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Editorial: Life is full of ups and downs

Life is full of ups and downs

A patient in ill health, an amazing night out with some friends, an article being rejected for the second time, watching a dorky movie with the one you love, your bike getting stolen, an offer to participate in research. Life is full of ups and downs. The same can be said about the life of AMSj. Periods of uncertainty followed by great opportunities; lots of articles being sent in for review, an amazing dinner to honour one of our founding members, uncertainty whether there would be a next issue, inspiring ideas from new board members. These ups and downs keep us motivated and inspire to work hard for progress in the long run. Without mentioning some timeworn quotes by Silvester Stallone or Sun Tzu, I think the most important thing is to stay balanced as an individual and as an organisation. This could be accomplished by opening up to people close to you, reflecting on yourself (or as an organisation) and sometimes to prioritise by giving up a dream in order to reach closer to another.

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Solving Statistics: Inter-observer reliability

Inter-observer reliability


In a prospective cohort study to propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA), the researchers also investigated inter-observer reliability between two readers. Images from 20 randomly chosen patients (of the 48 patients included in the study) were evaluated for the inflammation and joint damage parameters of the joints included in the US10 score (second and third MCPs and PIPs and wrists), yielding a total of 200 images. A trained rheumatologist preformed the initial US examination, he had eight years of experience in US and was blinded to all other study findings. The 2nd evaluation of the ultrasound images was performed by a rheumatologist, with five years of experie

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Radiology Image: An athlete with pain

An athlete with pain

[headline_subtitle title=”” subtitle=”Can you solve the radiology image of this edition?”]
Patient data
  • Age: 19
  • Gender: Male
  • Medical history: None
  • Initial presentation: Patient is a professional athlete (100 metres sprint) who has been intensively training for the last 6-8 weeks. Acute onset of pain in the medial part of the right foot.
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Clinical Image: A hairy problem

A hairy problem

[headline_subtitle subtitle=”Can you come up with the proper diagnosis?”]

A 9-year old boy with a long history of frequently relapsing nephrotic syndrome was reviewed at the pediatric outpatient clinic soon after recent immigration from another country. One striking feature on physical examination was excessive hair growth. The hair growth was restricted to his back and existed of long, dark hairs. Upon further examination, there were no signs of sexual development, such as testicular enlargement or pubic hair.

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Subject 101: Oxygenation


Medical doctors on general wards are frequently confronted with patients requiring oxygen suppletion. But which oxygen delivery system should be chosen and why?

This 101 focusses on the topic of oxygenation and its distinction from ventilation. Furthermore, several types of oxygen delivery systems are discussed.

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Changing Perspectives: DSM-IV: make way for DSM-5

DSM-IV: make way for DSM-5

As of 2017 the fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) will be the leading classification system for psychiatry in the Netherlands. It succeeds its predecessor DSM-IV, which has been around since the ‘90s and was known for adding the required ‘clinically significant impairment in functioning’ criterion to many disorders.

One of the biggest changes is the removal of the multiaxial system. Sixteen new classifications have been added and some disorder groups have changed radically. Most notably, the diagnosis ‘Autism Spectrum Disorder’ now encompasses autism, Asperger’s disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified and it is categorized in severity. Another notable change is the reorganization of the former anxiety disorders into separate anxiety, obsessive-compulsive-related and trauma- and stressor-related disorders.

Not all changes have been met with enthusiasm. For example, there has been much debate about the removal of the bereavement exclusion in major depressive disorder. This criterion was used to exclude the possibility of diagnosing someone with a depression in the first two months of grief. Some fear that this removal may lead to unnecessarily medicalizing normal grief.

According to Edith Schippers, Minister of Health, Welfare and Sport, the change to DSM-5 will not have any noticeable effect, insurance-wise. It will be interesting to see how much impact this DSM update will have in the everyday clinical setting.

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Changing Perspective: The use of 24-hour urine collections to estimate sodium intake: lessons from space

The use of 24-hour urine collections to estimate sodium intake: lessons from space

The relation between sodium intake and cardiovascular health is a subject of an ongoing, sometimes overheated, discussion. An important issue contributing to this discussion is the way by which sodium intake is assessed, e.g. by the use of morning urine samples or dietary questionnaires. Generally, measurement of sodium content in 24-hour urine collection is considered to be the best reflection of daily sodium intake. Recent data indicate that the latter may not be true, not only because of daily variation in sodium intake, sampling errors or urinary bladder retention. The recent discovery by Rakova et al in subjects that underwent training for a long-term space flight to Mars (!) importantly influences the interpretation of sodium excretion using 24-hour collections.1 At a perfectly stable sodium intake for months, 24-hour sodium excretion into the urine has been demonstrated to display huge day-to-day fluctuations. The finding of rhythmic sodium excretory and retention patterns by the kidney may contribute to variations exceeding 50-100 mmol/d when subjects are put on a fixed diet containing 200 mmol/d of sodium. In light of the discussion on health outcomes related to sodium intake, alternatives to reliably assess an individual’s dietary sodium intake are highly needed, but yet unknown.
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Trial and Error: Honesty is the best policy

Honesty is the best policy

It was my final internship at the department of Cardiology, the final test before becoming a real doctor. My supervisor had asked me to attend to a patient at the Oncology ward. The patient was diagnosed with stage IV lung carcinoma and the oncologist was worried about malignant pericarditis. I did a physical exam and went back to my supervisor.

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