Infectious complications in hematology patients: A clinical focus on prevention

The aim of this thesis was to contribute to infection preventive strategies in hematology patients with prolonged neutropenia. Invasive pulmonary aspergillosis (IPA) develops by pulmonary deposition of conidia. A placebo-controlled trial on the efficacy of prophylactic aerosolized liposomal amphotericin-B (L-AmB) was performed in hematology patients during treatment-related neutropenia. For the intent-to-treat analysis, 18 of 132 placebo patients developed IPA, versus 6 of 139 in L-AmB patients (P=.005). Short-term prophylactic nebulization of liposomal amphotericin B was not associated with decline in pulmonary function or systemic adverse effects, only coughing was significantly more reported. In a study among acute leukemia patients, the mortality rate was 26% and 16%, respectively, in patients with and without IPA (P=.08), with corrected additional IPA-related costs of €15280 (P<.001), which makes IPA prevention both efficacious and cost-effective. Current guidelines advocate administration of 7-14 days of broad-spectrum antibiotics for unexplained ferver (UF) in neutropenic hematology patients. Effective antimicrobial prophylaxis reduces the incidence of gram-negative infections, which may allow shorter treatment. In the Erasmus MC, broad-spectrum antibiotics are initially administered, but discontinued when after 72 hours no bacterial etiology is documented. Among 166 hematology patients on selective antibiotic prophylaxis, 317 febrile episodes were observed; 56% were due to UF. Due to the restrictive antibiotic policy, the mean treatment duration was only 3.7 days. Overall-mortality after neutrophil recovery was 3.6% (6 of 166 patients). No patient died from untreated bacterial infection, suggesting that discontinuation of broad-spectrum antibiotics in this setting is safe, provided that no infectious etiology is documented. Diagnosing catheter-related bloodstream infection (CRBSI) often involves tip culture, using the conventional semi-quantitative roll-plate method. The quantitative sonication technique could have additional value, as it may also detect endoluminal microorganisms. However, in a prospective study of 313 tunnelled catheters from 279 hematology patients, the diagnostic performance in patients with suspected CRBSI was equally limited for both methods. Finally, in a placebo-controlled trial on the efficacy of a daily prophylactic 70%-ethanol lock on the prevention of endoluminal CRBSI in tunneled devices, a 3.6-fold, non-significant, reduction was observed for ethanol-treated hematology patients. Partially, the lack of significance may reflect a lack of power. More patients receiving ethanol discontinued lock-therapy, because of non-severe adverse events

Beeldvorming over biologische varkenshouderij

Gangbare varkenshouders weten vaak niet zoveel van biologische varkenshouderij. Daardoor missen ze ook de kans om van hen te leren. Onderzoek laat zien dat de kruisbestuiving over en weer groot kan zijn

Keeping venomous snakes in the netherlands:A harmless hobby or a public health threat?

Objective: To describe the incidence of venomous snakebites and the hospital treatment thereof (if any) amongst private individuals who keep venomous snakes as a hobby. Structure: Descriptive study. Method: Private keepers of venomous snakes were invited via the social media Facebook, Hyves, Twitter, Google Plus, Linked In and two large discussion forums to fill in an online questionnaire on a purely voluntary and anonymous basis. Results: In the period from 1 September 2012 to 31 December 2012, 86 questionnaires were completed by individuals who keep venomous snakes as a hobby. One-third of the venomous snake keepers stated that they had at some point been bitten by a venomous snake. Out of those, two-thirds needed hospital treatment and one-third of those bitten required at least one, sometimes more, doses of antiserum. The chances of being bitten increased the more venomous snakes a person kept. An inventory of the collections of venomous snakes being kept further revealed that no antiserum exists for 16 of the species, including for the most commonly held venomous snake, the coral cobra. Conclusion: Keeping venomous snakes as a hobby is not without danger. Although in the majority of snakebite cases no antiserum had to be administered, there is nevertheless a significant risk of morbidity and sequel. Preventing snakebites in the first place remains the most important safety measure since there are no antiserums available for a substantial number of venomous snakes.</p

Relatório de viagem as plantações de dendê e coco no Estado do Pará (17/08 a 23/08/1987).

bitstream/item/66782/1/Belem-Doc5-Rel.pdfPublicação não convencional. Datilografado

Zika virus and the current outbreak:an overview

Zika virus (ZIKV), a mosquito-borne flavivirus closely related to yellow fever virus and dengue virus, is currently causing a large outbreak in the Americas. Historically, ZIKV infection was considered a sporadic, relatively mild disease characterised by fever, maculopapular rash, conjunctivitis and often arthralgia. However, current observational studies suggest that ZIKV may cause more severe neurological sequelae such as Guillain-Barre syndrome, and birth defects, mainly microcephaly, in babies of whom the mother was infected with ZIKV during pregnancy. This article provides a clinically focussed overview of ZIKV, with emphasis on the current outbreak, clinical manifestations, diagnostic tools and caveats. </p