Alewijn Ott - Academia.edu (original) (raw)
Papers by Alewijn Ott
European neurology, Jan 14, 2015
General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syp... more General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalization. Nowadays, physicians consider GPI to be exceptional. It should be noted, however, that syphilis re-emerged worldwide at the turn of the 20th to 21st century and a revival of GPI can, therefore, be expected. Advanced diagnosis is crucial in that treatment in the early, inflammatory phase is warranted before irreversible tissue damage occurs. Therefore, a renewed clinical awareness of the broad spectrum of psychiatric and neurologic signs and symptoms of GPI is needed. In this historical cohort study, comprising 105 patients with GPI admitted to the Dutch Vincent van Gogh Psychiatric Hospital in the period 1924-1954, the clinical presentation of this invalidating disorder is investigated and described in detail. © 2015 S. Karger AG, Basel.
Nederlands tijdschrift voor geneeskunde, 2015
Encephalitis caused by a free-living amoeba is relatively rare and usually fatal. This is because... more Encephalitis caused by a free-living amoeba is relatively rare and usually fatal. This is because the diagnosis is often made late and treatment is difficult. A 41-year-old patient with a previous history including kidney transplant was admitted with clinical symptoms of encephalitis. Brain imaging showed a number of hypodense regions, which were possibly abscesses. Although an infectious cause seemed probable, even the most extensive antimicrobial treatment was ineffective. The cause was not found until 2 months after the patient's death: infection with Balamuthia mandrillaris. A PCR test was used to detect this amoeba. This case study describes the first patient in the Netherlands to be diagnosed with granulomatous amoebic encephalitis caused by B. mandrillaris. An amoeba may be the cause of encephalitis with either a fulminant course or with a gradual increase of symptoms, without conventional anti-infective therapy being effective.
Nederlands tijdschrift voor geneeskunde, 2015
In the revised Dutch guidelines, faeces testing for Shigella is advised for all household contact... more In the revised Dutch guidelines, faeces testing for Shigella is advised for all household contacts if the index person is less than 6 years old and for persons with symptoms. We argue that in most cases there is no need for faeces testing. Clusters of shigelloses have become rare, and hygienic measures are sufficient to prevent transmission. The statistical significance of shigella transmission in children under 6 years old, on which the revised guideline is based, has no clinical relevance. In fact, the infection rate is only 7% even among the high-risk contacts of the index patients under 6 years old and only 1 infection per 4 index persons (25/104). Hygienic measures and exclusion from childcare centres or school in the event of symptoms are sufficient measures to prevent transmission.
European Journal of Epidemiology, May 3, 2011
New England Journal of Medicine
Nederlands tijdschrift voor geneeskunde
Nederlands tijdschrift voor geneeskunde
Epidemiology of Alzheimer’s Disease: From Gene to Prevention, 1999
Trials, 2015
Access for endovascular repair of abdominal aortic aneurysms (EVAR) is obtained through surgical ... more Access for endovascular repair of abdominal aortic aneurysms (EVAR) is obtained through surgical cutdown or percutaneously. The only devices suitable for percutaneous closure of the 20 French arteriotomies of the common femoral artery (CFA) are the Prostar™ and Proglide™ devices (Abbott Vascular). Positive effects of these devices seem to consist of a lower infection rate, and shorter operation time and hospital stay. This conclusion was published in previous reports comparing techniques in patients in two different groups (cohort or randomized). Access techniques were never compared in one and the same patient; this research simplifies comparison because patient characteristics will be similar in both groups. Percutaneous access of the CFA is compared to surgical cutdown in a single patient; in EVAR surgery, access is necessary in both groins in each patient. Randomization is performed on the introduction site of the larger main device of the endoprosthesis. The contralateral devic...
The Lancet Infectious Diseases, 2015
Existing approaches for the screening and treatment of asymptomatic bacteriuria in pregnancy are ... more Existing approaches for the screening and treatment of asymptomatic bacteriuria in pregnancy are based on trials that were done more than 30 years ago. In this study, we reassessed the consequences of treated and untreated asymptomatic bacteriuria in pregnancy. In this multicentre prospective cohort study with an embedded randomised controlled trial, we screened women (aged ≥18 years) at eight hospitals and five ultrasound centres in the Netherlands with a singleton pregnancy between 16 and 22 weeks' gestation for asymptomatic bacteriuria. Screening was done with a single dipslide and two culture media. Dipslides were judged positive when the colony concentration was at least 1×10(5) colony-forming units (CFU) per mL of a single microorganism or when two different colony types were present but one had a concentration of at least 1×10(5) CFU per mL. Asymptomatic bacteriuria-positive women were eligible to participate in the randomised controlled trial comparing nitrofurantoin with placebo treatment. In this trial, participants were randomly assigned 1:1 to receive either nitrofurantoin 100 mg or identical placebo tablets, and were instructed to self-administer these tablets twice daily for 5 consecutive days. Randomisation was done by a web-based application with a computer-generated list with random block sizes of two, four, or six participants rendered by an independent data manager. 1 week after the end of treatment, they provided us with a follow-up dipslide. Women, treating physicians, and researchers all remained unaware of the bacteriuria status and treatment allocation. Women who refused to participate in the randomised controlled trial did not receive any antibiotics, but their outcomes were collected for analysis in the cohort study. We compared untreated and placebo-treated asymptomatic bacteriuria-positive women with asymptomatic bacteriuria-negative women and nitrofurantoin-treated asymptomatic bacteriuria-positive women. The primary endpoint was a composite of pyelonephritis with or without preterm birth at less than 34 weeks, analysed by intention to treat at 6 weeks post-partum. This trial is registered with the Dutch Trial Registry, number NTR3068. Between Oct 11, 2011, and June 10, 2013, we enrolled 5621 women into our screening cohort, of whom 5132 were eligible for screening. After exclusions for contaminated dipslides and patients lost to follow-up, in our final cohort of 4283 women, 248 were asymptomatic bacteriuria positive, of whom 40 were randomly assigned to nitrofurantoin and 45 to placebo for the randomised controlled trial, whereas the other 163 asymptomatic bacteriuria-positive women were followed without treatment. The proportion of women with pyelonephritis, preterm birth, or both did not differ between untreated or placebo-treated asymptomatic bacteriuria-positive women and asymptomatic bacteriuria-negative women (6 [2·9%] of 208 vs 77 [1·9%] of 4035; adjusted odds ratio [OR] 1·5, 95% CI 0·6-3·5) nor between asymptomatic bacteriuria-positive women treated with nitrofurantoin versus those who were untreated or received placebo (1 [2·5%] of 40 vs 6 [2·9%] of 208; risk difference -0·4, 95% CI -3·6 to 9·4). Untreated or placebo-treated asymptomatic bacteriuria-positive women developed pyelonephritis in five [2·4%] of 208 cases, compared with 24 [0·6%] of 4035 asymptomatic bacteriuria-negative women (adjusted OR 3·9, 95% CI 1·4-11·4). In women with an uncomplicated singleton pregnancy, asymptomatic bacteriuria is not associated with preterm birth. Asymptomatic bacteriuria showed a significant association with pyelonephritis, but the absolute risk of pyelonephritis in untreated asymptomatic bacteriuria is low. These findings question a routine screen-treat-policy for asymptomatic bacteriuria in pregnancy. ZonMw (the Netherlands Organisation for Health Research and Development).
![Research paper thumbnail of [MRSA carriership in families of MRSA patients]](https://attachments.academia-assets.com/43629532/thumbnails/1.jpg)
](Nederlands tijdschrift voor geneeskunde, 2011
To determine how many family members of methicillin resistant Staphylococcus aureus (MRSA) patien... more To determine how many family members of methicillin resistant Staphylococcus aureus (MRSA) patients were colonised with MRSA and how this colonisation developed over time. Descriptive, prospective. Two laboratories notified the Public Health Services of newly-diagnosed MRSA patients in three provinces of the Netherlands. These persons and their family members were screened for MRSA colonisation at baseline, after 3 to 4 months and after 6 to 12 months. No advice on medical intervention was given. Relevant medical interventions by general practitioners were registered. Nineteen index patients and their families were included. A total of 41% of the family members (n = 44) proved MRSA positive on at least one of the three tests. At second follow-up the proportion of colonised family members had decreased slightly from 32% to 27%; by the end of the study only a third of the index patients were still MRSA positive. Colonisation of index patients was more persistent if family members were...
Neurobiology of aging
Recent studies suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce t... more Recent studies suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the risk for Alzheimer's disease (AD). We investigated the relation of NSAID use over a 10-year period and the risk for incident AD using a nested case-control design in the population-based Rotterdam Study. The study was performed in 306 subjects; 74 Alzheimer patients diagnosed according to NINCDS-ADRDRA criteria and 232 age and sex-matched controls. NSAID use was abstracted from general practitioners' medical records and expressed as cumulative prescription days. The relative risk for AD associated with long-term use (> or = 2 months) was 0.95 (95% CI: 0.46-1.99) as compared to nonusers, after controlling for possible confounders. In a separate examination, subjects who had more than 6 months of prescription days had a reduced relative risk for AD (RR = 0.74 (95% CI: 0.20-2.72). In an age-stratified analysis the effect in long-term users was evident in those aged 85 and unde...
Journal of neural transmission. Supplementum, 1998
The apolipoprotein E4 allele (APOE epsilon 4) and atherosclerosis are risk factors for cognitive ... more The apolipoprotein E4 allele (APOE epsilon 4) and atherosclerosis are risk factors for cognitive decline. We investigated whether the effects of APOE epsilon 4 and atherosclerosis on cognitive decline are independent. A population-based follow-up study was performed on 838 subjects who were non-demented at baseline. The Mini Mental State Examination (MMSE) score at follow-up was studied as a function of APOE epsilon 4 and atherosclerosis. Mild, non-significant effects on the MMSE score were found for atherosclerosis in the absence of APOE epsilon 4 and for APOE epsilon 4 in the absence of atherosclerosis. APOE epsilon 4 carriers with two or more indicators of atherosclerosis positive, had a significantly lower MMSE score at follow-up (mean difference -0.7 points; 95% confidence interval -1.1 to -0.2) relative to non-APOE epsilon 4 carriers with no evidence of atherosclerosis. Our findings suggest that the consequences of APOE epsilon 4 and atherosclerosis are not independent, and th...
European neurology, Jan 14, 2015
General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syp... more General paralysis of the insane (GPI) or dementia paralytica was once a fatal complication of syphilitic infection and a major reason for psychiatric hospitalization. Nowadays, physicians consider GPI to be exceptional. It should be noted, however, that syphilis re-emerged worldwide at the turn of the 20th to 21st century and a revival of GPI can, therefore, be expected. Advanced diagnosis is crucial in that treatment in the early, inflammatory phase is warranted before irreversible tissue damage occurs. Therefore, a renewed clinical awareness of the broad spectrum of psychiatric and neurologic signs and symptoms of GPI is needed. In this historical cohort study, comprising 105 patients with GPI admitted to the Dutch Vincent van Gogh Psychiatric Hospital in the period 1924-1954, the clinical presentation of this invalidating disorder is investigated and described in detail. © 2015 S. Karger AG, Basel.
Nederlands tijdschrift voor geneeskunde, 2015
Encephalitis caused by a free-living amoeba is relatively rare and usually fatal. This is because... more Encephalitis caused by a free-living amoeba is relatively rare and usually fatal. This is because the diagnosis is often made late and treatment is difficult. A 41-year-old patient with a previous history including kidney transplant was admitted with clinical symptoms of encephalitis. Brain imaging showed a number of hypodense regions, which were possibly abscesses. Although an infectious cause seemed probable, even the most extensive antimicrobial treatment was ineffective. The cause was not found until 2 months after the patient's death: infection with Balamuthia mandrillaris. A PCR test was used to detect this amoeba. This case study describes the first patient in the Netherlands to be diagnosed with granulomatous amoebic encephalitis caused by B. mandrillaris. An amoeba may be the cause of encephalitis with either a fulminant course or with a gradual increase of symptoms, without conventional anti-infective therapy being effective.
Nederlands tijdschrift voor geneeskunde, 2015
In the revised Dutch guidelines, faeces testing for Shigella is advised for all household contact... more In the revised Dutch guidelines, faeces testing for Shigella is advised for all household contacts if the index person is less than 6 years old and for persons with symptoms. We argue that in most cases there is no need for faeces testing. Clusters of shigelloses have become rare, and hygienic measures are sufficient to prevent transmission. The statistical significance of shigella transmission in children under 6 years old, on which the revised guideline is based, has no clinical relevance. In fact, the infection rate is only 7% even among the high-risk contacts of the index patients under 6 years old and only 1 infection per 4 index persons (25/104). Hygienic measures and exclusion from childcare centres or school in the event of symptoms are sufficient measures to prevent transmission.
European Journal of Epidemiology, May 3, 2011
New England Journal of Medicine
Nederlands tijdschrift voor geneeskunde
Nederlands tijdschrift voor geneeskunde
Epidemiology of Alzheimer’s Disease: From Gene to Prevention, 1999
Trials, 2015
Access for endovascular repair of abdominal aortic aneurysms (EVAR) is obtained through surgical ... more Access for endovascular repair of abdominal aortic aneurysms (EVAR) is obtained through surgical cutdown or percutaneously. The only devices suitable for percutaneous closure of the 20 French arteriotomies of the common femoral artery (CFA) are the Prostar™ and Proglide™ devices (Abbott Vascular). Positive effects of these devices seem to consist of a lower infection rate, and shorter operation time and hospital stay. This conclusion was published in previous reports comparing techniques in patients in two different groups (cohort or randomized). Access techniques were never compared in one and the same patient; this research simplifies comparison because patient characteristics will be similar in both groups. Percutaneous access of the CFA is compared to surgical cutdown in a single patient; in EVAR surgery, access is necessary in both groins in each patient. Randomization is performed on the introduction site of the larger main device of the endoprosthesis. The contralateral devic...
The Lancet Infectious Diseases, 2015
Existing approaches for the screening and treatment of asymptomatic bacteriuria in pregnancy are ... more Existing approaches for the screening and treatment of asymptomatic bacteriuria in pregnancy are based on trials that were done more than 30 years ago. In this study, we reassessed the consequences of treated and untreated asymptomatic bacteriuria in pregnancy. In this multicentre prospective cohort study with an embedded randomised controlled trial, we screened women (aged ≥18 years) at eight hospitals and five ultrasound centres in the Netherlands with a singleton pregnancy between 16 and 22 weeks' gestation for asymptomatic bacteriuria. Screening was done with a single dipslide and two culture media. Dipslides were judged positive when the colony concentration was at least 1×10(5) colony-forming units (CFU) per mL of a single microorganism or when two different colony types were present but one had a concentration of at least 1×10(5) CFU per mL. Asymptomatic bacteriuria-positive women were eligible to participate in the randomised controlled trial comparing nitrofurantoin with placebo treatment. In this trial, participants were randomly assigned 1:1 to receive either nitrofurantoin 100 mg or identical placebo tablets, and were instructed to self-administer these tablets twice daily for 5 consecutive days. Randomisation was done by a web-based application with a computer-generated list with random block sizes of two, four, or six participants rendered by an independent data manager. 1 week after the end of treatment, they provided us with a follow-up dipslide. Women, treating physicians, and researchers all remained unaware of the bacteriuria status and treatment allocation. Women who refused to participate in the randomised controlled trial did not receive any antibiotics, but their outcomes were collected for analysis in the cohort study. We compared untreated and placebo-treated asymptomatic bacteriuria-positive women with asymptomatic bacteriuria-negative women and nitrofurantoin-treated asymptomatic bacteriuria-positive women. The primary endpoint was a composite of pyelonephritis with or without preterm birth at less than 34 weeks, analysed by intention to treat at 6 weeks post-partum. This trial is registered with the Dutch Trial Registry, number NTR3068. Between Oct 11, 2011, and June 10, 2013, we enrolled 5621 women into our screening cohort, of whom 5132 were eligible for screening. After exclusions for contaminated dipslides and patients lost to follow-up, in our final cohort of 4283 women, 248 were asymptomatic bacteriuria positive, of whom 40 were randomly assigned to nitrofurantoin and 45 to placebo for the randomised controlled trial, whereas the other 163 asymptomatic bacteriuria-positive women were followed without treatment. The proportion of women with pyelonephritis, preterm birth, or both did not differ between untreated or placebo-treated asymptomatic bacteriuria-positive women and asymptomatic bacteriuria-negative women (6 [2·9%] of 208 vs 77 [1·9%] of 4035; adjusted odds ratio [OR] 1·5, 95% CI 0·6-3·5) nor between asymptomatic bacteriuria-positive women treated with nitrofurantoin versus those who were untreated or received placebo (1 [2·5%] of 40 vs 6 [2·9%] of 208; risk difference -0·4, 95% CI -3·6 to 9·4). Untreated or placebo-treated asymptomatic bacteriuria-positive women developed pyelonephritis in five [2·4%] of 208 cases, compared with 24 [0·6%] of 4035 asymptomatic bacteriuria-negative women (adjusted OR 3·9, 95% CI 1·4-11·4). In women with an uncomplicated singleton pregnancy, asymptomatic bacteriuria is not associated with preterm birth. Asymptomatic bacteriuria showed a significant association with pyelonephritis, but the absolute risk of pyelonephritis in untreated asymptomatic bacteriuria is low. These findings question a routine screen-treat-policy for asymptomatic bacteriuria in pregnancy. ZonMw (the Netherlands Organisation for Health Research and Development).
Nederlands tijdschrift voor geneeskunde, 2011
To determine how many family members of methicillin resistant Staphylococcus aureus (MRSA) patien... more To determine how many family members of methicillin resistant Staphylococcus aureus (MRSA) patients were colonised with MRSA and how this colonisation developed over time. Descriptive, prospective. Two laboratories notified the Public Health Services of newly-diagnosed MRSA patients in three provinces of the Netherlands. These persons and their family members were screened for MRSA colonisation at baseline, after 3 to 4 months and after 6 to 12 months. No advice on medical intervention was given. Relevant medical interventions by general practitioners were registered. Nineteen index patients and their families were included. A total of 41% of the family members (n = 44) proved MRSA positive on at least one of the three tests. At second follow-up the proportion of colonised family members had decreased slightly from 32% to 27%; by the end of the study only a third of the index patients were still MRSA positive. Colonisation of index patients was more persistent if family members were...
Neurobiology of aging
Recent studies suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce t... more Recent studies suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the risk for Alzheimer's disease (AD). We investigated the relation of NSAID use over a 10-year period and the risk for incident AD using a nested case-control design in the population-based Rotterdam Study. The study was performed in 306 subjects; 74 Alzheimer patients diagnosed according to NINCDS-ADRDRA criteria and 232 age and sex-matched controls. NSAID use was abstracted from general practitioners' medical records and expressed as cumulative prescription days. The relative risk for AD associated with long-term use (> or = 2 months) was 0.95 (95% CI: 0.46-1.99) as compared to nonusers, after controlling for possible confounders. In a separate examination, subjects who had more than 6 months of prescription days had a reduced relative risk for AD (RR = 0.74 (95% CI: 0.20-2.72). In an age-stratified analysis the effect in long-term users was evident in those aged 85 and unde...
Journal of neural transmission. Supplementum, 1998
The apolipoprotein E4 allele (APOE epsilon 4) and atherosclerosis are risk factors for cognitive ... more The apolipoprotein E4 allele (APOE epsilon 4) and atherosclerosis are risk factors for cognitive decline. We investigated whether the effects of APOE epsilon 4 and atherosclerosis on cognitive decline are independent. A population-based follow-up study was performed on 838 subjects who were non-demented at baseline. The Mini Mental State Examination (MMSE) score at follow-up was studied as a function of APOE epsilon 4 and atherosclerosis. Mild, non-significant effects on the MMSE score were found for atherosclerosis in the absence of APOE epsilon 4 and for APOE epsilon 4 in the absence of atherosclerosis. APOE epsilon 4 carriers with two or more indicators of atherosclerosis positive, had a significantly lower MMSE score at follow-up (mean difference -0.7 points; 95% confidence interval -1.1 to -0.2) relative to non-APOE epsilon 4 carriers with no evidence of atherosclerosis. Our findings suggest that the consequences of APOE epsilon 4 and atherosclerosis are not independent, and th...