A 73 year old female presented with five non-painful nodules on the dorsal side of her right lower arm that occured after an infection on her third digit finger after cleaning her aquarium. PCR of the biopsy from on of the nodules shows a mycobacterium marinum infection.Macrolides are antibiotics with anti-inflammatory properties that may be beneficial in the treatment of asthma. In a systematic review, Hiles et al. analysed the effect of azithromycin in the prevention of asthma exacerbations in patients with severe asthma. In their study they conclude that prolonged treatment with azithromycin (at least 3 months) reduces the number of asthma exacerbations; however, the conclusions of this review should be interpreted carefully as the included studies vary in study design, dosing schedule and severity of the asthma. Additionally, maintenance treatment with macrolides may have safety risks, side-effects and lead to antibiotic resistance. Prolonged macrolide therapy should, therefore, be reserved for patients with non-eosinophilic asthma who have no alternative treatment options. Euthanasia in patients with dementia is legally permitted, but many physicians experience it as (too) complex. They are frightened of the legal consequences and do not know how to assess the nature of the suffering. They also find it difficult to assess the patient's ability to provide consent. Here we describe two cases of patients who were registered at Euthanasia Expertise Centre by a family member a 72-year-old woman who had been diagnosed with Alzheimer disease 18 months previously and a 67-year-old man with Lewy body dementia. https://www.selleckchem.com/products/ly3522348.html During the various consultations we had with them we were given a distinct picture of the nature of their suffering, and it became clear to us why they found this suffering unbearable. By paying extra attention to the assessment of the ability to give consent and by exploring the degree of suffering experienced it is possible to meet the request for euthanasia by a patient with dementia within the framework of the law. By paying extra attention to the assessment of the ability to give consent and by exploring the degree of suffering experienced it is possible to meet the request for euthanasia by a patient with dementia within the framework of the law.Current theories of grief assume that surviving relatives have to carry out a number of grief-related tasks after the loss of a loved one. If these tasks cannot be carried out properly and the intensity of the emotional pain does not decrease over time, we speak of complicated grief. Non-natural causes of death, such as suicide, violence, accidents or disasters, are associated with increased risk of complicated grief. The effects of euthanasia on surviving relatives are still unknown in this context. Social support may help with the grieving process. Psychological treatment of people with complicated grief symptoms is effective in many cases. Attention for complicated grief in surviving relatives, especially in cases of suicide and other non-natural causes of death, is of great importance in view of timely referral and treatment.Dealing with euthanasia requests can be a complex matter for a doctor. How to determine whether the due diligence criteria of the Dutch Euthanasia Act are met in cases that are not straightforward? We argue that moral case deliberation (MCD), methodically structured reflective discussions on concrete moral dilemmas, can provide support in dealing with complex euthanasia requests. In this article, we discuss a case that was talked about during a MCD (in particular the CURA method, where CURA stands for 'concentrating, postponing, reflecting and action') by a group of GPs and nurses who met in the context of a network for ambulatory palliative care.This was about an older patient with multiple chronic conditions who lost any prospects of quality of life.Among other things, it was examined whether requests could be 'well-considered' (one of the due diligence criteria) when the patients are in doubt as to when euthanasia should be carried out.The importance of recognising one's own emotions as a doctor and the quality of communication between patient and doctor were also considered.For that reason, we try to show that MCD can assist in making careful and well-considered decisions when determining a course of action in the case of complex euthanasia requests and can encourage collaborative learning processes.Ecthymagangrenosum is a painful node that rapidly progresses to a necrotic ulcer and occurs as a result of a local infection or hematogenous spread. It has a high mortality rate when treatment is delayed. We describe a 19-year-old male with neutropenic fever due to ecthymagangrenosum caused by Pseudomonas aeruginosa without bacteremia. Psychiatric disorders can also be the cause of unbearable and hopeless suffering, which can lead to a carefully considered and voluntary desire for euthanasia. A 76-year-old patient had a history of unexplained physical symptoms for many years. After another new clinical treatment had not had any effect, she was helped to die at her own explicit request. Hopeless psychological suffering can also be a reason for providing euthanasia, on the basis of the diligence requirements of the Netherlands Termination of Life on Request and Assisted Suicide Act and the guidelines provided by the Netherlands Psychiatric Association. This route is also open to physicians who have not specialized in psychiatry. Hopeless psychological suffering can also be a reason for providing euthanasia, on the basis of the diligence requirements of the Netherlands Termination of Life on Request and Assisted Suicide Act and the guidelines provided by the Netherlands Psychiatric Association. This route is also open to physicians who have not specialized in psychiatry.An 84-year-old woman was found dead at home. There were no suspicious circumstances. Non-contrast enhanced post mortem CT was performed to establish the cause of death. CT showed hyperdense fluid in the pericardial cavity consistent with hemopericardium secondary to left ventricular rupture caused by acute myocardial infarction.