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[Which aldosterone antagonist? Choosing between sprionolactone and the novel drug finerenone]. 哪种醛固酮拮抗剂？在spronolactone和新药finerenone之间进行选择。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-11
Kang He Zheng, Camiel L M de Roij van Zuijdewijn, Loek van Heerebeek, Michiel A van Agtmael
{"title":"[Which aldosterone antagonist? Choosing between sprionolactone and the novel drug finerenone].","authors":"Kang He Zheng, Camiel L M de Roij van Zuijdewijn, Loek van Heerebeek, Michiel A van Agtmael","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Patients with chronic kidney disease (CKD) and metabolic diseases including type 2 diabetes mellitus (T2DM) have an increased cardiovascular risk. Mineralocorticoid receptor overactivation plays a key role in inflammation and fibrosis in heart and kidneys.</p><p><strong>Objective: </strong>To review the clinical evidence and provide practical guidance on selecting mineralocorticoid receptor antagonists (MRAs) in cardiovascular-kidney-metabolic syndrome.</p><p><strong>Discussion: </strong>Finerenone reduced kidney and cardiovascular events in patients with T2DM (FIDELIO-DKD, FIGARO-DKD). The CONFIDENCE trial showed reduction of proteinuria when combining finerenone with empagliflozin. Outcome studies are lacking for spironolactone and eplerenone. In heart failure with preserved ejection fraction (HFpEF), FINEARTS-HF demonstrated cardiovascular benefits with finerenone, while TOPCAT with spironolactone showed mixed results. In the Netherlands, finerenone uptake remains limited despite regulatory approval.</p><p><strong>Conclusion: </strong>Finerenone offers proven efficacy in CKD and DM2. For treatment-resistant hypertension, classic steroidal MRA's remain valuable. Patient-specific factors including blood pressure and susceptibility to hyperkalemia can further guide MRA selection.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252444","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Swelling in the neck]. [颈部肿胀]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-09
Thomas Pézier, Jiska van Stralen, Marthe Mansour, Jacob Bosma
{"title":"[Swelling in the neck].","authors":"Thomas Pézier, Jiska van Stralen, Marthe Mansour, Jacob Bosma","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Neck swellings are a common presentation in general practice and encompass a broad differential diagnosis ranging from benign congenital lesions to life-threatening malignancies. Early recognition of red-flag symptoms and appropriate investigation /timely referral particularly when airway compromise is suspected or in head and neck cancer is essential for safe practice. This article provides an overview for general practitioners including a structured history and physical examination as well clinical pearls for frequently encountered pathologies.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Range of symptoms after contact with the clinging jellyfish (Gonionemus vertens)]. [接触黏附水母（Gonionemus vertens）后的症状范围]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-08
F P Overweel, Nienke A F Verheijden-van Dorp, Michiel Bil, Johanneke F de Rijk-van Andel, Renee Otten, Marjan J van Ledden-Klok
{"title":"[Range of symptoms after contact with the clinging jellyfish (Gonionemus vertens)].","authors":"F P Overweel, Nienke A F Verheijden-van Dorp, Michiel Bil, Johanneke F de Rijk-van Andel, Renee Otten, Marjan J van Ledden-Klok","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Ten patients showed to the general practitioner with complaints of dyspnea and/or heavy generalised pain after contact with the clinging jellyfish (Gonionemus vertens) after swimming in a local lake. Four patients were referred to the emergency department for additional treatment. Available literature describes local treatment with seawater of a compress with lukewarm water. In the cases described above, additional treatment was needed.Because of the lack of available literature we decided to aim on treating the symptoms. One patient was seen afterward with neuropathic pain. Taking in consideration the public health risk we contacted the GGD and the province to connect this incidence to the local people.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Stiff-person syndrome; the diagnostic challenges of a treatable condition]. [Stiff-person综合症;一种可治疗疾病的诊断挑战]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-02
Jeroen W Bos, Juna M de Vries, Perry T C van Doormaal
{"title":"[Stiff-person syndrome; the diagnostic challenges of a treatable condition].","authors":"Jeroen W Bos, Juna M de Vries, Perry T C van Doormaal","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Stiff-person syndrome (SPS) is a rare immune-mediated neurological condition, characterized by ambulatory problems and falls, muscle hypertonia and spasms, and debilitating task-specific phobias. The diagnostic delay is often significant due to physicians not recognizing SPS and due to misdiagnoses such as a functional neurological disorder or a psychiatric condition. In this article, we present a case of a patient with SPS. We discuss the clinical characteristics and propose ways to recognize SPS sooner in patients presenting with falls or muscle spasms. The aim of this article is to increase awareness for SPS. An early diagnosis is important, as SPS is a treatable condition.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[A woman with vanishing shoulders]. [肩膀消失的女人]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-02
Danny van Zoest, Bart J M Schouten, Lindy-Anne Korswagen
{"title":"[A woman with vanishing shoulders].","authors":"Danny van Zoest, Bart J M Schouten, Lindy-Anne Korswagen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>An 89-year-old woman presented with stiffness in her shoulders. X-ray showed bilateral absence of the humeral head. MRI showed destruction of the humeral head, with the cavity filled with fluid and soft tissue proliferation. Suspected for Milwaukee shoulder or Gorham-stout disease.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Screening for prostate cancer; a screening program is favored over current opportunistic testing]. [前列腺癌筛查；筛选程序比目前的机会性测试更受青睐。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-06-01
Roderick C N van den Bergh, Monique J Roobol, Pim J van Leeuwen
{"title":"[Screening for prostate cancer; a screening program is favored over current opportunistic testing].","authors":"Roderick C N van den Bergh, Monique J Roobol, Pim J van Leeuwen","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>In The Netherlands, no national prostate cancer (PCa) screening program exists, despite evidence that screening can reduce mortality and metastasis. Overdiagnosis, a primary concern, is considered too detrimental to justify population-based screening. However, individual early detection through PSA testing is widely practiced, particularly in older men who may derive limited benefit. Variations in patient access to information, health literacy, and general practitioners' screening policies, coupled with high referral rates to secondary care, contribute to inefficiency, overdiagnosis, and social inequality. An organized modern risk-based, imaging-guided screening approach should aim to: (1) reduce disease burden by decreasing mortality and metastases, and enhancing the quality of life in those who would benefit from early detection, (2) minimize unnecessary testing and overdiagnosis in men unlikely to benefit. A pilot implementation study is essential to provide the data required to determine the feasibility and sustainability of a potential national screening program.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Considerations of Medical Students for a Career in Public Health]. 医学生从事公共卫生工作的思考
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-05-28
Karin Apperloo-Swiersema, A J M Jessie Hermans, Robbert Duvivier
{"title":"[Considerations of Medical Students for a Career in Public Health].","authors":"Karin Apperloo-Swiersema, A J M Jessie Hermans, Robbert Duvivier","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>To gain insight into the considerations that play a role for medical students in the final two years of their education when (possibly) choosing the specialty of Public and Occupational Health.</p><p><strong>Design: </strong>Qualitative study using semi-structured interviews.</p><p><strong>Method: </strong>Eleven medical students in their 5th or 6th year who were planning or considering a career in public health care were interviewed.</p><p><strong>Results: </strong>Students tend to explore social medicine specialties late in their studies, due to a lack of internships, networks, and role models. Experiences during clinical hospital rotations prompt students to explore other career paths. Through informal sources, they discover alternatives and choose work that aligns with their ideals and identity.</p><p><strong>Conclusion: </strong>The decision to pursue a career in Public and Occupational Health often emerges late in medical training. Structural reinforcement of undergraduate medical education with content related to social medicine and exposure to role models, combined with career orientation support, can contribute to well-informed career choices.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[A woman with 'whip marks']. [有鞭痕的女人]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-05-27
Charlotte Burms, Lotte M Voeten, Aimée H M M Arits
{"title":"[A woman with 'whip marks'].","authors":"Charlotte Burms, Lotte M Voeten, Aimée H M M Arits","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>A 63-year-old woman presented with a pruritic rash on her back. Clinical examination revealed erythematous linear lesions resembling whip marks. She confirmed eating undercooked shiitake mushrooms, confirming the diagnosis of shiitake dermatitis. This case highlights the rising incidence of this rare toxic reaction in Europe due to increased shiitake mushroom consumption.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[The rise of genetic therapies: urgent moral and societal questions]. [基因疗法的兴起：紧迫的道德和社会问题]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-05-26
Kris E Leeuwenberg, Karlien Mul, Bart P van de Warrenburg, Gert Olthuis
{"title":"[The rise of genetic therapies: urgent moral and societal questions].","authors":"Kris E Leeuwenberg, Karlien Mul, Bart P van de Warrenburg, Gert Olthuis","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Genetic therapies offer long-awaited hope for patients with rare genetic diseases and are emerging as cancer treatment as well. While these innovations appear promising, they are also extremely expensive and raise concerns about how they fit into an already overburdened healthcare system. What are the societal implications when these treatments become available? And how can we guide their adoption in the Dutch healthcare system in an ethically responsible manner? We describe the emerging landscape of genetic therapies, and specifically examine the ethical concerns surrounding their implementation within the Dutch healthcare system. From this reflection, we seek to offer direction on how to approach these new biomedical developments in a way that preserves the fundamental values of solidarity and justice. This is particularly important, given how rapidly developments in this field are progressing.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148308770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Management of older adults with traumatic injuries: extending the ABCDE approach with Frailty and Goals of care]. [老年人创伤性损伤的管理：扩展ABCDE方法与虚弱和护理目标]。
Nederlands tijdschrift voor geneeskunde Pub Date : 2026-05-20
D W P M Laane, J J M Haverkort, H C Willems, D van der Velde
{"title":"[Management of older adults with traumatic injuries: extending the ABCDE approach with Frailty and Goals of care].","authors":"D W P M Laane, J J M Haverkort, H C Willems, D van der Velde","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>The incidence of older adults with traumatic injuries is expected to increase markedly in the coming years with the aging of the population. Clinical decision-making for these patients requires a holistic perspective that takes into account frailty and individual patient preferences. In trauma care, the ABCDE protocol as described in ATLS has been used for decades and is regarded as the international gold standard for the assessment and management of trauma patients. The ABCDE approach has undeniably contributed to significant improvements in trauma care and patient outcomes. In this article, however, we propose a trauma geriatrics-specific acronym: ABCDE-FG. During the secondary survey (after stabilization of life-threatening injuries) attention should be given to two additional dimensions: Frailty (F) and Goals of care (G). This approach aims to minimize overdiagnosis and overtreatment and to ensure that care truly aligns with the patient's values and preferences.</p>","PeriodicalId":18903,"journal":{"name":"Nederlands tijdschrift voor geneeskunde","volume":"170 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148144048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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