A 61-year-old man presented to the emergency department with acute fluent but nonsensical speech and intact comprehension. Imaging showed a contrast-enhancing lesion near Wernicke's area, suspect for an intracranial neoplasm, without signs of ischemia or hemorrhage. Suspecting focal epilepsy with conduction aphasia, symptoms resolved after anti-convulsive therapy.

In the Netherlands, all pregnant persons are screened for hiv, hepatitis B and syphilis at 10 weeks' gestation. Treatment of these infections both promote maternal health and prevent perinatal transmission. Other viral infections may also impair maternal and fetal health, but screening for these infections is not a routine in pregnancy. Sometimes opportunistic screening is done in presumed high-risk groups such as in child- and healthcare workers or viral diagnostic tests are done in case of illness or in the presence of fetal anomalies. We aim to discuss these viral illnesses with maternal and fetal consequences.

Pain relief during labor is a critical aspect of obstetric care, balancing maternal comfort with neonatal safety. With the increasing use, questions arise regarding the available pharmaceutical pain relief options and their obstetric, anesthetic, and neonatal implications. This article discusses two cases involving epidural analgesia and briefly reviews remifentanil and nitrous oxide, including their mechanisms, side effects, and implications. Epidural analgesia remains the gold standard for labor pain management due to its effectiveness and safety. Although it generally causes only mild and well-manageable side effects without clinical consequences, it remains an invasive technique that can, in rare cases, lead to (serious) complications. Remifentanil offers an alternative but with reduced efficacy and risks like respiratory depression. Nitrous oxide provides rapid pain relief but is less effective and limited by its short duration, environmental impact, healthcare personal exposure risks and uncertain neonatal effects.

Multi-cancer early detection (MCED) is a new development within cancer screening. A blood test combined with analysis of circulating tumor DNA could lead to early detection of multiple cancer types simultaneously, potentially reducing cancer-related mortality. While this sounds promising, a proactive ethical reflection on the possibilities and potential consequences of MCED in population screening is essential for its responsible implementation. In this article, we explore the ethics of MCED offered as population screening using the bioethical principles of beneficence and maleficence (proportionality), autonomy and justice. Proportionality of MCED screening requires that benefits outweigh harms. To respect autonomy, meaningful choices and understandable information need to be offered. Distributive justice requires at a minimum fairness in both the implementation and costs of screening. MCED screening does not currently meet these requirements, due to limited validity of MCED tests and potential harmful consequences of MCED introduction on both the individual and societal level.

Inguinal hernias are a common finding in young children. In female patients, these hernias may contain the ovary in some cases, particularly in early childhood. In very rare instances, the uterus may also be found. We present the case of a 3-year-old girl with a left-sided inguinal hernia. During herniotomy, both the left ovary and the uterus were found to be adherent to the hernia sac. For this reason, a laparoscopic approach was chosen for safe evaluation and reduction. Awareness of the potential herniation of internal reproductive organs in young girls is essential, particularly in case of signs of incarceration. Early surgical intervention is recommended to prevent ischemic damage. This case highlights the importance of prompt recognition, careful intraoperative assessment and the consideration of minimally invasive techniques.

Examination of the development of socio-economic differences in mortality because of ischemic heart disease (IHD) in The Netherlands during 1996-2022. Repeated cross-sectional research. The socio-economic position (SEP) of people is determined by deciles of the combination of disposable income and wealth of the corresponding household, and subsequently related to IHD-mortality. The data came from Statistics Netherlands. The socio-economic inequality in IHD-mortality showed for men first a decrease which weakened gradually and subsequently shifted into an increase from 2014 onwards. The difference between lowest and highest financial wealth increased from 4.9 IHD-deaths per 10 thousand to 6.3 IHD-deaths in 2022. For women, the inequality also decreased in the beginning, but remained from 2014 onwards constant. Inequality in IHD-mortality between high and low SEP persists for both men and women. By taking these differences into account, prevention can be worked on more specifically.

A review in the Annals of Surgery addressed the role of cognitive bias and heuristics in creating surgical complications and death. Bias and heuristics in decision making is not new, but the fact that surgeons and clinicians in general are influenced by them is apparently still noteworthy. The idea that clinicians act purely rational or should persists. But doctors are not computers. Nevertheless interventions aiming at improving behaviour of clinicians is based on the assumption that more knowledge or guidelines will lead to better behaviour. But these elements are seldomly sufficiently adequate or key for better conduct. Medical decision making will never be fully objective. Interventions to improve decision making should be realistic and respond to how clinicians work and make decisions. Biases are there and always will be, sometimes innocent, sometimes harmful, but unrealistic expectations on human decision making will not help. As soon as we are able to realize this, there will be room for improvement.

A healthy 21-month old boy presented with a red purple preauricular swelling. Initial antibiotics were ineffective. Fine needle aspiration revealed an atypical mycobacterium after 6 weeks. The location taken into consideration, we chose a conservative approach to avoid potential facial nerve damage.

In the Netherlands, 80% of paracetamol poisoned patients is treated for 24 hours with 600 mg/kg body weight of acetylcysteine. In the SNAP regimen, 300 mg/kg acetylcysteine is dosed in 12 hours, with the option to extend the treatment. If paracetamol concentration < 10 mg/L, ALT < 100 U/L, and INR ≤ 1.3, acetylcysteine treatment can be discontinued. Seventy percent of patients treated with the SNAP regimen require only 12 hours of treatment. The SNAP regimen has fewer side effects and is as effective as the previous Dutch acetylcysteine regimen and the international 'Prescott 21-hour' protocol. Recently, two treatment guidelines (NVIC and toxicologie.org) have been revised to adopt the SNAP regimen. Apart from a reduction in side effects, implementing the SNAP regimen for the treatment of paracetamol poisoning in the Netherlands likely reduce hospital stay and healthcare costs.

Postcovid is a debilitating persistent multisystem disease for which no specific (curative) treatment is available yet. We present two postcovid patients and evaluate interventions that were tried. We comment on the use of a biopsychosocial approach in the evaluation of postcovid and the identification of possible 'treatable traits'. Interventions in the biological domain are aimed at 'treatable traits' such as pain, sleep problems, POTS and MCAS-type symptoms, as well as comorbidities. Comorbidities may require specialized care, and rehabilitative care may be necessary to stabilize the illness and (hopefully) improve functioning in severely ill patients. Interventions in the psychosocial domain are aimed at psychological complaints that often accompany postcovid (anxiety, depression) and reducing stress (related to work or school, financial insecurity, etc.). In absence of a specific treatment for postcovid, meaningful intervention is aimed at stabilizing the illness and (hopefully) improving functioning by addressing 'treatable traits' in all biopsychosocial domains.