrospectively analysed. The international disease severity score was used. RESULTS: Between 1990-2012, 53 patients were identified, 28 were female. Main country of origin was Turkey. The mean age at the time of analysis was 29.1 years; 13.8 years at onset of symptoms; and at time of diagnosis, 22.0 years. Most frequent symptoms were peritonitis (91%) and fever (81%). The mean C-reactive protein and erythrocyte sedimentation rate during acute attacks were 133 mg/l and 37 mm/first hour, respectively. One patient developed amyloidosis as a complication. Seventeen patients underwent abdominal surgery before diagnosis. Most patients (92%) received colchicine treatment and were responsive (81%). Most patients classified their disease as a mild disease (42%). MEFV gene mutation analysis was performed in 46 patients; most patients were compound heterozygotes (n = 17), and the most frequent mutation was M694V (n = 18). CONCLUSION: FMF in Amsterdam is diagnosed in relatively young patients and the delay to diagnosis is 8.2 years. Disease manifestations and genetic distribution of our FMF patients are comparable to those in Mediterranean regions, suggesting that ancestry is more important than environment.
Flecainide intoxication is a severe intoxication that can lead to cardiogenic shock. We report on a 68-year-old female patient, who presented with a flecainide intoxication in the setting of renal failure. She was manage...Flecainide intoxication is a severe intoxication that can lead to cardiogenic shock. We report on a 68-year-old female patient, who presented with a flecainide intoxication in the setting of renal failure. She was managed with invasive supportive therapy at the ICU and infusion of sodium bicarbonate and intravenous lipid emulsion (ILE, intralipid 20%), after which she made a complete recovery.
We describe a 27-year-old female with repeated episodes of pulseless electrical activity due to intoxication with a substance that was unidentified at presentation. Severe QRS widening was observed and empiric treatment...We describe a 27-year-old female with repeated episodes of pulseless electrical activity due to intoxication with a substance that was unidentified at presentation. Severe QRS widening was observed and empiric treatment with sodium bicarbonate and intravenous lipid emulsion was administered. In this case, intraosseous administration of lipid emulsion failed to improve haemodynamic parameters, suggesting that this dose remained in the bone marrow compartment. We recommend that physicians become aware of this possibility and to avoid intraosseous administration of lipid emulsion.
Alderweireld CEA, van der Kooij DC, Stuurman-Wieringa RE
… +2 more, Boom H, Postema PTE
Neth J Med
· 2019 Jun · PMID 31264583
Bladder outlet obstruction is a common aetiology of lower urinary tract symptoms in adult men and several treatment options are available. We report on a case of a 73-year-old man with a complicated soft tissue infection...Bladder outlet obstruction is a common aetiology of lower urinary tract symptoms in adult men and several treatment options are available. We report on a case of a 73-year-old man with a complicated soft tissue infection due to an urinoma after laser prostatectomy. He was treated by several surgical interventions and long-term antibiotic therapy.
Pinxterhuis TH, Out M, van den Broek RWF
… +2 more, Wouters RSME, van der Kleij FGH
Neth J Med
· 2019 Apr · PMID 31012430
Thyrotoxicosis due to thyroiditis is predominantly caused by infection or autoimmune disease of the thyroid. Parathyroid surgery however, is a lesser known cause of thyroiditis, due to thyroid manipulation. We treated a...Thyrotoxicosis due to thyroiditis is predominantly caused by infection or autoimmune disease of the thyroid. Parathyroid surgery however, is a lesser known cause of thyroiditis, due to thyroid manipulation. We treated a patient who developed transient symptomatic thyroiditis following parathyroid surgery for tertiary hyperparathyroidism. Therefore, the differential diagnosis for patients with symptoms after parathyroid surgery should include transient thyroiditis.
Houweling BM, van Meurs SJ, Versluis J
… +3 more, Grewal S, Verkaik NJ, van den Akker JPC
Neth J Med
· 2019 Apr · PMID 31012429
Invasive meningococcal disease is associated with significant mortality. Classic presentation consists of high fever, headache and neck stiffness. Neisseria meningitidis serogroup W may present with atypical symptoms, wh...Invasive meningococcal disease is associated with significant mortality. Classic presentation consists of high fever, headache and neck stiffness. Neisseria meningitidis serogroup W may present with atypical symptoms, which complicates recognition. Furthermore, it is associated with a high case fatality rate.