Ventilation rate and successful recovery from cardiac arrest: illusory correlation bias or real effect?
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - October 11, 2019 Category: Emergency Medicine Source Type: research

Serum albumin and risk of cardiovascular events in primary and secondary prevention: a systematic review of observational studies and Bayesian meta-regression analysis
AbstractThe predictive role of serum albumin (SA) has been evaluated in primary prevention studies. We want to assess the association of SA with the subsequent risk of cardiovascular events (CVE) in primary and secondary prevention studies. We performed a systematic review and Bayesian meta-regression analysis. Studies were identified by PubMed and EMBASE database using a combination of the following terms and MeSH terms: “serum albumin”, “myocardial infarction, “cardiovascular events”, “percutaneous coronary intervention” and “coronary restenosis”. No time restriction ...
Source: Internal and Emergency Medicine - October 11, 2019 Category: Emergency Medicine Source Type: research

Internists feel the rhythm
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - October 9, 2019 Category: Emergency Medicine Source Type: research

Chronic large pseudoaneurysm of the left ventricle
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - October 9, 2019 Category: Emergency Medicine Source Type: research

Why include humanities in medical studies: comment
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - October 9, 2019 Category: Emergency Medicine Source Type: research

Management of chronic ischemic heart disease into internal medicine and geriatric departments in Italy
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - October 3, 2019 Category: Emergency Medicine Source Type: research

Prognostic value of serial lactate levels in septic patients with and without shock
AbstractTo analyze the prognostic value of lactate levels for day-7 and in-hospital mortality, in septic patients with and without shock. In the period November 2011 –December 2016, we enrolled 268 patients, admitted to our High-Dependency Unit with a diagnosis of sepsis. Lactate dosage was performed at ED-HDU admission (T0), after 2 h (T2), 6 h (T6) and 24 h (T24); lactate clearance was calculated at T2 and T6 [T2: ((LAC T0—LAC T2/LAC T0)*100)]; T6: [(LA C T0—LAC T6/LAC T0)*100]. The end-points were day-7 and in-hospital mortality. At every evaluation, the lactate level was higher in patie...
Source: Internal and Emergency Medicine - September 25, 2019 Category: Emergency Medicine Source Type: research

Aspirin in primary prevention: the triumph of clinical judgement over complex equations
AbstractAspirin, in 2017, has celebrated its 120th birthday. The efficacy and safety of low-dose aspirin in secondary prevention of cardiovascular disease is well supported by many studies, instead in primary prevention it remains controversial, especially in the aftermath of the publication in 2018 of three novel primary prevention randomized clinical trials, showing that the benefit of low-dose aspirin, although additive to that of statin, is counterbalanced by an excess of (mainly gastrointestinal) bleeding events. The signal for a net benefit seems to be even more controversial in the elderly starting aspirin after the...
Source: Internal and Emergency Medicine - September 21, 2019 Category: Emergency Medicine Source Type: research

Acute colonic pseudo-obstruction: a syndrome due to many causes
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - September 21, 2019 Category: Emergency Medicine Source Type: research

Epidemiology of idiopathic pulmonary fibrosis: a population-based study in primary care
AbstractIdiopathic pulmonary fibrosis (IPF) is a chronic disease with unknown etiology and poor prognosis. Little is known about the epidemiology of this disease; most of the studies are limited by small and restricted cohort studies. We aim to investigate the epidemiology of IPF in the Italian primary care setting using the Health Search Database (HSD) between January 2002 and June 2017. In an attempt to define cases of IPF we adopted iterative combinations of International Classification of Diseases Ninth Revision (ICD-9-CM) and other clinical investigations according to three different operational Algorithms. Incidence ...
Source: Internal and Emergency Medicine - September 20, 2019 Category: Emergency Medicine Source Type: research

Lacunar stroke syndromes as predictors of lacunar and non-lacunar infarcts on neuroimaging: a hospital-based study
AbstractLacunar syndromes are usually caused by small ischemic lesions called lacunar infarcts. However, non-lacunar infarcts account for about 20% of lacunar syndromes. The aim of this study was to identify clinical predictors of lacunar syndromes led by non-lacunar infarcts. The following single centre, observational study was conducted on an analysis of the “Perugia hospital-based Stroke Registry” database enrolling consecutive patients admitted with ischemic stroke during the period 2010–2017. We evaluated patient risk factors and clinical features linked to stroke syndrome (lacunar/non-lacunar) and t...
Source: Internal and Emergency Medicine - September 18, 2019 Category: Emergency Medicine Source Type: research

Lemierre ’s syndrome: a possible cause of neck pain
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - September 18, 2019 Category: Emergency Medicine Source Type: research

Direct oral anticoagulants in factor VII deficiency patient
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - September 16, 2019 Category: Emergency Medicine Source Type: research

Plasmablastic lymphoma of the maxillary sinus
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - September 14, 2019 Category: Emergency Medicine Source Type: research

Intentional foreign body ingestion
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - September 10, 2019 Category: Emergency Medicine Source Type: research

Temporal patterns of premature atrial complexes predict atrial fibrillation occurrence in bradycardia patients continuously monitored through pacemaker diagnostics
AbstractThe frequency of premature atrial complexes (PACs) has been related with atrial fibrillation (AF) occurrence and adverse prognosis. Research objective was to evaluate whether temporal patterns of PACs are directly associated with AF onset in pacemaker patients with continuous monitoring of the atrial rhythm. Overall, 193 pacemaker patients (49% female, 72  ± 9 years old), enrolled in a national registry, were analyzed. Frequency of daily PACs was measured in a 14-day initial observation period, during which patients were in sinus rhythm. In the following period, temporal occurrence and fre...
Source: Internal and Emergency Medicine - September 9, 2019 Category: Emergency Medicine Source Type: research

Randomized trial of two after-dialysis gabapentin regimens for severe uremic pruritus in hemodialysis patients
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - September 7, 2019 Category: Emergency Medicine Source Type: research

Diagnostic imaging for acute abdominal pain in an Emergency Department in Italy
AbstractImaging plays a key role in the diagnostic work-up of patients with non-traumatic acute abdominal pain (AAP) in emergency department (ED). We aimed to evaluate the use and diagnostic performance of imaging techniques in adult patients with AAP in an ED in Italy. Patients with non-traumatic AAP admitted at the ED of S. Orsola-Malpighi University Hospital of Bologna (Italy) from the 1st to the 30th November 2016 were included. Demographic and clinical data, data on radiological procedures and discharge diagnosis were collected. Sensitivity and specificity for detecting acute diseases were assessed using the discharge...
Source: Internal and Emergency Medicine - September 6, 2019 Category: Emergency Medicine Source Type: research

A meta-analysis of randomized controlled trials: combination of ketamine and propofol versus ketamine alone for procedural sedation and analgesia in children
AbstractAlthough ketamine has been used for procedural sedation and analgesia, some researchers have assessed ketamine –propofol as a better alternative because of its reduced adverse events. The goal of this review was to compare adverse events between ketamine–propofol and ketamine for procedural sedation and analgesia in children. We searched the literature from their inception to May 2018 without the restric tion of language. We included all randomized controlled trials comparing ketamine–propofol with ketamine for procedural sedation and analgesia in children. The meta-analysis was conducted using th...
Source: Internal and Emergency Medicine - September 6, 2019 Category: Emergency Medicine Source Type: research

Emphysematous liver abscess with hepatic portal venous gas
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - September 4, 2019 Category: Emergency Medicine Source Type: research

The dangerous consequences of orthostatic hypotension
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - September 3, 2019 Category: Emergency Medicine Source Type: research

Early predictors for the diagnosis of pyogenic liver abscess
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - September 1, 2019 Category: Emergency Medicine Source Type: research

Why include the humanities in medical studies? Comment
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 31, 2019 Category: Emergency Medicine Source Type: research

Endoplasmic reticulum aminopeptidase protein 1 and Beh çet’s syndrome
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 31, 2019 Category: Emergency Medicine Source Type: research

High-dose lormetazepam dependence: strange case of Dr. Jekyll and Mr. Hyde —reply
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 30, 2019 Category: Emergency Medicine Source Type: research

Reversal agents for oral anticoagulant-associated major or life-threatening bleeding
AbstractOral anticoagulants (OA) are effective drugs for treating and preventing the formation of blood clots in patients with atrial fibrillation, mechanical heart valves and venous thromboembolism but their therapeutic effect is always counterbalanced by an increased risk of bleeding. Direct oral anticoagulants (DOACs) have brought advantages in the management of many patients, with evidence of a lower risk of intracranial bleeding in comparison to vitamin K antagonists (VKAs). However, due to the increased number of anticoagulated patients worldwide, major and life threatening OA-related bleeding is also increasing, and...
Source: Internal and Emergency Medicine - August 24, 2019 Category: Emergency Medicine Source Type: research

Patterns of infections in older patients acutely admitted to medical wards: data from the REPOSI register
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 23, 2019 Category: Emergency Medicine Source Type: research

Changes in exercise capacity and risk of all-cause mortality in patients with peripheral artery disease: a 10-year retrospective cohort study
AbstractWe retrospectively studied the association between changes in exercise capacity at discharge from a home-based exercise program and the risk of all-cause mortality among patients with peripheral artery disease (PAD) and claudication. The records of 1076 consecutive PAD patients were assessed between 2003 and 2013. The exercise program was prescribed during a few visits and executed at home at symptom-free walking speed. Ankle –Brachial Index (ABI) and maximal speed (Smax) on an incremental treadmill test were recorded at baseline and discharge. The number and date of deaths and hospitalizations for a 10-year ...
Source: Internal and Emergency Medicine - August 21, 2019 Category: Emergency Medicine Source Type: research

Orthostatic hypotension among elderly patients in Italian internal medicine wards: an observational study
AbstractOrthostatic hypotension (OH) is a multifactorial disorder, often asymptomatic. The prevalence of OH increases with age, ranging from 5 to 11% among middle-aged patients to 55% in the frail elderly depending on age and associated comorbidities. OH is often unrecognized or misdiagnosed and little is known about its prevalence in hospitalized elderly patients. Our aims were: (1) to determine the prevalence of OH in a cohort of elderly patients hospitalized in two internal medicine wards in Italy; (2) and to describe their characteristics and symptoms. During the 5 months from March 1, 2017 to July 31, 2017, the first ...
Source: Internal and Emergency Medicine - August 19, 2019 Category: Emergency Medicine Source Type: research

Telemedicine and decentralized models of care: from anticoagulant monitoring to an expanded concept of vascular medicine
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 19, 2019 Category: Emergency Medicine Source Type: research

Health impact of electronic cigarettes and heated tobacco systems
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 14, 2019 Category: Emergency Medicine Source Type: research

Why include the humanities in medical studies?
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 10, 2019 Category: Emergency Medicine Source Type: research

Female sex and stroke in atrial fibrillation: an intriguing relationship
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 8, 2019 Category: Emergency Medicine Source Type: research

Direct-acting antivirals improve endothelial function in patients with chronic hepatitis: a prospective cohort study
AbstractHepatitis C virus (HCV) infection is associated with increased cardiovascular risk. We evaluated effects of direct-acting antiviral agents (DAAs) on flow-mediated dilation (FMD), a recognized marker of cardiovascular risk. We evaluated FMD and post-ischemic hyperemia (PIH) in consecutive HCV out-patients before starting DAAs, at the end of treatment (Teot) and 12  weeks thereafter. In 22 HCV subjects (age 64.0 years), baseline FMD was 4.52% ± 1.90 and PIH of 5814.4 (IQR 3786.9–7861.9). At (Teot), all patients showed undetectable levels of HCV-RNA and FMD changed from 4.52% &thin...
Source: Internal and Emergency Medicine - August 8, 2019 Category: Emergency Medicine Source Type: research

Lumbar puncture after direct oral anticoagulant (DOAC) reversal: a proposed algorithm for the emergency department
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 8, 2019 Category: Emergency Medicine Source Type: research

An “unmodifiable” risk factor that has been modified
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 8, 2019 Category: Emergency Medicine Source Type: research

Incidence of hyperkalemia in the emergency department: a 10-year retrospective study
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 8, 2019 Category: Emergency Medicine Source Type: research

Metabolomics for contrast-induced nephropathy risk prediction?
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 7, 2019 Category: Emergency Medicine Source Type: research

Assessment of epinephrine efficacy in out-of-hospital cardiac arrest
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 7, 2019 Category: Emergency Medicine Source Type: research

Hyperchloremia and acute kidney injury: a retrospective observational cohort study on a general mixed medical-surgical not ICU-hospitalized population
AbstractThe aim of this observational retrospective cohort study was to analyze the association between hyperchloremia and serum chloride variation with in-hospital acute kidney injury (AKI) and mortality in a general, no-ICU hospitalized population. We performed a retrospective study on inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 2010 and December 2014 with inclusion of adult patients with at least two values available for chloride, sodium and creatinine. Hyperchloremia was defined as serum chloride concentration  ≥ 108 mmol/L (moderate hyper...
Source: Internal and Emergency Medicine - August 6, 2019 Category: Emergency Medicine Source Type: research

Cardio-metabolic risk factors in Tunisia: state of the art
AbstractCardiometabolic risk factors in Tunisia are growing fast. The main risk factor is metabolic syndrome which is a global health issue in both developing and developed countries. It is resulting from a new phase of epidemiological transition characterised by ageing and an increase in non-communicable diseases. It is common in both genders with some disparities between urban and rural regions, educational levels and social classes. Hypertension and diabetes are also additional risk factors predicting alarming mortality rates. We propose here a review of the determinants of metabolic syndrome in Tunisia and the overall ...
Source: Internal and Emergency Medicine - August 6, 2019 Category: Emergency Medicine Source Type: research

New perspectives in eosinophilic granulomatosis with polyangiitis (EGPA): report of the first meeting of the European EGPA Study Group
AbstractThe European Eosinophilic Granulomatosis with Polyangiitis (EGPA) study group first gathered in Firenze in December 2018. The discussion was centred around the clinical and therapeutic needs in EGPA which still remain unmet. Indeed, EGPA is a puzzling and rare disease which shares clinical features with other anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAVs) and hypereosinophilic syndromes (HESs). Some of the recommendations published in 2015 are based on data derived from EGPA-related diseases, rather than from EGPA itself, and therefore need to be updated. Thus, the aim of the meeting was t...
Source: Internal and Emergency Medicine - August 6, 2019 Category: Emergency Medicine Source Type: research

Sickle cell disease: a review for the internist
AbstractSickle cell disease (SCD) is the most important hemoglobinopathy worldwide in terms of frequency and social impact, recently recognized as a global public health problem by the World Health Organization. It is a monogenic but multisystem disorder with high morbidity and mortality. Vaso-occlusion, hemolytic anemia and vasculopathy are the hallmarks of SCD pathophysiology. This review focuses both on “time-dependent” acute clinical manifestations of SCD and chronic complications commonly described in adults with SCD. The review covers a broad spectrum of topics concerning current management of SCD targete...
Source: Internal and Emergency Medicine - August 5, 2019 Category: Emergency Medicine Source Type: research

Utility of intestinal ultrasound in the diagnosis and short-term follow-up of non-steroidal anti-inflammatory drug-induced enteropathy
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - August 1, 2019 Category: Emergency Medicine Source Type: research

Handling shock in idiopathic systemic capillary leak syndrome (Clarkson ’s disease): less is more
AbstractIdiopathic systemic capillary leak syndrome (ISCLS) presents with recurrent potentially life-threatening episodes of hypovolemic shock associated with severe hemoconcentration and hypoproteinemia. Timely recognition is of paramount importance because ISCLS, despite resembling other kinds of hypovolemic shock, requires a peculiar approach, to prevent life-threatening iatrogenic damage. Due to the rarity of this condition with only scattered cases described worldwide, evidence-based recommendations are still lacking. Here, we summarize our 40  years’ experience in treating shock in ISCLS patients to derive...
Source: Internal and Emergency Medicine - July 26, 2019 Category: Emergency Medicine Source Type: research

Information flow during pediatric trauma care transitions: things falling through the cracks
In this study, we interviewed 18 clinicians about communication and coordination during pediatric trauma care transitions between the ED, OR and PICU. After the interview was completed, we surveyed them about patient safety during these transitions. Results of our study show that, despite the fact that the many services and units involved in pediatric trauma cooperate well together during trauma cases, important patient care information is often lost when transitioning patients between units. To safely manage the transition of this fragile and complex population, we need to find ways to better manage the information flow d...
Source: Internal and Emergency Medicine - July 26, 2019 Category: Emergency Medicine Source Type: research

From sadness to stiffness: the spleen ’s progress
AbstractThe spleen is a lymphoid organ that has been poorly studied compared to other solid organs, probably because it has been considered a useless and unnecessary part of the body. For many centuries it has been considered a mysterious organ with uncertain functions. The first descriptions of the spleen date back to ancient ages. The spleen has been considered as a reservoir of liquids, strictly linked to stomach digestion, and in different cultures, it has been linked to melancholy and sadness due to the accumulation of black bile (humoral doctrine). A detailed anatomic description was first made by Vesalius during the...
Source: Internal and Emergency Medicine - July 26, 2019 Category: Emergency Medicine Source Type: research

Distribution of rs17482078 and rs27044 ERAP1 polymorphisms in a group of Italian Beh çet’s syndrome patients: a preliminary case–control study
This study was conducted on the two most consistently BS-associatedERAP1 polymorphisms, rs17482078 (NG_027839.1:g.35983G>A) and rs27044 (NG_027839.1:g.35997C>G) to analyse their distribution in 55 Italian BS patients and 65 ethnically matched controls (healthy controls, HC) and to test their association with BS risk. SNPs were detected by isolation, amplification of genomic DNA and direct sequencing. SNPs functional effects were predicted by bioinformatics software. The odds ratio (OR) with 95% confidence intervals was calculated to assess the strength of BS association for genotypes and alleles, also validated by lo...
Source: Internal and Emergency Medicine - July 26, 2019 Category: Emergency Medicine Source Type: research

Does illness perception associate with disease symptoms in Beh çet’s disease?
This study aims to assess the relationship between illness perception and disease course and symptoms in Beh çet disease (BD). One hundred ten consecutive BD patients (F/M 50/60, mean age 38.5 ± 9.88 years) and 57 patients with Psoriasis as a disease control group (F/M 28/29, mean age 48.12 ± 15.52) are included in this cross-sectional study. Illness perception is evaluated using a revised vers ion of the Illness Perception Questionnaire (IPQ-R). In IPQ-R, the identity score reflecting the number of symptoms is higher in BD patients with musculoskeletal involvement than...
Source: Internal and Emergency Medicine - July 26, 2019 Category: Emergency Medicine Source Type: research

Detecting delirium in elderly medical emergency patients: validation and subsequent modification of the German Nursing Delirium Screening Scale
AbstractDetecting delirium in elderly emergency patients is critical to their outcome. The Nursing Delirium Screening Scale (Nu-DESC) is a short, feasible instrument that allows nurses to systematically screen for delirium. This is the first study to validate the Nu-DESC in a German emergency department (ED). The Nu-DESC was implemented in a high-volume, interdisciplinary German ED. A consecutively recruited sample of medical patients aged  ≥ 70 years was screened by assigned nurses who performed the Nu-DESC as part of their daily work routine. The results were compared to a criterion standard diagnos...
Source: Internal and Emergency Medicine - July 26, 2019 Category: Emergency Medicine Source Type: research