AIM: To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection(CDI).METHODS: CDI has vast economic consequences emphasizing the need for innovative and co...AIM: To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection(CDI).METHODS: CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines.RESULTS: A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals. CONCLUSION: The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI.展开更多
BACKGROUND Patients with myasthenia gravis(MG)are at a higher risk of developing Takotsubo cardiomyopathy(TTC),particularly during a myasthenic crisis.Myasthenic crisis-associated TTC occurs predominantly in women.In ...BACKGROUND Patients with myasthenia gravis(MG)are at a higher risk of developing Takotsubo cardiomyopathy(TTC),particularly during a myasthenic crisis.Myasthenic crisis-associated TTC occurs predominantly in women.In this case report,we present a man with metastasized prostate carcinoma who developed TTC after new-onset MG.CASE SUMMARY An 81-year-old man with non-insulin dependent diabetes mellitus and metastasized prostate carcinoma presented with dyspnea.During primary assessment examination at the emergency department,there was evident blepharoptosis of his right eye.His electrocardiograms were suggestive of an acute anterior wall myocardial infarction,for which he underwent emergency coronary angiography.No obstructive coronary artery disease was found.During the coronary angiography,the patient developed respiratory failure and was admitted to the Intensive Care Unit for non-invasive respiratory support.The following day,diagnostic neostigmine test revealed a myasthenic crisis.Bedside echocardiography revealed left ventricular apical ballooning with a typical appearance of TTC.Despite the potentially reversible character of both MG and TTC,the patient and family requested an end of support in the Intensive Care Unit due to age and chronic malignancy with reduced quality of life in recent months after non-chemo-responding prostate carcinoma.The patient died soon after treatment withdrawal.CONCLUSION Elderly men should be carefully evaluated for TTC when new-onset MG is diagnosed.展开更多
Background: The etiology of Crohn’s disease (CD) and Ulcerative Colitis (UC) remains unclear. It has been suggested that apart from genetic factors, prenatal or perinatal environmental factors could change the risk o...Background: The etiology of Crohn’s disease (CD) and Ulcerative Colitis (UC) remains unclear. It has been suggested that apart from genetic factors, prenatal or perinatal environmental factors could change the risk of developing inflammatory bowel disease (IBD) later in life. Seasonality in birth distribution over the year has been demonstrated for several immune diseases, but studies on IBD have had inconsistent results. Aim: The aim of this study was to investigate in the Netherlands the effect of the month of birth on the probability to develop IBD later in life. Methods: Birth data from CD patients and UC patients of 4 different Dutch hospitals were compared to a control group of irritable bowel syndrome (IBS) patients from the same hospitals. A chi-square test was used to test whether there was heterogeneity between the monthly and seasonal birth rates of the three groups. Results: The patient cohort consisted of 1183 CD patients and 1293 UC patients. The control group consisted of 2113 IBS patients. Data showed no difference in birth distribution over the year or over the four seasons of IBD patients as compared to the control group. P-values over the year and over the seasons respectively are 0.428 and 0.237 for CD and 0.311 and 0.812 for UC. Conclusions: There is no seasonality in the distribution of births of IBD patients as compared to controls. The hypothesis that environmental factors present at the time of birth play a role in the pathogenesis of IBD is not supported by these data.展开更多
文摘AIM: To develop a framework for the clinical and health economic assessment for management of Clostridium difficile infection(CDI).METHODS: CDI has vast economic consequences emphasizing the need for innovative and cost effective solutions, which were aim of this study. A guidance model was developed for coverage decisions and guideline development in CDI. The model included pharmacotherapy with oral metronidazole or oral vancomycin, which is the mainstay for pharmacological treatment of CDI and is recommended by most treatment guidelines.RESULTS: A design for a patient-based cost-effectiveness model was developed, which can be used to estimate the cost-effectiveness of current and future treatment strategies in CDI. Patient-based outcomes were extrapolated to the population by including factors like, e.g., person-to-person transmission, isolation precautions and closing and cleaning wards of hospitals. CONCLUSION: The proposed framework for a population-based CDI model may be used for clinical and health economic assessments of CDI guidelines and coverage decisions for emerging treatments for CDI.
文摘BACKGROUND Patients with myasthenia gravis(MG)are at a higher risk of developing Takotsubo cardiomyopathy(TTC),particularly during a myasthenic crisis.Myasthenic crisis-associated TTC occurs predominantly in women.In this case report,we present a man with metastasized prostate carcinoma who developed TTC after new-onset MG.CASE SUMMARY An 81-year-old man with non-insulin dependent diabetes mellitus and metastasized prostate carcinoma presented with dyspnea.During primary assessment examination at the emergency department,there was evident blepharoptosis of his right eye.His electrocardiograms were suggestive of an acute anterior wall myocardial infarction,for which he underwent emergency coronary angiography.No obstructive coronary artery disease was found.During the coronary angiography,the patient developed respiratory failure and was admitted to the Intensive Care Unit for non-invasive respiratory support.The following day,diagnostic neostigmine test revealed a myasthenic crisis.Bedside echocardiography revealed left ventricular apical ballooning with a typical appearance of TTC.Despite the potentially reversible character of both MG and TTC,the patient and family requested an end of support in the Intensive Care Unit due to age and chronic malignancy with reduced quality of life in recent months after non-chemo-responding prostate carcinoma.The patient died soon after treatment withdrawal.CONCLUSION Elderly men should be carefully evaluated for TTC when new-onset MG is diagnosed.
文摘Background: The etiology of Crohn’s disease (CD) and Ulcerative Colitis (UC) remains unclear. It has been suggested that apart from genetic factors, prenatal or perinatal environmental factors could change the risk of developing inflammatory bowel disease (IBD) later in life. Seasonality in birth distribution over the year has been demonstrated for several immune diseases, but studies on IBD have had inconsistent results. Aim: The aim of this study was to investigate in the Netherlands the effect of the month of birth on the probability to develop IBD later in life. Methods: Birth data from CD patients and UC patients of 4 different Dutch hospitals were compared to a control group of irritable bowel syndrome (IBS) patients from the same hospitals. A chi-square test was used to test whether there was heterogeneity between the monthly and seasonal birth rates of the three groups. Results: The patient cohort consisted of 1183 CD patients and 1293 UC patients. The control group consisted of 2113 IBS patients. Data showed no difference in birth distribution over the year or over the four seasons of IBD patients as compared to the control group. P-values over the year and over the seasons respectively are 0.428 and 0.237 for CD and 0.311 and 0.812 for UC. Conclusions: There is no seasonality in the distribution of births of IBD patients as compared to controls. The hypothesis that environmental factors present at the time of birth play a role in the pathogenesis of IBD is not supported by these data.
