Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Apr 2020
Case Reports[Dysphagia caused by osteophytes of the cervical spine].
Diffuse idiopathic skeletal hyperostosis (DISH) is a systemic condition characterised by ossification of the ligaments around the spinal column due to unknown aetiology. This is often asymptomatic, but it can cause dysphagia in rare cases. ⋯ In rare cases, dysphagia can be caused by osteophytes of the cervical spine in patients with DISH. Surgical removal of these osteophytes usually has good results.
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There is a new type of injury that is observed increasingly often: frostbite of the thighs that has occurred as result of holding a cylinder containing nitrous oxide in position between the legs during recreational use of said substance. Because skin symptoms are often mild in the first few days after the event, the severity of the injury is often not recognized. However, patients can suffer serious scarring from this type of injury. ⋯ It is important to recognize this injury and to consult one of the burns units to treat these patients in a timeline and appropriate manner.
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COVID-19 is associated with a high prevalence of activation of the coagulation cascade. It has been suggested that this so-called COVID-19-associated coagulopathy is predictive of a poor outcome and of mortality. Consensus documents on how to manage patients with COVID-19-associated coagulopathy are based on the limited number of mainly retrospective studies that is currently available, and for this reason the recommendations are not always consistent with one another. In this article, we review the first studies into COVID-19-associated coagulopathy and give the most important do's and don'ts for diagnostics and the daily management of coagulopathy and the prevention of complications in patients with, or with strongly-suspected, COVID-19 in Dutch clinical practice.
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Ned Tijdschr Geneeskd · Apr 2020
Review Case Reports[Atypical clinical picture of COVID-19 in older patients].
Clinical characteristics and outcomes among older patients with a SARS-CoV-2 infection differ greatly from those seen in younger patients. Here we highlight atypical presentations of this fulminant infectious disease COVID-19, based on a clinical case and a cohort of 19 patients admitted to a geriatric ward. ⋯ As in other countries, morbidity and mortality is most severe among frail male patients; therefore, assessment of changes suggestive of typical acute geriatric syndromes in frail older patients with chronic diseases should lead to a careful clinical examination for a SARS-CoV-2 infection. Protocols for diagnosis, and contact isolation measures, should take these atypical presentations into account.
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Ned Tijdschr Geneeskd · Apr 2020
[Rational use of respiratory protective equipment: advice for health care professionals in time of COVID-19].
The current COVID-19 pandemic has led to a worldwide shortage of respiratory protective equipment. In order to offer maximum protection against infection for all healthcare workers, we need to optimise our use of the available equipment. This article provides practical advice on which type of mask is indicated in what specific situation, what requirements the mask should meet and how to optimise the local workflow, including the re-use of masks after decontamination.