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Hennen C, Demir S, Dafsari HS, Wunderlich G, Böll B, Hüser C, Barbe MT, Fink GR, Rueger MA. Botulism after intragastric botulinum toxin injections for weight reduction. Eur J Neurol 2023; 30:3979-3981. [PMID: 37584071 DOI: 10.1111/ene.16040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/26/2023] [Accepted: 08/10/2023] [Indexed: 08/17/2023]
Abstract
Although-considering the risk-benefit ratio-botulinum neurotoxin A (BoNT/A) is unequivocally recommended to treat severe neurological diseases such as dystonia, this has not yet been determined for its endoscopic intragastric injection aimed at weight reduction in obesity. However, severe adverse effects of intragastric BoNT/A had not yet been reported, prompting some European countries to endorse its (off-label) use and treat patients transnationally. We here present three cases of botulism after intragastric BoNT/A injections for obesity treatment in a Turkish hospital. Patients presented with cranial nerve affection, bulbar symptoms, and descending paresis, and benefited from treatment with BoNT antitoxin and pyridostigmine. We assume that iatrogenic botulism was induced by overdosing in combination with toxin spread via the highly vascularized gastric tissue. Of note, within a few weeks, more than 80 cases of iatrogenic botulism were reported across Europe after identical intragastric BoNT/A injections. These cases demonstrate the risks of BoNT/A injections if they are not applied within the limits of evidence-based medicine. There is a need for international guidelines to define the indication and a safe dosing scheme, especially in the context of medical tourism.
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Affiliation(s)
- Christina Hennen
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Seda Demir
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Haidar Salimi Dafsari
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gilbert Wunderlich
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Boris Böll
- First Department of Internal Medicine; Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Hüser
- Department of Internal Medicine II, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Thomas Barbe
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Jülich, Germany
| | - Maria Adele Rueger
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Jülich, Germany
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Hüser C. [Cardiac arrest due to poisoning]. Med Klin Intensivmed Notfmed 2023; 118:502-504. [PMID: 37606715 DOI: 10.1007/s00063-023-01053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/19/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Christoph Hüser
- Klinik II für Innere Medizin: Nephrologie, Rheumatologie, Diabetologie und Allgemeine Innere Medizin und Schwerpunkt Klinische Akut- und Notfallmedizin, Medizinische Fakultät und Uniklinik Köln, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Hüser C, Baumgärtel M, Ristau P, Wnent J, Suárez V, Hackl MJ, Gräsner JT, Seewald S. Higher chance of survival in patients with out-of-hospital cardiac arrest attributed to poisoning. Resuscitation 2022; 175:96-104. [PMID: 35288163 DOI: 10.1016/j.resuscitation.2022.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 01/31/2023]
Abstract
AIM OF THE STUDY Description and comparison of cohort characteristics and outcome of adult patients with out-of-hospital cardiac arrest (OHCA) attributed to poisoning (P-OHCA) versus patients with OHCA attributed to other medical causes (NP-OHCA). METHODS We included all patients who received cardiopulmonary resuscitation after OHCA between January 2011 and December 2020 from German emergency medical services with good data quality in the German Resuscitation Registry. EXCLUSION CRITERIA patients < 18 years of age or OHCA attributed to trauma, drowning, intracranial bleeding or exsanguination. RESULTS Patients with P-OHCA (n = 574) were significantly younger compared to NP-OHCA (n = 40,146) (median age of 43 (35-54) years vs. 73 (62-82) years; p < 0.001). Cardiac arrest in P-OHCA patients was significantly less often witnessed by bystanders (41.8 % vs. 66.2 %, p < 0.001). Asystole was the predominant initial rhythm in P-OHCA patients (73.5% vs. 53.7%, p < 0.001) while ventricular fibrillation (VF) and pulseless electrical activity (PEA) were less common (9.2% vs. 25.1% and 16.2 % vs. 20.5%, p < 0.001). P-OHCA had a higher chance of survival with good neurological outcome at hospital discharge (15.2 vs. 8.8 % p < 0.001) and poisoning was an independent protective prognostic factor in multivariate analysis (OR 2.47, 95%-CI [1.71-3.57]). P-OHCA patients with initial PEA survival with good neurological outcome was comparable to initial VF (34.3 % vs. 37.7%). CONCLUSION Patients in the P-OHCA group had a significantly higher chance of survival with good neurological outcome and PEA as initial rhythm was as favourable as initial VF. Therefore, in P-OHCA patients resuscitation efforts should be extended.
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Affiliation(s)
- Christoph Hüser
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Matthias Baumgärtel
- Department of Pulmonology, Intensive Care Medicine, Paracelsus Medical University, Hospital Nuremberg, Prof.-Ernst-Nathan-Straße 1, 90419 Nuremberg, Germany
| | - Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Building R3, 24105 Kiel, Germany
| | - Victor Suárez
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Matthias Johannes Hackl
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Building R3, 24105 Kiel, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Building R3, 24105 Kiel, Germany.
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Hüser C, Seewald S. Reply to: A debate on the relationship between out-of-hospital cardiac arrest attributed to poisoning and good neurological outcome. Resuscitation 2022; 175:173-174. [PMID: 35595498 DOI: 10.1016/j.resuscitation.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Christoph Hüser
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany; Emergency Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Building 404, 24105 Kiel, Germany; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, Building R3, 24105 Kiel, Germany
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Suárez V, Norello D, Sen E, Todorova P, Hackl MJ, Hüser C, Grundmann F, Kubacki T, Becker I, Peri A, Burst V. Impairment of Neurocognitive Functioning, Motor Performance, and Mood Stability in Hospitalized Patients With Euvolemic Moderate and Profound Hyponatremia. Am J Med 2020; 133:986-993.e5. [PMID: 32145210 DOI: 10.1016/j.amjmed.2019.12.056] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/23/2019] [Accepted: 12/24/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND The impact of chronic moderate and profound hyponatremia on neurocognitive performance, motor skills, and mood stability has not been investigated systematically so far, and results regarding mild to moderate hyponatremia are inconsistent. Furthermore, it is not known whether treatment has an effect on outcome in these patients. METHODS A total of 130 hospitalized patients with confirmed euvolemic hyponatremia (<130 mEq/L) were subjected to a test battery (Mini-Mental State Examination, DemTect, Trail-Making Tests A and B, Beck Depression Inventory, Timed-up-and-go Test) before and after treatment; additionally, 50 normonatremic group-matched patients served as reference group. RESULTS The scores of all tested domains were significantly worse in the hyponatremia group (median serum sodium [Na+] 122 (119-126) mEq/L) as compared to the reference group (P <0.001), and the odds of obtaining a pathological test result increased markedly with more profound hyponatremic states (odds ratios between 5.0 and 21.8 in the group with Na+ <120 mEq/L compared to reference group). Inversely, treatment led to a significant amelioration of all test results with medium to large effect sizes. Linear regression models revealed the increment of Na+ as an important predictor of test outcome. CONCLUSION We demonstrate a clear association between lower levels of Na+ beyond mild hyponatremia and impairment of neurocognitive and motor performance as well as mood disorders. Our analysis further suggests a causal role of hyponatremia in this context. However, there are apparent differences between the distinct tested domains warranting further investigations.
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Affiliation(s)
- Victor Suárez
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Dario Norello
- Department for Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Italy
| | - Emel Sen
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Polina Todorova
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matthias J Hackl
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christoph Hüser
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Franziska Grundmann
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Torsten Kubacki
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Alessandro Peri
- Department for Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Italy
| | - Volker Burst
- Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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Hüser C, Hackl G, Baumgärtel M. [Update - intoxications in critical care medicine]. Dtsch Med Wochenschr 2020; 145:161-165. [PMID: 32018289 DOI: 10.1055/a-0965-3203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
While monitoring and symptomatic care is sufficient for most intoxicated patients, some develop life threatening symptoms. We present recent changes in the recommendations of the treatment in patients with calcium channel blocker, beta blocker and high dose paracetamol intoxications. Additionally, new insights in the efficacy and safety of the use of physostigmine in anticholinergic patients and beta blockers in cocaine intoxication are discussed as well as the specific considerations in the resuscitation of intoxicated patients.
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Affiliation(s)
- Christoph Hüser
- Klinik II für Innere Medizin und Zentrum für Molekulare Medizin, Universität zu Köln, Medizinische Fakultät und Uniklinik Köln
| | - Gerald Hackl
- Allgemeine Intensivstation, Universitätsklinik für Innere Medizin sowie Notarztstützpunkt NEF Graz-Ost, LKH Universitätsklinikum Graz
| | - Matthias Baumgärtel
- Internistische Intensivstation, Klinik für Innere Medizin 3, Schwerpunkt Pneumologie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Klinikum Nürnberg, Standort Nord
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Hüser C, Dieterich P, Singh J, Shah‐Hosseini K, Allekotte S, Lehmacher W, Compalati E, Mösges R. A 12-week DBPC dose-finding study with sublingual monomeric allergoid tablets in house dust mite-allergic patients. Allergy 2017; 72:77-84. [PMID: 27068870 PMCID: PMC5217067 DOI: 10.1111/all.12913] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND In sublingual immunotherapy, optimal doses are a key factor for therapeutic outcomes. The aim of this study with tablets containing carbamylated monomeric house dust mite allergoids was to determine the most effective and safe dose. METHODS In this double-blind, placebo-controlled dose-finding study, 131 patients with house dust mite-induced allergic rhinoconjunctivitis were randomized to 12-week treatments with 300 UA/day, 1000 UA/day, 2000 UA/day, 3000 UA/day or placebo. Conjunctival provocation tests (CPT) were performed before, during and after treatment. The change in mean allergic severity (primary endpoint), calculated from the severity of the CPT reaction, and the proportion of patients with an improved CPT threshold (secondary endpoint) determined the treatment effect. RESULTS The mean allergic severity decreased in all groups, including the placebo group. It was lower in all active treatment groups (300 UA/day: 0.14, 1000 UA/day: 0.15, 2000 UA/day: 0.10, 3000 UA/day: 0.15) than in the placebo group (0.30). However, this difference was not statistically significant (P < 0.1). The percentage of patients with an improved CPT threshold was higher in the active treatment groups (300 UA/day: 73.9%; 1000 UA/day: 76.0%; 2000 UA/day: 88.5%; 3000 UA/day: 76.0%) than in the placebo group (64.3%). The difference between placebo and 2000 UA/day was statistically significant (P = 0.04). In 13 (10%) exposed patients, a total of 20 treatment-related adverse events of mild severity were observed. CONCLUSIONS The 12-week daily treatment using 2000 UA/day monomeric allergoid sublingual tablets is well tolerated and reduces the CPT reaction in house dust mite-allergic patients.
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Affiliation(s)
- C. Hüser
- Institute for Medical Statistics, Informatics and EpidemiologyFaculty of MedicineUniversity of CologneCologneGermany
| | - P. Dieterich
- Institute for Medical Statistics, Informatics and EpidemiologyFaculty of MedicineUniversity of CologneCologneGermany
| | - J. Singh
- Institute for Medical Statistics, Informatics and EpidemiologyFaculty of MedicineUniversity of CologneCologneGermany
| | - K. Shah‐Hosseini
- Institute for Medical Statistics, Informatics and EpidemiologyFaculty of MedicineUniversity of CologneCologneGermany
| | - S. Allekotte
- Institute for Medical Statistics, Informatics and EpidemiologyFaculty of MedicineUniversity of CologneCologneGermany
| | - W. Lehmacher
- Institute for Medical Statistics, Informatics and EpidemiologyFaculty of MedicineUniversity of CologneCologneGermany
| | | | - R. Mösges
- Institute for Medical Statistics, Informatics and EpidemiologyFaculty of MedicineUniversity of CologneCologneGermany
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Allekotte S, Hüser C, Dieterich P, Singh J, Compalati E, Mosges R. A Randomized Dbpc Dose-Finding Trial of Slit Allergoids Tablets in House Dust Mites (HDM) Allergic Patients. J Allergy Clin Immunol 2015. [DOI: 10.1016/j.jaci.2014.12.1897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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