Drug prescriptions unadapted to the renal function in patients aged 80 years and older.

BACKGROUND: Drug-related problems are common in older people. Often they are related to low estimated glomerular filtration rate (eGFR), which has a high prevalence among older adults. OBJECTIVES: The aim of this study was to investigate inappropriate drug prescriptions and dose adaptations in a very old population and their relationship with the eGFR. DESIGN: A cross-sectional study within a Belgian prospective population-based cohort study (the BELFRAIL study) of 539 participants aged 80 years and older (mean age 85 years). Drug prescriptions at inclusion were reported by the participant's responsible general practitioner. The eGFR was estimated using the MDRD equation. Based on their eGFR, the participants were divided in three groups: > 50, 30-50 and < 30 ml/min/1.73 m², respectively. Drug prescriptions were analysed in different eGFR groups. The prevalence and odds ratios of inappropriate drugs and the unadjusted defined daily doses (DDD) of the participant eGFRs were calculated. RESULTS: Thirty-six (of 111) and eight (of 31) of the participants with an eGFR between 30-50 and < 30 ml/min/1.73 m², respectively, had at least one inappropriate drug prescribed. No decrease in mean DDD, was observed in any prescribed drug in both lower eGFR groups. Participants with a lower eGFR were at higher risk of receiving gliclazide (OR: 4.51; 95% CI: 1.45-14.02) or unadjusted doses of allopurinol (OR: 3.48; 95% CI: 1.26-9.61). CONCLUSION: Drug prescriptions inappropriate for patient eGFR are common in subjects aged 80 years and older, despite automatic eGFR reporting.

Improvement of a real-time RT-PCR assay for the detection of enterovirus RNA.

We describe an improvement of an earlier reported real-time RT-PCR assay for the detection of enterovirus RNA, based on the 5' exonuclease digestion of a dual-labeled fluorogenic probe by Taq DNA polymerase. A different extraction method, real-time RT-PCR instrument and primer set were evaluated. Our data show that the optimized assay yields a higher sensitivity and reproducibility and resulted in a significant reduced hands-on time per sample.

Cholera among Belgian travellers in Turkey in 2005.

BACKGROUND: Two elderly people among a group of eight Belgian travellers who had stayed in Turkey for 2 weeks, developed a severe enteritis shortly after their return to Belgium. They had travelled by private bus, and had visited different places during their stay in Turkey from 6 to 17 September 2005. METHODS: After notification an epidemiological study was conducted by the Public Health authorities in Antwerp to identify the cause of the infection, to detect other cases, and to trace the source in Turkey. Vibrio cholerae was isolated from stools and a slide agglutination test was performed at the reference laboratory for cholera in Belgium. RESULTS: V. cholerae O1, El Tor, Inaba was identified in the stools of two patients. Four other patients, who suffered from a milder form of the disease, met the case definition of probable cases. No secondary infections among their contacts in Belgium were found. In spite of an epidemiological search conducted by the Turkish Public Health authorities, other cases of cholera in Turkey could not be detected. Nor a source for the outbreak could be established. CONCLUSIONS: The outbreak of imported cholera in Belgium stresses the risk of contracting cholera in a country not considered as a cholera endemic region. It highlights the need for careful laboratory surveillance of intestinal infections in travellers after their return to their homeland. Early detection and prompt reporting are recommended.

Hemolytic uremic syndrome in Belgium: incidence and association with verocytotoxin-producing Escherichia coli infection.

OBJECTIVE: To evaluate the incidence of hemolytic uremic syndrome (HUS) in Belgium and to determine the role of verocytotoxin-producing Escherichia coli O157:H7 and other serotypes (non-O157 VTEC). METHODS: Twenty-two centers, including the seven university hospitals, registered prospectively all cases of HUS; they collected clinical samples for isolation of VTEC strains and serum for detection of specific O-lipopolysaccharide antibodies. RESULTS: Forty-seven cases of HUS (including five incomplete cases) were recorded. Three cases were seen in non-residents. The incidence of complete HUS in Belgian residents was 4.3 cases/100 000 in children <5 years old, 1.8 cases/100 000 when all children <15 years were considered, and 0.42/100 000 when patients of all ages were taken into account. By combining bacteriologic and serologic results, evidence of VTEC infection was obtained in 64% of the patients, mainly but not exclusively in children with prodromal diarrhea. The 13 VTEC isolates belonged to serotypes O157:H7 (nine isolates), O26:H11, O121:H---, O145:H--- and O172:H--- (one each) and all produced VT2 (+VT2vh-a in three O157 strains) and were positive for the eaeA gene. CONCLUSIONS: The incidence rate found in this study and the high mortality and morbidity linked with this syndrome warrant further registration of pediatric and post-diarrheic adult HUS cases and also examination of stools for both O157 and non-O157 VTEC strains. For effective prevention of this disease, further study of the serotypes and accessory virulence factors associated with HUS is needed.