Background: OpenAI’s ChatGPT is a pioneering artificial intelligence (AI) in the field of natural language processing, and it holds significant potential in medicine for providing treatment advice. Additionally, recent studies have demonstrated promising results using ChatGPT for emergency medicine triage. However, its diagnostic accuracy in the emergency department (ED) has not yet been evaluated. Objective: This study compares the diagnostic accuracy of ChatGPT with GPT-3.5 and GPT-4 and primary treating resident physicians in an ED setting. Methods: Among 100 adults admitted to our ED in January 2023 with internal medicine issues, the diagnostic accuracy was assessed by comparing the diagnoses made by ED resident physicians and those made by ChatGPT with GPT-3.5 or GPT-4 against the final hospital discharge diagnosis, using a point system for grading accuracy. Results: The study enrolled 100 patients with a median age of 72 (IQR 58.5-82.0) years who were admitted to our internal medicine ED primarily for cardiovascular, endocrine, gastrointestinal, or infectious diseases. GPT-4 outperformed both GPT-3.5 (P<.001) and ED resident physicians (P=.01) in diagnostic accuracy for internal medicine emergencies. Furthermore, across various disease subgroups, GPT-4 consistently outperformed GPT-3.5 and resident physicians. It demonstrated significant superiority in cardiovascular (GPT-4 vs ED physicians: P=.03) and endocrine or gastrointestinal diseases (GPT-4 vs GPT-3.5: P=.01). However, in other categories, the differences were not statistically significant. Conclusions: In this study, which compared the diagnostic accuracy of GPT-3.5, GPT-4, and ED resident physicians against a discharge diagnosis gold standard, GPT-4 outperformed both the resident physicians and its predecessor, GPT-3.5. Despite the retrospective design of the study and its limited sample size, the results underscore the potential of AI as a supportive diagnostic tool in ED settings.

COVID-19 is a severe viral infection of the respiratory tract and has become a worldwide pandemic. Months after the initial infection several people report persistent limitations in daily life. Previous studies have identified body composition as a predictor of clinical progression in cases of COVID-19. However, body impedance measurements were limited to baseline and not repeated in serial measurements. In this study we analyzed the impact of a moderate oxygen-dependent COVID-19 infection on body composition during hospitalization. We enrolled 12 consecutive patients hospitalized due to an oxygen-dependent SARS-CoV-2 infection. Body impedance analysis was performed within 24 h of admission and repeated on day 3 ± 1 as well as on the day of discharge. Endpoints were any significant changes in body composition. Median age of enrolled patients was 70.6 years with a BMI of 30.8 kg/m². Patients were hospitalized for 14 days. Median oxygen demand was 3 l/min, 2 patients required mechanical ventilation. Body water and fat remained unchanged during the study period. We observed a significant decrease of phase angle (−0.6, p < 0.01) and body cell mass (−2.3%, p < 0.01) with an increase in extracellular mass on day 3. Values returned to baseline along recovery. We found a significant reduction in body cell mass and phase angle during the active infection with slow regression towards hospital discharge. Future studies are needed to clarify if nutrition and training programs during and after COVID-19 might limit these changes and have a positive impact on clinical course and rehabilitation.

Management of calcineurin inhibitor (CNI) therapy in kidney transplant recipients may be complicated due to polypharmacy. As CNI undergo extensive metabolism by cytochrome-P450 enzymes (CYP), drug-mediated CYP inhibition poses a risk for elevated CNI blood concentrations. Here, we report on 2 kidney transplant recipients treated with tacrolimus who presented with signs of tacrolimus intoxication at admission. Patient A was started on antiviral medication ombitasvir, paritaprevir, ritonavir, and dasabuvir for hepatitis C virus treatment 3 days prior to hospitalization. Patient B was treated with clarithromycin for pneumonia. Both therapies cause drug-mediated CYP inhibition, and both patients displayed highly elevated tacrolimus serum concentrations and acute kidney injury (Table 1). After application of the CYP-inducing agents rifampicin and phenytoin, respectively, tacrolimus levels were rapidly reduced, and renal function recovered. Treating severe CNI intoxication is an infrequent yet emergent condition. These results add to the knowledge of therapeutic drug-induced CYP induction as rescue therapy.

Background/Objectives: Alcohol consumption is known to influence cardiovascular regulation and sleep quality; however, real-world data on its acute effects—particularly during nocturnal rest—are limited. This study aimed to investigate the impact of moderate alcohol intake on nocturnal resting heart rate (HR) and sleep parameters using continuous smartwatch-based monitoring in healthy individuals. Methods: In this prospective observational study, 40 healthy adults (63% female, mean age of 30.5 years) underwent a structured 9-day smartwatch monitoring period. The protocol included three alcohol-free baseline days, three consecutive evenings with moderate alcohol consumption (40 g/day for women, 60 g/day for men), and three post-exposure days. Continuous data on HR, sleep stages, nocturnal awakenings, and physical activity were recorded. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) at baseline. The primary endpoint was the change in the average nocturnal resting HR. Secondary outcomes included sleep parameters and activity levels. Results: Alcohol consumption led to a statistically significant increase in nocturnal resting HR from 63.6 ± 9.2 bpm at baseline to 66.6 ± 9.0 bpm during exposure (p < 0.001), with rapid normalization during the post-exposure phase (64.9 ± 9.3 bpm). No significant changes were observed in objective sleep architecture or daytime activity. Despite stable sleep structure, participants reported reduced subjective sleep quality under alcohol exposure, suggesting a potential link to the elevated HR. Conclusions: Even moderate alcohol intake transiently elevates nocturnal resting HR without affecting sleep architecture, likely impairing physiological recovery. These findings underscore the underestimated cardiovascular impact of alcohol and warrant further research in larger and more diverse populations.

Background/Objective: Chronic sleep deprivation can lead to adverse health effects and therefore represents a public health burden While caffeine is a widely used stimulant, the relationship between caffeine consumption and sleep remains uncertain. Moreover, many studies might be subject to methodological bias, as invasive sleep measurements may themselves serve as confounders. The aim of the SleepSmart study was to assess the impact of caffeine consumption through coffee and energy drinks, utilizing both smartwatch data and questionnaire responses. Methods: The SleepSmart study is an observational cohort study conducted at LMU Hospital Munich, Germany, from July 2024 to January 2025. The study investigated two intervention groups: (1) coffee and (2) energy drink consumption. Each intervention lasted 1 week, with days 1 to 3 serving as a reference period (water consumption to adjust for increased fluid intake) and days 4 to 6 serving as the intervention period (consumption of an equivalent of 240 mg of caffeine per day, 3 h before bedtime). Data was collected through self-administered questionnaires and wearable devices. The primary endpoint was sleep duration. Objective measures of sleep (duration of light/deep sleep, duration of wake phases, heart rate) and self-assed quality of sleep (Pittsburgh Sleep Quality Index) served as secondary endpoints. Results: For the primary endpoint, we did not find a significant difference in average sleep duration (baseline [hours] 6.7, coffee 6.9, energy drink 6.7, p-value 0.183). Similarly, secondary endpoints related to sleep measures showed no significant changes in the duration of light/deep sleep (coffee [min]: 242.2, reference coffee [ref_C] 255.7 I energy drink: 237.5, reference energy drink [ref_E] 261.3), time awake (coffee 22.7, ref_C 23.4 I energy drink 21.3, ref_E 18.9), time to fall asleep/wake up (coffee 4.2, ref_C 4.0 I energy drink 4.4, ref_E 2.7), or average heart rate (coffee [bpm] 62.2, ref_C 62.1 I energy drink 62.6, ref_E 62.3)—neither between the two intervention groups nor compared to the reference period. However, self-assessed sleep quality revealed a decrease in perceived sleep quality, with reports of poor sleep increasing by 8% after coffee consumption (rather bad/very bad sleeping quality: 29.7%) and 20% after energy drink consumption (46.6%), compared to baseline data (21.6%). Conclusions: The SleepSmart study introduces wearable sleep tracking as an innovative, low-interference method for objectively recording sleep data. While wearable data did not indicate significant sleep deterioration in the group of young, healthy adults, caffeine appeared to negatively impact the subjective perception of sleep in the study cohort.

Zieve syndrome is a rare condition which occurs in patients with severe alcohol abuse. It is typically characterised by the triad of jaundice, haemolytic anaemia and transient hyperlipidaemia. In the following report, we present the case of a man in his 30s who was admitted to our emergency department with severe epigastric pain and signs of alcohol intoxication. Blood samples showed signs of severe hyperlipidaemia and jaundice. Due to massive hyperlipidaemia, laboratory measurements of triglycerides were impaired and the blood samples had a ‘yellowish’ and ‘creamy’ texture. In order to prevent pancreatitis, plasmapheresis was performed. Subsequently, triglyceride concentration dropped and the patient was discharged a few days later in significantly improved physical condition. In the following case report, we discuss plasmapheresis as a possible treatment for patients with severe Zieve syndrome in addition to conventional symptomatic therapy.