ABSTRACT
BACKGROUND: In the Netherlands a substantial proportion of newly diagnosed human immunodeficiency virus (HIV) patients present late for care and an estimated 12-34% of people living with HIV are undiagnosed. Linkage to care of these patients is important to decrease HIV transmission and to improve individual patient outcomes. We investigated if non-targeted HIV testing in emergency departments is a useful and cost-effective way to identify these patients. METHODS: In a cross-sectional multicentre study, eligible adult patients who underwent phlebotomy were given an active choice to be additionally tested for HIV. In a subset of patients, risk factors for HIV infection were asked for. A cost-effectiveness analysis was conducted. RESULTS: Of 7577 eligible patients, 3223 patients were tested, and two new HIV infections were diagnosed (0.06%). Both patients had risk factors for HIV infection. Non-targeted HIV testing in the emergency department was not considered cost-effective, with a cost per quality adjusted life years gained of 77,050, more than triple the Dutch cost-effectiveness threshold of 20,000. CONCLUSION: Non-targeted HIV testing in emergency departments in the Netherlands had a low yield of newly diagnosed HIV infections and was not cost-effective. Our data suggest that targeted HIV testing may offer an alternative approach to decrease the number of undiagnosed people living with HIV.
Subject(s)
Emergency Service, Hospital , HIV Infections/diagnosis , Mass Screening/economics , Adult , Aged , Cost-Benefit Analysis , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Netherlands , Quality-Adjusted Life Years , Risk FactorsABSTRACT
Bartter syndrome consists a group of rare autosomal-recessive renal tubulopathies characterised by renal salt wasting, hypokalaemic metabolic alkalosis, hypercalciuria and hyperreninaemic hyperaldosteronism. It is classified into five types. Mutations in the KCNJ1 gene (classified as type II) usually cause the neonatal form of Bartter syndrome. We describe an adult patient with a homozygous KCNJ1 mutation resulting in a remarkably mild phenotype of neonatal type Bartter syndrome.
Subject(s)
Bartter Syndrome/complications , Nephrocalcinosis/etiology , Adult , Bartter Syndrome/diagnosis , Bartter Syndrome/genetics , DNA Mutational Analysis , Diagnosis, Differential , Humans , Male , Mutation, Missense , Nephrocalcinosis/diagnosis , Potassium Channels, Inwardly Rectifying/genetics , Tomography, X-Ray ComputedSubject(s)
Boxing/injuries , Mycobacterium tuberculosis/isolation & purification , Skin Ulcer/microbiology , Tuberculosis, Cutaneous/microbiology , Adult , DNA Fingerprinting , Diagnosis, Differential , Extremities , Ghana/ethnology , Humans , Male , Skin Ulcer/etiology , Transients and Migrants , Tuberculosis, Cutaneous/etiologyABSTRACT
Thirty-six women with postmenopausal osteoporosis (31 of them with at least one non-traumatic vertebral compression fracture) were matched pair-wise as to age, years since menopause and body mass index and randomized to receive either cyclical estrogen-progestagen replacement treatment (group 1) or the same treatment plus nandrolone decanoate (group 2). During the first year of treatment in both groups the forearm BMC (SPA) rose proximally and distally 2-3%. Over 2 years the increments of forearm BMC in both groups were up to 4.5%. Lumbar BMC (DPA) rose in both groups nearly 10% over the first year and 12-12.5% over 2 years. The cancellous bone density of L3 (QCT) showed in 6 months an increase of 21% in group 1 and 29% in group 2 to subsequently stay at that level. All these changes from the basal levels were highly significant but there were no significant differences between the two groups. These two conclusions were also drawn with regard to the induced fall of serum alkaline phosphatase (-23%), osteocalcin (-35% to -44%) and procollagen I (-15% to -22%) and of the fasting urinary hydroxyproline (-33% to -36%). No significant increase in the number of newly deformed vertebrae occurred in 2 years.
