Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[Imported Zika virus infection in the Netherlands].
Since mid-2015, a rapidly expanding outbreak of Zika virus infection is spreading across Latin America and the Caribbean. Although Zika virus infection usually causes only mild disease, the World Health Organization has declared the epidemiological association with the occurrence of congenital microcephaly and neurological complications a 'Public Health Emergency of International Concern' and urged the international community to mount a coordinated international response aimed to protect people at risk, especially pregnant women. ⋯ To date, more than 20 cases have been reported in The Netherlands, all imported from Surinam. We describe the epidemiology, clinical aspects, diagnostic challenges and the existing evidence to date that link Zika virus infection to complications.
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Homeless people have substantial health disadvantages as compared to the general population, and excessive losses in life expectancy. High proportions of psychiatric disorders, substance abuse and intellectual disability have been reported. This makes palliative care for this population extremely complex. ⋯ Involvement of a palliative care consultation team and transfer to a homeless shelter, to which homeless people with life-threatening diseases could be admitted, gave both the patient and his family relief. This case illustrates that palliative care in homeless patients may be extremely complex due to the specific physical and psychosocial features involved. Such care should be offered proactively and on a multidisciplinary basis.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[Acute kidney injury caused by hantavirus in the Netherlands].
Although unusual in the Netherlands, acute kidney injury is sometimes caused by infection with Hantavirus, a zoonosis transmitted by rodents. Hantavirus infections can cause a syndrome known as 'haemorrhagic fever with renal syndrome', characterized by fever, acute kidney injury and thrombocytopenia. Recovery is spontaneous and treatment is mostly supportive. ⋯ Dialysis could be avoided, with spontaneous recovery of renal function in both cases. Serological testing revealed acute Hantavirus infection. Acute kidney injury caused by Hantavirus infections is rare in the Netherlands, but should be suspected in any patient presenting with renal failure and a history of viral infection.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[The elderly patient with multiple rib fractures].
Rib fractures resulting from blunt thoracic trauma occur frequently in the elderly. Even though these are usually due to a low impact trauma mechanism (e.g. a fall from standing height), rib fractures are associated with significant morbidity and mortality in the elderly patient. ⋯ More specifically, age-specific indications and contra-indications for intravenous or epidural analgesia and operative rib fixation are discussed. In addition, we show that a multidisciplinary approach, involving a trauma surgeon, anaesthetist, intensive care physician and physiotherapist, is paramount for the prevention of potentially lethal complications.
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Ned Tijdschr Geneeskd · Jan 2015
Review Case Reports[Dichotomy of psychiatric and somatic emergency care; fundamental flaw should be addressed].
In the Netherlands, acute psychiatric care is characterised by mind-body dualism. For acute psychiatric patients, the first port of call is the general practitioner (GP); after-hour care is provided by the out-of-hours GP service. ⋯ Integration of the out-of-hours GP service, A&E and acute psychiatric care, therefore, would enable elimination of the current partitioning of somatic and psychiatric medicine in acute emergency care. This solution would not only improve acute emergency care, but would also ensure a targeted and efficient implementation of services and might even lead to a decreased stigmatisation of psychiatric patients in general.