Contemporary management of patients with atrial fibrillation in the Netherlands and Belgium: a report from the EORP-AF long-term general registry.

BACKGROUND: Contemporary data regarding the characteristics, treatment and outcomes of patients with atrial fibrillation (AF) are needed. We aimed to assess these data and guideline adherence in the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) long-term general registry. METHODS: We analysed 967 patients from the EORP-AF long-term general registry included in the Netherlands and Belgium from 2013 to 2016. Baseline and 1­year follow-up data were gathered. RESULTS: At baseline, 887 patients (92%) received anticoagulant treatment. In 88 (10%) of these patients, no indication for chronic anticoagulant treatment was present. A rhythm intervention was performed or planned in 52 of these patients, meaning that the remaining 36 (41%) were anticoagulated without indication. Forty patients were not anticoagulated, even though they had an indication for chronic anticoagulation. Additionally, 63 of the 371 patients (17%) treated with a non-vitamin K antagonist oral anticoagulant (NOAC) were incorrectly dosed. In total, 50 patients (5%) were overtreated and 89 patients (9%) were undertreated. However, the occurrence of major adverse cardiac and cerebrovascular events (MACCE) was still low with 4.2% (37 patients). CONCLUSIONS: Overtreatment and undertreatment with anticoagulants are still observable in 14% of this contemporary, West-European AF population. Still, MACCE occurred in only 4% of the patients after 1 year of follow-up.

[Avoidable visual impairment in The Netherlands: the project "Vision 2020 Netherlands" of the World Health Organization]. / Vermijdbare slechtziendheid in Nederland: het project 'Vision 2020 Netherlands' van de Wereldgezondheidsorganisatie.

In the year 2004 there were an estimated 220,000-320,000 people in The Netherlands with visual impairment. In 150,000-220,000 (70%) of them the visual impairment is either curable or could have been prevented. Those most at risk are people with intellectual disabilities, elderly people in care institutions, elderly people in general and diabetics. 'Vision 2020 Netherlands', an initiative of the World Health Organization, was launched to eliminate avoidable visual impairment in the Netherlands by the year 2020 by means of awareness campaigns, implementation of screening programmes and by expanding eye care capacity through efficient cooperation between the professional groups involved in eye care.

Estrogen therapy in older patients with recurrent urinary tract infections: a review.

Although urogenital complaints, such as recurrent lower urinary tract infections (UTI), and dysuria, are commonly encountered in elderly women, few women have participated in randomized studies of estrogen therapy for this condition. This is a paradox in view of the often cited beneficial effect of estrogen in reducing the incidence of UTI. Present evidence documents that in postmenopausal women, hormone replacement therapy using topical estrogen normalizes the vaginal flora and greatly reduces the risk of vaginal atrophy. Similarly, vaginal estrogen administration seems to be effective for preventing recurrent urinary tract infections (UTI).

Magnetic resonance imaging in acute myocarditis: a case report and a review of literature.

We report a case of acute myocarditis in a 20-year-old male, suggested by the clinical picture, elevated cardiac enzymes, electrocardiography and serology. Diagnosis was confirmed by gadolinium-enhanced MRI showing part of the myocardium affected by an infiltrate. Impaired LV function and wall motion abnormalities were documented by echocardiography and FFE MRI. The patient recovered well within two weeks, but will be followed intensively since dilated cardiomyopathy may ensue.

Return to fertility in nulliparous and parous women after removal of the GyneFix intrauterine contraceptive system.

OBJECTIVE: To evaluate the return to fertility following removal of the GyneFix intrauterine implant system in women wishing to conceive. STUDY DESIGN: A retrospective study was performed on a sample of healthy, sexually active nulligravid/nulliparous and parous women. The participants were 18-41 years of age, with no apparent infertility problem, living in a stable relationship and planning to become pregnant. Women who changed their mind and did not wish to become pregnant immediately after intrauterine device (IUD) removal were excluded from the study. Women were evaluated in terms of rates of conception and fertility outcome. A total of 128 women were evaluated. RESULTS: The study shows that 119 out of 128 (93%) past users of GyneFix have conceived, accounting for a net cumulative pregnancy rate of 88% at 12 months and 99% after 2 years' observation. No statistical differences in pregnancy rates were found for age and duration of use of the IUD. A strong significant difference in pregnancy rate was shown (p = 0.007) between parous and nulligravid/nulliparous women. Seventy-seven women (66.9%) gave birth to a term infant. There were no stillbirths. Twenty-five women (21.8%) are pregnant at the time of writing. Five (4.4%) spontaneous abortions occurred and in eight women (6.9%) the pregnancy was terminated. There were no ectopic pregnancies. CONCLUSION: The results obtained compare favorably with those obtained in previous studies conducted following the removal of copper IUDs. The use of the frameless IUD does not affect future fertility in nulligravid/nulliparous and parous women wishing to become pregnant following removal of the device. Nulliparous women conceive significantly earlier than parous women.

[Fainting caused by a neck tumor]. / Flauwvallen door een tumor in de hals.

An 86-year-old woman was admitted with progressive complaints of dizziness and the sensation of losing consciousness several times a day; this had led her to fall down on a few occasions. The patient had experienced these symptoms for a month prior to admission. Two weeks before admission her family had noticed a swelling on the left side of her neck. During admission, bradycardia and subsequently asystole occurred while she was eating or when turning her head to the left, followed by a slow junctional escape rhythm. A CT scan of the head and neck region revealed a large tumour in the left parapharyngeal space entrapping the left carotid artery. Histology disclosed a low-grade malignant non-Hodgkin lymphoma, sensitive to radiotherapy. The patient received a pacemaker and treatment of the lymphoma was uneventful. The symptomatic sinus bradycardia and asystole were caused by intermittent carotid massage by the lymphoma.

Decrease of bone mineral density during estrogen substitution therapy.

A decrease in bone mineral density (BMD) in patients treated with hormone replacement therapy (HRT) is sometimes observed in clinical practice. In order to assess the frequency and the characteristics of these cases, we reviewed the data of 102 women treated with HRT for more than 2 years, and who had undergone at least 3 lumbar BMD measurements during that period. For each patient, a linear function was fitted to the BMD data in relation to time. The slope was calculated. There was an overall gain in BMD during treatment, mean (+/- S.E.M.) values of slope 0.007 g/cm2/year (+/- 0.002). Fifty-three patients had a slope higher than 0.005, 28 a slope close to 0 (between 0.005 and -0.005) and 21 a slope lower than -0.005. By dividing the patients in tertiles of slopes (tertile I: slope < 0; tertile II: 0 < slope < 0.011; tertile III: slope > 0.011), significant differences were observed between the three groups of slope for the initial BMD (P < 0.001), hydroxyproline/creatinine ratio (P < 0.01), weight, DHEAS and alkaline phosphatase (P < 0.05). Only 1 of the 15 patients with a low bone mass (lower than mean +/- 1 S.D.) had a negative slope, while 9 of the 16 with a high-bone mass (higher than mean +/- 1 S.D.), had a negative slope. Under HRT, about 21% of postmenopausal women have a slight decrease in BMD as assessed by DPA. Because of the DPA coefficient of variation, however, the exact number of bone losers cannot be determined.(ABSTRACT TRUNCATED AT 250 WORDS)