Nederlands tijdschrift voor geneeskunde
-
Ned Tijdschr Geneeskd · Nov 2005
Review[Differences in folic-acid policy and the prevalence of neural-tube defects in Europe; recommendations for food fortification in a EUROCAT report].
The European Registration Of Congenital Anomalies and Twins (EUROCAT), a network of 40 European registries of congenital anomalies, has published a special report on the prevention of neural-tube defects by, periconceptional folic-acid supplementation in Europe. This report reviews the progress made in 17 European countries since i99I in terms of developing and implementing public health policies to raise periconceptional folate status. Data on the prevalence of neural-tube defects in 1980-2000 were also analysed. - At the beginning of 2002, 10 of the 17 countries had an official government recommendation that women planning a pregnancy should take folic-acid supplementation daily. ⋯ Even in the Netherlands, where the percentage of planned pregnancies is estimated at 85%, only 36% of women take folic-acid supplements during the advised period. - Overall, the number of neural-tube defects has not decreased in Europe. A slight decrease was seen in those countries with an official policy regarding periconceptional folic-acid supplementation. - It is clear from the report that more effective prevention of neuraltube defects could be achieved with folic-acid fortification of staple foods; this approach has led to a reduction in the prevalence of neuraltube defects in the US and Canada. This approach can also prevent the majority of neural-tube defects in unplanned pregnancies and reduce the socioeconomic differences in prevalence.
-
Ned Tijdschr Geneeskd · Nov 2005
Case Reports[Acute abdominal pain as the first sign of Henoch-Schönlein purpura; a hidden diagnosis in the absence of purpura].
2 girls with abdominal pain, aged 7 and 9 years, were admitted and underwent extensive evaluation: the first girl underwent colonoscopy and the second appendectomy, in which a negative appendix was removed. After 6 and 14 days, respectively, they developed skin lesions that did not disappear on pressure, characteristic of Henoch-Schönlein purpura (HSP). They recovered after treatment with prednisone. ⋯ HSP presenting with acute abdominal pain as an initial symptom can give rise to unnecessary additional investigation and even laparotomy. Apart from the other clinical features of HSP, i.e. bloody stools, oligo-articular arthritis and (microscopic) haematuria, diagnosis can be made earlier if biopsies of the normal skin or duodenum are taken and assessed for IgA depositions. Treatment of the abdominal pain with corticosteroids can be considered.
-
Ned Tijdschr Geneeskd · Nov 2005
Practice Guideline[Guideline 'Diagnosis and treatment of community-acquired pneumonia' from the Dutch Thoracic Society].
Community-acquired pneumonia (CAP) is associated with considerable morbidity and mortality. The incidence of CAP in the Netherlands is estimated to be 5-10 per 1000 per year. This guideline can be used for the scientifically-based diagnosis and antibiotic treatment of adults with CAP. ⋯ Parapneumonic effusion frequently occurs in cases of CAP. Drainage is indicated if the pleural fluid contains bacteria or yields a pH < 7.0. Influenza vaccination is recommended in the elderly to prevent CAP.