Molecular characteristics of carbapenemase-producing Enterobacterales in the Netherlands; results of the 2014-2018 national laboratory surveillance.

Objectives: Carbapenem resistance mediated by mobile genetic elements has emerged worldwide and has become a major public health threat. To gain insight into the molecular epidemiology of carbapenem resistance in The Netherlands, Dutch medical microbiology laboratories are requested to submit suspected carbapenemase-producing Enterobacterales (CPE) to the National Institute for Public Health and the Environment as part of a national surveillance system.

Methods: Meropenem MICs and species identification were confirmed by E-test and MALDI-TOF and carbapenemase production was assessed by the Carbapenem Inactivation Method.

Inter-individual differences in sleep response to shift work in novice police officers - A prospective study.

The aim of this longitudinal study on novice police officers was to investigate inter-individual differences in sleep response to shift work, and to identify potential baseline predictors thereof. A total of 42 subjects were assessed at baseline, prior to commencing shift work. They were re-assessed during three follow-up sessions within the first 2 years of shift work exposure after approximately 4, 12, and 20 months of rotating shift work.

Individual differences in the cortisol-awakening response during the first two years of shift work: A longitudinal study in novice police officers.

Cortisol acts as a critical biological intermediary through which chronic stressors like shift work impact upon multiple physiological, neuro-endocrine and hormonal functions. Therefore, the cortisol awakening response (CAR) is suggested as a prime index of shift work tolerance. Repeated assessments of the CAR (calculated as MnInc) in a group of 25 young novice police officers showed that in the interval between about 4 and 14 months after transitioning from regular day work to rotating shift work, mean values began to rise from baseline to significantly higher levels at about 14 months after they commenced shift work.

Increased prevalence of restless legs syndrome in patients with Crohn's disease.

Objective: To determine (a) the incidence of restless legs syndrome (RLS) in patients with Crohn's disease (CD), (b) whether and how the occurrence and severity of RLS is related to severity of CD, and (c) how RLS influences the quality of life of CD patients.

Basic Methods: We carried out a cross-sectional questionnaire study in a random selection of 144 CD patients and 80 controls. Differences were calculated using a χ-test (categorical data), an independent T-test (continuous data, normal distribution), or a Mann-Whitney U-test (continuous data, non-normal distribution).

Unilateral reversible posterior leukoencephalopathy syndrome after coiling of an aneurysm.

Background: Reversible posterior leukoencephalopathy syndrome (RPLS) is radiologically characterized by symmetrical subcortical areas of vasogenic edema that are preferentially parieto-occipital, and it typically resolves after appropriate treatment.

Case Report: We present a patient with strikingly unilateral RPLS that developed 21 days after coiling of an anterior communicating artery aneurysm and several days of triple-H therapy. Cortical and subcortical vasogenic edema and enhancement developed only in the left hemisphere, with a pattern suggesting RPLS.

Massive congenital bidirectional coronary arteriovenous malformation presenting with signs and symptoms of congestive heart failure in an adult: a case report and review of the literature.

Congenital anomalies of the coronary arteries are relatively rare. Mostly asymptomatic, however, some can cause problems, as heart failure, myocardial ischemia, and ventricular arrhythmia, and are associated with risk of complications, such as endocarditis and coronary rupture or sudden death. A case of a 69-year-old man with complaints of tiredness, dyspnea, and palpitation due to coronary artery fistula is presented with a review of the literature.

MR imaging: effectiveness and costs at triage of patients with nonacute knee symptoms.

Purpose: To prospectively evaluate the cost and effectiveness of magnetic resonance (MR) imaging performed to exclude the need for arthroscopy in patients with nonacute knee symptoms who are highly suspected clinically of having intraarticular knee abnormality.

Materials And Methods: The study was approved by the institutional review boards of three hospitals; informed patient consent was obtained. All 584 included patients (406 male, 178 female; mean age, 31.

Abdominal wall endometriosis: clinical presentation and imaging features with emphasis on sonography.

Objective: The purpose of our study was to evaluate clinical findings and sonographic features of abdominal wall endometriosis and also to report its CT and MR appearance.

Materials And Methods: A computerized search of our institution's database over a 5-year period was performed, yielding 12 surgically proven cases of abdominal wall endometriosis that were retrospectively studied. All patients had undergone sonography including power Doppler examination.

Periodic limb movement disorder and restless legs syndrome in dialysis patients.

Background: Sleep disturbances, in particular restless legs or limb movements, during the night are often reported by uremic patients. However, polysomnography (PSG) studies have never been carried out to confirm the actual occurrence of these disorders and the association with other objective and self-reported sleep-wake data.

Methods: Forty-eight participants were subjected to a 2-day PSG.

Abnormal H-reflexes in periodic limb movement disorder; impact on understanding the pathophysiology of the disorder.

Objective: To get more insight in the pathophysiological basis of periodic limb movement disorder (PLMD) with or without restless legs syndrome (RLS), we investigated whether these patients have spontaneous changes in H-reflexes or show altered reflex patterns after (external) inhibition or excitation of the relevant spinal segment.

Methods: The ratio of the peak-to-peak values of the maximal soleus H-reflex and the maximal direct muscle potential (H/M ratio), H-reflex recruitment curves, vibratory inhibition and recovery curves of the soleus H-reflex in double stimulus experiments were measured in 9 PLMD patients and 11 controls.

Results: In comparison to controls the vibratory inhibition, predominantly reflecting pre-synaptic inhibitory action, was depressed in PLMD patients.

Epidemiology of restless legs in The Netherlands.

The prevalence of restless legs syndrome (RLS) in various regions in the world has been estimated between 2.5 and 29%. For The Netherlands these figures are not known.

Ultrasonography of the acute abdomen: gastrointestinal conditions.

Although multislice, helical CT is increasingly replacing ultrasonography for the evaluation of patients with acute abdominal pain, ultrasound does have certain specific advantages over CT. This article discusses the advantages of ultrasound in imaging of the acute abdomen, exploring such areas as appendicitis, ileocecal Crohn's disease, infectious ileocolitis and infectious ileocecitis, mesenteric lymphadenitis, cecal carcinoma, sigmoid diverticulitis, right-sided colonic diverticulitis, and perforated peptic ulcer.

Sleep disorders and depressive feelings: a global survey with the Beck depression scale.

Objectives: Patients with (chronic) sleep disorders are prone to depression. Until now studies on the prevalence of depression in the various sleep disorders focused mainly on obstructive sleep apnea patients and narcolepsy. Studies in other common sleep disorders are scarce.

Effect of ultrasonography and optional computed tomography on the outcome of appendectomy.

The aim of this study was to investigate the value of US and complementary CT in patients with suspected appendicitis, and to detect adverse outcomes of preoperative imaging. We retrospectively reviewed the data of 233 consecutive patients who underwent an appendectomy as an emergency procedure in our hospital, within a 2-year period. Our hospital policy is to perform diagnostic imaging in all patients with clinical suspicion of appendicitis.

Comparison of serological assays for detection of Chlamydia trachomatis antibodies in different groups of obstetrical and gynecological patients.

New serological enzyme immunoassays (EIAs) were compared with microimmunofluorescence (MIF) as a "gold standard" to detect Chlamydia trachomatis antibodies in different groups of obstetrical, gynecological, and subfertile patients. There were no significant differences in seroprevalence rates, except for the group of C. trachomatis-positive patients (P < 0.

A 43-year-old male with untreated panhypopituitarism due to absence of the pituitary stalk: from dwarf to giant.

A 43-yr-old male was referred because of an x-ray made after a fall, which showed open epiphysis of the arm. The man had always been short for his age; during childhood he once consulted a pediatrician because of short stature, but thereafter he never sought medical attention. At age 18 yr he was not allowed to join the army because of his height of 147 cm.

Epiploic appendagitis and omental infarction.

Epiploic appendagitis and omental infarction are benign self-limiting disorders. They are uncommon, though more common than is generally assumed. In both diseases the main clinical symptom is non-specific focal abdominal pain, with a normal or moderately raised white blood cell count and erythrocyte sedimentation rate.

Epiploic appendagitis and omental infarction: pitfalls and look-alikes.

Epiploic appendagitis and omental infarction are benign self-limiting conditions that are more frequent than generally assumed. Both disorders frequently mimic symptoms of an abdominal surgical emergency, often leading to clinical misdiagnosis of appendicitis or diverticulitis. Because a misdiagnosis can result in an unnecessary laparotomy, a correct diagnosis is of great importance.

Ultrasound of acute GI tract conditions.

Patients with acute abdominal pain are a great challenge to the radiologist. The clinical diagnosis is classically unreliable, resulting in both negative laparotomies as well as ill-advised surgical delay in a large number of patients. Ultrasound offers a non-invasive way to decrease both false-negative and false-positive diagnoses in this category of patients.

Analysis of a sleep-dependent neuronal feedback loop: the slow-wave microcontinuity of the EEG.

Increasing depth of sleep corresponds to an increasing gain in the neuronal feedback loops that generate the low-frequency (slow-wave) electroencephalogram (EEG). We derived the maximum-likelihood estimator of the feedback gain and applied it to quantify sleep depth. The estimator computes the fraction (0%-100%) of the current slow wave which continues in the near-future (0.