[Safe administration of medicines: learning from our mistakes]. / Veilige geneesmiddeltoediening: leren van onze fouten.

This issue of the Dutch Journal of Medicine (NTvG) features a review article by Van der Veen et al. on safe administration of medicines in hospitals. This topic is part of an increased focus on patient safety that started at the beginning of the 21st century, following publication of the renowned report 'To err is human'. Now, almost 20 years later, we are a little disappointed that there is still no set of interventions that can be implemented to guarantee safe administration of medicines in hospitals. Why ever not? In this commentary we discuss the main limitations of the interventions that have been studied, but also describe what we think can already be implemented without further research.

[Splenomegaly in an Eritrean refugee: the hyper-reactive malaria splenomegaly syndrome.] / Splenomegalie bij een Eritrese vluchteling.

BACKGROUND: Hyper-reactive malaria splenomegaly (HMS) is a rare and potentially severe complication of malaria. It is likely that the incidence of patients with HMS will rise in the Netherlands due to the recent increase in asylum-seekers from Sub-Saharan Africa. It can be difficult to diagnose this disease, as this case shows. CASE DESCRIPTION: A 31-year-old male from Eritrea was admitted with fever and dyspnea, caused by an influenza A-infection. The patient also presented with cachexia, pronounced hepatosplenomegaly and pancytopenia. Microscopic diagnostic analysis for malaria was negative. HMS was eventually diagnosed through high-sensitivity qPCR for malaria, which showed the presence of a very low level of Plasmodium falciparum parasitemia; furthermore, IgM levels were high and malaria serology was strongly positive. CONCLUSION: HMS should be considered in patients from malaria-endemic areas presenting with splenomegaly and pancytopenia. Because standard diagnostics for malaria are often negative in this population, malaria serology and sensitive qPCR play an important diagnostic role.

Perioperative glycaemic control in insulin-treated type 2 diabetes patients undergoing gastric bypass surgery.

BACKGROUND: Roux-and-Y gastric bypass (RYGB) rapidly reduces insulin requirements in patients with insulin-dependent type 2 diabetes mellitus (T2DMi). A too modest reduction in insulin dose may lead to hypoglycaemia in the early postoperative period. OBJECTIVE: To evaluate a regimen designed to maintain blood glucose levels between 5-15 mmol/l and to prevent hypoglycaemic events (blood glucose <3.5 mmol/l) after RYGB surgery. DESIGN: The effect of a 75% reduction in insulin dose was studied in 85 T2DMi patients during the first ten days after RYGB. Patients with severe b-cell failure (fasting C-peptide <0.3 nmol/l) were excluded. PRIMARY OUTCOME MEASURES: percentage of patients exceeding the upper or lower blood glucose limits, and the number of hypoglycaemic events. RESULTS: The mean blood glucose level was 12.4±0.3 mmol/l (mean ± SE) on the day of surgery (day 0), 10.7±0.3 mmol/l on day 1, 10.0±0.5 mmol/l on day 2, and 8.3±0.3 on day 10. Of all measurements performed during this ten-day period, 12.4% were above the target range, and 2.6% were <5 mmol/l. There were no hypoglycaemic events during the stay in hospital. During the first week at home 2% of the measurements were <3.5 mmol/l. CONCLUSION: A 75% reduction in insulin dose is safe in T2DMi patients without severe b-cell failure, and prevents hypoglycaemia in the early postoperative period of RYGB in most cases.