Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2009
Review[Acetylsalicylic acid in patients with diabetes mellitus: can be used for secondary but not primary prevention of cardiovascular events].
There is no consensus in international guidelines about the role of acetylsalicylic acid in primary prevention of cardiovascular events in patients with diabetes mellitus. Primary prevention trials suggest that in diabetic patients, acetylsalicylic acid has either no or less favourable effects in preventing cardiovascular events compared to patients with other cardiovascular risk factors. ⋯ Also increasing the dose of acetylsalicylic acid is probably not worthwhile. We do not recommend acetylsalicylic acid as primary prevention of cardiovascular events in patients with diabetes mellitus, but we do recommend it as a means of secondary prevention.
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Adequate training for the insertion of chest drains in a trauma setting reduces the occurrence of procedure-related complications. Prophylactic antibiotics reduce the risk of infectious complications and empyema. For drainage of a traumatic pneumo- or haemothorax a large drain (28-36 French) is advised. ⋯ Occult air leaks before removal of the drain can be detected by a temporary water seal or by clamping the drain followed by a chest X-ray. Removal of a chest drain at end-inspiration is as secure as end-expiration. Attention must be paid to potential complications of chest drains.
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Ned Tijdschr Geneeskd · Jan 2009
Review[Vaccination against chickenpox, shingles and rotavirus-infection].
The Dutch National Immunisation Programme (NIP) has been very successful over the past 50 years. In future, this programme shall not include all new vaccines. Such vaccines can, however, be individually administered. ⋯ More than 95% of children experience one or more episodes of rotavirus gastroenteritis before their 5th birthday. In the Netherlands about 3400 children are hospitalised each year for rehydration following rotavirus infection. The vaccine is given orally.
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Ned Tijdschr Geneeskd · Jan 2009
Review[Dengue: a growing risk to travellers to tropical and sub-tropical regions].
Dengue is currently the most common arboviral infection worldwide. Due to global climate change and other factors, the vector of the virus - the Aedes mosquito - has spread considerably over the past decades. ⋯ Considering the limited possibilities of prevention it is anticipated that the incidence of dengue will increase in the future. It is expected that health-care providers in non-endemic regions will encounter dengue-infected patients with increasing frequency in their practices.
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Ned Tijdschr Geneeskd · Jan 2009
[Neuraminidase inhibitors and high risk of influenza complications: considered and widely-supported recommendations].
It has been suggested that it is unwise to employ neuraminidase inhibitors in order to diminish the risk of influenza-related complications in cases of infection with the new influenza A(H1N1). However, the major argument, i.e. that the beneficial effects shown in the published evidence may be due to age differences between treatment and placebo groups, can easily be refuted. The Netherlands' policy to limit treatment to those patient groups who are considered at high risk of influenza complications is a sound one. In addition, it is endorsed by recent guidelines of the WHO and CDC.