Nederlands tijdschrift voor geneeskunde
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All NSAIDs may induce cardiotoxicity. In this respect naproxen is relatively the safest choice. ⋯ After a serious gastrointestinal complication while using NSAIDs, in principal the patient should no longer use NSAIDs. If needed, a coxib plus a PPI is the first choice.
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Ned Tijdschr Geneeskd · Jan 2014
Review Case Reports[Diagnostic evaluation of β-lactam antibiotic allergy].
Many patients report a β-lactam allergy or hypersensitivity without actually having this allergy. Targeted questioning, in combination with an accurate description of the nature of the symptoms, leads to rejection of a large number of these presumed allergies. In a suspected allergic reaction one has to distinguish between the potentially life-threatening, acute type I mediated allergy and delayed type IV skin reaction. ⋯ Patient B was a 58-year-old man with anaphylaxis triggered by amoxicillin/clavulanate as a result of a selective allergy to amoxicillin. Patient C was a 50-year-old man who had had a possible reaction to a penicillin in his childhood. Analysis in an allergology department can be useful for further treatment.
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Ned Tijdschr Geneeskd · Jan 2014
Review[Pain relief in lumbosacral radicular syndrome: the role of transforaminal epidural injections with glucocorticoids].
Lumbosacral radicular syndrome is characterized by radiating pain into a part of the leg typically served by one nerve root in the lumbar or sacral spine. The most common cause of radicular syndrome is a herniated disk. The estimated annual incidence of radicular syndrome in The Netherlands is 9 cases per 1000 adults per year. ⋯ Besides pain medication, transforaminal, fluoroscopic injections with corticosteroids can be chosen. Transforaminal, fluoroscopic injections with glucocorticoids are safe and effective compared to placebo. The position within the treatment protocol for radicular pain of epidural steroid injections has yet to be determined based upon further scientific knowledge.
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Ned Tijdschr Geneeskd · Jan 2014
Review[What do you think of Thuisarts.nl? Experiences after 3 years of www.Thuisarts.nl].
Many people need information on health and disease, but the internet is a maze of medical information. In order to offer patients reliable medical information, and to support general practitioners, the Dutch College of General Practitioners (NHG) set up the public website Thuisarts.nl in 2011, which was later followed by an app. The NHG members survey amongst general practitioners from June 2013 showed that 90% of the general practitioners used Thuisarts.nl. ⋯ Information is also available from questionnaires filled in by the NIVEL Health Care Consumer Panel (n = 2846) and participants in a study on information technology and independence (n = 25). Thuisarts.nl meets an important need and is highly valued by doctors and patients. There are plans for the further development of Thuisarts.nl including short videos, illustrations, searchable anatomical structures and information from other reliable organisations such as associations of specialist doctors.
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The human gut microbiota, formerly known as 'gut flora', may be regarded as an external organ with many physiological functions in metabolism, development of the immune system and defense against pathogens. The adult gut microbiota consist of 1013-1014 micro-organisms. The aggregate genome of these, known as the microbiome, is 100 times larger than the human genome. ⋯ It should be noted that until now most of the studies conducted have been association studies, without proof of causality. This increasing insight has led to identification of new therapeutic strategies, which are currently being investigated in clinical studies. Although the implications of this knowledge for individual patients have yet to become clear, various interventions are conceivable, such as supplementation of nutritional elements, prebiotics or probiotics and feces transplantation.