[Heat illness]. / Hitteziekte.

Thermoregulation keeps the normal body temperature of humans at approximately 37 °C. However, as a result of heat load - both endogenous and exogenous heat - it can occur that the body is unable to dissipate excess heat, leading to an increase in the core body temperature. This can result in various heat illnesses, ranging from mild, non-life-threatening conditions, such as heat rash, heat edema, heat cramps, heat syncope and exercise associated collapse to life-threatening conditions, namely exertional heatstroke and classic heatstroke. Exertional heatstroke is the result of strenuous exercise in a (relatively) hot environment, whereas classic heatstroke is caused by environmental heat. Both forms result in a core temperature of > 40 °C in combination with a lowered or altered consciousness. Early recognition and treatment are critical in reducing morbidity and mortality. Cornerstone of treatment is cooling.

Multi-organ failure with necrotic skin lesions due to infection with Chlamydia psittaci.

Presented is a patient with dyspnea and painful ulcers finally resulting in multi-organ failure. A detailed history resulted in positive PCR testing for Chlamydia psittaci. We emphasize the importance of a definitive history in establishing the correct diagnosis. When clinicians observe dyspnea with multi-organ failure, they should be aware of psittacosis.

[A body packer with cannabis]. / Een bodypacker met cannabis.

BACKGROUND: In recent years, numerous reports have been published on body packers, i.e. people who use their own body to transport drugs. Most body packers swallow small packages of cocaine or heroin. CASE DESCRIPTION: We describe the case of a patient who, two days after ingestion of packages containing cannabis, was admitted for dizziness and drowsiness. Urinalysis was positive for cannabis and negative for other drugs. The deterioration in clinical status possibly indicated a burst package. The packages were surgically removed and the patient made a full recovery. CONCLUSION: Some body packers transport other drugs than cocaine or heroin, such as cannabis. In body packers who ingest cannabis, depressed consciousness is a main symptom of intoxication. They should be admitted and monitored for symptoms of intoxication or paralytic ileus. Laboratory tests provide qualitative support when interpreting clinical symptoms. Surgical intervention is indicated in cases of bowel obstruction or when intoxication due to package leakage is suspected.

Comparative effectiveness of a serious game and an e-module to support patient safety knowledge and awareness.

BACKGROUND: Serious games have the potential to teach complex cognitive skills in an engaging way, at relatively low costs. Their flexibility in use and scalability makes them an attractive learning tool, but more research is needed on the effectiveness of serious games compared to more traditional formats such e-modules. We investigated whether undergraduate medical students developed better knowledge and awareness and were more motivated after learning about patient-safety through a serious game than peers who studied the same topics using an e-module. METHODS: Fourth-year medical students were randomly assigned to either a serious game that included video-lectures, biofeedback exercises and patient missions (n = 32) or an e-module, that included text-based lectures on the same topics (n = 34). A third group acted as a historical control-group without extra education (n = 37). After the intervention, which took place during the clinical introduction course, before the start of the first rotation, all students completed a knowledge test, a self-efficacy test and a motivation questionnaire. During the following 10-week clinical rotation they filled out weekly questionnaires on patient-safety awareness and stress. RESULTS: The results showed patient safety knowledge had equally improved in the game group and e-module group compared to controls, who received no extra education. Average learning-time was 3 h for the game and 1 h for the e-module-group. The serious game was evaluated as more engaging; the e-module as more easy to use. During rotations, students in the three groups reported low and similar levels of patient-safety awareness and stress. Students who had treated patients successfully during game missions experienced higher self-efficacy and less stress during their rotation than students who treated patients unsuccessfully. CONCLUSIONS: Video-lectures (in a game) and text-based lectures (in an e-module) can be equally effective in developing knowledge on specific topics. Although serious games are strongly engaging for students and stimulate them to study longer, they do not necessarily result in better performance in patient safety issues.

Small bowel angioedema due to acquired C1 inhibitor deficiency: a case report and overview.

Acquired angioedema is a rare disorder caused by an acquired deficiency of C1 inhibitor. It is characterized by nonpitting, nonpruritic subcutaneous or submucosal edema of the skin, or of the respiratory or gastrointestinal tract. When localized in the gastrointestinal tract, it can cause severe abdominal pain, mimicking an acute surgical abdomen, or chronic recurrent pain of moderate intensity. We report a case of a 48-year-old man presenting with recurrent episodes of hypotension and abdominal pain. Computed tomography of the abdomen showed edema of the small bowel. The first determinations of C1 inhibitor level and activity, measured in a symptom-free period, were normal. Repetition of the laboratory tests in the acute phase, however, showed a low C1 inhibitor level. Further diagnostic work-up indicated an acquired C1 inhibitor deficiency caused by a monoclonal gammopathy. He was treated with tranexamic acid as prophylaxis for his frequent attacks and to date, he has remained symptom free. Acquired C1 inhibitor deficiency is a rare cause of angioedema and is, among others, related to autoantibodies and abnormal B-cell proliferation, for example monoclonal gammopathy. The diagnosis of acquired C1 inhibitor deficiency is made on the basis of the medical history and on the level and activity of plasma C4, C1q, and C1 inhibitor. In case of high suspicion and a normal C1 inhibitor activity, it is recommended to repeat this test during an angioedema attack. Early diagnosis is important for the treatment of severe, potentially life-threatening attacks and to start prophylactic treatment in patients with frequent or severe angioedema attacks.