Most primary care clinical guidelines recommend restrictive antibiotic use for childhood infections. We investigated antibiotic prescription rates over time for oral and topical antibiotics for children (≤12 years) in the period 2000-2010.Longitudinal observational study among children (≤12 years) in a large Dutch general practice database in the period 2000-2010.Oral and topical antibiotic prescribing rates per year and independent factors influencing antibiotic prescriptions.We analysed 108 555 patient-years during 2000-2010. At least one chronic disease was recorded in 15.8% of patient-years, with asthma most commonly registered. In 14.8% of the patient-years at least one antibiotic was prescribed, while 26.3% of these received two or more prescriptions. Young age and chronic disease had a significant effect on antibiotic prescriptions. Prescriptions for oral and topical antibiotics increased 4.9% and 1.8%, respectively, during 2000-2005 (p<0.001). Prescription rates for oral antibiotics decreased 3.3% during 2006-2010 (p<0.001), while topical prescribing rates remained stable.One in six children received at least one oral antibiotic prescription per year during 2000-2010. While topical prescription rates steadily increased during 2005-2010 and remained stable during 2006-2010, prescription rates for oral antibiotics increased significantly during the period 2000-2005 and then significantly decreased during the period 2006-2010. As clinical guidelines remained the same over this period, the effects could be contributed to the initiation of the Dutch nationwide pneumococcal vaccination campaign in 2006.
Penile swab sampling is the gold standard when testing for human papilloma virus (HPV) in men. Urine could provide a more convenient sampling material. Therefore we compared the detection and typing of HPV in urine samples and penile swabs using a highly sensitive method.
Methods
First void urine and self-obtained penile swabs were collected from 120 men visiting a Sexually Transmitted Infections (STI) clinic in South Limburg, The Netherlands. When exclusion criteria were met, the results of 111 men (mean age 29.4 years) were analysed. Broad-spectrum HPV DNA amplification and genotyping were performed using SPF10-DEIA-LiPA25 system (Labo Bio-Medical Products, Rijswijk, The Netherlands). There are 12 high risk HPV types (hrHPV), 5 possible hrHPV types and 8 low risk HPV types (lrHPV) detectable by SPF10LiPA25.
Results
HPV DNA was found in 75 (67.6%) men. In 73 men HPV DNA was detected in the penile swab or both samples and in two men HPV DNA was detected only in the urine sample. Sixty-six paired samples were concordant in being HPV positive (n = 30) or negative (n = 36). Eleven of the 30 matching samples were concordant in their genotypes, fourteen pairs were comparable (≥ 1 genotype identical) and five pairs were discordant in genotypes. Three of these discordant and one comparable urine sample contained (possible) high risk types which were not found in the swab. Furthermore, the two positive urines with a negative swab contained (possible) high risk types as well.
Conclusion
Urine samples are not comparable to penile swabs in the detection of HPV in men. However, in the urine sample of six men high risk types were found that could not be detected in the penile swab alone. This could be an indication of an additional value of the urine sample aside the penile swab in the detection of HPV in men.
PROBLEM: About one out of six pregnancies ends in spontaneous abortion before the 17th week. In more than half of these a chromosome abnormality is present, which explains the abortion. The role of cytomegalovirus (CMV) infections in early pregnancy failure is unclear. If there is a role for CMV, a preponderance of infections would be expected in a chromosomally normal group. METHOD: The significance of CMV in abortions has been studied by screening 80 spontaneous and nine induced abortions with known karyotype for the presence of phosphoprotein pp65, an early CMV antigen. Also, endometrial biopsies (n = 55) and menstruum (n = 10) were screened. In 11 patients more than one specimen was available for study. RESULT: The protein was present in the glandular epithelium of the decidua of spontaneous as well as induced abortions in 31 of 89 (35%) cases, irrespective of chromosomal constitution. Trophoblastic cells were pp65 positive in 6/89 cases. A total of 17 embryos could be studied, seven of which were positive. Positive staining of embryonic organs correlated strongly with the presence of the antigen in the decidua. The endometrial biopsies and menstrual discharges from women of comparable ages showed the same percentages of positive tests for pp65: 35 and 20%. Histologically positive and negative specimens could not be differentiated other than by the specific staining. In 10 of 11 patients with more than one specimen available, the results were consistent. One patient had two positive and one negative specimen. CONCLUSION: The findings indicate that in early pregnancy cytomegalovirus is transmitted from the decidual glands to the foetus. However, we have not found indications that the presence of cytomegalovirus infection as shown by the presence of antigen is pathogenic for early pregnancy.
In 1999 the decision was taken to start a transmural consultation service for HIV-seropositive drug users at the Consultation Office for Alcohol and Drugs [Dutch acronym: CAD] in Heerlen, the Netherlands. This consultation service was run by an AIDS consultant from Maastricht University Hospital together with the addiction physician from the CAD. In the period 1 November 1998-30 April 2002 29 HIV-seropositive drug users made use of this consultation service. Highly active antiretroviral therapy was prescribed to 23 patients during an average of 21 months (range: 4-51). Eighteen patients responded well to this therapy (viral load < 50 copies/ml) after 12-24 weeks of treatment and thereafter during 21 months. Direct observed therapy (DOT) was applied to 16 patients. Therapeutic failure due to poor compliance was observed in 3 patients. Two of them had initially been successfully treated with medication whilst under supervision but the treatment failed when they became responsible for taking their own medication. It seems that involving the Consultation Office for Alcohol and Drugs in the treatment and DOT has a favourable effect on the treatment of HIV-positive drug users.
Introduction There is considerable uncertainty about the reproducibility of the various instruments used to measure dyspnea, their ability to reflect changes in symptoms, whether they accurately reflect the patient's experience and if its evolution is similar between acute heart failure syndrome patients and nonacute heart failure syndrome patients.URGENT was a prospective multicenter trial designed to address these issues.Methods Patients were interviewed within 1 hour of first physician evaluation, in the emergency department or acute care setting, with dyspnea assessed by the patient using both a five-point Likert scale and a 10-point visual analog scale (VAS) in the sitting (60º) and then supine (20º) position if dyspnea had not been considered severe or very severe by the sitting versus decubitus dyspnea measurement.Results Very good agreements were found between the five-point Likert and VAS at baseline (0.891, P <0.0001) and between changes (from baseline to hour 6) in the five-point Likert and in VAS (0.800, P <0.0001) in acute heart failure (AHF) patients.Lower agreements were found when changes from baseline to H6 measured by Likert or VAS were compared with the seven-point comparative Likert (0.512 and 0.500 respectively) in AHF patients.The worse the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours; this relationship is stronger when dyspnea is measured with VAS (Spearman's rho coefficient = 0.672) than with the five-point Likert (0.272) (both P <0.0001) in AHF patients.By the five-point Likert, only nine patients (3% (1% to 5%)) reported an improvement in their dyspnea, 177 (51% (46% to 57%)) had no change, and 159 (46% (41% to 52%)) reported worse dyspnea supine compared with sitting up in AHF patients.The PDA test with VAS was markedly different between AHF and non-AHF patients.Conclusions Both clinical tools five-point Likert and VAS showed very good agreement at baseline and between changes from baseline to tests performed 6 hours later in AHF patients.The PDA test with VAS was markedly different between AHF and non-AHF patients.Dyspnea is improved within 6 hours in more than threequarters of the patients regardless of the tool used to measure the change in dyspnea.The greater the dyspnea at admission, the greater the amplitude of improvement in the first 6 hours. P2
Nucleic acid sequence-based amplification (NASBA) was used for detection of the human cytomegalovirus (CMV) immediate early-1 (IE) and the late pp67 mRNA in 353 blood samples collected from 34 liver transplant patients. The diagnostic value of these assays was compared to that of the pp65 antigenemia assay. Overall, 95 and 42% of the antigenemia-positive samples were IE NASBA and pp67 NASBA positive, respectively. Although the results from pp67 NASBA and the antigenemia assay appeared to correspond poorly, a clear correlation was seen between pp67 NASBA-negative results and low numbers of pp65 antigen-positive cells. Twenty patients (59%) were treated with ganciclovir after the diagnosis of symptomatic CMV infection. Before initiation of the antiviral therapy, the antigenemia assay detected the onset of symptomatic infection in all patients, whereas 95 and 60% of these patients were IE NASBA and pp67 NASBA positive, respectively. Although the sensitivity of IE NASBA was very high, the positive predictive value (PPV) of this assay for the onset of a symptomatic infection was only 63%. The PPV of the antigenemia assay as well as pp67 NASBA was considerably higher (80 and 86%, respectively). Thus, the detection of IE mRNA using NASBA appears to be particularly useful as a marker for early initiation of antiviral therapy in patients at high risk for the development of a symptomatic infection. Also, IE NASBA was found to be more sensitive than the antigenemia assay for monitoring CMV infection during antiviral therapy. On the contrary, pp67 NASBA did not appear to have additional diagnostic value compared to the antigenemia assay.
