Learning the value of Africa ’s collectivism for an individualistic Europe
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - April 11, 2019 Category: Emergency Medicine Source Type: research

Daylight saving time transitions and circulatory deaths: data from the Veneto region of Italy
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - April 9, 2019 Category: Emergency Medicine Source Type: research

Identifying patients with refusal of percutaneous coronary intervention for acute myocardial infarction: a classification and regression tree analysis
AbstractThe purpose of the present study is to develop and validate a prediction tool to identify patients who refuse to receive percutaneous coronary intervention (PCI) rapidly. We developed a risk stratification model using the derivation cohort of 288 patients with ST segment elevation myocardial infarction (STEMI) in our hospital and validated it in a prospective cohort of 115 patients. There were 52 (18.1%) patients and 18 (15.7%) patients who refused PCI among derivation and validation cohort, respectively. A classification and regression tree (CART) analysis and multivariate logistic regression were used for statist...
Source: Internal and Emergency Medicine - April 4, 2019 Category: Emergency Medicine Source Type: research

Prevalence of antiphospholipid antibodies among patients with chronic thromboembolic pulmonary hypertension
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - April 1, 2019 Category: Emergency Medicine Source Type: research

Rapid rule-out of suspected acute coronary syndrome in the Emergency Department by high-sensitivity cardiac troponin T levels at presentation
AbstractThe reliability of initial high-sensitivity cardiac troponin T (hs-cTnT) under limit-of-detection in ruling-out short- and long-term acute coronary events in subjects for suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not definitely settled. In a retrospective chart review analysis, 1001 subjects with hs-cTnT  ≤ 14 ng/L out of 4053 subjects with hs-cTnT measured at Emergency Department (ED) presentation were recruited. The main outcome measure is fatal or non-fatal myocardial infarction (MI) within 30 days; secondary outcomes are MI or major acute coronary events...
Source: Internal and Emergency Medicine - March 28, 2019 Category: Emergency Medicine Source Type: research

Safety and efficacy of sucrosomial iron in inflammatory bowel disease patients with iron deficiency anemia
AbstractIron deficiency anemia (IDA) is one of the most common complications of inflammatory bowel disease (IBD). We planned a prospective study to address tolerability and efficacy of sucrosomial iron, a new oral formulation of ferric pyrophosphate, in IBD patients. Thirty patients with a confirmed diagnosis of Crohn ’s Disease (CD) or ulcerative colitis (UC) and mild IDA were enrolled. Patients with severe IBD were excluded. All patients underwent 12 weeks of oral treatment with 30 mg/day of sucrosomial iron. Treatment compliance and adverse events were investigated every 4 weeks. Iron status, hemato...
Source: Internal and Emergency Medicine - March 28, 2019 Category: Emergency Medicine Source Type: research

Is there a role for lumbar puncture in early detection of subarachnoid hemorrhage after negative head CT?
AbstractTo investigate the role of lumbar puncture (LP) after a negative head computed tomography (CT) when ruling out subarachnoid hemorrhage (SAH) within 24  h of symptom onset. In a single-center, retrospective cohort study, we studied a consecutive series of patients from 2011 to 2015. All patients underwent CT or CT following LP to rule out SAH. Patients were categorized into four groups depending on the time of symptom onset to initial head CT: 0– 6 h, 6–12 h, 12–24 h, and over 24 h. Experienced radiologists interpreted all CT scans. We investigated the sensitivity, specific...
Source: Internal and Emergency Medicine - March 28, 2019 Category: Emergency Medicine Source Type: research

Landmark trials in thrombotic vascular disease: a critical appraisal of potential practice-changing trials in 2016 –2017
AbstractRecent years have witnessed an onslaught of large, multicenter, randomized controlled trials evaluating the prevention and management of thrombotic vascular diseases. While these trials have applied rigorous methodology to pragmatic and clinically relevant questions, several important gaps in knowledge remain. In this review, we critically appraise landmark studies in thrombosis published between 2016 and 2017 that address several ongoing areas of clinical uncertainty. Specifically, we review the role of endovascular therapy in the prevention of post-thrombotic syndrome following acute lower limb deep vein thrombos...
Source: Internal and Emergency Medicine - March 28, 2019 Category: Emergency Medicine Source Type: research

A denture gone missing!
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 28, 2019 Category: Emergency Medicine Source Type: research

Fahr ’s syndrome
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 28, 2019 Category: Emergency Medicine Source Type: research

A combined care model using early access to specialists off-hours to reduce cardiac admissions
AbstractDespite the implementation of diagnostic and treatment algorithms for many common cardiovascular (CV) complaints, identifying low- and intermediate-risk cardiac patients presenting to the emergency department (ED) who could be managed without hospital admission remains difficult. We hypothesized that the presence of an attending cardiologist in the ED after normal working hours would decrease the proportion of these patients admitted to the hospital. We conducted a retrospective study of patients seen in the ED with cardiac diagnoses identified by ICD-9 codes during the time period when the cardiologist was availab...
Source: Internal and Emergency Medicine - March 27, 2019 Category: Emergency Medicine Source Type: research

Is social support associated with hypertension control among Ghanaian migrants in Europe and non-migrants in Ghana? The RODAM study
This study assessed the association between multiple proxies for social support and HTN control among Ghanaians resident in Ghana and Europe. The Research on Obesity and Diabetes among African Migrants (RODAM) study participants with HTN and who self-reported HTN (n = 1327) were included in this analysis. Logistic regression was used to assess the association between proxies of social support and HTN control (SBP 
Source: Internal and Emergency Medicine - March 26, 2019 Category: Emergency Medicine Source Type: research

Is echocardiography mandatory for patients with chronic kidney disease?
This study aims at evaluating the prevalence of left ventricular diastolic dysfunction in a group of 319 hypertensive patients with stage 3b –4–5 chronic kidney disease (according to Kidney Disease Improving Global Outcomes classification), compared with 216 patients with essential hypertension and normal renal function. All patients underwent echocardiographic examination. Patients on stage 1–2–3a chronic kidney disease, dialysi s treatment, or with previous manifestations of heart failure or other cardiovascular diseases were excluded. Patients with renal disease had significantly worse diastolic ...
Source: Internal and Emergency Medicine - March 25, 2019 Category: Emergency Medicine Source Type: research

Leptin: a marker of renal injury
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 25, 2019 Category: Emergency Medicine Source Type: research

The impact of different models of resident supervision on patient safety and resident education
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 21, 2019 Category: Emergency Medicine Source Type: research

Right ventricular diameter predicts all-cause mortality in heart failure with preserved ejection fraction
AbstractLeft ventricular ejection fraction (EF) is helpful to differentiate heart failure (HF) phenotype in clinical practice. The aim of the study was to identify simple echocardiographic predictors of post-discharge all-cause mortality in hospitalized HF patients. Patients with acute HF (75  ± 9.8 years), classified in preserved (≥ 50%) and reduced (
Source: Internal and Emergency Medicine - March 20, 2019 Category: Emergency Medicine Source Type: research

Elder abuse: are we turning a blind eye to a crucial issue?
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 18, 2019 Category: Emergency Medicine Source Type: research

Is vitamin D deficiency predictor of complications development in patients with HCV-related cirrhosis?
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 16, 2019 Category: Emergency Medicine Source Type: research

Thyroid hormones modulate uric acid metabolism in patients with recent onset subclinical hypothyroidism by improving insulin sensitivity
This report was designed to evaluate the influential role of levothyroxine (L-T4) replacement therapy on circulating levels of UA in patients with recent onset post-thyroidectomy subclinical hypothyroidism. Circulating levels of thyroid hormones, UA and other metabolic parameters were assessed in 155 recently thyroidectomized patients (131 females, mean age 51.1  ± 12.7 years) at baseline (5–7 day after surgery) and after 2 months under replacement therapy with L-T4. At baseline, circulating levels of thyroid hormones were indicative of a subclinical hypothyroidism (TSH 8.2 ...
Source: Internal and Emergency Medicine - March 13, 2019 Category: Emergency Medicine Source Type: research

Clinical significance of pleural effusions and association with outcome in patients hospitalized with a first episode of acute pericarditis
AbstractThe clinical significance of pleural effusions (PLEs) in the setting of acute pericarditis remains poorly investigated. We sought to identify predictive factors for PLEs and their association with the short- and long-term prognosis of patients with acute pericarditis. We enrolled 177 patients hospitalized with a first episode of acute pericarditis. In all cases an extensive clinical, biochemical, and diagnostic work-up to detect PLEs and establish etiological diagnosis was performed. All patients included were prospectively followed for a maximum of 18  months (median 12, range 1–18) and complications we...
Source: Internal and Emergency Medicine - March 13, 2019 Category: Emergency Medicine Source Type: research

In-flight cardiac arrest and in-flight cardiopulmonary resuscitation during commercial air travel: consensus statement and supplementary treatment guideline from the German society of aerospace medicine (DGLRM): reply
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 13, 2019 Category: Emergency Medicine Source Type: research

Proximal and isolated distal deep vein thrombosis and Wells score accuracy in hospitalized patients
AbstractDeep vein thrombosis (DVT) is an important cause of morbidity and mortality in hospitalized patients. The Wells score for DVT pretest probability (PTP) was validated in outpatients, but its utility for inpatients is unclear. The aim of this study was to establish the prevalence of inpatient proximal and distal DVT and the Wells score performance in inpatients. A single-center cross-sectional study was conducted in a university hospital. During 183  days, all inpatients with suspected lower-extremity DVT were evaluated with the Wells score and whole-leg ultrasound. Among 634 inpatients (age 77.5 ±...
Source: Internal and Emergency Medicine - March 12, 2019 Category: Emergency Medicine Source Type: research

Effects of allopurinol and febuxostat on cardiovascular mortality in elderly heart failure patients
AbstractHyperuricemia is an emerging risk factor for the development of heart failure (HF) and is associated with a worsen prognosis of the disease. The effect of urate lowering drugs (ULT) and, in particular, the xanthine oxidase inhibitor in patients with HF is controversial. The aim of the study is to compare the effects of treatment with two different xanthine oxidase inhibitors (allopurinol or febuxostat) on cardiovascular mortality in elderly patients with chronic HF in a setting of clinical practice. In this observational trial, 255 elderly patients affected by chronic HF and treated with ULT on top of optimal medic...
Source: Internal and Emergency Medicine - March 12, 2019 Category: Emergency Medicine Source Type: research

Assessment of the feasibility of a partial oral regimen for antibiotic therapy of endocarditis
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 12, 2019 Category: Emergency Medicine Source Type: research

Intranasal sufentanil given in the emergency department triage zone for severe acute traumatic pain —a randomized double-blind controlled trail: comment
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 12, 2019 Category: Emergency Medicine Source Type: research

Early predictors for the diagnosis of liver abscess in the emergency department
AbstractDiagnosing pyogenic liver abscess (PLA) in the emergency department (ED) is challenging due to its non-specific clinical presentation. We aim to identify predictors that aid in diagnosis of PLA in ED patients. This retrospective chart review included patients diagnosed with PLA in a tertiary hospital between January 2008 and December 2012. We compared the demographics, clinical characteristics, investigations and outcomes between patients with PLA diagnosed and missed in the ED. During the study period, 155 patients were admitted via the ED with a cause of death or discharge diagnosis of PLA. Mean age was 58.1 (sta...
Source: Internal and Emergency Medicine - March 7, 2019 Category: Emergency Medicine Source Type: research

Prevalence and outcome of diuretic resistance in heart failure: reply
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 6, 2019 Category: Emergency Medicine Source Type: research

Causes and impact on survival of underuse of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in heart failure
AbstractGuidelines recommend angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) for treatment of heart failure with reduced ejection fraction (HFrEF), but these medications are underprescribed in clinical practice. We reviewed the records of HF patients receiving a first visit in a tertiary outpatient clinic from January 1st 2004 to May 31st 2015, and selected those with a serum creatinine concentration (sCr) available at both the first and last visit and  
Source: Internal and Emergency Medicine - March 5, 2019 Category: Emergency Medicine Source Type: research

A lower impact of an acute exposure to electronic cigarette aerosols than to cigarette smoke in human organotypic buccal and small airway cultures was demonstrated using systems toxicology assessment
AbstractIn the context of tobacco harm-reduction strategy, the potential reduced impact of electronic cigarette (EC) exposure should be evaluated relative to the impact of cigarette smoke exposure. We conducted a series of in vitro studies to compare the biological impact of an acute exposure to aerosols of “test mix” (flavors, nicotine, and humectants), “base” (nicotine and humectants), and “carrier” (humectants) formulations usingMarkTen® EC devices with the impact of exposure to smoke of 3R4F reference cigarettes, at a matching puff number, using human organotypic air –liqui...
Source: Internal and Emergency Medicine - March 5, 2019 Category: Emergency Medicine Source Type: research

Chronic diarrhea: an unusual clinical presentation of vitamin B 12 deficiency?
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - March 5, 2019 Category: Emergency Medicine Source Type: research

Five common errors to avoid in clinical practice: the Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) Choosing Wisely Campaign
AbstractModern medicine provides almost infinite diagnostic and therapeutic possibilities if compared to the past. As a result, patients undergo a multiplication of tests and therapies, which in turn may trigger further tests, often based on physicians ’ attitudes or beliefs, which are not always evidence-based. The Italian Association of Hospital Gastroenterologists and Endoscopists (AIGO) adhered to the Choosing Wisely Campaign to promote an informed, evidence-based approach to gastroenterological problems. The aim of this article is to report the five recommendations of the AIGO Choosing Wisely Campaign, and the p...
Source: Internal and Emergency Medicine - February 23, 2019 Category: Emergency Medicine Source Type: research

Emergency department visits by patients with an internal medicine specialist: understanding the role of specialists in reducing ED crowding
AbstractAs emergency department (ED) crowding continues to worsen, many visits are at academic referral hospitals. As a result, engaging specialty services will be essential to decompressing the ED. To do this, it will be important to understand which specialties to focus interventions on for the greatest impact. To characterize the ED utilization of non-surgical adult patients with an ambulatory specialist who were seen and discharged from the ED. Retrospective cohort study of all consecutive patients currently under the care from a specialist presenting to an urban, university affiliated hospital between 01 January 2015 ...
Source: Internal and Emergency Medicine - February 22, 2019 Category: Emergency Medicine Source Type: research

Acute pericarditis or a systemic disease with pleuropulmonary involvement?
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 21, 2019 Category: Emergency Medicine Source Type: research

Facial palsy associated with Epstein –Barr infection in an adult patient: case report
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 20, 2019 Category: Emergency Medicine Source Type: research

Prevalence and outcome of diuretic resistance in heart failure: comment
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 20, 2019 Category: Emergency Medicine Source Type: research

Driving the route of laboratory medicine: a manifesto for the future
AbstractThe role of laboratory medicine is essential in healthcare, since in vitro diagnostic testing represents now an unavoidable part of reasoning and clinical decision making. Laboratory tests are an essential part of most care pathways, aimed at optimizing resource utilization and improving patient outcome. The activity of laboratory professionals is interconnected with all medical disciplines, and provides a crucial support for ordering the right test, for the right patient and at the right time, but also helps interpreting and using laboratory data. Although recent advancement in laboratory medicine, catalyzed by te...
Source: Internal and Emergency Medicine - February 19, 2019 Category: Emergency Medicine Source Type: research

Comparison of Reverse Triage with National Early Warning Score, Sequential Organ Failure Assessment and Charlson Comorbidity Index to classify medical inpatients of an Italian II level hospital according to their resource ’s need
AbstractResource allocation in our overcrowded hospitals would require classification of inpatients according to the severity of illness, the evolving risk and the clinical complexity. Reverse triage (RT) is a method used in disasters to identify inpatients according to their use of hospital resources. The aim of this observational prospective study is to evaluate the use of RT in medical inpatients of an Italian Hospital and to compare the RT score with National Early Warning Score, Sequential Organ Failure Assessment and Charlson Comorbidity Index. Cluster sampling was performed on high dependency unit (HDU), geriatrics ...
Source: Internal and Emergency Medicine - February 18, 2019 Category: Emergency Medicine Source Type: research

Hypocalcemia and hypophosphatemia after treatment with zoledronic acid in a patient with AL amyloidosis
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 15, 2019 Category: Emergency Medicine Source Type: research

Assessing the lung cancer risk reduction potential of candidate modified risk tobacco products
AbstractSmoking is the major cause of lung cancer. While the risk of lung cancer increases with the number of cigarettes smoked and the duration of smoking, it also decreases upon smoking cessation. The development of candidate modified risk tobacco products (cMRTP) is aimed at providing smokers who will not quit with alternatives to cigarettes that present less risk of harm and smoking-related disease. It is necessary to assess the risk reduction potential of cMRTPs, including their potential to reduce the risk of lung cancer. Assessing the lung cancer risk reduction potential of cMRTPs is hampered by (i) the absence of c...
Source: Internal and Emergency Medicine - February 14, 2019 Category: Emergency Medicine Source Type: research

A 29-year-old woman with persistent thrombocytopenia
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 12, 2019 Category: Emergency Medicine Source Type: research

Nephrotic range proteinuria and acute heart failure
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 12, 2019 Category: Emergency Medicine Source Type: research

Phenotypes in Beh çet’s syndrome
AbstractBeh çet syndrome (BS) is a multi-systemic complex disorder with unknown etiology and a unique geographic distribution. It could not be possible to include it into specific classification schemes and it is certainly not a uniform disease. Several cluster and association studies revealed that it has been composed of multiple phenotypes ascribing the principal problem such as skin-mucosa, joint, eye, vascular, neurological and gastrointestinal involvement. Each phenotype has its own characteristic demographic and clinical features as such their management strategies and prognosis differ substantiall y. Actually...
Source: Internal and Emergency Medicine - February 11, 2019 Category: Emergency Medicine Source Type: research

Pathergy testing: prospective comparison of dermatoscopic evaluation and naked eye examination
This study revealed that naked eye evaluation of pathergy test results can yield different results among different interpreters. Use of dermatoscopy during the evaluation process decreases interobserver variation and subjectivity of the test. (Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 8, 2019 Category: Emergency Medicine Source Type: research

Risk factors for extended-spectrum beta-lactamase-producing Enterobacteriales infection: are they the same in neutropenic and non-neutropenic patients?
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 8, 2019 Category: Emergency Medicine Source Type: research

Sepsis patients with complication of hypoglycemia and hypoalbuminemia are an early and easy identification of high mortality risk
This study evaluates whether the mortality risk increases in septic patients if these conditions are combined. Patients admitted to our hospital from 2008 to 2015 who satisfied the definition of sepsis were targeted (n = 336). We classified cases into three groups based on blood glucose (BG) level measured at admission: hypoglycemia (Hypo-G; BG 
Source: Internal and Emergency Medicine - February 7, 2019 Category: Emergency Medicine Source Type: research

Five steps for the use and interpretation of D-dimer in the Emergency Department
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 7, 2019 Category: Emergency Medicine Source Type: research

Quick Sequential Organ Failure Assessment as a prognostic factor for infected patients outside the intensive care unit: a systematic review and meta-analysis
AbstractQuick Sequential Organ Failure Assessment (qSOFA) was proposed to replace SIRS as a new screening tool for the identification of septic patients at high mortality. However, researches from infected patients outside of ICU especially in Emergency Department (ED) drew contradictory conclusions on the prognostic value of qSOFA. This systematic review evaluated  qSOFA as a prognostic marker of infected patients outside of ICU. The primary outcome was hospital mortality or 28- or 30-day mortality. Data were pooled based on sensitivity and specificity. Twenty-four trials with 121,237 participants were included....
Source: Internal and Emergency Medicine - February 6, 2019 Category: Emergency Medicine Source Type: research

Iron replacement in inflammatory bowel diseases: an evolving scenario
(Source: Internal and Emergency Medicine)
Source: Internal and Emergency Medicine - February 5, 2019 Category: Emergency Medicine Source Type: research

Assessment of deep venous thrombosis in the lower extremity in Beh çet’s syndrome: MR venography versus Doppler ultrasonography
AbstractLower extremity venous thrombosis (DVT) is the most common vascular manifestation of Beh çet’s syndrome (BS). Currently, Doppler ultrasonography (USG) is the most commonly preferred imaging modality in the diagnosis and follow-up of patients with acute and chronic DVT. Magnetic resonance (MR) venography, a quick and a non-invasive imaging modality, is successfully used to detect DVT in various settings. We had been unaware of studies with MR venography in BS. The aim of this study is to compare the diagnostic value of true fast imaging with steady-state precession magnetic resonance (True-FISP MR) veno...
Source: Internal and Emergency Medicine - February 2, 2019 Category: Emergency Medicine Source Type: research

A randomised, open-label, cross-over clinical study to evaluate the pharmacokinetic profiles of cigarettes and e-cigarettes with nicotine salt formulations in US adult smokers
AbstractE-cigarettes containing ‘nicotine salts’ aim to increase smoker’s satisfaction by improving blood nicotine delivery and other sensory properties. Here, we evaluated the pharmacokinetic profiles and subjective effects of nicotine from two e-cigarette device platforms with varying concentrations of nicotine lactate (ni cotine salt) e-liquid relative to conventional cigarettes. A randomised, open-label, cross-over clinical study was conducted in 15 healthy US adult smokers. Five different e-cigarette products were evaluated consecutively on different days after use of own brand conventional cigarette...
Source: Internal and Emergency Medicine - February 2, 2019 Category: Emergency Medicine Source Type: research