C.S. de Vries

The epidemiology of Guillain-Barré syndrome worldwide. A systematic literature review

Background: This systematic literature review of the epidemiology of Guillain-Barré syndrome (GBS) identifies trends in incidence rates by age, study method and cause of disease. It is important to have a reliable estimate of incidence to determine and investigate any changes: no previous systematic reviews of GBS have been found. Methods: After critical assessment of the reliability of the reported data, incidence rates were extracted from all relevant papers published between 1980 and 2008, identified through searches of Medline, Embase and Science Direct. Results: Sixty-three papers were included in this review; these studies were prospective, retrospective reviews of medical records or retrospective database studies. Ten studies reported on the incidence in children (0–15 years old), and found the annual incidence to be between 0.34 and 1.34/100,000. Most studies investigated populations in Europe and North America and reported similar annual incidence rates, i.e. between 0.84 and 1.91/100,000. A decrease in incidence over the time between the 1980s and 1990s was found. Up to 70% of cases of GBS were caused by antecedent infections. Conclusions: Our best estimate of the overall incidence of GBS was between 1.1/100,000/year and 1.8/100,000/year. The incidence of GBS increased with age after 50 years from 1.7/100,000/year to 3.3/100,000/year.

Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study - Part 1

Objective  To determine the value of patient‐reported symptoms in diagnosing endometriosis.

The Incidence of Myasthenia Gravis: A Systematic Literature Review

Background: A systematic review of literature published between 1980 and 2007, on the incidence of myasthenia gravis, was undertaken. Methods: All relevant papers found through searches of Medline, Embase and Science Direct were critically appraised and an assessment was made of the reliability of the reported incidence data. Results: Thirty-one studies were included in the review, the majority of which investigated populations in Europe. The incidence rates reported were between 3.0 and 30.0/1,000,000/year. However, it is thought that the rates at the upper end of this range, reported by the prospective studies, provided the most accurate estimates. Overall, incidence rates have increased over time owing to a greater awareness of the disease and improved methods of diagnosis. Conclusions: The most accurate estimate of incidence of myasthenia gravis was around 30/ 1,000,000/year. The incidence in children and adolescents aged 0–19 years was found to be between 1.0 and 5.0/ 1,000,000/year. The rates presented in this review are likely to be an underestimate of the true incidence rates, as mild cases will have been missed and cases in the elderly will have been misdiagnosed.

Multicentre evaluation of intraoperative molecular analysis of sentinel lymph nodes in breast carcinoma

Ideally, intraoperative sentinel lymph node (SLN) analysis in breast cancer should be automated, have high concordance with extensive histopathology, and be applicable in any hospital setting. A prospective multicentre evaluation of the one‐step nucleic acid amplification (OSNA) automated molecular diagnostic system of SLN analysis was undertaken.

Endometriosis and its coexistence with irritable bowel syndrome and pelvic inflammatory disease: findings from a national case-control study--Part 2.

Objective  To investigate whether the increased chances of having a diagnosis of irritable bowel syndrome (IBS) and pelvic inflammatory disease (PID) in women with endometriosis is due to misdiagnosis or co‐morbidity.

Utilisation of hormone replacement therapy in the united kingdom. A descriptive study using the general practice research database

Objective  To determine prevalence and patterns of hormone replacement therapy (HRT) utilisation in women in the UK.

Prescribing of gastroprotective drugs among elderly NSAID users in the Netherlands

Background: Use of non-steroidal anti-inflammatory drugs (NSAIDs) is associated with an increased risk of gastrointestinal toxicity, in particular when risk factors are present. Methods: A study was performed to investigate concomitant prescribing of gastroprotective agents (H2-receptor antagonists, proton pump inhibitors, or misoprostol) in an ambulatory cohort of NSAID users aged 65 years and over. The prevalence of concomitant prescribing was studied, as well as the prophylactic prescribing of gastroprotective drugs. A stepwise logistic regression was performed to determine predictive variables of prophylactic and concomitant gastroprotective drug prescribing.Results: Co-prescribing of gastroprotective drugs occurred in 1522 (23%) (of which 944 concerned prophylactic prescribing) of the NSAID users (n=6557), with an average duration of 67 days per 100 days of NSAID use.Co-prescribing of gastroprotective drugs varied among individual NSAIDs. Concomitant use of oral corticosteroids (ORadj 2.4; CI95 2.0-2.9), coumarins (ORadj 1.6; CI95 1.3-2.0), and low dose aspirin (ORadj 1.6; CI95 1.4-1.9) were significantly associated with both prophylactic and concomitant prescribing of gastroprotective agents during NSAID therapy. Discussion: Despite current guidelines recommending gastroprotective drug prescribing among high risk groups, the rate of concomitant prescribing of gastroprotective agents in NSAID users aged 65 years and over is low. Feedback to prescribers should be given to improve prescribing practices in this high risk group.

Concomitant prescribing of benzodiazepines during antidepressant therapy in the elderly

A follow-up study was performed in two ambulatory cohorts aged > or =65 to investigate whether the prevalence and incidence of anxiolytic/hypnotic benzodiazepine drug prescribing is comparable between users of serotonin reuptake inhibitors (SSRIs) and users of tricyclic antidepressants (TCAs). The prevalence and incidence of benzodiazepines during antidepressant therapy was estimated among users of TCAs and SSRIs. Coprescribing of benzodiazepines occurred in 53% of the TCA users and 57% of the SSRI users (prevalence RR 1.1; CI(95) 0.9-1.2). The average duration of benzodiazepine drug use was >65 days per 100 days of antidepressant use. During SSRI therapy, significantly more people started benzodiazepine drug therapy than during TCA therapy (incidence rate ratio (RR) 1.7; CI(95) 1.2-2.4). Analyses repeated 5 years later yielded similar results (overall incidence RR(MH) 1.6; CI(95) 1.3-2.0). These data indicate that SSRI use is associated with a significantly higher chance of starting benzodiazepines compared with TCA use.

Pregnancy losses in women with type 1 or type 2 diabetes in the UK: an investigation using primary care records

This study aims to investigate pregnancy losses in women with Type 1 or Type 2 diabetes and compare this with the general population.

Registration of drug use in a birth defect monitoring system: a priority worthy of emphasis!

This article examines sources of information on drug use during pregnancy in the northeastern part of The Netherlands, comparing data from a congenital anomalies registry and figures obtained from community pharmacy records for a drug utilization study. Physicians and midwives report to the congenital anomalies registry on a voluntary basis. A limited quantity of exposure data is registered. According to the congenital anomalies registry, drug use during pregnancy is significantly less than it is according to the drug utilization study in the same area, suggesting that the former obtains incomplete data.For anomalies occurring spontaneously in a relatively high frequency, any link between a small further increase in the frequency of these anomalies and the maternal use of certain drugs is likely to go undetected if one monitors only the frequency of these anomalies, the increase being rendered inconspicuous by spontaneous variations. Routine monitoring of drug use in association with congenital anomalies will be needed if such links are to be profiled. Preferably, a complete and correct registration of all drug use should be assured, from three months before conception to the time of delivery.Data retrieved from the records of community pharmacies on the use of prescription drugs, complemented by data on hospital drug use and information from the women themselves on their self-medication is likely to produce a relatively complete picture of drug utilization for the purpose of a register of congenital anomalies.