Nederlands tijdschrift voor geneeskunde
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HIV/AIDS and tuberculosis impose a large infectious burden world wide. The conditions mutually interact, both epidemiologically and biologically. The course and treatment of tuberculosis are importantly complicated by HIV co-infection. ⋯ Two random samples of TB cases from the national registry were analysed--1993 and 2003--before and after the introduction of effective therapy for HIV/AIDS became available. There was no significant increase in HIV sero-testing. Guidelines for the treatment of tuberculosis should include routine HIV testing.
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Ned Tijdschr Geneeskd · Nov 2007
Comment[Prevention of postoperative pulmonary complications by preoperative training].
Postoperative pulmonary complications are the main cause of morbidity and mortality after surgery. A likely explanation is dysfunction of the respiratory muscles, in particular the diaphragm, which results in rapid, shallow breathing and ultimately-in closing of the airways, atelectasis and hypoxaemia. ⋯ A promising new approach is specific training of inspiratory muscles. A randomized clinical trial, published in this issue of the journal, found this to be effective in patients at increased risk for postoperative complications who underwent cardiac surgery.
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Ned Tijdschr Geneeskd · Nov 2007
Randomized Controlled Trial[Fewer lung complications following inspiratory muscle training in patients undergoing coronary bypass surgery: a randomized trial].
The aim of this study was to evaluate the prophylactic efficacy of preoperative physiotherapy, including inspiratory muscle training (IMT), on the incidence of postoperative pulmonary complications (PPCs) in high-risk patients scheduled for elective coronary artery bypass grafting (CABG). ⋯ Preoperative physiotherapy, including IMT, statistically significantly reduced the incidence ofPPCs and the duration ofpostoperative hospitalization in patients at high risk of developing a pulmonary complication on undergoing CABG.
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Ned Tijdschr Geneeskd · Nov 2007
Case Reports[Anaphylactic reactions to chlorhexidine during urinary catheterisation].
Three men of 65, 41 and 54 years old respectively, developed an anaphylactic reaction during a medical procedure. Two were under general anaesthesia and the third was undergoing urinary catheterisation. After allergy tests chlorhexidine, an ingredient in the gel which was used during the urinary catheterisation procedure, was found to be the causative agent in all three men. ⋯ Chlorhexidine is a widely used antiseptic and disinfectant. Despite multiple publications on anaphylactic reactions mostly during surgery under general anaesthesia or urological procedures, chlorhexidine is often initially overlooked as a cause of anaphylaxis. All three men had had previous reactions to chlorhexidine, however, not enough attention was paid to this fact, or it was not thought of.