[Out-of-hospital cardiac arrest during lockdown]. / Prähospitaler Kreislaufstillstand im Lockdown: Auswirkungen der übergreifenden Infektionspräventionsmaßnahmen während der ersten SARS-CoV-2-Welle.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide. Consequences of infection prevention measures during such contagion events can cause disadvantages especially for patients in out-of-hospital cardiac arrest (OHCA). METHODS: Retrospective analysis of OHCAs in one county from January-May in 2018, 2019 and 2020, with the first appearance of the SARS-CoV­2 pandemic in 2020 and a high incidence of the influenza virus in 2018. RESULTS: A total of 497 OHCAs were investigated (2018 n = 173; 2019 n = 149; 2020 n = 175). In this study, a constant resuscitation incidence (85-99 resuscitations/100,000 population/year) and locally typical patients (mean 70 years, 66% male; median PES 3) were found. There were no statistically significant differences in the initial situation of the patients (number of observed OHCAs, frequency of lay resuscitations, suspected causes of OHCAs, initial ECG rhythm) and the treatment course (frequency of return of spontaneous circulation [ROSC]/hospital admission/survival to hospital discharge, neurological outcome). None of the OHCA patients in 2020 tested positive for SARS-CoV­2 and 3 patients in 2018 tested positive for the influenza virus. DISCUSSION: The lockdown during the first wave of SARS-CoV­2 pandemic does not seem to have affected the outcome of OHCA patients without coronavirus disease 2019 (COVID-19) in the end.

[Teaching patient safety during undergraduate medical studies]. / Patientensicherheit schon im Studium vermitteln.

BACKGROUND: In the professional public there is agreement that healthcare professionals worldwide should already be prepared for safety in patient care during their education. OBJECTIVE: How can the topic of patient safety be successfully integrated into the curricula of healthcare professions? MATERIAL AND METHODS: Overview of the Marburg curriculum on patient safety during the practical year as well as of other approaches to teaching patient safety described in the literature. RESULTS: In recent years teaching initiatives on patient safety have significantly increased; however, they are still not comprehensively distributed in German-speaking countries or throughout Europe. In the context of implementation, the multiprofessional edition of the World Health Organization (WHO) patient safety curriculum guide may be used as guideline. A current, very promising development in connection with acquiring and examining the competences that are necessary for safe patient care is the establishment of interprofessional training wards. CONCLUSION: In the meantime, there are clearly defined strategies for the integration of the topic of patient safety into the curricula of healthcare professionals. On the way towards a successful restructuring of the curricula including the necessary competences and behavioral changes of the students, however, relevant support by the management of faculties and teaching hospitals is essential.

[Computer-assisted diagnosis of rare diseases]. / Computerunterstützte Diagnosefindung bei seltenen Erkrankungen.

To establish a comprehensive diagnosis is by far the most challenging task in a physician's daily routine. Especially rare diseases place high demands on differential diagnosis, caused by the high number of around 8000 diseases and their clinical variability. No clinician can be aware of all the different entities and memorizing them all is impossible and inefficient. Specific diagnostic decision-supported systems provide better results than standard search engines in this context. The systems FindZebra, Phenomizer, Orphanet, and Isabel are presented here concisely with their advantages and limitations. An outlook is given to social media usage and big data technologies. Due to the high number of initial misdiagnoses and long periods of time until a confirmatory diagnosis is reached, these tools might be promising in practice to improve the diagnosis of rare diseases.

[Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)]. / Eosinophile Granulomatose mit Polyangiitis (Churg-Strauss-Syndrom).

This article presents the case of a patient with dyspnea, a history of poorly controlled asthma, sinonasal polyposis, blood eosinophilia and transient pulmonary infiltrates. The autoantibodies antinuclear antibodies, cytoplasmic anti-neutrophil cytoplasmic antibodies (c-ANCA) and perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) were negative. These symptoms are typical for eosinophilic granulomatosis with polyangiitis (EGPA, alternatively known as Churg-Strauss syndrome). The delay between onset and diagnosis in this case was several years. Although EGPA belongs to the spectrum of ANCA-associated vasculitis, less than 50% of EGPA patients are ANCA positive. Cardiac involvement (such as endomyocardial infiltration, arrhythmia and pericarditis) is the major cause of early death and a poor prognosis. In therapeutic regimens glucocorticoids and/or another immunosuppressant (e. g. cyclophosphamide, methotrexate or azathioprine) are used. The so-called five-factor score is a useful tool for assessment of prognosis.

[Pulmonary allergic reactions]. / Allergische Reaktionen der Lunge.

Allergic diseases of the lungs may affect the airways, the pulmonary parenchyma and the pulmonary vessels. The most relevant representatives are allergic asthma, hypersensitivity pneumonitis, bronchopulmonary aspergillosis and the Churg-Strauss syndrome. The type of allergic reaction and the pathophysiological consequences vary considerably between these entities. New drugs target specific mechanisms based on new insights into the pathogenetic processes of the underlying disease.

A prospective polysomnographic study on the evolution of complex sleep apnoea.

Complex sleep apnoea (CompSA) may be observed following continuous positive airway pressure (CPAP) treatment. In a prospective study, 675 obstructive sleep apnoea patients (mean age 55.9 yrs; 13.9% female) participated. Full-night polysomnography was performed at diagnosis, during the first night with stable CPAP and after 3 months of CPAP. 12.2% (82 out of 675 patients) had initial CompSA. 28 of those were lost to follow-up. Only 14 out of the remaining 54 patients continued to satisfy criteria for CompSA at follow-up. 16 out of 382 patients not initially diagnosed with CompSA exhibited novel CompSA after 3 months. 30 (6.9%) out of 436 patients had follow-up CompSA. Individuals with CompSA were 5 yrs older and 40% had coronary artery disease. At diagnosis, they had similar sleep quality but more central and mixed apnoeas. On the first CPAP night and at follow-up, sleep quality was impaired (more wakefulness after sleep onset) for patients with CompSA. Sleepiness was improved with CPAP, and was similar for patients with or without CompSA at diagnosis and follow-up. CompSA is not stable over time and is mainly observed in predisposed patients on nights with impaired sleep quality. It remains unclear to what extent sleep impairment is cause or effect of CompSA.

[New approaches to lecture medicine--or: what can we learn from television?]. / Neue Ansätze zur Wissensvermittlung oder: was können wir vom Fernsehen lernen?

The development of new media and high-performance Internet connections do not stop in front of the auditorium. The classic teaching course is in direct competition with the new media that provide some excellent illustrated and animated educational videos and clips. In order to bring students back into the classroom, it is mandatory to make teaching more attractive. One can, as we shall show in the following contribution, use popular television series for successful teaching. This approach is accepted by the students with great interest and allows us to teach our students also in the field of rare diseases.

[Sleep-disordered breathing in long-term opioid therapy]. / Schlafbezogene Atmungsstörungen bei Opioid-Langzeittherapie.

Chronic opioid use has been known to cause disturbed sleep as well as excessive daytime sleepiness. During induction and maintenance of opioid use there is a reduction of REM- and slow wave sleep. Central sleep apnea (CSA) has been reported in about 30 % of patients with chronic opioid use. Ataxic breathing and CSA are more prominent in NREM- than REM-sleep. CSA does not seem the sole cause of excessive daytime sleepiness in these patients. Further studies are necessary regarding the effects and consequences of chronic opioid use during sleep.

Automatic CPAP titration with different self-setting devices in patients with obstructive sleep apnoea.

Autotitrating continuous positive airway pressure (CPAP) devices automatically adjust the pressure according to upper airway obstructions. The aim of this study was to compare the treatment effects of different automatic CPAP devices (AutoSet, Horizon and Virtuoso) with conventional CPAP in patients with obstructive sleep apnoea independently of financial manufacturer support. Twelve male patients with obstructive sleep apnoea were submitted to a crossover study protocol with overnight polysomnography for 6 consecutive nights. After diagnostic polysomnography, the CPAP pressure was manually titrated. Over the next 4 nights, the patients were treated with any one of the three automatic CPAP devices or fixed CPAP in random order. The apnoea/hypopnoea index on the diagnostic night was 67.3+/-21.7 events h(-1), and was significantly reduced to 0.7+/-1.2, 3.0+/-2.9, 2.3+/-2.5 and 12.0+/-13.6 events x h(-1) with the fixed CPAP, AutoSet, Horizon and Virtuoso devices respectively. An apnoea/ hypopnoea index of <5 events h(-1), an indicator of optimal treatment, was achieved in all patients with fixed CPAP and in 10 patients using the Autoset and Horizon devices, but in only six of the 12 using the Virtuoso. The mean pressure was significantly lower with the AutoSet and Virtuoso devices, but not with the Horizon as compared to fixed CPAP. The maximum pressure was significantly higher with the Horizon. It is concluded that automatic continuous positive airway pressure devices produce a significant reduction in apnoea/hypopnoea index; however, there is considerable difference in the efficacy of the various devices.

Peripheral arterial tonometry for the diagnosis of obstructive sleep apnea.

Sleep related breathing disorders have been recognized as a risk factor for cardiovascular disorders. Peripheral arterial tonometry (PAT) allows to monitor vasoconstriction on the finger continuously and non-invasively. We investigated whether the rapid changes of autonomous function can be assessed by PAT. In 21 patients with obstructive sleep apnea and arterial hypertension we recorded PAT in parallel to cardiorespiratory polysomnography and invasive arterial blood pressure. The correlation between periodic PAT attenuations and the total number of apneas (r = 0.656, p < 0.01) and the total number of cortical arousal (r = 0.583, p < 0.01) were significant. The PAT signal cannot substitute blood pressure but allows a good recognition of apneas and subcortical arousal and gives additional information on changes of sympathetic and parasympathetic tone during sleep.

[Eosinophilic myocarditis in Churg-Strauss syndrome. A rare cause of left heart decompensation with lung edema]. / Eosinophile Myokarditis bei Churg-Strauss-Syndrom. Seltene Ursache einer Linksherzdekompensation mit Lungenödem.

HISTORY: A 50-year-old woman was admitted because of marked dyspnoea at rest and signs of left heart failure with pulmonary oedema. 9 years ago, the diagnostic constellation of bronchial asthma, polyneuropathy, pericardial effusion and eosinophilia had indicated Churg-Strauss syndrome. Since then she had remained symptom-free under maintenance doses of azathioprine (for 2 years) and gradually reduced doses of steroids. INVESTIGATIONS: Chest X-ray showed signs of pulmonary congestion and cardiomegaly, echocardiography demonstrating enlargement of the left heart with marked impairment of ventricular function, and both revealed pericardial effusion. The electrocardiogram showed complete absence of R waves and ST elevation in leads V1-V5. Coronary angiography excluded coronary artery disease. Myocardial biopsy contained signs of active but no longer acute myocarditis with eosinophilic tissue infiltration and microgranulomas. White blood cell count was normal, but there was marked eosinophilia (39%). IgE was elevated (601 kIU/l). DIAGNOSIS, TREATMENT AND COURSE: In view of the good therapeutic effects 9 years ago, this relapse of Churg-Strauss syndrome with eosinophilic myocarditis was again treated with azathioprine and steroids. In addition, diuretics, digitalis and ACE-inhibitors successfully treated the heart failure. In the course of treatment the signs of inflammation, including the eosinophilia, regressed or became normal. CONCLUSION: After a 10-year remission without complication of a Churg-Strauss syndrome the onset of cardiac signs is the decisive long-term prognostic factor.