Deutsches Arzteblatt international最新文献

Background: Many case reports of acute caffeine intoxication have been published, but there have been hardly any systematic data analyses, nor have there been any prospective studies, representative epidemiologic studies, or guideline recommendations. In this review, we aim to describe the clinical entity of acute caffeine intoxication and its treatments to date on the basis of published case reports.

Methods: This review is based on pertinent case reports retrieved by a search in the PubMed, Google Scholar, and Semantic Scholar databases covering the period 1851-2023 and employing the keywords "caffeine intoxication," "caffeine poisoning," and "caffeine overdose."

Results: 216 published individual cases were analyzed. The median caffeine intoxication dose was 12 g (0.05-106 g), and the median serum caffeine concentration was 160 mg/L (15.6-1560 mg/L). The intoxication was deliberate with suicidal intent in 40% of cases, accidental in 22%, and a treatment error in 6%. 21% of the accidental intoxications were in minors. Convulsions and wide-complex tachycardias due to intoxication were associated with a worse outcome, and extracorporeal hemodialysis appears to be a safe and effective way to eliminate caffeine, with a better survival rate even after severe intoxication. Doses of 5-10 g of caffeine can be lethal.

Conclusion: This is the largest analysis of caffeine intoxications ever carried out to date, yet no defin - itive treatment recommendations can be derived from it. Caffeine elimination by hemodialysis can be considered if the quantity ingested is potentially lethal, or in cases with a severe clinical course.

Background: Patients with a history of penicillin allergy are often given a less suitable non-ß-lactam antibiotic as single-shot peri - operative prophylaxis, for fear of an allergic reaction. This endangers these patients' health, particularly exposing them to a higher risk of wound infection.

Methods: With the aid of a quality management tool and three iterative "Plan-Do-Study-Act (PDSA)" cycles, we developed and evaluated an algorithm for the safe administration of single-shot cefuroxime as perioperative antibiotic prophylaxis in patients with a history of penicillin allergy.

Results: 6045 anesthesia records were evaluated in three PDSA cycles. 340 patients (5.6%) reported a penicillin allergy in their medical history, and 166 of these patients (2.7% of the total) received perioperative antibiotic prophylaxis: 156 (2.5%) patients were given cefuroxime, and 7 (0.1%) were given another antibiotic, mainly for surgery-specific reasons. In two cases, clindamycin was given despite the algorithm; these two led to quality improvement measures, so that in the third PDSA cycle, over an observation period of 6 months, no patient was denied cefuroxime because they had a penicillin allergy. No allergic reactions to cefuroxime were observed.

Conclusion: As part of a quality management measure, we developed an algorithm that allowed cefuroxime to be given as single-shot perioperative antibiotic prophylaxis to almost all patients with a history of penicillin allergy. Only patients with severe T-cell-mediated reactions should not be given ß-lactam antibiotics.

Background: Emergencies in otorhinolaryngology are common: According to a Spanish study, approximately 12% of patients in a general emergency room have symptoms relating to the ear, nose, or throat (ENT). Such situations range in severity from minimal to lifethreatening and affect persons of all ages. These patients may pre - sent first to a general practitioner or to an emergency room without specialized ENT coverage. In this article, we discuss the assessment of clinical urgency based on symptoms, and the ensuing treatments.

Methods: This narrative review is based on pertinent publications retrieved by a literature search. Common and typical ENT emergencies are discussed, including the necessary diagnostic evaluation, time management, and treatment. For each clinical entity, "red flags" are defined, i.e., warning signs indicating the need for urgent, specialized care.

Results: Treatment by a specialist in otorhinolaryngology (usually surgical and in-hospital, and often as part of an interdisciplinary collaboration) is needed, in particular, for clinical entities that may be life-threatening, such as otogenic or sinugenic complications, neck abscesses, angioedema, posterior epistaxis, tumor hemorrhages, and foreign bodies in the respiratory tract, as well as inner ear diseases that cause severe vertigo and vomiting.

Conclusion: The rising number of patients presenting to emergency rooms presents a challenge to all affected areas of the health care system. The physician in the emergency room has the task of recognizing the risk of serious complications in certain clinical situations with nonspecific symptoms that may seem harmless, and of obtaining specialized care for these patients in a timely manner. The "red flags" presented in this article can serve as an initial guide to ENT emergencies.

Background: Familial hypercholesterolemia (FH) is among the more common monogenic diseases, yet population-based data on genetically confirmed FH (genFH) and its association with LDL cholesterol (LDL-C) in Germany are lacking.

Methods: In the Hamburg City Health Study (registration: Clinical Trials.gov, NCT03934957), five FH-associated genes were exam - ined for pathogenic mutations with whole genome sequencing and compared with LDL-C levels that had been corrected for lipidlowering medication. Severe hypercholesterolemia was defined as an LDL-C level of 190 mg/dL or above.

Results: There were 7373 adult participants (49.1% women; median age 62 years), of whom 23 had FH, corresponding to a prevalence of 0.31% (95% confidence interval [CI]: [0.21; 0.47]), or a prevalence ratio of 1:321 [1:213; 1:476]. All genFH cases were due to mutations in the LDLR gene. The median treatment-adjusted LDL-C level was higher in genFH cases (191 mg/dL) than in persons without genFH (128 mg/dL; p <0.001). Eleven of the participants with genFH had severe hypercholesterolemia. Among the 7253 participants without genFH, 465 had severe hypercholesterolemia. Only 2.3% (n = 11) of the severely hypercholesterolemic participants had genFH. Forty-three people would need to be genetically tested to identify one genFH case if an LDL-C threshold of ≥190 mg/dL is selected, 98 people at ≥160 mg/dL, and 175 people at ≥130 mg/dL.

Conclusion: The prevalence of genFH in this German study was 0.31%, which corresponds to the global average. As only half of the persons from our adult cohort identified as having genFH had severe hypercholesterolemia, population-based genetic screening would seem to be of questionable benefit.