Patient data Age: 42 Gender: female Medical history: none Initial presentation: heavy, painful and elongated menstrual period for a few years.
Area of expertise Cholestatic and autoimmune liver and bile duct diseases. When did you decide to become a physician? As a child, I had grown up on a ‘Zauberberg’ (Thomas Mann) next to a hospital for pulmonary diseases - my…
This Syrian boy, the second child of consanguineous parents, presented with kidney stones in his country of origin at the age of 5½ years. In the following years he developed end stage kidney disease. He started hemodialysis treatment at the age of 11 years. In 2012 he underwent a kidney transplant, which failed soon after surgery. Hemodialysis was resumed. The following year he lost his ability to walk. In 2015 the patient moved to the Netherlands. Upon arrival, he was found to be underdialysed, underfed and to suffer from severe bone disease. An abdominal X-ray was performed.
The distribution of a continuous numerical variable tells you something about how likely each possible outcome or groups of outcomes will occur. The distribution of a continuous numerical variable can be described as normal or non-normal. A normal distribution is the name for a specific mathematical concept that follows a symmetric bell shaped curve and is completely defined by its mean and standard deviation. Approximately 68% of the observations fall between one standard deviation below and one standard deviation above the mean. And approximately 95% of the observations fall between two standard deviations below and two standard deviations above the mean. Normal distribution is an important term within the field of statistics. If you have a normal distribution you can perform a certain number of statistical tests that you cannot perform if your distribution is non-normal.1
In the Netherlands knee injuries occur approximately 300,000 times a year.1 Meniscal tears are among the most common knee injuries with an incidence of 2 per 1,000 patients a year.2 As a result arthroscopic meniscectomy is performed nearly 30,000 times a year in patients over 50 years of age.3 In over half of these patients magnetic resonance imaging (MRI) was performed prior to surgery. However, multiple randomized controlled trial observed no significant difference between knee function, pain relief and patient satisfaction when comparing arthroscopy to conservative treatment.4,5 In addition, the amount of knee arthroscopies where no therapeutic intervention was conducted during surgery ranges from 27 to 61%.1
Consequently, it is questioned whether these procedures benefit healthcare efficacy. Especially when taking into account that patients over 50 years of age are at risk of having existing osteoarthritis (OA) of the knee.6 This is accompanied by degenerative meniscal tears in up to 80%.7 Therefore, differentiating whether the symptoms are caused by the meniscal tear or developing OA is quite challenging. As a result, there is no indication to perform MRI in patients over 50 years of age according to the Netherlands Orthopedic Association (NOV). On that account, it is advised only to perform knee arthroscopy in case of locking of the knee caused by mechanical obstruction in these patients. This is without performing MRI prior to surgery.1
Therefore a substantial reduction of MRI and knee arthroscopies in patients over 50 years of age is warranted, especially in these times of increasing awareness of cost-effectiveness.6
Low density lipoprotein (LDL) cholesterol is an important modifiable risk factor for cardiovascular disease. The recently developed monoclonal antibody evolocumab, targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), has superior lipid-lowering effects to conventional statin therapy, additionally decreasing LDL cholesterol levels by approximately 60%. The trial we will discuss in this article is the first to assess the potential of evolocumab as secondary prevention for cardiovascular events in a large patient cohort.