Nederlands tijdschrift voor geneeskunde
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Chikungunya is a rapidly spreading infectious disease throughout the Caribbean, reaching epidemic proportions in Suriname, with more than 1200 registered cases in 2014. Similar to dengue, classic symptoms are high fever, rash and arthralgia. However, the presentation differs in adults and children. ⋯ A 2.5-month-old baby with fever, vomiting, diarrhoea and a rash was brought to the ER. She was agitated and had signs of meningism. The symptoms resolved quickly in all patients after rehydration and pain medication.
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Ned Tijdschr Geneeskd · Jan 2015
Comment[New potassium binders effective: treatment of hyperkalaemia secondary to RAAS inhibitors].
This commentary discusses two recent publications by Weir et al. and Packham et al. in The New England Journal of Medicine on the efficacy of two novel potassium binders, sodium zirconium cyclosilicate and patiromer. In a similar manner to existing potassium binders, these drugs exchange dietary potassium for either sodium or calcium in the gut, thereby preventing absorption of potassium. Both drugs were tested against placebo in patients with chronic kidney disease who developed hyperkalaemia because they were also using renin-angiotensin-aldosterone system (RAAS) inhibitors. ⋯ A strong point in the trials is that the new potassium binders allow patients to continue using RAAS inhibitors. By doing so, these patients with high cardiovascular risk may continue to benefit from the protective effects of RAAS inhibitors. Limitations include the relatively short treatment period, the lack of a control group using existing potassium binders, and the exclusion of patients with severe or symptomatic hyperkalaemia.
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Ned Tijdschr Geneeskd · Jan 2015
[Predictive value of the VMS theme 'Frail elderly': delirium, falling and mortality in elderly hospital patients].
To determine the predictive value of safety management system (VMS) screening questions for falling, delirium, and mortality, as punt down in the VMS theme 'Frail elderly'. ⋯ The VMS screening for delirium is a reasonably reliable instrument for identifying those elderly people with a high risk of developing this condition; the VMS sensitivity for fall risk is moderate. The number of positive VMS risk factors correlates with mortality and may therefore be regarded as a measure of frailty.
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Ned Tijdschr Geneeskd · Jan 2015
Biography Historical Article[David Sackett and 25 years of evidence-based medicine: person and the context].
David Sackett, the father of evidence-based medicine (EBM), died recently - exactly 25 years after the term EBM was coined. This coincidence calls for reflection on the historical significance of EBM and on Sackett's role. ⋯ However, context alone does not explain everything; the course of history - and the history of EBM - is partly determined by special men and women, individual reformers who manage to set things and people in motion. David Sackett is an excellent example of this.
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Ned Tijdschr Geneeskd · Jan 2015
Historical Article[Guild medals from the Surgeons' Guild of Amsterdam].
Between around 1620 and the end of the eighteenth century, every surgeon working in Amsterdam was presented with a guild medal on passing their surgeon's exams. These medals actually represented membership of the Surgeon's Guild of Amsterdam and could be used as proof of attendance at meetings of the Guild. From 1864 onwards surgeons also received the Hortus medal, which allowed them entry to the Hortus Medicus. ⋯ The collection of 17th and 18th century Amsterdam Surgeon's Guild medals numbers some 230 examples, and is the largest and most varied collection of its kind in the world. A few of the medals that have been preserved actually belonged to surgeons depicted in the famous series of group portraits. We examined who these surgeons were and what the purpose of these medals was.