[A sore tip of the tongue]. / Een pijnlijke tongpunt.

A 41-year-old patient presented with a sore tip of the tongue. The anterior side of the tongue had a red appearance showing a number of pronounced fungiform papillae and there were tooth impressions on the lateral sides of the tongue. This clinical picture is consistent with transient lingual papillitis. It has an unknown etiology. Local irritation might be a contributing factor. Transient lingual papillitis regresses spontaneously within a few weeks. Chronic lingual papulosis is a variant and shows enlarged filiform papillae; it can persist for years and is rarely painful. The cause of chronic lingual papulosis is similarly often unclear. Both conditions are very common, but often not recognized.

Association between the degree of obstructive sleep apnea and the severity of COVID-19: An explorative retrospective cross-sectional study.

Obstructive sleep apnea (OSA) on its own, as well as its risk factors, have been found to be associated with the outcome of Coronavirus disease 2019 (COVID-19). However, the association between the degree of OSA and COVID-19 severity is unclear. Therefore, the aim of the study was to evaluate whether or not parameters to clinically evaluate OSA severity and the type of OSA treatment are associated with COVID-19 severity. Patient data from OSA patients diagnosed with COVID-19 were reviewed from outpatients from the Isala Hospital and patients admitted to the Isala Hospital, starting from March until December 2020. Baseline patient data, sleep study parameters, OSA treatment information and hospital admission data were collected. Apnea hypopnea index (AHI), low oxyhemoglobin desaturation (LSAT), oxygen desaturation index (ODI), respiratory disturbance index (RDI), and the type of OSA treatment were regarded as the independent variables. COVID-19 severity-based on hospital or intensive care unit (ICU) admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days-were regarded as the outcome variables. Multinomial regression analysis, binary logistic regression analysis, and zero-inflated negative binomial regression analysis were used to assess the association between the parameters to clinically evaluate OSA severity and COVID-19 severity. A total of 137 patients were included. Only LSAT was found to be significantly associated with the COVID-19 severity (p<0.05) when COVID-19 severity was dichotomized as non-hospitalized or hospitalized and ICU admission or death. Therefore, our findings showed that LSAT seems to be a significant risk factor for COVID-19 severity. However, the degree of OSA-based on AHI, ODI, and RDI-and OSA treatment were not found to be risk factors for COVID-19 severity when looking at hospital or ICU admission, the number of days of hospitalization, and number of intubation and mechanical ventilation days.

Benzalkonium tolerance genes and outcome in Listeria monocytogenes meningitis.

OBJECTIVES: Listeria monocytogenes is a food-borne pathogen that can cause meningitis. The listerial genotype ST6 has been linked to increasing rates of unfavourable outcome over time. We investigated listerial genetic variation and the relation with clinical outcome in meningitis. METHODS: We sequenced 96 isolates from adults with listerial meningitis included in two prospective nationwide cohort studies by whole genome sequencing, and evaluated associations between bacterial genetic variation and clinical outcome. We validated these results by screening listerial genotypes of 445 cerebrospinal fluid and blood isolates from patients over a 30-year period from the Dutch national surveillance cohort. RESULTS: We identified a bacteriophage, phiLMST6 co-occurring with a novel plasmid, pLMST6, in ST6 isolates to be associated with unfavourable outcome in patients (p 2.83e-05). The plasmid carries a benzalkonium chloride tolerance gene, emrC, conferring decreased susceptibility to disinfectants used in the food-processing industry. Isolates harbouring emrC were growth inhibited at higher levels of benzalkonium chloride (median 60 mg/L versus 15 mg/L; p <0.001), and had higher MICs for amoxicillin and gentamicin compared with isolates without emrC (both p <0.001). Transformation of pLMST6 into naive strains led to benzalkonium chloride tolerance and higher MICs for gentamicin. CONCLUSIONS: These results show that a novel plasmid, carrying the efflux transporter emrC, is associated with increased incidence of ST6 listerial meningitis in the Netherlands. Suggesting increased disease severity, our findings warrant consideration of disinfectants used in the food-processing industry that select for resistance mechanisms and may, inadvertently, lead to increased risk of poor disease outcome.

Strategies for disseminating recommendations or guidelines to patients: a systematic review.

BACKGROUND: The aim of this systematic literature review was to assess what dissemination strategies are feasible to inform and educate patients about recommendations (also known as guidelines). METHODS: The search was performed in February 2016 in PubMed, Ebsco/PsycINFO, Ebsco/CINAHL and Embase. Studies evaluating dissemination strategies, involving patients and/or reaching patients, were included. A hand search and a search in the grey literature, also done in February 2016, were added. Searches were not restricted by language or publication type. Publications that referred to (1) guideline(s) or recommendation(s), (2) dissemination, (3) dissemination with patients/patient organisations and (4) dissemination to patients/patient organisations were included in this article. Criteria 1 AND 2 were mandatory together with criteria 3 OR 4. RESULTS: The initial search revealed 3753 unique publications. Forty-seven articles met the inclusion criteria and were selected for detailed review. The hand search and grey literature resulted in four relevant articles. After reading the full text of the 47 articles, 21 were relevant for answering our research question. Most publications had low levels of evidence, 3 or 4 of the Oxford levels of evidence. One article had a level of evidence of 2(b). This article gives an overview of tools and strategies to disseminate recommendations to patients. Key factors of success were a dissemination plan, written at the start of the recommendation development process, involvement of patients in this development process and the use of a combination of traditional and innovative dissemination tools. The lack of strong evidence calls for more research of the effectiveness of different dissemination strategies as well as the barriers for implementing a strategic approach of dissemination. CONCLUSION: Our findings provide the first systematic overview of tools and strategies to disseminate recommendations to patients and patient organisations. Participation of patients in the whole process is one of the most important findings. These findings are relevant to develop, implement and evaluate more (effective) dissemination strategies which can improve health care.

Living with moderate to severe renal failure from the perspective of patients.

BACKGROUND: Within healthcare, almost no attention is given to patients with moderate-to- severe chronic kidney disease, having a with GFR between 20 and 45 while the presumption exists that these patients already experience several problems in their lives during the course of their illness. METHODS: A team of academic researchers and a renal patient participated in a qualitative study. Individual interviews (n = 31) and focus groups (10 participants in total) with patients having moderate-to-severe chronic kidney disease were conducted to gain insight into their everyday problems. RESULTS: Participants mentioned several experiences that can be divided into physical, social, societal and psychological aspects as well as aspects related to healthcare. The most important findings, following under each of these categories are: 1) the experience of fatigue (physical aspects) 2) the search for acknowledgment of complaints/not enough attention given to complaints leading to overcompensation and secrecy (societal aspects) 3) work problems (societal aspects) and 4) the wish to control the disease but not receiving enough support for this (healthcare). Patients feel in general that healthcare professionals do not take them seriously in their complaints and problems. CONCLUSIONS: This study offers important new insights into an expanding group of patients having moderate-to-severe chronic kidney disease. Healthcare professionals should acknowledge their problems instead of ignoring or rejecting them and they should support patients in finding a way to deal with them. The assumptions of Personalised Care Planning could be used to support patients.

How do scientists perceive the current publication culture? A qualitative focus group interview study among Dutch biomedical researchers.

OBJECTIVE: To investigate the biomedical scientist's perception of the prevailing publication culture. DESIGN: Qualitative focus group interview study. SETTING: Four university medical centres in the Netherlands. PARTICIPANTS: Three randomly selected groups of biomedical scientists (PhD, postdoctoral staff members and full professors). MAIN OUTCOME MEASURES: Main themes for discussion were selected by participants. RESULTS: Frequently perceived detrimental effects of contemporary publication culture were the strong focus on citation measures (like the Journal Impact Factor and the H-index), gift and ghost authorships and the order of authors, the peer review process, competition, the funding system and publication bias. These themes were generally associated with detrimental and undesirable effects on publication practices and on the validity of reported results. Furthermore, senior scientists tended to display a more cynical perception of the publication culture than their junior colleagues. However, even among the PhD students and the postdoctoral fellows, the sentiment was quite negative. Positive perceptions of specific features of contemporary scientific and publication culture were rare. CONCLUSIONS: Our findings suggest that the current publication culture leads to negative sentiments, counterproductive stress levels and, most importantly, to questionable research practices among junior and senior biomedical scientists.

Living with Parkinson's disease: priorities for research suggested by patients.

PURPOSE: To describe a study in which patients with Parkinson's disease (PD) were engaged to list priorities for research to complement the professionals' research agenda. METHOD: The study was conducted by researchers and people with PD or relatives. Interviews and focus groups were held to develop a research agenda from patients' perspectives. A questionnaire was completed by patients to prioritize the research topics. Voiceover group meetings and meetings with the advisory group were organized to obtain feedback on the research process and to deliberate the preliminary findings. Finally, dialog meetings were organized with stakeholders to discuss the agenda and to achieve a shared research agenda. RESULTS: Patients prioritized 18 research themes. Top priorities included fundamental research, research on medication, coping, family & relations and good care. Patients asked for applied and multidisciplinary research. Professionals and charitable funding bodies acknowledged the importance of such research but did not feel capable of judging such proposals. Patients furthermore asked for more attention to be paid to living with the illness in the here-and-now to complement fundamental research. CONCLUSIONS: The patients' research agenda can be used to match research with patients' needs and to adapt the clinical support of professionals to patients' wishes.

Renal dysplasia in three young adult Dutch kooiker dogs.

Chronic renal failure as consequence of renal dysplasia was diagnosed in three young adult Dutch kooiker dogs (Dutch decoy dogs). Two animals were anorectic from an early age and were thinner than healthy dogs of the same breed. All three were presented because of apathy and weakness. Laboratory examination revealed anaemia and uraemia. One dog was presented with severe dehydration and died during emergency treatment. One dog was euthanatised because of a poor prognosis, and one was given a low-protein diet. This dog survived for 7 months after the diagnosis of chronic renal failure. At necropsy all three animals had shrunken, pale, and firm kidneys that showed microscopical lesions characteristic of canine renal dysplasia, such as asynchronous differentiation of nephrons, persistent immature mesenchyme, persistent metanephric ducts, and adenomatoid proliferation of the tubular epithelium. Secondary degenerative and inflammatory changes consisted of interstitial fibrosis and predominantly lymphocytic/plasmacytic inflammation. This is the first report of renal dysplasia in the Dutch kooiker dog. The disease should be included in the differential diagnosis in young Dutch kooiker dogs with signs of chronic renal failure. The presentation of three cases of this rare disease in this breed, which is based on a rather small gene pool, suggests that it is a familial or hereditary nephropathy.

Results of the performance testing of purpose-built and PC-based electrocardiographs using a simple evaluation procedure.

This paper presents the results of the evaluation testing of six 12-lead electrocardiographs, three purpose-built instruments and three of the recently introduced personal computer-based type (PC-based). As for PC-based electrocardiographs, three examples of the MRT systems, two examples of the 300 Hz CardioScope model and one prototype of the 1200 Hz CardioScope were examined but only results for one representative example of each are given here. It was of particular interest to compare the performance advantages and limitations of the PC-based electrocardiographs with that of instruments currently in use. A test procedure was developed that can be used by a medical technical department to evaluate an electrocardiograph before making a purchase decision. The procedure includes tests of frequency response, sampling rate, 50 Hz filter attenuation, gain and common mode rejection ratio (CMRR) plus tests based upon simulated electrocardiograms (ECGs). The procedure takes account of the AHA and ECRI recommendations for electrocardiograph checks and can be completed in less than two hours. The only equipment required being an ECG simulator and a signal generator. The results of this work show that purpose-built electrocardiographs meet all normal performance requirements, whereas the PC-based types, whilst having the potential to at least equal these requirements, currently exhibit software and hardware related problems.

Grain dust and lung function. Dose-response relationships.

Grain dust exposure has been associated with both acute and chronic respiratory abnormalities. We sought to answer two questions with regard to this exposure: (1) is there a dose-response relationship between grain dust and respiratory abnormalities, and (2) is there evidence to suggest that the allowable exposure (currently 10 mg/m3 in Canada) be lowered? We compared respiratory symptoms and lung function among 454 grain elevator workers and 55 civic workers to estimates of lifetime average grain dust exposure. A total of 781 personal air samples representing 20 different job titles over a 15-yr period were used to construct a job title-time period matrix for average dust exposure levels. The matrix was applied to each worker's detailed job history to obtain a value for estimated cumulative and average dust exposure. Significant dose-response relationships were seen for chronic phlegm production, breathlessness on exertion, FEV1, and FVC; and dose-response trends were evident for the longitudinal change in both FEV1 and FVC. Workers with estimated average exposure between 4 and 9 mg/m3 were found to have significantly lower values for FEV1 and FVC compared to both grain workers exposed to less than 4 mg/m3 on average and civic workers, despite no difference in duration of employment among these groups. The results indicate a strong dose-response relationship between grain dust exposure and both respiratory symptoms and lung function and also suggest that the current Canadian allowable exposure level of 10 mg/m3 is too high.

[Developments in veterinary medicine and possible impact on veterinary practice and education]. / De ontwikkelingen in de diergeneeskunde en de mogelijke gevolgen voor de beroepsuitoefening en de opleiding.

What are the recent developments in the various fields of the veterinary profession and which adjustments in veterinary medicine are required for successful anticipation to these new conditions? Efforts are made to answer these questions from the point of view of each of the authors' professional disciplines. The authors all specialised in different fields of veterinary medicine. The present paper is a summary of each of the authors' editorial contributions on this subject as published in Fakulteitsnieuws (magazine of the Utrecht Faculty of Veterinary Medicine) in 1984 and 1985. Veterinary practice is found to be developing into two main directions: (i) veterinary medicine of pet animals which concentrates on the individual diseased animal and (ii) veterinary medicine of farm animals in which herd health control and preventive medicine are increasingly emphasized. In addition, industry has an increasing need for veterinarians having a specific veterinary pathobiological background. Optimum veterinary care requires veterinarians increasingly to concentrate on one of these (sub)disciplines. This implies that, in veterinary training, students should be afforded ample opportunity to achieve depth in the areas of personal interest. This is made possible by ensuring further differentiation in the veterinary curriculum and by setting up an intensive system of post-graduate education.