The need for the GREAT+ score to predict relapse in Graves' disease: a questionnaire among patients and internal medicine specialists.

PURPOSE: Graves' disease (GD) is an auto-immune cause of hyperthyroidism. First-line treatment often consists of a 12-18 month course of antithyroid drugs (ATD). After discontinuation of ATD, GD relapses in approximately 50% of patients. The 'Graves recurrent event after therapy+ ' (GREAT+) score may predict individual relapse chances after ATD discontinuation more accurately based on clinical and laboratory parameters at diagnosis. We investigated the need for the GREAT+ score through an online questionnaire among GD patients and physicians treating GD. METHODS: An anonymous online questionnaire was distributed to patients and physicians between June 2022 and August 2023. RESULTS: The questionnaire was completed by 532 patients and 44 physicians. Results showed that 94% of patients were interested in knowing their GREAT+ score at the start of treatment. 55% would consider definite treatment (radioiodine/thyroidectomy) as first-line treatment in case of a high relapse chance. 98% of the physicians indicated the GREAT + score would support patient counseling. 84% may change their advice for first-line treatment if a patient has a high relapse chance based on the score. CONCLUSION: Patients and physicians considered the GREAT+ score as a valuable addition to the current available information which could change treatment decisions. Therefore, external validation of the GREAT+ score is justified to implement this score in clinical practice.

[Headache in adults; article for education and training purposes]. / Hoofdpijn bij volwassenen.

Headache is one of the most common complaints for which patients request help from the general practitioner (GP). Anxiety and fear of serious illness are the most common reasons for consulting the GP, but a request for medication and worries about daily functioning can also prompt the consultation. In this educational article we describe a practical approach to the symptom 'headache' in adults on the basis of a number of questions. Our aim is to enable the general practitioner to: recognise alarm signals; identify the type of primary headache correctly; discuss, implement and evaluate the appropriate treatment; and reassure the patient.

Concentration and size distribution of particles in abstracted groundwater.

Particle number concentrations have been counted and particle size distributions calculated in groundwater derived by abstraction wells. Both concentration and size distribution are governed by the discharge rate: the higher this rate the higher the concentration and the higher the proportion of larger particles. However, the particle concentration in groundwater derived from abstraction wells, with high groundwater flow velocities, is much lower than in groundwater from monitor wells, with minimal flow velocities. This inconsistency points to exhaustion of the particle supply in the aquifer around wells due to groundwater abstraction for many years. The particle size distribution can be described with the help of a power law or Pareto distribution. Comparing the measured particle size distribution with the Pareto distribution shows that particles with a diameter >7 microm are under-represented. As the particle size distribution is dependent on the flow velocity, so is the value of the "Pareto" slope beta.

Sterile empyematous pleural effusion in a patient with systemic lupus erythematosus: a diagnostic challenge.

Herein we present a case of a patient with systemic lupus erythematosus (SLE) and a sterile empyematous pleural effusion, a complication not generally associated with SLE. A discussion of the diagnostic and treatment dilemmas follows the case presentation.

Data processing.

X-ray diffraction data processing proceeds through indexing, pre-refinement of camera parameters and crystal orientation, intensity integration, post-refinement and scaling. The DENZO program has set new standards for autoindexing, but no publication has appeared which describes the algorithm. In the development of the new Data Processing Suite (DPS), one of the first aims has been the development of an autoindexing procedure at least as powerful as that used by DENZO. The resultant algorithm will be described. Another major problem which has arisen in recent years is scaling and post-refinement of data from different images when there are few, if any, full reflections. This occurs when the mosaic spread approaches or exceeds the angle of oscillation, as is usually the case for frozen crystals. A procedure which is able to obtain satisfactory results for such a situation will be described.

Indocyanine green fluorescence angiography of the choroid.

Indocyanine green fluorescence (ICG) angiography of the choroid gives better visualization of the choroidal vessels than does fluorescein angiography. We found that the detachment of the pigment epithelium seems bigger on ICG than on fluorescein angiograms, and pigmented lesions are more clearly delineated.