Nederlands tijdschrift voor geneeskunde
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Andexanet alfa (andexanet) was specifically developed to reverse factor Xa inhibitors. Its effect on patients who are experiencing major bleeding while being treated with an oral Xa inhibitor or low molecular weight heparin was studied in the ANNEXA 4 study. ⋯ With the recent approval by the European Medicines Agency (EMA) but unknown Dutch reimbursement status, the role of andexanet for daily clinical practice in the Netherlands remains to be determined. Notably, and importantly, when treating patients with anticoagulant-associated major bleeding, local haemostatic control and-if relevant-adequate fluid resuscitation are at least as important as choosing the optimal anticoagulation antidote.
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Myocarditis, a treacherous condition It is important to recognize myocarditis at an early stage. To illustrate this, we present two male patients aged 39 and 51, respectively, who were admitted with febrile disease and signs of circulatory instability. Initially, myocarditis was not suspected in these patients. ⋯ Early and liberal consultation of a cardiologist is important. Primary diagnostics include blood testing (e.g. troponin, creatinine kinase), ECG, echocardiography and exclusion of coronary ischaemia. The diagnosis can be confirmed by cardiovascular MRI or endomyocardial biopsy.
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'The more my patient looks like a real patient, the more I will look like a real doctor.' Certain young medical professionals may think that way, as they widen the gap between themselves as 'trained professionals' and their patients as 'ignorant laymen'. Medical doctors and patients have a relationship with each other. ⋯ First, a young neurologist in training seemed to push him into a template of her idea of a typical patient, apparently in order to reinforce her role as a doctor. The second situation is an example of a trained specialist who acted in such a way that he adopted the role of an authentic doctor independently.
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From experiments by the Nazis in Germany, to the infamous American Tuskegee study, controversies surround racialized medical science and clinical practice. However, although 'race' is a social construct, disease patterns may cluster in groups with a common ethno-cultural ancestry. In this journal, Buckle and Achterbergh et al. discuss the use of race and ethnicity in a medical context in the Netherlands. ⋯ A comment on these papers states that the term 'race' is controversial and biologically invalid, and should not be used in medical practice in the Netherlands. A client's self-described ethnic origin or ancestry may be taken into account when relevant for diagnosis and treatment, without equating European ancestry with 'normalcy', as opposed to other ethnic groups. It is concluded that more research should be directed towards defining biomarkers that transcend racialized human categorization based on presumed external characteristics.
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A 51 years old woman came to the emergency room with acute onset abdominal hematomas. She complained of vague abdominal pain without preceding trauma. Two large hematomas were present, one in the infra-umbilical region and one in the right flank, corresponding to Cullen's and Grey Turner's sign, respectively. Laboratory analysis and CT confirmed the diagnosis of necrotising pancreatitis.