The Netherlands journal of medicine
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Comparative Study
Chemotherapy-induced febrile neutropenia: primary G-CSF prophylaxis indicated during docetaxel cycles.
Chemotherapy-induced febrile neutropaenia (FN) is a common and life-threatening adverse event, which can be largely prevented by the use of granulocyte colony-stimulating factor (G-CSF); G-CSF, however is expensive and not without side effects. Although primary G-CSF prophylaxis is recommended when the risk of FN is ≥ 20%, it is unclear during which cycles it should be administered. This study assessed and compared the FN incidence in the neo-adjuvant or adjuvant administration of two chemotherapy regimens that are widely used in breast cancer care to provide clinically useful recommendations for G-CSF use. ⋯ In breast cancer treatment, compared to other frequently-used agents, monotherapy with docetaxel (100 mg/m2) renders a substantial risk of FN (20.9%), thereby justifying the use of primary G-CSF according to international guidelines.
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Case Reports
Exceptional response of brain metastases to short course nivolumab while on high-dose steroids.
In this manuscript, we describe a patient with an exceptional response of brain metastases from lung cancer to short course nivolumab while on high-dose steroids. This case shows that immunotherapy can cause delayed and enduring responses even in patients with poor predictive parameters for treatment success, such as low programmed death ligand-1 (PDL1) expression and long-term treatment with high-dose corticosteroids. Secondly, it underscores the importance of follow up after the administration of immunotherapy, even in cases with a deemed poor prognosis and few received cycles of immunotherapy.
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Infectious mononucleosis may mimic lymphoma, both clinically and histopathologically. We present a patient with neurological symptoms and lymphadenopathy, initially diagnosed as Epstein-Barr virus (EBV)-positive angioimmunoblastic T-cell lymphoma (AITL) with cerebrospinal fluid (CSF) localisation based on lymph node pathology and a 30-fold higher EBV load in the CSF compared with serum. However, the patient fully recovered spontaneously and EBV became negative in both CSF and serum, suggestive of a dramatic presentation of EBV meningoencephalitis.
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Acute withdrawal of calcium channel blockers can lead to the so-called calcium channel blocker withdrawal phenomenon, in particular, when high dosages are used. In the case presented, inadequate drug substitution led to this phenomenon which resulted in a serious course of events. Careful monitoring the process of drug substitution with respect to equal therapeutic dosages is therefore a necessity, especially in vulnerable patients.
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The use of digital tools is indispensable in our daily lives. The medical world keeps up with this progress by implementing digital tools to facilitate and improve patient care, such as eConsults and self-care apps. Serious games are also becoming increasingly popular in healthcare education, particularly in surgical residency training and nursing education. ⋯ Therefore, these programs are not yet modernised to meet the demands of the 21th century physician. In this article, we will explicate our view on digitisation of the internal medical education programme with special attention to serious gaming. We will discuss pros and cons of digitisation, describe challenges of development and implementation of games, and offer some examples of digital educational tools for practical use.