Nederlands tijdschrift voor geneeskunde
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Not all questions concerning therapeutic effects in medical research can be answered satisfactorily by standard trials. The stepped wedge cluster design is a special form of randomised study in which an intervention at group level is implemented in stages. ⋯ The statistical analysis of cluster trials should account for the fact that individuals within clusters may show many similarities. Ethical aspects of stepped wedge design should be considered carefully, especially when obtaining individual informed consent is not possible.
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Blunt scrotal trauma, mostly induced by sports injuries, can cause a testis rupture. Patient exhibit extreme pain and swollen tender testicle. ⋯ A rupture or a suspicion thereof requires a surgical exploration. Delay of diagnosis can cause irreversible damage to the testicle.
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Ned Tijdschr Geneeskd · Jan 2012
Review[Eosinophilic oesophagitis: a frequently missed cause of dysphagia].
Oesophageal dysphagia is the subjective feeling that there is a problem with the passage of solids or liquids through the oesophagus. The differential diagnosis of dysphagia is long and can be divided into mechanical and motility disorders. Dysphagia is an alarming symptom which requires short-term endoscopic evaluation. ⋯ The typical eosinophilic oesophagitis patient is a young adult man, often with an atopic constitution, who has intermittent symptoms of dysphagia. The diagnosis of 'eosinophilic oesophagitis' is based on characteristic histological findings in the oesophagus, seen in a fitting clinical context. Best evidence for the effects of treatment of eosinophilic oesophagitis is available for topical glucocorticoids.
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The new global strategy to achieve long-term malaria eradication is based on rapid treatment of individual malaria patients and blocking the spread of Plasmodium parasites in the population. In a number of countries increased funding combined with more effective control measures have resulted in a substantial decline in the incidence of malaria and in the resulting morbidity and mortality. Increasing resistance of Anopheles mosquitoes to insecticides (pyrethroids and DDT), and reduced sensitivity of Plasmodium parasites to various antimalarials increase the need for the development of new vector control strategies and medicines. Vaccine development efforts have been speeding up and a first vaccine is expected within three years.
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Vaccination against the human papilloma virus (HPV) has been included in the national Vaccination Programme of the Netherlands for 12-year-old girls since 2010. Vaccination coverage for the birth cohort of 1997 was 56.; there is a gradual increase in uptake. Continuous safety monitoring brought no new unknown serious side effects to light; many girls suffered from transient symptoms such as painful arm, fatigue and headache. ⋯ HPV vaccination of 12-year-old girls is cost-effective, even for relatively low vaccination coverage. The potential protection of HPV vaccination extends beyond prevention of cervical cancer by preventing other oncological manifestations of HPV infection in women as well as men and genital warts. The preventive HPV vaccines do not appear to be effective in treating existing abnormalities.