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1.
Eur Respir J ; 39(3): 529-45, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22379148

RESUMEN

Work-related asthma, which includes occupational asthma and work-aggravated asthma, has become one of the most prevalent occupational lung diseases. These guidelines aim to upgrade occupational health standards, contribute importantly to transnational legal harmonisation and reduce the high socio-economic burden caused by this disorder. A systematic literature search related to five key questions was performed: diagnostics; risk factors; outcome of management options; medical screening and surveillance; controlling exposure for primary prevention. Each of the 1,329 retrieved papers was reviewed by two experts, followed by Scottish Intercollegiate Guidelines Network grading, and formulation of statements graded according to the Royal College of General Practitioners' three-star system. Recommendations were made on the basis of the evidence-based statements, which comprise the following major evidence-based strategic points. 1) A comprehensive diagnostic approach considering the individual specific aspects is recommended. 2) Early recognition and diagnosis is necessary for timely and appropriate preventative measures. 3) A stratified medical screening strategy and surveillance programme should be applied to at-risk workers. 4) Whenever possible, removing exposure to the causative agent should be achieved, as it leads to the best health outcome. If this is not possible, reduction is the second best option, whereas respirators are of limited value. 5) Exposure elimination should be the preferred primary prevention approach.


Asunto(s)
Asma Ocupacional/prevención & control , Asma Ocupacional/diagnóstico , Asma Ocupacional/epidemiología , Medicina Basada en la Evidencia , Femenino , Humanos , Incidencia , Masculino , Dispositivos de Protección Respiratoria , Factores de Riesgo
2.
Occup Environ Med ; 68(12): 876-82, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21493638

RESUMEN

UNLABELLED: OBJECTIVES To investigate exposures, respiratory symptoms, lung function and exposure-response relationships among aluminium cast-house workers. METHODS: A cross-sectional study was conducted among 182 workers. Exposure data were used to model exposure to irritants. Lung function and questionnaire data on respiratory symptoms were compared to a general population sample and an internal reference group. Blood samples were taken from 156 workers to examine total IgE, eosinophils and sensitisation to common allergens. RESULTS: Average daily mean exposure to inhalable dust, metals, hydrogen fluoride, fluoride salts and sulphur dioxide was relatively low compared to reference values. Airflow patterns in the hall were disturbed regularly and resulted in pot emissions with high concentrations of fluorides. Peak exposures to chlorine gas occurred intermittently due to production process disturbances. Workers reported significantly more respiratory symptoms (continuous trouble with breathing (prevalence ratio (PR) 2.5; 95% CI 1.2 to 5.3), repeated trouble with breathing (PR 1.8; 95% CI 1.1 to 3.0), wheezing (PR 1.4; 95% CI 1.1 to 1.8), asthma attack (ever) (PR 2.8; 95% CI 1.7 to 4.6) and doctor diagnosed asthma (PR 2.6; 95% CI 1.5 to 4.4). Regression analysis showed significantly lower FEV(1) values (-195 ml) and FVC values (-142 ml) compared to a general population sample. Lung function did not differ between groups. CONCLUSION: This epidemiological study suggests cast-house workers in the aluminium industry are exposed to respiratory hazards. Exposure-response relationships could not be demonstrated but this study supports preventive measures in the work environment with a focus on (peak) exposures to irritants.


Asunto(s)
Contaminantes Ocupacionales del Aire/toxicidad , Aluminio/toxicidad , Asma/epidemiología , Tos/epidemiología , Enfermedades Profesionales/epidemiología , Exposición Profesional/efectos adversos , Adulto , Anciano , Asma/inducido químicamente , Tos/inducido químicamente , Estudios Transversales , Polvo/análisis , Volumen Espiratorio Forzado/fisiología , Humanos , Industrias , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Enfermedades Profesionales/inducido químicamente , Ruidos Respiratorios , Factores de Riesgo , Espirometría , Capacidad Vital/fisiología
3.
Occup Environ Med ; 66(11): 759-65, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19687021

RESUMEN

OBJECTIVES: To investigate sensitisation and respiratory health among workers who produce liquid detergent products and handle liquid detergent enzymes. METHODS: We performed a cross-sectional study among 109 eligible workers of a detergent products plant. 108 were interviewed for respiratory and allergic symptoms and 106 blood samples were taken from them to examine sensitisation to enzymes. Those sensitised to > or = 1 enzymes were referred for clinical evaluation. Workers and representatives were interviewed to characterise exposure qualitatively and estimate exposure semi-quantitatively. Workers were classified into three exposure groups with varying exposure profiles to enzymes, based on frequency, duration, and level of exposure. RESULTS: Workers were exposed to proteases, alpha-amylase, lipase and cellulase. The highest exposures occurred in the mixing area. Liquid spills with concentrated enzyme preparations and leakage of enzymes during weighing, transportation and filling were causing workplace contaminations and subsequently leading to both dermal and inhalation exposure for workers. Workers with the highest exposures reported significantly more work-related symptoms of itching nose (prevalence ratio (PR) = 4.2, 95% CI 1.5 to 12.0) and sneezing (PR = 4.0, 95% CI 1.5 to 10.8) and marginally significant more symptoms of wheezing (PR = 2.9, 95% CI 0.9 to 8.7) compared with the least exposed group. Fifteen workers (14.2%) were sensitised to > or = 1 enzymes. A marginally statistically significant gradient in sensitisation across the exposure categories was found (p = 0.09). There was a clinical case of occupational asthma and two others with probable occupational rhinitis. CONCLUSIONS: Workers exposed to liquid detergent enzymes are at risk of developing sensitisation (14%) and respiratory allergy.


Asunto(s)
Detergentes/toxicidad , Enzimas/toxicidad , Enfermedades Profesionales/inducido químicamente , Hipersensibilidad Respiratoria/inducido químicamente , Adulto , Asma/inducido químicamente , Detergentes/química , Polvo/análisis , Monitoreo del Ambiente/métodos , Enzimas/análisis , Métodos Epidemiológicos , Monitoreo Epidemiológico , Femenino , Humanos , Inmunoglobulina E/sangre , Masculino , Persona de Mediana Edad , Exposición Profesional/efectos adversos , Exposición Profesional/análisis , Soluciones , Adulto Joven
4.
Eur Respir J ; 33(6): 1507-9, 2009 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-19483053

RESUMEN

A 43-yr-old male presented with a 6-month history of episodes of coughing, shortness of breath and fever. He suffered from dyspnoea on minor exertion. The patient worked in a cattle feed factory and noticed that he had more complaints after his working hours. His symptoms could be ascribed to hypersensitivity pneumonitis due to contact with phytase, an enzyme added to cattle feed to strengthen bone and diminish phosphorus excretion. The diagnosis was supported by bibasal lung crackles on physical examination, restrictive ventilatory defect (with decreased diffusion capacity for carbon monoxide), typical radiographical findings, lymphocytosis in bronchoalveolar lavage fluid and a positive exposure test performed at the workplace. Blood examination showed high immunoglobulin G levels to phytase. After treatment and cessation of phytase contact the patient became symptom free and lung function normalised. Phytase should be considered as a cause of occupational hypersensitivity pneumonitis in the animal feed industry.


Asunto(s)
6-Fitasa/toxicidad , Alveolitis Alérgica Extrínseca/etiología , Enfermedades Profesionales/etiología , Exposición Profesional/efectos adversos , Adulto , Alveolitis Alérgica Extrínseca/diagnóstico , Alveolitis Alérgica Extrínseca/prevención & control , Alimentación Animal , Animales , Bovinos , Diagnóstico Diferencial , Humanos , Masculino , Máscaras , Enfermedades Profesionales/diagnóstico , Enfermedades Profesionales/prevención & control , Exposición Profesional/prevención & control , Pruebas de Función Respiratoria , Tomografía Computarizada por Rayos X
5.
Occup Environ Med ; 66(2): 105-10, 2009 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-18805877

RESUMEN

OBJECTIVES: Four diacetyl workers were found to have bronchiolitis obliterans syndrome. Exposures, respiratory symptoms, lung function and exposure-response relationships were investigated. METHODS: 175 workers from a plant producing diacetyl between 1960 and 2003 were investigated. Exposure data were used to model diacetyl exposure. Lung function and questionnaire data on respiratory symptoms were compared to a general population sample and respiratory symptoms to an internal reference group. RESULTS: Workers were potentially exposed to acetoin, diacetyl, acetaldehyde and acetic acid. Historic diacetyl exposure ranged from 1.8 to 351 mg/m(3), and from 3 to 396 mg/m(3) for specific tasks. Diacetyl workers reported significantly more respiratory symptoms compared to the general population sample (continuous trouble with breathing (prevalence ratio (PR) = 2.6; 95% CI 1.3 to 5.1), daily cough (PR = 1.5; 95% CI 1.1 to 2.1), asthma attack (ever) (PR = 2.0; 95% CI 1.2 to 3.4), doctor diagnosed asthma (PR = 2.2; 95% CI 1.3 to 3.8) and asthma attack in the last year (PR = 4.7; 95% CI 1.9 to 11.4)) and to a minimally exposed internal reference group (ever trouble with breathing (PR = 2.8; 95% CI 1.1 to 7.0) and work-related shortness of breath in the last year (PR = 7.5; 95% CI 1.1 to 52.9)). Lung function did not differ between groups. A positive relationship between exposure and FEV(1) was found. CONCLUSION: The excess of respiratory symptoms in this retrospective cohort suggests that diacetyl production poses an occupational hazard. Limited historical exposure data did not support a quantitative individual diacetyl exposure-response relationship, but our findings suggest that preventive measures are prudent.


Asunto(s)
Contaminantes Ocupacionales del Aire/efectos adversos , Diacetil/toxicidad , Aromatizantes/toxicidad , Enfermedades Profesionales/inducido químicamente , Trastornos Respiratorios/inducido químicamente , Adulto , Contaminantes Ocupacionales del Aire/análisis , Bronquiolitis Obliterante/inducido químicamente , Industria Química , Estudios Transversales , Diacetil/análisis , Monitoreo del Ambiente/métodos , Aromatizantes/análisis , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Exposición Profesional/efectos adversos , Exposición Profesional/análisis , Espirometría , Capacidad Vital/efectos de los fármacos
6.
Eur Respir J ; 29(4): 690-8, 2007 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-17107995

RESUMEN

The association between swimming pool characteristics and activities of employees and respiratory symptoms in employees was studied. Trichloramine levels were measured to evaluate relationships with pool characteristics and to estimate long-term exposure levels. Questionnaires were available from 624 pool workers and 38 swimming facilities. Chloramine levels were measured by area sampling over 2-h periods and analysed using ion chromatography. Work-related and general respiratory symptoms, and symptoms indicative of atopy and bronchial hyperresponsiveness were considered. Respiratory symptom prevalence among pool workers was compared with symptoms in a Dutch population sample. Chloramine levels were modelled with regression analysis. This model was used to estimate long-term average chloramine levels for each pool studied. Employees with higher exposure reported upper respiratory symptoms with greater frequency. Upper respiratory symptoms were statistically significantly associated with cumulative chloramine levels (odds ratio (OR) >1.4 for hoarseness, lost voice, sinusitis). General respiratory symptoms were significantly elevated compared with a Dutch population sample (OR ranged 1.4-7.2). An excess risk for respiratory symptoms indicative of asthma was observed in swimming pool employees. Aggravation of existing respiratory disease or interactions between irritants and allergen exposures are the most likely explanations for the observed associations.


Asunto(s)
Contaminación del Aire Interior/efectos adversos , Cloruros/efectos adversos , Compuestos de Nitrógeno/efectos adversos , Enfermedades Profesionales/inducido químicamente , Trastornos Respiratorios/inducido químicamente , Trastornos Respiratorios/diagnóstico , Adolescente , Adulto , Anciano , Femenino , Humanos , Exposición por Inhalación/efectos adversos , Masculino , Persona de Mediana Edad , Países Bajos , Exposición Profesional/efectos adversos , Encuestas y Cuestionarios , Piscinas
7.
Ned Tijdschr Geneeskd ; 150(22): 1238-42, 2006 Jun 03.
Artículo en Holandés | MEDLINE | ID: mdl-16796175

RESUMEN

In 2000 the Netherlands Expertise Centre for Occupational Respiratory Disorders (NECORD) was started as a centre of expertise in occupational health. The centre received a grant from the ministry of Health Welfare and Sport for a period of 5 years. Their mission was to collect, develop and implement knowledge in the fields of diagnosis, treatment, reintegration and prevention of work-related health- and occupational disorders. In cooperation with two other institutes for health, NECORD has become a multidisciplinary clinical occupational respiratory health service. Occupational hygienists, occupational health physicians and chest physicians are working on three programmes: research projects on the prevalence and monitoring of respiratory health effects resulting from exposure to substances in the work place; patient care (out-patient clinic); and support of professionals (website, helpdesk, development and implementation of guidelines, education and postgraduate training).


Asunto(s)
Enfermedades Profesionales/epidemiología , Enfermedades Profesionales/terapia , Servicios de Salud del Trabajador/organización & administración , Enfermedades Respiratorias/epidemiología , Enfermedades Respiratorias/terapia , Recolección de Datos , Humanos , Países Bajos , Enfermedades Profesionales/prevención & control , Medicina Preventiva , Enfermedades Respiratorias/prevención & control
8.
Cochrane Database Syst Rev ; (1): CD004532, 2006 Jan 25.
Artículo en Inglés | MEDLINE | ID: mdl-16437489

RESUMEN

BACKGROUND: Tuberculosis is generally curable with chemotherapy, but there is controversy in the literature about the need for surgical intervention in the one to two per cent of people with tuberculosis of the spine. OBJECTIVES: To compare chemotherapy plus surgery with chemotherapy alone for treating people diagnosed with active tuberculosis of the spine. SEARCH STRATEGY: We searched the Cochrane Infectious Diseases Group Specialized Register (October 2005), CENTRAL (The Cochrane Library 2005, Issue 4), MEDLINE (1966 to October 2005), EMBASE (1974 to October 2005), LILACS (1982 to October 2005), conference proceedings, and reference lists. SELECTION CRITERIA: Randomized controlled trials with at least one year follow up that compared chemotherapy plus surgery with chemotherapy alone for treating active tuberculosis of the thoracic and/or lumbar spine. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial eligibility, methodological quality, and extracted data. We analysed data using odds ratio with 95% confidence intervals. MAIN RESULTS: Two randomized controlled trials (331 participants) met the inclusion criteria. They were conducted in the 1970s and 1980s with follow-up reports available after 18 months, three years, and five years; one trial also reported 10 years follow up. Completeness of follow up varied at the different time points, with less than 80% of participants available for analysis at several time points. There was no statistically significant difference for any of the outcome measures: kyphosis angle, neurological deficit (none went on to develop this), bony fusion, absence of spinal tuberculosis, death from any cause, activity level regained, change of allocated treatment, or bone loss. Neither trial reported on pain. Of the 130 participants allocated to chemotherapy only, 12 had a neurological deficit and five needed a decompression operation. One trial suggested that an initial kyphosis angle greater than 30 degrees is likely to deteriorate, especially in children. AUTHORS' CONCLUSIONS: The two included trials had too few participants to be able to say whether routine surgery might help. Although current medication and operative techniques are now far more advanced, these results indicate that routine surgery cannot be recommended unless within the context of a large, well-conducted randomized controlled trial. Clinicians may judge that surgery may be clinically indicated in some groups of patients. Future studies need to address these topics as well as the patient's view of their disease and treatment.


Asunto(s)
Antituberculosos/uso terapéutico , Tuberculosis de la Columna Vertebral/tratamiento farmacológico , Tuberculosis de la Columna Vertebral/cirugía , Ácido Aminosalicílico/uso terapéutico , Terapia Combinada/métodos , Humanos , Isoniazida/uso terapéutico , Cifosis/etiología , Ensayos Clínicos Controlados Aleatorios como Asunto , Rifampin/uso terapéutico , Estreptomicina/uso terapéutico , Tuberculosis de la Columna Vertebral/complicaciones
9.
Eur Respir J ; 26(1): 126-32, 2005 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-15994399

RESUMEN

The present study aimed to determine what proportion of children who are in close contact with immigrant tuberculosis (TB) patients are infected with Mycobacterium tuberculosis. For 1.5 yrs, 14 municipal health services in The Netherlands collected data from all non-Dutch TB patients and their contacts. Close contacts aged < 16 yrs received a tuberculin skin test (TST). A positive TST was defined as an induration of > or = 10 mm among nonvaccinated children, and > or = 16 mm among bacille Calmette-Guérin-vaccinated children. In total, 244 patients had 359 close contacts aged < 16 yrs. Nine out of the 359 (2.5%) had TB. A TST test was given to 298 out of the 359 (83%). Of the 115 contacts of 44 extrapulmonary TB patients, three (3%) had a positive TST. Of the 186 contacts of 58 positive pulmonary TB patients, 30 (16%) had a positive TST. Contacts of sputum smear-positive patients significantly more often had a positive TST (25%), compared with the contacts of sputum smear-negative patients (7%). Children born abroad significantly more often had a positive TST (20%) than children born in The Netherlands (5%). In conclusion, the prevalence of active tuberculosis and latent tuberculosis infection among children who are close contacts of immigrant tuberculosis patients is high and warrants an expansion of contact investigation.


Asunto(s)
Trazado de Contacto , Emigración e Inmigración , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Pulmonar/epidemiología , Tuberculosis Pulmonar/etiología , Adolescente , Adulto , Factores de Edad , Análisis de Varianza , Vacuna BCG , Niño , Preescolar , Control de Enfermedades Transmisibles/métodos , Femenino , Humanos , Modelos Logísticos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Análisis Multivariante , Países Bajos/epidemiología , Vigilancia de la Población , Prevalencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Tuberculosis Pulmonar/diagnóstico
10.
J Bone Joint Surg Br ; 86(6): 901-4, 2004 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-15330034

RESUMEN

There has been an increase in the incidence of bone and joint tuberculosis (BJTB) in The Netherlands and we have carried out an epidemiological study in order to find an explanation for this increase. Data from 1993 to 2000 from The Netherlands Tuberculosis Register (NTR) were used. In 1993 there was a total of 52 patients with BJTB. This figure increased gradually to 80 in 1999 before decreasing to 61 in 2000. There was a total of 12447 patients with tuberculosis; BJTB was found in 532, accounting for 4.3% of all cases and 10.6% of all extrapulmonary cases. Localisation in the spine occurred in 56%. Certain immigrants, in particular from Somalia, were more likely to have BJTB than other immigrants or the native Dutch population. Increased age and female gender were associated with BJTB. Only 15% of BJTB patients also suffered from pulmonary tuberculosis. The usual long delay in the diagnosis of BJTB may be shortened if physicians are more aware of tuberculosis.


Asunto(s)
Tuberculosis Osteoarticular/epidemiología , Adulto , África/etnología , Anciano , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Factores de Tiempo , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Osteoarticular/etnología , Turquía/etnología
11.
Int J Rehabil Res ; 26(1): 47-9, 2003 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-12601267

RESUMEN

The oxygen cost of eccentric exercise is lower than that of concentric exercise at similar work-loads. In this study, the response to eccentric cycle exercise training (EET) in addition to general exercise training (GET) on exercise performance and quality of life was investigated in 24 patients with severe chronic obstructive pulmonary disease (COPD). All patients had a normal resting PaO2 and an arterial oxygen saturation (SaO2) below 90% at Wmax, achieved during a maximal incremental concentric cycle exercise test. The patients participated in a comprehensive inpatient pulmonary rehabilitation programme of 10 weeks. They were randomly assigned either to GET (GET group: mean FEV 38% predicted) or to GET and additional EET (GET/EET group: FEV1 45% predicted). During EET, the patients were able to cycle eccentrically for 15 min continuously at a mean of 160 (69%) of Wmax whereas the Borg dyspnoea score did not exceed 3.0 and SaO2 did not fall below 90%. Parameters of cardiocirculatory fitness and gas exchange improved in the GET/EET group but no further improvement in exercise capacity occurred compared to GET. It is concluded that eccentric cycle exercise is a safe and attractive training modality for patients with severe COPD and can be performed at a high intensity without the patient becoming out of breath or needing supplemental oxygen.


Asunto(s)
Terapia por Ejercicio/métodos , Enfermedad Pulmonar Obstructiva Crónica/rehabilitación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadísticas no Paramétricas
12.
Int J Tuberc Lung Dis ; 6(3): 259-65, 2002 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-11934144

RESUMEN

AIM: To evaluate whether 6 months of chemotherapy for patients with spinal tuberculosis prevents relapse as effectively as more than 6 months of chemotherapy. METHOD: Literature review. Medline search including references, from January 1978 to November 2000. Inclusion criteria for publications: diagnosis of spinal tuberculosis confirmed bacteriologically and/or histologically, or probable on the basis of clinical and radiological parameters; treatment regimen (whether or not in combination with surgery) included isoniazid (H), rifampicin (R) and pyrazinamide (Z); follow-up period after completion of treatment of 12 months or more. EXCLUSION CRITERIA: patients with relapse who had previously been treated adequately for tuberculosis. OUTCOME PARAMETERS: Relapse rate. RESULTS: Four publications were found with HRZ regimens of 6 months' duration and 10 publications with HRZ regimens of >6 months' duration. A number of patients had received HRE (E = ethambutol) for > or = 9 months. In the results, no distinction was made between treatment groups. HRZ for 6 months led to a relapse rate of 0% (0/56, 95%CI 0.0-6.4); follow-up after surgical intervention ranged from 6 to 108 months. HRZ for > or = 9 months (> or = 119 patients) or HRE for > or = 9 months (< or = 71 patients) led to a relapse rate of 2% (4/218, 95%CI 0.6-5.0); follow-up after surgical intervention was 6-168 months. Despite the small number of studies, 6 months of therapy is probably sufficient for patients with spinal tuberculosis.


Asunto(s)
Antibióticos Antituberculosos/administración & dosificación , Antituberculosos/administración & dosificación , Isoniazida/administración & dosificación , Pirazinamida/administración & dosificación , Rifampin/administración & dosificación , Tuberculosis de la Columna Vertebral/tratamiento farmacológico , Adulto , Antibióticos Antituberculosos/uso terapéutico , Antituberculosos/uso terapéutico , Niño , Esquema de Medicación , Femenino , Humanos , Isoniazida/uso terapéutico , Masculino , Pirazinamida/uso terapéutico , Recurrencia , Rifampin/uso terapéutico , Resultado del Tratamiento , Tuberculosis de la Columna Vertebral/patología
13.
Int J Tuberc Lung Dis ; 5(11): 1028-35, 2001 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-11716339

RESUMEN

SETTING: The British Thoracic Society and the American Thoracic Society advise 12 months treatment for tuberculous meningitis, with at least isoniazid (H), rifampicin (R) and pyrazinamide (Z). OBJECTIVE: To establish whether a 6-month treatment regimen for tuberculous meningitis is equally as effective as longer treatment. METHOD: Medline search for papers published between 1978 and 1999. INCLUSION CRITERIA: study populations of patients with tuberculous meningitis in whom the diagnosis was confirmed with clinical, cerebrospinal fluid and epidemiological findings; a treatment regimen with at least HRZ and at least 12 months of follow-up after the completion of treatment. OUTCOME MEASURE: the number of relapses. RESULTS: There were four 6-month treatment regimens (G6) and seven longer treatment regimens (G>6); 160/197 (81%) patients completed the 6-month treatment regimens, while 577/675 (85%) completed the longer-term regimens. The clinical stage of patients in the G6 group was poorer than in the G>6 group. Relapse occurred in two out of 131 (1.5%) G6 and in 0 out of 591 G>6 patients. CONCLUSION: Although no studies have compared 6-month treatment regimens with longer treatment, it can be concluded on the basis of this literature review that 6-month treatment is sufficient for tuberculous meningitis with fully susceptible mycobacteria.


Asunto(s)
Antituberculosos/administración & dosificación , Tuberculosis Meníngea/tratamiento farmacológico , Adulto , Niño , Esquema de Medicación , Quimioterapia Combinada , Humanos , Isoniazida/administración & dosificación , Pirazinamida/administración & dosificación , Recurrencia , Rifampin/administración & dosificación , Tuberculosis Meníngea/complicaciones
14.
Ned Tijdschr Geneeskd ; 145(41): 1975-80, 2001 Oct 13.
Artículo en Holandés | MEDLINE | ID: mdl-11680068

RESUMEN

In the Netherlands, domiciliary oxygen therapy is regularly prescribed incorrectly and thus inefficiently, and the policies surrounding this therapy are inconsistent. This applies particularly to patients with chronic hypoxaemia due to chronic obstructive pulmonary disease (COPD). In order to establish a scientific basis for a uniform prescription policy, guidelines have been developed under the auspices of the Dutch Thoracic Society with the support of the Dutch Institute for Health Care Improvement. Based on scientific research, recommendations have been formulated for the indications and aims of domiciliary oxygen therapy and long-term oxygen therapy (LTOT). The most important recommendations (summarised on the back of an oxygen application form) are: domiciliary oxygen therapy is only indicated for severe hypoxaemia by day at rest; if domiciliary oxygen therapy was prescribed following recovery from an acute exacerbation or hospitalisation, the arterial oxygen tension should be rechecked within three months of starting oxygen therapy; prescription of LTOT is only justified in case of an optimal (non-)medical regimen, clinical stability, and chronic hypoxaemia, and providing a number of preconditions, such as smoking cessation (partly due to the fire hazard), have been met; LTOT is a lifelong therapy that should be prescribed for at least 15, and preferably 24, hours per day, and the oxygen flow rate settings for rest, exertion and sleep should be adjusted to meet the patient's needs; for ambulatory patients, the prescribing physician should consider the portability of the oxygen equipment; as patient education and supervision are essential to secure the success of LTOT, the prescribing physician should cooperate with the general practitioner, the district nurse and the oxygen supplier in this respect.


Asunto(s)
Atención Domiciliaria de Salud/normas , Terapia por Inhalación de Oxígeno/normas , Educación del Paciente como Asunto , Enfermedad Pulmonar Obstructiva Crónica/terapia , Algoritmos , Incendios/prevención & control , Humanos , Hipoxia/etiología , Países Bajos , Terapia por Inhalación de Oxígeno/efectos adversos
15.
Int J Tuberc Lung Dis ; 5(12): 1156-60, 2001 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-11769775

RESUMEN

OBJECTIVE: To develop a method of validating the notification of active tuberculosis by physicians in the Netherlands. METHOD: The chemotherapeutic agent pyrazinamide was used as a marker for the occurrence of tuberculosis. On the basis of defined daily doses (DDD) of pyrazinamide dispensed to out-patients, an estimate was made of the number of patients with tuberculosis in the Netherlands in the period 1994-1998. DDD is a technical unit of measurement and does not necessarily reflect the recommended or actual dose used. Usually it is based on the average dosage per day for the main indication in adults with normal organ function. The Dutch Drug Information Project (GIP) of the Health Care Insurance Board (CVZ) provided the DDD data. Based on the notification of tuberculosis patients to the Netherlands Tuberculosis Register (NTR) we calculated how much pyrazinamide (measured in DDDs) these patients would have used depending on their body weight. RESULTS: The number of DDDs prescribed according to the GIP pharmacy records differed by only 8% from the number of DDDs calculated on the basis of notification to the NTR; 6889 patients should have been registered instead of 6349. CONCLUSION: The close correlation between the use of pyrazinamide as measured by the GIP and NTR provides strong evidence that in the Netherlands tuberculosis is reported in conformity with the guidelines for notifiable diseases. The method was simple to apply and may deserve follow-up in other countries.


Asunto(s)
Antituberculosos/administración & dosificación , Notificación de Enfermedades/métodos , Notificación de Enfermedades/estadística & datos numéricos , Pirazinamida/administración & dosificación , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Adolescente , Adulto , Humanos , Países Bajos/epidemiología , Sistema de Registros
16.
Ned Tijdschr Geneeskd ; 144(47): 2243-7, 2000 Nov 18.
Artículo en Holandés | MEDLINE | ID: mdl-11109467

RESUMEN

The incidence of extrapulmonary tuberculosis is rising. The patients are predominantly immigrants and HIV-infected persons. Tuberculous lymphadenitis of the neck is the most common presentation, in the Netherlands about 200 patients a year. Fine needle aspiration with auramine/Ziehl-Neelsen stain investigation, culture and cytological examination is the diagnostic procedure of choice. If this fails to be conclusive excision biopsy is the next step. If the diagnosis is suspected on clinical, epidemiological, laboratory and bacteriological (presence of acid-fast bacilli) or cytological/histological grounds, treatment is always started, awaiting culture results. The principles for treatment are the same as for pulmonary tuberculosis. On the basis of the available literature it can be proposed to shorten the duration of treatment from 9 to 6 months.


Asunto(s)
Ganglios Linfáticos/microbiología , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Antituberculosos/uso terapéutico , Biopsia con Aguja , Diagnóstico Diferencial , Emigración e Inmigración , Humanos , Hipertrofia , Incidencia , Ganglios Linfáticos/patología , Países Bajos/epidemiología , Factores de Riesgo , Tuberculosis Ganglionar/epidemiología
17.
Eur Respir J ; 15(1): 192-5, 2000 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-10678645

RESUMEN

The aim of the study was to determine the optimal duration of treatment for patients with tuberculous lymphadenitis. The Medline database was searched for relevant articles published between 1978-1997. Inclusion criteria were study populations of patients with predominantly cervical tuberculous lymphadenitis in whom the diagnosis had been confirmed bacteriologically and/or histologically, or was made probable by using clinical and laboratory markers. Treatment management had to include at least isoniazid, rifampicin and pyrazinamide and a follow-up of at least 12 months after the end of treatment. Patients with resistance to rifampicin and pyrazinamide and previous treatment for tuberculosis were excluded. The number of patients who relapsed after treatment was calculated. The study population in eight out of the 35 articles retrieved were suitable for analysis. Some concerned comparative studies. There were eight treatment schedules of 6 months' duration and three schedules of 9 months' duration. Treatment for 6 months resulted in a tuberculous lymphadenitis relapse rate of 13/422=3.3% (95% confidence interval: 1.7-5.5), with a mean follow-up of 31 months after completion of treatment. Treatment for 9 months resulted in a relapse rate of 3/112=2.7% (95% confidence interval: 0.6-7.8), with a mean follow-up of 20 months. Despite the limitations of the literature available, 6 months of therapy is probably sufficient for patients with tuberculous lymphadenitis.


Asunto(s)
Antituberculosos/administración & dosificación , Tuberculosis Ganglionar/tratamiento farmacológico , Antituberculosos/efectos adversos , Esquema de Medicación , Quimioterapia Combinada , Estudios de Seguimiento , Humanos , Isoniazida/administración & dosificación , Isoniazida/efectos adversos , Cuello , Pirazinamida/administración & dosificación , Pirazinamida/efectos adversos , Rifampin/administración & dosificación , Rifampin/efectos adversos , Resultado del Tratamiento
20.
Eur Respir J ; 12(4): 848-52, 1998 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-9817157

RESUMEN

Home peak expiratory flow (PEF) measurements have become the cornerstone of asthma self-management plans. However, the cut-off values for changing treatment have not been formally tested. This study focusses on the possible overtreatment brought about by the different cut-off values and denominators currently employed. Data from 133 clinically stable asthmatic patients from a 2.5 yr follow-up study were analysed. The results showed that strict adherence to current criteria would lead to severe overtreatment, with up to 30% of clinically stable patients crossing into the lowest (red) zone at least once a year when personal best is the denominator and when it has not been limited to a defined time of day or to defined prior bronchodilator use. As expected, the passage of clinically stable patients into the lower zones became less frequent when cut-off values were sharpened and when time- and treatment-specific PEFs were used as the denominators. Strict adherence to commonly used peak expiratory flow cut-off values would lead to considerable overtreatment. In order to avoid overtreatment, the morning peak expiratory flow before any (bronchodilator) treatment should be related to the personal best peak expiratory flow measured under the same conditions. The choice of the right cut-off value will also depend on studies being performed to test the amount of undertreatment with a given value.


Asunto(s)
Asma/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Glucocorticoides/administración & dosificación , Mal Uso de los Servicios de Salud/estadística & datos numéricos , Ápice del Flujo Espiratorio/efectos de los fármacos , Administración por Inhalación , Adolescente , Adulto , Asma/diagnóstico , Beclometasona/administración & dosificación , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Ipratropio/administración & dosificación , Masculino , Persona de Mediana Edad , Prevalencia , Pronóstico , Medición de Riesgo , Autoadministración , Terbutalina/administración & dosificación , Resultado del Tratamiento
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