Universitair ziekenhuis Leuven

Leuven, Belgium

Universitair ziekenhuis Leuven

Leuven, Belgium
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Wybo I.,Vrije Universiteit Brussel | den Bossche D.V.,Vrije Universiteit Brussel | Soetens O.,Vrije Universiteit Brussel | Vekens E.,Vrije Universiteit Brussel | And 10 more authors.
Journal of Antimicrobial Chemotherapy | Year: 2014

Objectives: To collect recent data on the susceptibility of anaerobes to antimicrobial agents with known activity against anaerobes, and to compare them with results from previous Belgian multicentre studies. Methods: Four hundred and three strict anaerobic clinical isolateswere prospectively collected fromFebruary 2011 to April2012 in eight Belgian university hospitals. MICswere determined byonecentral laboratory for 11antimicrobial agents using Etest methodology. Results: According to EUCAST breakpoints, >90% of isolates were susceptible to amoxicillin/clavulanate (94%), piperacillin/tazobactam (91%), meropenem (96%), metronidazole (92%) and chloramphenicol (98%), but only 70% and 40% to clindamycin and penicillin, respectively. At CLSI recommended breakpoints, only 71% were susceptible tomoxifloxacin and79%to cefoxitin. MIC50/MIC90 values for linezolid and for tigecyclinewere 1/4 and 0.5/4 mg/L, respectively. When compared with survey data from 2004, no major differences in susceptibility profiles were noticed. However, the susceptibility of Prevotella spp. and other Gram-negative bacilli to clindamycin decreased from91%in1993-94and82%in2004to69%in this survey. Furthermore, the susceptibility of clostridia to moxifloxacin decreased from 88% in 2004 to 66% in 2011-12 and that of fusobacteria from 90% to 71%. Conclusions: Compared with previous surveys, little evolution was seen in susceptibility, except a decline in activity of clindamycin against Prevotella spp. and other Gram-negative bacteria, and of moxifloxacin against clostridia. Since resistance was detected to all antibiotics, susceptibility testing of anaerobic isolates is indicated in severe infections to confirm appropriateness of antimicrobial therapy. © The Author 2013. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.

Haentjens P.,Vrije Universiteit Brussel | Magaziner J.,University of Maryland, Baltimore | Colon-Emeric C.S.,Durham Veterans Affairs Geriatric Research Education and Clinical Center | Vanderschueren D.,Universitair Ziekenhuis Leuven | And 2 more authors.
Annals of Internal Medicine | Year: 2010

Background: Although an increased risk for death after hip fracture is well established, whether this excess mortality persists over time is unclear. Purpose: To determine the magnitude and duration of excess mortality after hip fracture in older men and women. Data Sources: Electronic search of MEDLINE and EMBASE for English and non-English articles from 1957 to May 2009 and manual search of article references. Study Selection: Prospective cohort studies were selected by 2 independent reviewers. The studies had to assess mortality in women (22 cohorts) or men (17 cohorts) aged 50 years or older with hip fracture, carry out a life-table analysis, and display the survival curves of the hip fracture group and age- and sex-matched control groups. Data Extraction: Survival curve data and items relevant to study validity and generalizability were independently extracted by 2 reviewers. Data Synthesis: Time-to-event meta-analyses showed that the relative hazard for all-cause mortality in the first 3 months after hip fracture was 5.75 (95% CI, 4.94 to 6.67) in women and 7.95 (CI, 6.13 to 10.30) in men. Relative hazards decreased substantially over time but did not return to rates seen in age- and sex-matched control groups. Through use of life-table methods, investigators estimated that white women having a hip fracture at age 80 years have excess annual mortality compared with white women of the same age without a fracture of 8%, 11%, 18%, and 22% at 1, 2, 5, and 10 years after injury, respectively. Men with a hip fracture at age 80 years have excess annual mortality of 18%, 22%, 26%, and 20% at 1, 2, 5, and 10 years after injury, respectively. Limitations: Cohort studies varied, sometimes markedly, in size, duration of observation, selection of control populations, ascertainment of death, and adjustment for comorbid conditions. Only published data that displayed findings with survival curves were examined. Publication bias was possible. Conclusion: Older adults have a 5- to 8-fold increased risk for all-cause mortality during the first 3 months after hip fracture. Excess annual mortality persists over time for both women and men, but at any given age, excess annual mortality after hip fracture is higher in men than in women. © 2010 American College of Physicians.

Janssens A.,Universitair Ziekenhuis Leuven | Verhoef G.,Universitair Ziekenhuis Leuven
Tijdschrift voor Geneeskunde | Year: 2017

The lymphoproliferative disorders compromise a large group of entities that were classified by the World Health Organization according to clinical characteristics, histology, immunophenotyping and cytogenetic/molecular abnormalities. Treatment and long-term outcome are different for each type and are mainly driven by the subtype of lymphoma. In this overview, the characteristics of the five most common subtypes are described. Clinical characteristics, staging procedures, treatment and new trends are discussed.

Vercammen M.,Universitair Ziekenhuis Brussel | Meirlaen P.,Universitair Ziekenhuis Brussel | Broodtaerts L.,Universitair Ziekenhuis Brussel | Broek I.V.,Iridium Kanker Netwerk | Bossuyt X.,Universitair Ziekenhuis Leuven
Clinica Chimica Acta | Year: 2011

Background: Free light chains (FLC) are useful biomarkers in the assessment of plasma cell disorders. Concerns have been raised about some technical aspects of the assay. This report examined the occurrence of dilution anomalies and/or antigen excess. Methods: FLC were determined on a BNII instrument at at-least two dilutions (100- and 2000-fold) in 2088 consecutive samples from 865 different patients. In part of them, the 400-fold dilution was also available. Results: Higher than 2-fold differences and inconsistencies ["<" or ">" result at one dilution not consistent with the result obtained at another dilution] between the 100- and 2000-fold dilutions were found in 12.7% of patients for κ FLC and in 3.1% of patients for λ FLC. More than 4-fold differences between results obtained at the 2000-fold and the 100-fold dilutions were observed in 5.4% of patients for κ FLC and in 1.2% of patients for λ FLC. Conclusions: The FLC assay on BNII suffers from sample dilution anomalies and/or failure of antigen excess detection in a substantial fraction of patients. Laboratory professionals and clinicians should be alert to such analytical difficulties. © 2011 Elsevier B.V.

Merckx M.,Universitair Medisch Centrum St Pieter | Donders G.G.,Heilig Hart Ziekenhuis | Donders G.G.,Universitair Ziekenhuis Leuven | Grandjean P.,Center Hospitalier Regional Of Mons | And 2 more authors.
European Journal of Contraception and Reproductive Health Care | Year: 2011

Objective: To assess the effect of structured counselling on women's contraceptive decisions and to evaluate gynaecologists' perceptions of comprehensive contraceptive counselling. Methods: Belgian women (1840 years old) who were considering using a combined hormonal contraceptive (CHC) were counselled by their gynaecologists about available CHCs (combined oral contraceptive [COC], transdermal patch, vaginal ring), using a comprehensive leaflet. Patients and gynaecologists completed questionnaires that gathered information on the woman's pre- and post-counselling contraceptive choice, her perceptions, and the reasons behind her post-counselling decision. Results: The gynaecologists (N = 121) enrolled 1801 eligible women. Nearly all women (94%) were able to choose a method after counselling (53%, 5%, and 27% chose the COC, the patch, and the ring, respectively). Counselling made many women (39%) select a different method: patch use increased from 3% to 5% (p < 0.0001); ring use tripled (from 9% to 27%, p < 0.0001). Women who were undecided before counselling most often opted for the method their gynaecologist recommended, irrespective of counselling. Conclusion: Counselling allows most women to select a contraceptive method; a sizeable proportion of them decide on a method different from the one they initially had in mind. Gynaecologists' preferences influenced the contraceptive choices of women who were initially undecided regarding the method to use. © 2011 The European Society of Contraception and Reproductive Health.

Pauwels G.,Universitair Ziekenhuis Leuven
Acta clinica Belgica | Year: 2012

Screening for congenital adrenal hyperplasia (CAH) by measurement of 17-hydroxyprogesterone (17-OHP) in dried blood spots results in a high false positive rate among preterm newborns admitted in a neonatal intensive care unit (NICU). We searched for risk factors of this population for raised 17-OHP levels. We retrospectively collected clinical characteristics (prenatal, at birth, postnatal) in newborns with an increased 17-OHP level at initial screening (> 30 nmol/L for a birth weight > 2000 g and > or = 60 nmol/L for a birth weight < or = 2000 g), that turned out to be false positive (no CAH). The correlation of these characteristics with individual 17-OHP levels was evaluated. We also performed a case-control study matched for gestational age (GA). In 94 screened newborns 17-OHP levels were raised at initial screening. Negative correlations were found between 17-OHP levels and GA and birth weight, positive correlations with prenatal betamethasone administration and several parameters of respiratory disease. In a multiple regression model GA was the dominant variable. In the case control study with 91 index patients admitted to the NICU (91/1275 newborns admitted to the NICU, 7.1%) a positive correlation with respiratory disease was confirmed and cases had a significant higher birth weight and a significant lower incidence of prenatal betamethasone administration. Application of new cutoff tables adjusted by GA and/or day of sampling would have resulted in a reduction in false positive rate. The dominant risk factor for a false positive screening during NICU admission is GA. Prenatal administration of betamethasone and birth weight are more complex risk factors. These observations support the use of new cut-off values based on GA to reduce the problem of false positive screening.

Khuenl-Brady K.S.,Innsbruck Medical University | Wattwil M.,Universitetssjukhuset Orebro | Vanacker B.F.,Universitair Ziekenhuis Leuven | Lora-Tamayo J.I.,Hospital Universitario Puerta Of Hierro | And 2 more authors.
Anesthesia and Analgesia | Year: 2010

Background: Sugammadex, a specifically designed γ-cyclodextrin, is a selective relaxant binding drug that rapidly reverses rocuronium-induced and, to a lesser extent, vecuronium-induced neuromuscular blockade. In this study, we compared the efficacy of sugammadex and neostigmine for the reversal of vecuronium-induced neuromuscular blockade in patients scheduled for elective surgery. Methods: Patients aged ≥18 yr, ASA Class I-III, and scheduled for a surgical procedure under sevoflurane/opioid anesthesia received an intubating dose of vecuronium (0.1 mg/kg) and maintenance doses of 0.02-0.03 mg/kg at reappearance of the second twitch (T2) of train-of-four (TOF) if required. Neuromuscular blockade was monitored using acceleromyography (TOF-Watch® SX, Schering-Plough Ireland, Dublin, Ireland). At end of surgery, at reappearance of T2 after the last dose of vecuronium, patients were randomized to receive either sugammadex (2 mg/kg) or neostigmine (50 μg/kg) plus glycopyrrolate (10 μg/kg) IV. The primary efficacy end-point was time from start of administration of sugammadex or neostigmine to recovery of TOF ratio to 0.9. Results: The geometric mean time to recovery of the TOF ratio to 0.9 was significantly faster with sugammadex compared with neostigmine (2.7 min [95% confidence interval {CI}]: 2.2-3.3) versus 17.9 min [95% CI: 13.1-24.3], respectively; P < 0.0001). The mean recovery times to a TOF ratio of 0.8 and 0.7 were also significantly shorter with sugammadex. No serious adverse events or unexpected side effects were reported with either drug. CONCLUSION: Sugammadex provided significantly faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine. Copyright © 2009 International Anesthesia Research Society.

Welkenhuysen M.,Catholic University of Leuven | Andrei A.,Bioelectronics Systems Group | Ameye L.,ESAT SCD | Eberle W.,Bioelectronics Systems Group | And 2 more authors.
IEEE Transactions on Biomedical Engineering | Year: 2011

In this study, the effect of insertion speed on long-term tissue response and insertion mechanics was investigated. A dummy silicon parylene-coated probe was used in this context and implanted in the rat brain at 10μm/s (n 6) or 100μm/s ( n 6) to a depth of 9mm. The insertion mechanics were assessed by the dimpling distance, and the force at the point of penetration, at the end of the insertion phase, and after a 3-min rest period in the brain. After 6 weeks, the tissue response was evaluated by estimating the amount of gliosis, inflammation, and neuronal cell loss with immunohistochemistry. No difference in dimpling, penetration force, or the force after a 3-min rest period in the brain was observed. However, the force at the end of the insertion phase was significantly higher when inserting the probes at 100μm/s compared to 10μm/s. Furthermore, an expected tissue response was seen with an increase of glial and microglial reactivity around the probe. This reaction was similar along the entire length of the probe. However, evidence for a neuronal kill zone was observed only in the most superficial part of the implant. In this region, the lesion size was also greatest. Comparison of the tissue response between insertion speeds showed no differences. © 2011 IEEE.

News Article | February 15, 2017
Site: www.eurekalert.org

Vitamin D supplements protect against acute respiratory infections including colds and flu, according to a study led by Queen Mary University of London (QMUL) Vitamin D supplements protect against acute respiratory infections including colds and flu, according to a study led by Queen Mary University of London (QMUL). The study provides the most robust evidence yet that vitamin D has benefits beyond bone and muscle health, and could have major implications for public health policy, including the fortification of foods with vitamin D to tackle high levels of deficiency in the UK. The results, published in the BMJ, are based on a new analysis of raw data from around 11,000 participants in 25 clinical trials conducted in 14 countries including the UK, USA, Japan, India, Afghanistan, Belgium, Italy, Australia and Canada. Individually, these trials yielded conflicting results, with some reporting that vitamin D protected against respiratory infections, and others showing no effect. Lead researcher Professor Adrian Martineau from QMUL said: "This major collaborative research effort has yielded the first definitive evidence that vitamin D really does protect against respiratory infections. Our analysis of pooled raw data from each of the 10,933 trial participants allowed us to address the thorny question of why vitamin D 'worked' in some trials, but not in others. "The bottom line is that the protective effects of vitamin D supplementation are strongest in those who have the lowest vitamin D levels, and when supplementation is given daily or weekly rather than in more widely spaced doses. "Vitamin D fortification of foods provides a steady, low-level intake of vitamin D that has virtually eliminated profound vitamin D deficiency in several countries. By demonstrating this new benefit of vitamin D, our study strengthens the case for introducing food fortification to improve vitamin D levels in countries such as the UK where profound vitamin D deficiency is common." Vitamin D - the 'sunshine vitamin' - is thought to protect against respiratory infections by boosting levels of antimicrobial peptides - natural antibiotic-like substances - in the lungs. Results of the study fit with the observation that colds and 'flu are commonest in winter and spring, when levels of vitamin D are at their lowest. They may also explain why vitamin D protects against asthma attacks, which are commonly triggered by respiratory viruses. Daily or weekly supplementation halved the risk of acute respiratory infection in people with the lowest baseline vitamin D levels, below 25 nanomoles per litre (nmol/L). However, people with higher baseline vitamin D levels also benefited, although the effect was more modest (10 per cent risk reduction). Overall, the reduction in risk of acute respiratory infection induced by vitamin D was on a par with the protective effect of injectable 'flu vaccine against 'flu-like illnesses. Acute respiratory infections are a major cause of global morbidity and mortality. Upper respiratory infections such as colds and 'flu are the commonest reason for GP consultations and days off work. Acute lower respiratory infections such as pneumonia are less common, but caused an estimated 2.65 million deaths worldwide in 2013. Vitamin D supplementation is safe and inexpensive, so reductions in acute respiratory infections brought about by vitamin D supplementation could be highly cost-effective. The study was conducted by a consortium of 25 investigators from 21 institutions worldwide* and funded by the National Institute for Health Research. Joel Winston, Public Relations Manager (School of Medicine and Dentistry) Queen Mary University of London j.winston@qmul.ac.uk Tel: +44 (0)20 7882 7943 / +44 (0)7970 096 188 * Institutions involved in the research: Edmond and Lily Safra Children's Hospital (Tel Hashomer, Israel), Geisel School of Medicine at Dartmouth (NH, USA), Harvard School of Public Health (Boston, MA, USA), Jikei University School of Medicine (Tokyo, Japan), Karolinska Institutet (Stockholm, Sweden), Massachusetts General Hospital (Boston, MA, USA), McMaster University (Hamilton, Ontario, Canada), Medical University of Lodz (Poland), QIMR Berghofer Medical Research Institute (Queensland, Australia), Queen Mary University of London (UK), The Pennsylvania State University (Hershey, PA, USA), Università degli Studi di Milano (Milan, Italy), Universitair ziekenhuis Leuven (Belgium), University of Auckland (New Zealand), University of Birmingham (UK), University of Colorado School of Medicine (Aurora, CO, USA), University of Delhi (India), University of Otago (Christchurch, New Zealand), University of Tampere (Finland), University of Tasmania (Australia), Winthrop University Hospital (Mineola, NY, USA). Research paper: 'Vitamin D supplementation to prevent acute respiratory infections: systematic review and meta-analysis of individual participant data'. Martineau et al. BMJ 2017 Queen Mary University of London (QMUL) is one of the UK's leading universities, and one of the largest institutions in the University of London, with 23,120 students from more than 155 countries. A member of the Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research. In the most recent national assessment of the quality of research, we were placed ninth in the UK (REF 2014). As well as our main site at Mile End - which is home to one of the largest self-contained residential campuses in London - we have campuses at Whitechapel, Charterhouse Square, and West Smithfield dedicated to the study of medicine, and a base for legal studies at Lincoln's Inn Fields. We have a rich history in London with roots in Europe's first public hospital, St Barts; England's first medical school, The London; one of the first colleges to provide higher education to women, Westfield College; and the Victorian philanthropic project, the People's Palace at Mile End. Today, as well as retaining these close connections to our local community, we are known for our international collaborations in both teaching and research. QMUL has an annual turnover of £350m, a research income worth £125m (2014/15), and generates employment and output worth £700m to the UK economy each year. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (http://www. ).

Ampe E.,Catholic University of Leuven | Ampe E.,Laboratoire Of Microbiologie | Ampe E.,Universitair Ziekenhuis Leuven | Delaere B.,Laboratoire Of Microbiologie | And 3 more authors.
International Journal of Antimicrobial Agents | Year: 2013

Optimising antibiotic administration is critical when dealing with pathogens with reduced susceptibility. Vancomycin activity is dependent on the area under the concentration-time curve over 24 h at steady-state divided by the minimum inhibitory concentration (AUC/MIC), making continuous infusion (CI) or conventional twice daily administration pharmacodynamically equipotent. Because CI facilitates drug administration and serum level monitoring, we have implemented a protocol for CI of vancomycin by: (i) examining whether maintaining stable serum concentrations (set at 25-30 mg/L based on local susceptibility data of Gram-positive target organisms) can be achieved in patients suffering from difficult-to-treat infections; (ii) assessing toxicity (n = 94) and overall efficacy (n = 59); and (iii) examining the correlation between AUC/MIC and the clinical outcome in patients for whom vancomycin was the only active agent against a single causative pathogen (n = 20). Stable serum levels at the expected target were obtained at the population level (loading dose 20 mg/kg; infusion of 2.57 g/24 h adjusted for creatinine clearance) for up to 44 days, but large intrapatient variations required frequent dose re-adjustments (increase in 57% and decrease in 16% of the total population). Recursive partitioning analysis of AUC/MIC ratios versus success or failure suggested threshold values of 667 (total serum level) and 451 (free serum level), corresponding to organisms with a MIC > 1 mg/L. Nephrotoxicity potentially related to vancomycin was observed in 10% of patients, but treatment had to be discontinued in only two of them. © 2013 Elsevier B.V. and the International Society of Chemotherapy.

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