Pneumococcal Endocarditis in Adult Patients : A Report of Five Cases and Review of the Literature

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The reliability of musculoskeletal ultrasound in the detection of cartilage abnormalities at the metacarpo-phalangeal joints

SummaryObjectiveTo assess the reliability of ultrasound (US) in detecting cartilage abnormalities at the metacarpo-phalangeal (MCP) joints in people with cartilage pathology.MethodsNine expert ultrasonographers initially achieved consensus on definitions and scanning protocols. They then examined the second to fifth MCP joints of the dominant hand of eight people with hand osteoarthritis (OA). US examinations were conducted in two rounds, with independent blinded evaluations of cartilage lesions. Global cartilage abnormalities were assessed by applying a dichotomous (presence/absence) score; in addition, the following lesions were evaluated using the same scoring system: loss of anechoic structure and/or thinning of the cartilage layer, and irregularities and/or loss of sharpness of at least one cartilage margin. Reliability was assessed using kappa (k) coefficients.ResultsThirty-two joints were examined. Intra-observer k values ranged from 0.52 to 1 for global cartilage abnormalities; k values ranged from 0.54 to 0.94 for loss of anechoic structure and/or thinning of cartilage layer and from 0.59 to 1 for irregularities and/or loss of sharpness of at least one cartilage margin. Values of k for inter-observer reliability were 0.80 for global cartilage abnormalities, 0.62 for loss of anechoic structure and/or thinning of cartilage layer, and 0.39 for irregularities and/or loss of sharpness of at least one cartilage margin.ConclusionUS is a reliable imaging modality for the detection of cartilage abnormalities in patients with cartilage pathology in the MCP joints. The analysis of specific cartilage measures showed more variable results that may be improved by modifying definitions and further standardization of US techniques

New perspectives for rheumatic patients. Anti-TNFα therapy with etanercept and infliximab: New perspectives for rheumatic patients. Anti-TNFα therapy with etanercept and infliximab

In The Netherlands anti-TNF-therapy, etanercept and infliximab, has become available for treatment of rheumatoid arthritis in patients with inadequate response to conventional therapy. The first randomized, clinical trials show good efficacy and (short term) safety, in monotherapy as well as in combination with methotrexate. Safety and efficacy on the long term are currently the most important questions concerning the use of etanercept and infliximab. This article provides an overview of the results of randomized, clinical trials and considerations for the use of anti-TNF-therapy

Systematic review of trends in prophylaxis of corticosteroid-induced osteoporosis: the need for standard audit guidelines

Corticosteroid-induced osteoporosis (CIOP) is currently undertreated. Systematic review of the literature revealed that the percentage of patients treated adequately is dependent on study quality. Therefore, it remains unknown whether adherence to the guidelines is really so poor. Five major quality criteria provide the standard for future studies on this scope. Introduction It has recently been stated that the degree of prophylaxis of corticosteroid-induced osteoporosis (CIOP) is low and effort should be put into determining reasons for non-prescribing of preventive agents. The aim of this study was to identify: how many studies adequately audit the prevalent guideline; the longitudinal trends in prevention of CIOP; which patient groups appear to be most undertreated; and which intervention strategies are effective. Methods We performed a comprehensive search of MEDLINE and systematically recorded the outcomes and quality of published studies, using five major criteria. Results Twenty-four studies were included in the analysis. The quality of the included studies was poor (31%) or moderate (37%). There was a longitudinal increase in quality of the studies and percentage of prevention. Multivariable linear regression showed that the quality of the study was the only independent predictor of the prevention rate reported in the study. Conclusions The results show undertreatment of CIOP might be due to insufficient quality of the studies rather than poor practice or failure to recognise the right patients. Future interventions should comply with five major quality criteria, and a multifaceted approach is required in order to make an impact on the underprescribing of CIOP prophylaxis

New perspectives for rheumatic patients. Anti-TNFα therapy with etanercept and infliximab

In The Netherlands anti-TNF-therapy, etanercept and infliximab, has become available for treatment of rheumatoid arthritis in patients with inadequate response to conventional therapy. The first randomized, clinical trials show good efficacy and (short term) safety, in monotherapy as well as in combination with methotrexate. Safety and efficacy on the long term are currently the most important questions concerning the use of etanercept and infliximab. This article provides an overview of the results of randomized, clinical trials and considerations for the use of anti-TNF-therapy