Disconnected: Poverty, Water Supply and Development in Jakarta, Indonesia

human development, water, sanitation

Zoonotic Transmission of Vaccine-Derived Bordetella bronchiseptica.

We describe a unique case of a 43-year-old-female with a Bordetella bronchiseptica infection caused by zoonotic transmission following vaccination of her dog. With this report, we want to raise awareness of potential zoonotic transmission of live attenuated vaccines from animals to patients with impaired immunity.</p

Pharmacological treatment of Lambert-Eaton Myasthenic Syndrome

Lambert-Eaton myasthenic syndrome (LEMS) is a very rare antibody-mediated autoimmune disease of the neuromuscular junction. Therapy can be divided in symptomatic treatment and immunosuppressive treatment. Symptomatic treatment with amifampridine is the only therapy currently authorized for use in LEMS patients. In the Netherlands the first choice drug is amifampridine base in an extended release formulation instead of the currently authorized amifampridine phosphate. This formulation has lower costs and is possibly safer due to lower peak concentrations. Other therapy used in LEMS patients is prescribed off-label and is based on experience in patients with myasthenia gravis. In many cases pyridostigmine is added as symptomatic treatment. In almost half of patients immunosuppressive therapy is started, mostly corticosteroids with or without azathioprine. Intravenous immunoglobulins and plasma exchange are used as emergency treatment. Currently no randomized clinical trials with new therapies are ongoing or announced in patients with LEMS, although multiple new therapies for myasthenia gravis are being investigated. These future therapies can be differentiated in symptomatic and immunomodulating drugs. The immunomodulating drugs can be further differentiated in early stage drugs which target the B-cell, later stage drugs which target the circulating antibodies and targeted therapy which have a disease-specific target. Some early and later stage immunomodulating drugs show promising results in myasthenia gravis although high cost and uncertain long term safety may be limiting for incorporating these drugs in LEMS treatment guidelines. Clinical trials in LEMS patients are lacking due to the rarity of the disease and we suggest the following requirements for future trials of potential new treatments: Sufficient power by performing multicenter or n-of-1 trials when appropriate, a cross-over design to reduce the number of patients and using a LEMS-specific quantitative primary outcome measure like the 3TUG score

Therapeutic Drug Monitoring of Posaconazole:an Update

Posaconazole is a second-generation triazole agent with a potent and broad antifungal activity. In addition to the oral suspension, a delayed-release tablet and intravenous formulation with improved pharmacokinetic properties have been introduced recently. Due to the large interindividual and intraindividual variation in bioavailability and drug-drug interactions, therapeutic drug monitoring (TDM) is advised to ensure adequate exposure and improve clinical response for posaconazole. Here, we highlight and discuss the most recent findings on pharmacokinetics and pharmacodynamics of posaconazole in the setting of prophylaxis and treatment of fungal infections and refer to the challenges associated with TDM of posaconazole

Klimaatverandering, verhoogde overstromingsrisico’s en kwelderbroedvogels [Climate change, tidal flooding risks and breeding shorebirds]

Het gaat slecht met veel vogels die in de Waddenzee broeden. Naast directe invloeden van menselijke activiteiten wordt vermoed dat klimaatverandering daarbij een belangrijke rol speelt. In dit artikel belichten we één aspect van klimaatverandering waarvan de gevolgen de laatste jaren al merkbaar zijn, namelijk het vaker optreden van overstromingen van nesten in buitendijkse broedgebieden. Lage kwelders vormen‘s zomers belangrijke broedgebieden: in hoeverre beïnvloedt een toenemend overstromingsrisico de levensvatbaarheid van vogelpopulaties, of kunnen vogels hun nestkeuze aanpassen aan deveranderende omstandigheden? Zou uitbreiding van kwelderareaal kunnen leiden tot het creëren van een ‘ecologische fuik’ voor vogels en zijn er maatregelen denkbaar om de overstromingsrisico’s voor kwelderbroedvogels tegen te gaan? [English] Climate change, tidal flooding risks and breeding shorebirds Bird populations are declining in the Wadden Sea. The contribution of climate change has been understudied, but recent evidence suggests that increased flooding frequencies during the breeding season are already affecting bird populations that breed on salt marshes. These effects are expected to get worse in the near future if birds do not adapt their nest-site selection, suggesting that the importance of low-lying breeding areas for shorebirds could decline substantially in the coming decades. The crucial question now is to what extent birds may adapt their habitat selection to the changing environment. Although several studies suggest that the adaptive potential of birds to more frequent flooding events is limited, this is based on anecdotal evidence and systematic long-term studies are now needed. Furthermore, such studies will inform us about the factors that constrain birds from selecting higher nest sites (vegetation, food, predators), such that efficient management strategies may be identified

Improving College Access and Completion for Low-Income and First-Generation Students: The Role of College Access and Success Programs

Resequencing of Agaricus bisporus herbarium specimen 99817338