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Utrecht, Netherlands

Ang W.,afdeling Medische Microbiologie en Infectiepreventie | Wolfs T.,Wilhelmina Kinderziekenhuis
Huisarts en Wetenschap | Year: 2015

Ang W, Wolfs TFW. Diagnosis of lyme borreliosis. Huisarts Wet 2015;58(5):264-8. Serology is the cornerstone of the microbiological diagnosis of Lyme borreliosis. In addition to classical tests, other diagnostic tools have been developed that can be used in the diagnosis of Lyme borreliosis. Some of these tests are used in non-accredited laboratories, some of which are located abroad. This article provides an overview of commonly used diagnostic tests and the value and limitations of each. © 2015, Bohn, Stafleu van Loghum.

Lazarevic D.,Pediatria II | Pistorio A.,Servizio di Epidemiologia e Biostatistica | Palmisani E.,Pediatria II | Miettunen P.,Pediatria II | And 16 more authors.
Annals of the Rheumatic Diseases | Year: 2013

Objectives: To develop data-driven criteria for clinically inactive disease on and off therapy for juvenile dermatomyositis (JDM). Methods: The Paediatric Rheumatology International Trials Organisation (PRINTO) database contains 275 patients with active JDM evaluated prospectively up to 24 months. Thirty-eight patients off therapy at 24 months were defined as clinically inactive and included in the reference group. These were compared with a random sample of 76 patients who had active disease at study baseline. Individual measures of muscle strength/ endurance, muscle enzymes, physician's and parent's global disease activity/damage evaluations, inactive disease criteria derived from the literature and other ad hoc criteria were evaluated for sensitivity, specificity and Cohen's κ agreement. Results: The individual measures that best characterised inactive disease (sensitivity and specificity >0.8 and Cohen's κ >0.8) were manual muscle testing (MMT) ≥78, physician global assessment of muscle activity=0, physician global assessment of overall disease activity (PhyGloVAS) ≤0.2, Childhood Myositis Assessment Scale (CMAS) ≥48, Disease Activity Score ≤3 and Myositis Disease Activity Assessment Visual Analogue Scale ≤0.2. The best combination of variables to classify a patient as being in a state of inactive disease on or off therapy is at least three of four of the following criteria: creatine kinase ≤150, CMAS ≥48, MMT ≥78 and PhyGloVAS ≤0.2. After 24 months, 30/31 patients (96.8%) were inactive off therapy and 69/145 (47.6%) were inactive on therapy. Conclusion: PRINTO established data-driven criteria with clearly evidence-based cut-off values to identify JDM patients with clinically inactive disease. These criteria can be used in clinical trials, in research and in clinical practice.

Stewart S.,Afdeling Dermatologie | Pasmans S.,Wilhelmina Kinderziekenhuis | De Bruin-Weller M.,Afdeling Dermatologie
Huisarts en Wetenschap | Year: 2013

Atopic dermatitis (constitutional eczema) is a chronic, relapsing, and common skin disorder that is a public health problem because of its prevalence, cost, and influence on the quality of life. Topical corticosteroids are the main treatment. These drugs are divided into four potency classes, with recommendations regarding the maximal amount (expressed in finger-tip units) to be applied per class. During exacerbations, topical corticosteroids should be applied twice daily, to bring the dermatitis under control as quickly as possible. If the response to treatment is good, then a maintenance dose can be used, with intermittent application of the topical corticosteroid. During remission, preventive use of topical corticosteroids can lead to a longer dermatitis-free interval. Unfortunately, patients, carers, and health professionals are reluctant to use topical corticosteroids, and the provision of inconsistent information by health professionals can further increase patients' and carers' concerns about using these agents. The main concern is thinning of the skin, but irreversible atrophy is rare if topical corticosteroids are used correctly. Suppression of the hypothalamus-pituitary-adrenal axis can occur with highly potent topical corticosteroids. Research has shown that the risk of systemic side effects is low with fluticasone proprionate and mometasone furoate. © 2013 Bohn, Stafleu van Loghum.

Ang W.,afdeling Medische Microbiologie en Infectiepreventie | Wolfs T.F.W.,Wilhelmina Kinderziekenhuis
Tijdschrift voor Kindergeneeskunde | Year: 2013

Serology is the cornerstone of diagnosis of Lyme borreliosis. In addition to the serological tests, other diagnostic modalities are available. Some of these tests are performed in laboratories abroad and/or laboratories that have not been officially accredited for microbiological diagnostics. Patients and doctors are both confused about the value and interpretations of tests for Lyme borreliosis. This article provides an overview of the most frequently used tests in the Netherlands. For each type of diagnostic test, the value for the diagnosis of Lyme borreliosis is indicated. © 2013 Bohn, Stafleu van Loghum. Literatuur:.

Fiolet A.T.,Wilhelmina Kinderziekenhuis
Nederlands tijdschrift voor geneeskunde | Year: 2013

A 14-month-old boy presented with a haematoma and an oedematous swelling in the left parieto-occipital region after sustaining a fall from 3 meters. CT images of the brain showed a multifragmentary fracture in the parietotemporal region. Because the swelling progressed during admission, an MRI of the brain was performed, which revealed extrusion of brain tissue through a skull defect into the subgaleal space. Resultantly, the diagnosis of 'cranial burst fracture' was established. After neurosurgical resection and dural repair, the boy was discharged from the hospital without neurological symptoms.

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