Klinische virologie: omzien naar de toekomst

Edward Jenner deed eind achttiende eeuw de waarneming dat melkmeisjes, die met koepokken (vaccinia) in aanraking waren geweest, beschermd waren tegen pokken (variola). In 1798 publiceerde hij over het beschermende effect van immunisatie met vaccinia. Dit inzicht heeft grote gevolgen gehad voor de uitroeiing van pokken, die uiteindelijk op 9 december 1979 zijn beslag heeft gekregen

Changing places, spaces and identity in the Shashe Limpopo region of Limpopo Province, South Africa

Faculty of Science School of Geography,Archaeolgy and Enviromental Studies 9408209v [email protected] the Iron Age sequence of the Shashe-Limpopo region of Limpopo Province has been the subject of much research in the past, little is known about the huntergatherer sequence of the area. I begin to address this lack through the description of three new hunter-gatherer sites: Tshisiku Shelter, Balerno Main Shelter and Balerno Shelter 2. I examine how hunter-gatherer spaces, places and identity changed with the movement of different groups of farmers (including Zhizo, K2 and Mapungubwe period farmers) into the Shashe-Limpopo region over the last 2000 years. I also investigate how hunter-gatherer / farmer proximity impacted on interaction, and what social structures, boundaries, and constructed identities underlie interaction in the region. The pre-contact and contact periods are compared in order to determine whether changes in the hunter-gatherer sequence were due to the arrival, and continued presence, of farmers. Ethnographic and archaeological interaction case studies are used to construct a model of interaction for the Shashe-Limpopo. Based on data from Tshisiku Shelter, Balerno Main Shelter, Balerno Shelters 2 and 3, and Little Muck Shelter, a new sequence is proposed for hunter-gatherer occupation in the Shashe-Limpopo region: · An early pre-contact phase (11 120 – 10 890 BC; 6000 – 1220 BC) · A late pre-contact phase (1220 BC - AD 100) · An early contact phase (AD 100 – AD 900) · A late contact phase divided into two periods: - The Zhizo period (AD 900 – AD 1000 / 1200) - The K2 / Mapungubwe period (AD 1000 – AD 1300) Finally, a late second millennium phase of Late Iron Age farmer utilisation of hunter- gatherer sites occurs in the recent past (AD 1600 – AD 1900). iv My research suggests that: · A hunter-gatherer presence occurs significantly earlier in the region than initially hypothesised. · Differences in farmer social structure and identity play a role in how farmers interact with hunter-gatherers, and vice versa. · Finally, due to the differences between farmer groups and decreasing space on the landscape, a range of hunter-gatherer reactions to the presence of farmers occurred throughout the last two millennia in the Shashe-Limpopo region

Establishing cross-discipline consensus on contraception, pregnancy and breast feeding-related educational messages and clinical practices to support women with rheumatoid arthritis: An Australian Delphi study

Objective: Recognising the need for a best-practice and consistent approach in providing care to women with rheumatoid arthritis (RA) in relation to (1) general health, (2) contraception, (3) conception and pregnancy, (4) breast feeding and (5) early parenting, we sought to achieve cross-discipline, clinical consensus on key messages and clinical practice behaviours in these 5 areas. Design: 3-round eDelphi study. In round 1, panellists provided free-text responses to open-ended questions about care for women with RA across the 5 areas. Subsequently, panellists refined and scored the synthesised responses, presented as metathemes, themes and detailed elements. Where =5% of panellists did not support a theme in a given round, it was removed. Setting: Panel of practicing Australian rheumatologists (n=22), obstetricians/obstetric medicine physicians (n=9) and pharmacists (n=5). Results: 34 (94.4%) panellists participated in all 3 rounds. The panel supported 18 themes across the 5 areas (support/strongly support: 88.2-100%) underpinned by 5 metathemes. Metathemes focused on coordination in information delivery, the mode and timing of information delivery, evidence underpinning information, engagement of the right health professionals at the right time and a non-judgemental approach to infant feeding. Themes included practices for primary prevention of chronic disease and their sequelae, the importance of contraception and planning pregnancy and breast feeding, close monitoring of medications, supporting mental wellbeing, managing disease activity and providing practical support for early parenting. Conclusions: A cross-disciplinary clinical panel highly supported key information and clinical practices in the care for women with RA across the continuum of contraception to early parenting within a whole-person, chronic disease management approach

Myocardial infarction and mortality following joint surgery in patients with rheumatoid arthritis: a retrospective cohort study

Summary of patient level comparing those with rheumatoid arthritis to those without rheumatoid arthritis. (DOCX 14 kb

Cardiovascular disease in systemic sclerosis - an emerging association?

Microvascular disease is a prominent feature of systemic sclerosis (SSc) and leads to Raynaud's phenomenon, pulmonary arterial hypertension, and scleroderma renal crisis. The presence of macrovascular disease is less well established, and, in particular, it is not known whether the prevalence of coronary heart disease in SSc is increased. Furthermore, in terms of cardiac involvement in SSc, there remains conjecture about the relative contributions of atherosclerotic macrovascular disease and myocardial microvascular disease. In this review, we summarize the literature describing cardiovascular disease in SSc, discuss the pathophysiological mechanisms common to SSc and atherosclerosis, and review the surrogate markers of cardiovascular disease which have been examined in SSc. Proposed mediators of the vasculopathy of SSc which have also been implicated in atherosclerosis include endothelial dysfunction, a reduced number of circulating endothelial progenitor cells, and an increased number of microparticles. Excess cardiovascular risk in SSc is suggested by increased arterial stiffness and carotid intima thickening and reduced flow-mediated dilatation. Cohort studies of adequate size are required to resolve whether this translates into an increased incidence of cardiovascular events in patients with SSc

Diagnosing herpesvirus infections by real-time amplification and rapid culture

Procedures using real-time technique were developed to demonstrate the presence of herpes simplex virus type 1 (HSV-1) and HSV-2, varicella zoster virus (VZV), and cytomegalovirus (CMV) in miscellaneous clinical specimens. The assays were compared to rapid culture using centrifugation followed by detection with monoclonal antibodies. A total of 711 consecutive samples were collected from different patient groups. Throat swabs were obtained from transplant patients; dermal or oral specimens were collected from patients suspected for VZV or HSV infection. Genital specimens were taken from patients who attended the Clinic for Sexually Transmitted Diseases at the Dijkzigt Hospital Rotterdam presenting with symptoms of a primary genital ulcer. Nucleic acid extraction was carried out using a MagnaPure LC instrument. The amplification steps were performed on the ABI Prism 7700 sequence detection system. To monitor the process of extraction and amplification, a universal control consisting of seal herpesvirus type 1 (PhHV-1

Glucocorticoid-Induced Bone Loss Is Associated with Abnormal Intravertebral Areal Bone Mineral Density Distribution

Individuals with glucocorticoid-induced osteoporosis experience vertebral fractures at an increased rate and at higher vertebral areal bone mineral density (aBMD) than individuals with primary osteoporosis. Standard posteroanterior- (PA-) projection dual energy X-ray absorptiometry (DXA) lacks the diagnostic sensitivity required for reliable estimation of vertebral fracture risk in individuals. Assessment of subregional vertebral aBMD using lateral-projection DXA may improve the predictive value of DXA parameters for fracture. One hundred and four individuals were recruited and grouped for this study: primary osteoporosis with no history of vertebral fracture (n = 43), glucocorticoid-induced bone loss (n = 13), and healthy controls (n = 48). Standard PA-projection and supine-lateral scans were performed, and lateral scans were analysed according to an established protocol to measure aBMD within 6 subregions. Main effects for subregion and group were assessed and observed, by ANCOVA. Ratios were calculated between subregions and compared between groups, to overcome the potentially confounding influence of variability in subregional geometry. Significantly lower values were observed in the glucocorticoid group for the ratios of (i) anterior subregion: whole vertebral body and (ii) posterior: whole vertebral body when compared to the primary osteoporosis and control groups (P < 0.0 5). Lower anterior subregional aBMD in individuals on glucocorticoid therapy may help to explain the increased vertebral fracture risk in this patient group