BackgroundHeatstroke is a life-threatening condition defined by failure of heat load dissipation, resulting in a core temperature higher than 40 °C (104 °F) associated with neurological dysfunction. Topiramate may cause anhidrosis, potentially resulting in heatstroke, as reported especially in children.Case presentationA 57-year-old Caucasian man was admitted to the emergency room in a febrile comatose state. After a complete workup ruling out the usual etiologies of such a condition, we assumed the hypothesis of a heatstroke caused by topiramate, recently prescribed for essential tremor.ConclusionsTopiramate-related heatstroke has been described in children but must be recognized in adults as well. Outcomes may range from total clinical recovery to persistent neurological dysfunction or death. The prescription of topiramate and the follow-up of adult patients under this medication should include an evaluation of hypohidrosis, especially in contexts of high temperature.

BackgroundIron deficiency is a common problem in primary care and is usually treated with oral iron substitution. With the recent simplification of intravenous (IV) iron administration (ferric carboxymaltose) and its approval in many countries for iron deficiency, physicians may be inclined to overutilize it as a first-line substitution.ObjectiveThe aim of this study was to evaluate iron deficiency management and substitution practices in an academic primary care division 5 years after ferric carboxymaltose was approved for treatment of iron deficiency in Switzerland.MethodsAll patients treated for iron deficiency during March and April 2012 at the Geneva University Division of Primary Care were identified. Their medical files were analyzed for information, including initial ferritin value, reasons for the investigation of iron levels, suspected etiology, type of treatment initiated, and clinical and biological follow-up. Findings were assessed using an algorithm for iron deficiency management based on a literature review.ResultsOut of 1,671 patients, 93 were treated for iron deficiency. Median patients’ age was 40 years and 92.5% (n=86) were female. The average ferritin value was 17.2 μg/L (standard deviation 13.3 μg/L). The reasons for the investigation of iron levels were documented in 82% and the suspected etiology for iron deficiency was reported in 67%. Seventy percent of the patients received oral treatment, 14% IV treatment, and 16% both. The reasons for IV treatment as first- and second-line treatment were reported in 57% and 95%, respectively. Clinical and biological follow-up was planned in less than two-thirds of the cases.ConclusionThere was no clear overutilization of IV iron substitution. However, several steps of the iron deficiency management were not optimally documented, suggesting shortcuts in clinical reasoning.

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Surveying a large corpus of Modern Greek fiction from the interwar years to the decade of the financial crisis (2010-2020) we set out to delineate the national inflection of ‘working-class fiction’ along the axes of theme and style as well as answerability, i.e. the engagement with working-class interests in distinct periods (interwar years, WWII and postwar, Metapolitefsi and beyond). Characterized by quantitative and aesthetic variability, the Greek version of the genre is shown to engage actively with topical contextual issues as well as with changing imperatives of authorial commitment and the shifting composition of the working class.