Chronic Q fever associated with systemic sclerosis

Contains fulltext : 205462.pdf (publisher's version ) (Open Access)BACKGROUND: After the Q fever outbreak in the Netherlands between 2007 and 2010, more than 300 patients with chronic Q fever have been identified. Some patients were also diagnosed with systemic sclerosis, a rare immune-mediated disease. We aimed to increase awareness of concomitant chronic Q fever infection and systemic sclerosis and to give insight into the course of systemic sclerosis during persistent Q fever infection. MATERIALS AND METHODS: Chronic Q fever patients were identified after the Dutch Q fever outbreak in 2007-2010. Systemic sclerosis was diagnosed by a scleroderma expert and patients fulfilled the 2013 Classification Criteria for Systemic Sclerosis. RESULTS: Four cases presented with chronic Q fever, persistent Coxiella burnetii infection, shortly preceded or followed by the diagnosis of limited cutaneous systemic sclerosis. The three male patients of 60 years or older developed a relatively mild systemic sclerosis, which did not require immunosuppressive therapy during adequate treatment of the chronic Q fever infection. The 58-year-old female patient used immunosuppressives for her newly diagnosed systemic sclerosis at the time she likely developed a chronic Q fever infection. CONCLUSIONS: In this case series, chronic Q fever preceding systemic sclerosis was associated with a mild course of systemic sclerosis without the necessity of immunosuppressive drugs, while chronic Q fever development due to immunocompromised state was associated with a more deteriorating course of systemic sclerosis

Postponed or immediate drainage of infected necrotizing pancreatitis (POINTER trial): study protocol for a randomized controlled trial

Background Infected necrosis complicates 10% of all acute pancreatitis episodes and is associated with 15–20% mortality. The current standard treatment for infected necrotizing pancreatitis is the step-up approach (catheter drainage, followed, if necessary, by minimally invasive necrosectomy). Catheter drainage is preferably postponed until the stage of walled-off necrosis, which usually takes 4 weeks. This delay stems from the time when open necrosectomy was the standard. It is unclear whether such delay is needed for catheter drainage or whether earlier intervention could actually be beneficial in the current step-up approach. The POINTER trial investigates if immediate catheter drainage in patients with infected necrotizing pancreatitis is superior to the current practice of postponed intervention. Methods POINTER is a randomized controlled multicenter superiority trial. All patients with necrotizing pancreatitis are screened for eligibility. In total, 104 adult patients with (suspected) infected necrotizing pancreatitis will be randomized to immediate (within 24 h) catheter drainage or current standard care involving postponed catheter drainage. Necrosectomy, if necessary, is preferably postponed until the stage of walled-off necrosis, in both treatment arms. The primary outcome is the Comprehensive Complication Index (CCI), which covers all complications between randomization and 6-month follow up. Secondary outcomes include mortality, complications, number of (repeat) interventions, hospital and intensive care unit (ICU) lengths of stay, quality-adjusted life years (QALYs) and direct and indirect costs. Standard follow-up is at 3 and 6 months after randomization. Discussion The POINTER trial investigates if immediate catheter drainage in infected necrotizing pancreatitis reduces the composite endpoint of complications, as compared with the current standard treatment strategy involving delay of intervention until the stage of walled-off necrosis

Immunology of chronic Q fever

Contains fulltext : 201894.pdf (publisher's version ) (Open Access)Radboud University, 26 april 2019Promotores : Joosten, L.A.B., Netea, M.G. Co-promotores : Deuren, M. van, Bleeker-Rovers, C.P

Relatie bos en waterwinning 2. Verkenning van samenwerkingsmogelijkheden

In twee delen wordt een publikatie uit 2001 van KIWA en Alterra over de fysieke relaties tussen waterwinning en bos herdrukt. In deel 2 de invloed van waterwinning op bos en boomsoorten. Waterwinning en grondwaterdaling kunnen bijdragen aan verdroging, verzuring en vermesting in bossen, met nadelige effecten voor de productiecapaciteit (aanwasvermindering) en de natuurwaarden. Anderzijds kan bij omschakeling van donker naaldbos naar licht naaldbos of loofbos sprake zijn van wederzijds voordeel voor bossen en waterwinnin

Relatie bos en waterwinning 2. Verkenning van samenwerkingsmogelijkheden

In twee delen wordt een publikatie uit 2001 van KIWA en Alterra over de fysieke relaties tussen waterwinning en bos herdrukt. In deel 2 de invloed van waterwinning op bos en boomsoorten. Waterwinning en grondwaterdaling kunnen bijdragen aan verdroging, verzuring en vermesting in bossen, met nadelige effecten voor de productiecapaciteit (aanwasvermindering) en de natuurwaarden. Anderzijds kan bij omschakeling van donker naaldbos naar licht naaldbos of loofbos sprake zijn van wederzijds voordeel voor bossen en waterwinnin

Relatie bos en waterwinning. 1. Verkenning van samenwerkingsmogelijkheden

In twee delen wordt een publikatie uit 2001 van KIWA en Alterra over de fysieke relaties tussen waterwinning en bos herdrukt. In deel 1 de invloed van bos- en boomsoorten op de waterkwaliteit en de wijze waarop bos- en boomsoorten de grondwateraanvulling beïnvloede

Türkiye’de Kadına Yönelik Aile içi Şiddet

Kadına yönelik aile içi şiddetin yaygınlığı-yoğunluğu ve türleri değişmekle beraber dünyanın heryerinde ,tüm toplumlarda , toplumların çeşitli katmanlarında varolmuş ve varolmaya devam eden , dünya kadınlarının yaşadığı ortak bir sorundur.Dünyada ,özellikle gelişmiş ülkelerde , 1960'lardan itibaren etkili hale gelmeye başlayan kadın harekatının çabalarıyla kadına yönelik aile içi şiddet toplumların gündemine girmeye başlamış ve son 30 yılda da kadına yönelik en önemli insan hakları ihlallerinden birisi olarak kabul edilmiştir

National Research on Domestic Violence Against Women in Turkey Summary Report

Violence against women is a common worldwide problem faced by all women vithout distinction of race ,language , religion and ethnic group.Violence against women , in the last 30 years , is being considered a violation of womens's human rights and a social problem affecting public health