SARS-CoV-2-Induced Multisystem Inflammatory Syndrome in a Young Adult: Case Report.

We describe a case of a previous healthy 20-year-old male athlete who presented with an atypical clinical profile with multiorgan involvement within five weeks after confirmed SARS-CoV-2 infection, suggestive for multisystem inflammatory syndrome (MIS); MIS is a rare, potentially life-threatening complication associated with SARS-CoV-2. MIS shares similar clinical features compatible with several overlapping lifethreatening hyperinflammatory syndromes, such as incomplete Kawasaki Disease (KD) and toxic shock syndrome (TSS) associated to a cytokine storm suggestive of a macrophage activation syndrome (MAS) without fulfilling the criteria for hemophagocytic lymphohistiocytosis (HLH), that may create a great challenge to distinguish between them. MIS should promptly be considered and treated, as uncontrolled MIS has a high mortality. In MIS cardiac involvement, heart failure may present as an additional problem, especially because volume loading is advised in accordance with proposed therapy. Carefully monitoring of the respiratory and cardiac status in response of resuscitation is therefore warranted.

[Use of quality assessments by internists: added pressure to carry out assessments or an aid to improve quality?]. / Gebruik van kwaliteitsevaluaties door internisten: belastende evaluatiedruk of hulp bij kwaliteitsverbetering?

OBJECTIVE: To obtain an insight into how internists and residents use quality assessments and their opinions on these assessments. DESIGN: Questionnaire survey. METHOD: All 139 internists and residents who attended a national training day on internal medicine in 2012 were invited to answer questions anonymously on the actual use of various quality assessments and to give their opinion on these assessments. The questionnaire consisted of closed and free text questions. The answers were analysed using descriptive statistics. The qualitative information was analysed together by the investigators. RESULTS: In total 123 doctors (88% of the 139 attendants at the training day) from 45 training hospitals (74% of all internal medicine residency training programs) participated in this study. All respondents had recently participated as an individual or as a member of a group in one or more quality assessments. Medical departments and group practices carried out quality assessments more often than required in many cases. Respondents recognised and acknowledged the advantages of quality assessments. The disadvantages of quality assessments related to the methods, the ways assessments were used and undesirable effects. Most of the medical departments and group practices developed policies on how to follow up on the assessment results. Individual performance data was also discussed in the majority of cases. CONCLUSION: Internists (whether or not undergoing training) make extensive and intensive use of quality assessments. The benefits and the weaknesses of quality assessments are both acknowledged. Proactive efforts are required so that improvements can be made in addition to the assessments.

Diabetes-related distress, insulin dose, and age contribute to insulin-associated weight gain in patients with type 2 diabetes: results of a prospective study.

OBJECTIVE: The determinants of insulin-associated weight gain in type 2 diabetes mellitus (T2DM) are partly unknown. Therefore, we conducted a prospective study to identify predictors of insulin-associated weight gain. RESEARCH DESIGN AND METHODS: In patients with T2DM, we assessed physical activity by accelerometry and measured diabetes-related distress by questionnaires before and 6 and 12 months after starting insulin therapy. Glycemic control (HbA1c) and insulin dose were monitored. RESULTS: After 12 months of insulin therapy, mean body weight had increased by 3.0 ± 2.5 kg (P < 0.001). The drop in HbA1c was correlated with insulin-associated weight gain. With the use of a multiple linear regression model, a cluster of variables was identified that significantly related to weight gain. Diabetes-related distress, initial insulin dose, and the increase of insulin dose during the course of the study as well as age appeared to be important predictors of weight gain after initiation of insulin therapy. Physical activity (measured as MET) decreased from 1.40 ± 0.04 at baseline to 1.32 ± 0.04 MET (P < 0.05) but was not significantly related to weight changes. CONCLUSIONS: Diabetes-related distress, initial and titration of insulin dose, and age all significantly predict insulin-associated weight gain. After the initiation of insulin therapy, physical activity decreased significantly, but this did not determine weight gain over the first 12 months. Our study findings may have clinical implications.