Hensgens M.P.M.,LUMC |
Goorhuis A.,Tropical Medicine and AIDS |
Dekkers O.M.,LUMC |
Journal of Antimicrobial Chemotherapy | Year: 2012
Background: Clostridium difficile infections (CDIs) are common in developed countries and affect >250000 hospitalized patients annually in the USA. The most important risk factor for the disease is antibiotic therapy. Methods: To determine the period at risk for CDI after cessation of antibiotics, we performed a multicentre case-control study in the Netherlands between March 2006 and May 2009. Three hundred and thirty-seven hospitalized patients with diarrhoea and a positive toxin test were compared with 337 patients without diarrhoea. Additionally, a control group of patients with diarrhoea due to a cause other than CDI (n=227) was included. Results: In the month prior to the date of inclusion, CDI patients more frequently used an antibiotic compared with non-diarrhoeal patients (77% versus 49%). During antibiotic therapy and in the first month after cessation of the therapy, patients had a 7-10-fold increased risk for CDI (OR 6.7-10.4). This risk declined in the period between 1 and 3 months after the antibiotic was stopped (OR 2.7). Similar results were observed when the second control group was used. All antibiotic classes, except first-generation cephalosporins and macrolides, were associated with CDI. Second- and third-generation cephalosporins (OR 3.3 and 5.3, respectively) and carbapenems (OR 4.7) were the strongest risk factors for CDI. Patients with CDI used more antibiotic classes and more defined daily doses, compared with non-diarrhoeal patients. Conclusions: Antibiotic use increases the risk for CDI during therapy and in the period of 3 months after cessation of antibiotic therapy. The highest risk for CDI was found during and in the first month after antibiotic use. Our study will aid clinicians to identify high-risk patients. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.
Hensgens M.P.M.,LUMC |
Dekkers O.M.,LUMC |
Goorhuis A.,AMC |
Lecessie S.,LUMC |
Clinical Microbiology and Infection | Year: 2014
Clostridium difficile infections (CDIs) are a common cause of antibiotic-associated diarrhoea and associated with CDI-related mortality in c. 10%. To date, there is no prediction model in use that guides clinicians to identify patients at high risk for complicated CDI. From 2006 to 2009, nine Dutch hospitals included hospitalized CDI patients in a prospective cohort. Potential predictors of a complicated course (ICU admission, colectomy or death due to CDI) were evaluated in uni- and multivariate logistic regression. A score was constructed that was internally validated by bootstrapping. Furthermore, a pilot external validation was performed. Twelve per cent of 395 CDI patients had a complicated course within 30 days after diagnosis. Age (≥85 years, OR 4.96; 50-84 years, 1.83), admission due to diarrhoea (OR 3.27), diagnosis at the ICU department (OR 7.03), recent abdominal surgery (OR 0.23) and hypotension (OR 3.25) were independent predictors of a complicated course. These variables were used to construct a prediction model. A score subsequently classified patients into high risk (39% with a complicated course), intermediate (16%), low (5%) or virtually no risk of experiencing a complicated course. The score performed well after internal validation (AUC 0.78) and a pilot external validation among 139 patients showed similar good performance (AUC 0.73). We present an easy-to-use, clinically useful risk score that is capable of categorizing CDI patients according to their outcome. Because classification is available at diagnosis, it could have major implications for treatment choice. © 2013 European Society of Clinical Microbiology and Infectious Diseases.
Gooren L.J.,VU University Amsterdam |
van Trotsenburg M.A.A.,VU University Amsterdam |
Giltay E.J.,LUMC |
van Diest P.J.,University Utrecht
Journal of Sexual Medicine | Year: 2013
Introduction: Transsexual people receive cross-sex hormones as part of their treatment, potentially inducing hormone-sensitive malignancies. Aim: To examine the occurrence of breast cancer in a large cohort of Dutch male and female transsexual persons, also evaluating whether the epidemiology accords with the natal sex or the new sex. Main Outcome Measure: Number of people with breast cancer between 1975 and 2011. Methods: We researched the occurrence of breast cancer among transsexual persons 18-80 years with an exposure to cross-sex hormones between 5 to >30 years. Our study included 2,307 male-to-female (MtF) transsexual persons undergoing androgen deprivation and estrogen administration (52,370 person-years of exposure), and 795 female-to-male (FtM) subjects receiving testosterone (15,974 total years of exposure). Results: Among MtF individuals one case was encountered, as well as a probable but not proven second case. The estimated rate of 4.1 per 100,000 person-years (95% confidence interval [CI]: 0.8-13.0) was lower than expected if these two cases are regarded as female breast cancer, but within expectations if viewed as male breast cancer. In FtM subjects, who were younger and had shorter exposure to cross-sex hormones compared with the MtF group, one breast cancer case occurred. This translated into a rate of 5.9 per 100,000 person-years (95% CI: 0.5-27.4), again lower than expected for female breast cancer but within expected norms for male breast cancer. Conclusions: The number of people studied and duration of hormone exposure are limited but it would appear that cross-sex hormone administration does not increase the risk of breast cancer development, in either MtF or FtM transsexual individuals. Breast carcinoma incidences in both groups are comparable to male breast cancers. Cross-sex hormone treatment of transsexual subjects does not seem to be associated with an increased risk of malignant breast development. Gooren LJ, van Trotsenburg MAA, Giltay EJ, and van Diest PJ. Breast cancer development in transsexual subjects receiving cross-sex hormone treatment. J Sex Med 2013;10:3129-3134. © 2013 International Society for Sexual Medicine.
Orphanet Journal of Rare Diseases | Year: 2010
Huntington disease (HD) is a rare neurodegenerative disorder of the central nervous system characterized by unwanted choreatic movements, behavioral and psychiatric disturbances and dementia. Prevalence in the Caucasian population is estimated at 1/10,000-1/20,000. Mean age at onset of symptoms is 30-50 years. In some cases symptoms start before the age of 20 years with behavior disturbances and learning difficulties at school (Juvenile Huntington's disease; JHD). The classic sign is chorea that gradually spreads to all muscles. All psychomotor processes become severely retarded. Patients experience psychiatric symptoms and cognitive decline. HD is an autosomal dominant inherited disease caused by an elongated CAG repeat (36 repeats or more) on the short arm of chromosome 4p16.3 in the Huntingtine gene. The longer the CAG repeat, the earlier the onset of disease. In cases of JHD the repeat often exceeds 55. Diagnosis is based on clinical symptoms and signs in an individual with a parent with proven HD, and is confirmed by DNA determination. Pre-manifest diagnosis should only be performed by multidisciplinary teams in healthy at-risk adult individuals who want to know whether they carry the mutation or not. Differential diagnoses include other causes of chorea including general internal disorders or iatrogenic disorders. Phenocopies (clinically diagnosed cases of HD without the genetic mutation) are observed. Prenatal diagnosis is possible by chorionic villus sampling or amniocentesis. Preimplantation diagnosis with in vitro fertilization is offered in several countries. There is no cure. Management should be multidisciplinary and is based on treating symptoms with a view to improving quality of life. Chorea is treated with dopamine receptor blocking or depleting agents. Medication and non-medical care for depression and aggressive behavior may be required. The progression of the disease leads to a complete dependency in daily life, which results in patients requiring full-time care, and finally death. The most common cause of death is pneumonia, followed by suicide. © 2010 Roos; licensee BioMed Central Ltd.
Van Den Berg R.,Leiden University |
Van Gaalen F.,LUMC |
Van Der Helm-Van Mil A.,Leiden University |
Huizinga T.,Leiden University |
Van Der Heijde D.,Leiden University
Annals of the Rheumatic Diseases | Year: 2012
Objectives: The performance of spondyloarthritis (SpA) classification criteria is not well-established in general early arthritis cohorts. Therefore, the authors tested their performance in the Leiden Early Arthritis Clinic (EAC) cohort and assessed whether these criteria can assist rheumatologists in diagnosing patients. Methods: The authors identified all SpA and psoriatic arthritis (PsA) patients in the EAC cohort according to the diagnosis of the treating rheumatologist. A control group consisting of arthritis patients with other diagnoses was matched to the SpA and PsA patients on gender, age and symptom duration. The authors assessed the fulfilment of SpA criteria in all three groups. Results: Of the patients in the EAC cohort (n=2011), 7.5% was diagnosed with PsA and 3.8% with SpA. In the PsA group, the ClASsification criteria for Psoratic ARthritis (CASPAR) criteria had the highest sensitivity (88.7%). In the SpA group, the Assessment of SpondyloArthritis international Society (ASAS) peripheral SpA and European Spondylarthropathy Study Group (ESSG) criteria had the highest sensitivity (both 48.7%). Specificity of all criteria sets was good: ranging from 88.5% (ESSG) to 100% (Amor). Conclusions: In early arthritis, sensitivity of SpA classification criteria is modest except for the CASPAR criteria in PsA. However, specificity of classification criteria, including the new ASAS-peripheral SpA criteria, is high.
van der Sluis T.C.,Leiden University |
van der Burg S.H.,LUMC |
Arens R.,Leiden University |
Melief C.J.M.,Leiden University
Current Opinion in Immunology | Year: 2015
The identification of human papillomavirus as the etiological factor for cervical cancer provides an opportunity to treat these malignancies by vaccination. Although therapeutic vaccination against viral oncogenes regularly induces a specific T cell response, clinical effectivity remains low. Three factors are particularly important for clinical outcome: the balance between cytotoxic T cells and regulatory immune subsets, the balance between cytotoxic T cells and tumor cells and finally the killing efficiency of cytotoxic T cells within the tumor. To improve these three factors, therapeutic vaccination is combined with other treatments. Here, we review those studies that are based on understanding the inhibitory mechanisms that prevent unleashing the full power of therapeutic vaccine-induced T cells and utilize combinatorial interventions based on these insights. © 2015 Elsevier Ltd.
Nederlands tijdschrift voor geneeskunde | Year: 2013
In medical research missing data are sometimes inevitable. Different missingness mechanisms can be distinguished: (a) missing completely at random; (b) missing by design; (c) missing at random, and (d) missing not at random. If participants with missing data are excluded from statistical analyses, this can lead to biased study results and loss of statistical power. Imputation methods can be applied to estimate missing values; multiple imputation gives a good idea of the inaccuracy of the reconstructed measurements. The most common imputation methods assume that missing data are missing at random. Multiple imputation contributes greatly to the efficiency and reliability of estimates because maximum use is made of the data collected. Imputation is not meant to obviate low-quality data.
Zondag W.,LUMC |
Kooiman J.,LUMC |
Klok F.A.,LUMC |
Dekkers O.M.,LUMC |
European Respiratory Journal | Year: 2013
Our aim was to study the safety of outpatient treatment in low risk patients with acute pulmonary embolism compared with inpatient treatment, the current clinical standard. We searched Medline, Web of Science, Cochrane and EMBASE databases and included studies on outpatient treatment of pulmonary embolism. The outcomes were 3-month recurrent venous thromboembolism, major bleeding and all-cause mortality. We identified 13 studies (1657 patients) with outpatients (discharge < 24 h), three studies (256 patients) with early discharge patients (discharged within 72 h) and five studies (383 patients) with inpatients. The pooled incidence of recurrent venous thromboembolism was 1.7%(95%CI 0.92-3.1%) in outpatients, 1.1%(0.22-5.4%) in patients discharged early and 1.2%(0.16-8.1%) in inpatients. The pooled incidence of major bleeding was 0.97%(0.58-1.6%) in outpatients, 0.78%(0.16-3.7%) in early discharge patients and 1.0%(0.39-2.8%) in inpatients. The pooled incidence of mortality was 1.9%(0.79-4.6%) in outpatients, 2.3%(1.1-5.1%) in early discharge patients and 0.74%(0.04-11%) in inpatients. Incidences of recurrent venous thromboembolism, major bleeding and, after correction for malignancies, mortality were comparable between outpatients, patients discharged early and inpatients. We conclude that home treatment or early discharge of selected low-risk patients with pulmonary embolism is as safe as inpatient treatment. Copyright © ERS 2013.
van der Hulle T.,LUMC |
den Exter P.L.,LUMC |
Kooiman J.,LUMC |
van der Hoeven J.J.M.,LUMC |
And 2 more authors.
Journal of Thrombosis and Haemostasis | Year: 2014
Introduction: Treatment of acute venous thromboembolism (VTE) in cancer patients is challenging, owing to a high risk of recurrent VTE and bleeding complications. The anticoagulants of choice are low molecular weight heparins (LMWHs), because of a proven higher efficacy than vitamin K antagonists (VKAs) and a similar bleeding profile. The recently introduced new oral anticoagulants (NOACs) have the potential to be alternative options for these patients, as these drugs share practical advantages with LMWH, are administered orally, and had similar efficacy to VKAs but a lower bleeding risk in phase 3 studies in the general VTE population. Methods: A systematic literature search was performed to identify phase 3 trials investigating NOACs for the treatment of VTE. The efficacy outcome was recurrent VTE, and the safety outcome was major and clinically relevant non-major bleeding. Pooled incidence rates and risk ratios (RRs) were calculated for cancer patients and non-cancer patients separately. Results and discussion: Five studies were included, with 19 060 patients, of whom 973 (5.1%) had active cancer. The pooled incidence rates of recurrent VTE were 4.1% (95% confidence interval [CI] 2.6-6.0) in cancer patients treated with NOACs, and 6.1% (95% CI 4.1-8.5) in patients treated with VKAs (RR 0.66, 95% CI 0.38-1.2). The pooled incidence rates of major or non-major clinically relevant bleeding were 15% (95% CI 12-18) in cancer patients treated with NOACs, and 16% (95% CI 9.9-22) in patients treated with VKAs (RR 0.94, 95% CI 0.70-1.3). These results form a solid basis for the initiation of a head-to-head comparison of NOACs with LMWH in cancer patients. © 2014 International Society on Thrombosis and Haemostasis.
News Article | November 2, 2016
Global Village Market to be Held at Littleton United Methodist Church The local United Methodist Church in Littleton, CO announced today that it will offer fair trade items for sale November 11 and 12 from 10:00 a.m. to 4:00 p.m. and November 13 from 8:30 a.m. to 1:00 p.m. Littleton, CO, November 02, 2016 --( The market will be supplied by 10,000 Villages, a non-profit that buys items from artisans around the world offering opportunities to people in developing countries. Every purchase improves the lives of the artisans by supporting their craft and providing a fair, stable income. A special item this year is the Bijar Kurdish Iranian wool rug which is a slip weave handwoven rug from the Northwest Mountains of Kurdistan region of Iran. It was made around 1960–1970. It will be offered in a silent auction which will end at 12:30 p.m. on Sunday November 13th. About Littleton United Methodist Church Since its beginning in 1890, LUMC has been a place people of all ages and stages can call home. We consider all our ministries—from toddlers to seniors—to be of equal importance. No matter the age, circumstance or background of those joining our church family, we are certain there’s a place for you. For more information, please visit: littletonumc.church Contact To learn more about the Global Market Village, please contact: John R Morrison Littleton United Methodist Church 5894 South Datura Street Littleton, CO 80120 Office: (303) 794 6379 JMorrison@littletonumc.org Littleton, CO, November 02, 2016 --( PR.com )-- The local United Methodist Church in Littleton announced today that it will offer fair trade items for sale November 11 and 12 from 10:00 a.m. to 4:00 p.m. and November 13 from 8:30 a.m. to 1:00 p.m.The market will be supplied by 10,000 Villages, a non-profit that buys items from artisans around the world offering opportunities to people in developing countries. Every purchase improves the lives of the artisans by supporting their craft and providing a fair, stable income.A special item this year is the Bijar Kurdish Iranian wool rug which is a slip weave handwoven rug from the Northwest Mountains of Kurdistan region of Iran. It was made around 1960–1970. It will be offered in a silent auction which will end at 12:30 p.m. on Sunday November 13th.About Littleton United Methodist ChurchSince its beginning in 1890, LUMC has been a place people of all ages and stages can call home. We consider all our ministries—from toddlers to seniors—to be of equal importance. No matter the age, circumstance or background of those joining our church family, we are certain there’s a place for you. For more information, please visit: littletonumc.churchContactTo learn more about the Global Market Village, please contact:John R MorrisonLittleton United Methodist Church5894 South Datura StreetLittleton, CO 80120Office: (303) 794 6379JMorrison@littletonumc.org