Surveillance of HIV infection among injecting drug users in the Netherlands: results Den Haag 2000

Between March 21 and July 3 2000, a serum sample and a questionnaire on risk behaviour were obtained from 217 IDU in Den Haag. Participation was on a voluntary basis. Participants were recruited at methadone treatment sites (35%) and low-threshold daytime care projects (65%). Of 211 IDU, four persons were found to be infected with HIV (prevalence 1.9%, 95% confidence interval [CI] 0.5 - 4.8). Thirtyfive percent of the participants had antibodies to HBc (previous or current HBV-infection), for 3% of the participants HBsAg was detected in the blood (carrier). Of the IDU, 47% had antibodies to HCV. The prevalence of anti-HBc and -HCV is lower than in other cities in the Netherlands. Sixteen (20%) out of 81 currently injecting IDU borrowed syringes or needles in the last 6 months, this level is somewhat higher than in other cities studied in the Netherlands. Twenty percent lent syringes or needles to other IDU. Condom use was very low during sexual contact between steady partners (84% not always using a condom). 48% of the IDU have a non-drug user as a steady sexual partner. With casual partners and clients, condoms were used more often. The risk of further spread of HIV among IDU in Den Haag is low. At this low level of HIV prevalence, the risk of spread to non-IDU or the general population is also low.Tussen 21 maart en 3 juli 2000 werd bij 217 IDs uit Den Haag een bloedmonster en een vragenlijst naar risicogedrag afgenomen. De IDs werden geworven via methadonposten (35%) en laagdrempelige instellingen voor druggebruikers (65%). Van de 211 IDs waren vier deelnemers HIV-positief (prevalentie 1,9%; 95% betrouwbaarheidsinterval [BI] 0,5 - 4,8%). Vijfendertig procent van de deelnemers had antistoffen tegen HBc (vroeger doorgemaakte of huidige HBV-infectie), bij 3% van de deelnemers werd HBsAg aangetoond in het bloed (dragerschap). Bij 47% werden antistoffen aangetoond tegen HCV. De prevalentie van anti-HBc en anti-HCV is lager dan in andere Nederlandse steden. Van de 81 actuele spuiters had 20% in de laatste 6 maanden een gebruikte spuit of naald van een ander geleend, relatief veel in vergelijking met metingen in andere steden. Eveneens 20% had een spuit of naald uitgeleend. Eenenzestig procent van de IDs had in de laatste zes maanden een vaste seksuele partner gehad. Bij 48% van deze IDs was de vaste partner geen druggebruiker, bij 17% een niet-injecterende druggebruiker. Met de vaste seksuele partner werd in 84% van de contacten niet altijd een condoom gebruikt. Met losse partners en met klanten werden condooms vaker gebruikt. Door de lage HIV-prevalentie wordt het risico op verspreiding van HIV naar niet-IDs of de rest van de algemene bevolking laag ingeschat

Surveillance of HIV infection among injecting drug users in the Netherlands: results Den Haag 2000

Tussen 21 maart en 3 juli 2000 werd bij 217 IDs uit Den Haag een bloedmonster en een vragenlijst naar risicogedrag afgenomen. De IDs werden geworven via methadonposten (35%) en laagdrempelige instellingen voor druggebruikers (65%). Van de 211 IDs waren vier deelnemers HIV-positief (prevalentie 1,9%; 95% betrouwbaarheidsinterval [BI] 0,5 - 4,8%). Vijfendertig procent van de deelnemers had antistoffen tegen HBc (vroeger doorgemaakte of huidige HBV-infectie), bij 3% van de deelnemers werd HBsAg aangetoond in het bloed (dragerschap). Bij 47% werden antistoffen aangetoond tegen HCV. De prevalentie van anti-HBc en anti-HCV is lager dan in andere Nederlandse steden. Van de 81 actuele spuiters had 20% in de laatste 6 maanden een gebruikte spuit of naald van een ander geleend, relatief veel in vergelijking met metingen in andere steden. Eveneens 20% had een spuit of naald uitgeleend. Eenenzestig procent van de IDs had in de laatste zes maanden een vaste seksuele partner gehad. Bij 48% van deze IDs was de vaste partner geen druggebruiker, bij 17% een niet-injecterende druggebruiker. Met de vaste seksuele partner werd in 84% van de contacten niet altijd een condoom gebruikt. Met losse partners en met klanten werden condooms vaker gebruikt. Door de lage HIV-prevalentie wordt het risico op verspreiding van HIV naar niet-IDs of de rest van de algemene bevolking laag ingeschat.Between March 21 and July 3 2000, a serum sample and a questionnaire on risk behaviour were obtained from 217 IDU in Den Haag. Participation was on a voluntary basis. Participants were recruited at methadone treatment sites (35%) and low-threshold daytime care projects (65%). Of 211 IDU, four persons were found to be infected with HIV (prevalence 1.9%, 95% confidence interval [CI] 0.5 - 4.8). Thirtyfive percent of the participants had antibodies to HBc (previous or current HBV-infection), for 3% of the participants HBsAg was detected in the blood (carrier). Of the IDU, 47% had antibodies to HCV. The prevalence of anti-HBc and -HCV is lower than in other cities in the Netherlands. Sixteen (20%) out of 81 currently injecting IDU borrowed syringes or needles in the last 6 months, this level is somewhat higher than in other cities studied in the Netherlands. Twenty percent lent syringes or needles to other IDU. Condom use was very low during sexual contact between steady partners (84% not always using a condom). 48% of the IDU have a non-drug user as a steady sexual partner. With casual partners and clients, condoms were used more often. The risk of further spread of HIV among IDU in Den Haag is low. At this low level of HIV prevalence, the risk of spread to non-IDU or the general population is also low.IG

Hartmann's procedure versus sigmoidectomy with primary anastomosis for perforated diverticulitis with purulent or faecal peritonitis (LADIES): a multicentre, parallel-group, randomised, open-label, superiority trial

BACKGROUND: Previous studies have suggested that sigmoidectomy with primary anastomosis is superior to Hartmann's procedure. The likelihood of stoma reversal after primary anastomosis has been reported to be higher and reversal seems to be associated with lower morbidity and mortality. Although promising, results from these previous studies remain uncertain because of potential selection bias. Therefore, this study aimed to assess outcomes after Hartmann's procedure versus sigmoidectomy with primary anastomosis, with or without defunctioning ileostomy, for perforated diverticulitis with purulent or faecal peritonitis (Hinchey III or IV disease) in a randomised trial. METHODS: A multicentre, randomised, open-label, superiority trial was done in eight academic hospitals and 34 teaching hospitals in Belgium, Italy, and the Netherlands. Patients aged between 18 and 85 years who presented with clinical signs of general peritonitis and suspected perforated diverticulitis were eligible for inclusion if plain abdominal radiography or CT scan showed diffuse free air or fluid. Patients with Hinchey I or II diverticulitis were not eligible for inclusion. Patients were allocated (1:1) to Hartmann's procedure or sigmoidectomy with primary anastomosis, with or without defunctioning ileostomy. Patients were enrolled by the surgeon or surgical resident involved, and secure online randomisation software was used in the operating room or by the trial coordinator on the phone. Random and concealed block sizes of two, four, or six were used, and randomisation was stratified by age (<60 and ≥60 years). The primary endpoint was 12-month stoma-free survival. Patients were analysed according to a modified intention-to-treat principle. The trial is registered with the Netherlands Trial Register, number NTR2037, and ClinicalTrials.gov, number NCT01317485. FINDINGS: Between July 1, 2010, and Feb 22, 2013, and June 9, 2013, and trial termination on June 3, 2016, 133 patients (93 with Hinchey III disease and 40 with Hinchey IV disease) were randomly assigned to Hartmann's procedure (68 patients) or primary anastomosis (65 patients). Two patients in the Hartmann's group were excluded, as was one in the primary anastomosis group; the modified intention-to-treat population therefore consisted of 66 patients in the Hartmann's procedure group (46 with Hinchey III disease, 20 with Hinchey IV disease) and 64 in the primary anastomosis group (46 with Hinchey III disease, 18 with Hinchey IV disease). In 17 (27%) of 64 patients assigned to primary anastomosis, no stoma was constructed. 12-month stoma-free survival was significantly better for patients undergoing primary anastomosis compared with Hartmann's procedure (94·6% [95% CI 88·7-100] vs 71·7% [95% CI 60·1-83·3], hazard ratio 2·79 [95% CI 1·86-4·18]; log-rank p<0·0001). There were no significant differences in short-term morbidity and mortality after the index procedure for Hartmann's procedure compared with primary anastomosis (morbidity: 29 [44%] of 66 patients vs 25 [39%] of 64, p=0·60; mortality: two [3%] vs four [6%], p=0·44). INTERPRETATION: In haemodynamically stable, immunocompetent patients younger than 85 years, primary anastomosis is preferable to Hartmann's procedure as a treatment for perforated diverticulitis (Hinchey III or Hinchey IV disease). FUNDING: Netherlands Organisation for Health Research and Development.status: publishe