The Netherlands journal of medicine
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Case Reports
Large-vessel vasculitis associated with PEGylated granulocyte-colony stimulating factor.
A 71-year-old female with advanced endometrial cancer was treated with pegfilgrastim. She developed a fever within seven days, and contrast-enhanced computed tomography scans repeated within three days revealed rapidly progressive thickening of the aortic wall. When clinicians administer PEGylated granulocyte-colony stimulating factor (G-CSF) to cancer patients, drug-associated vasculitis should be suspected. This report discusses the manifestation of G-CSF-associated large-vessel vasculitis (LVV).
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A substantial group of patients visit the emergency department (ED) with complaints of urinary tract infections (UTI). Treatment advice is based on national and local public health surveillance data. It is unclear whether this advice is adequate for hospitals with selected patient populations, such as university hospitals. ⋯ The distribution and antibiotic susceptibility of uropathogens for intravenous antibiotics in a Dutch university hospital is comparable with overall distribution in the Netherlands. Empiric antibiotic therapy in our local guideline appears to be an adequate antibiotic regimen for cUTI and we therefore recommend treating patients accordingly. Extension of the chosen regimen based on earlier cultured pathogens is advised, and narrowing of the antibiotic regimen strongly discouraged.
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Current hospital-level care is "mostly disease-specific and monodisciplinary-oriented". These three case reports show different journeys that patients with multiple chronic conditions experienced in Dutch secondary outpatient care, and aim to demonstrate why an integrated care approach might be beneficial for this group of patients.
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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. ⋯ 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.
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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. ⋯ 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.