Internal and Emergency Medicine最新文献

{"title":"Validation of syncope short-term outcomes prediction by machine learning models in an Italian emergency department cohort.","authors":"Alessandro Giaj Levra, Mauro Gatti, Roberto Mene, Dana Shiffer, Giorgio Costantino, Monica Solbiati, Raffaello Furlan, Franca Dipaola","doi":"10.1007/s11739-025-04034-x","DOIUrl":"https://doi.org/10.1007/s11739-025-04034-x","url":null,"abstract":"<p><p>Machine learning (ML) algorithms have the potential to enhance the prediction of adverse outcomes in patients with syncope. Recently, gradient boosting (GB) and logistic regression (LR) models have been applied to predict these outcomes following a syncope episode, using the Canadian Syncope Risk Score (CSRS) predictors. This study aims to externally validate these models and compare their performance with novel models. We included all consecutive non-low-risk patients evaluated in the emergency department for syncope between 2015 and 2017 at six Italian hospitals. The GB and LR models were trained and tested using previously validated CSRS predictors. Additionally, recently developed deep learning (TabPFN) and large language models (TabLLM) were validated on the same cohort. The area under the curve (AUC), Matthews correlation coefficient (MCC), and Brier score (BS) were compared for each model. A total of 257 patients were enrolled, with a median age of 71 years. Thirteen percent had adverse outcomes at 30 days. The GB model achieved the best performance, with an AUC of 0.78, an MCC of 0.36, and a BS of 0.42. Significant performance differences were observed compared with the TabPFN model (p < 0.01) and the TabLLM model (p = 0.01). The GB model performed only slightly better than the LR model. The predictive capability of the GB and LR models using CSRS variables was reduced when validated in an external syncope cohort characterized by a higher event rate.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prescription of ACE-Is/ARBs in patients with cardio-renal disease: a multicenter retrospective cohort study from the REPOSI registry.","authors":"Paolo Lido, Silvia Cantiero, Antonio Galluccio, Annalisa Noce, Luca Di Lullo, Roberto Bei, Ferdinando Iellamo, Pier Mannuccio Mannucci, Alessandro Nobili, Mauro Tettamanti","doi":"10.1007/s11739-025-04026-x","DOIUrl":"https://doi.org/10.1007/s11739-025-04026-x","url":null,"abstract":"<p><p>Cardio-renal disease is a common clinical condition leading to increased morbidity and mortality. Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) are the cornerstone of treatment of chronic cardio-renal disease. Using data from the REPOSI register, we performed a multicenter, observational, retrospective study to determine which factors are associated with the non-prescription or discontinuation of ACE-Is/ARBS in a cohort of 889 cardio-renal patients hospitalized in 109 Italian internal medicine and geriatric wards. Only 55% of the patients with cardio-renal disease of the investigated cohort were on treatment with ACE-Is or ARBs at admission. The primary end point was ACE-Is/ARBs use at discharge. Patients with lower probability of receiving ACE-Is/ARBs at discharge were older and hospitalized for longer periods. Furthermore, patients with advanced chronic kidney disease (advanced CKD: eGFR ≤ 29 mL/min/1.73m²) had a much lower (54%) probability of being discharged or continuing ACE-Is/ARBs treatment than those with eGFR ≥ 60 mL/min/1.73m². A more prominent lower probability was found comparing advanced CKD patients with G3 stage CKD patients (eGFR: 59-30 mL/min/1.73m²) in multivariate analyses (OR and 95%CI: 0.37, 0.24-0.57. multivariate p-value < 0.001). The probability of stopping treatment in patients already on treatment with ACE-Is/ARBs at hospital admission (secondary end point) almost reached a threefold increase (OR and 95%CI: 2.82, 1.69-4.71. multivariate p-value < 0.001) when the advanced CKD group was compared with G3 CKD patients. The data of our study are not in line with the recently published updated KDIGO 2024 Guidelines, which recommend patients with advanced CKD to continue treatment with ACE-Is/ARBs.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of e-cigarette use among individuals with asthma: findings from a cross-sectional population-based study.","authors":"Yusuff Adebayo Adebisi, Najim Z Alshahrani","doi":"10.1007/s11739-025-04045-8","DOIUrl":"https://doi.org/10.1007/s11739-025-04045-8","url":null,"abstract":"<p><p>The use of electronic cigarettes (e-cigarettes) among individuals with asthma is rising, yet limited evidence exists on predictors of use in this clinical population. Understanding factors associated with e-cigarette use may help inform public health interventions. In this study, we analysed data from 2671 individuals aged 16 years and older with doctor-diagnosed asthma, drawn from the 2017, 2018, 2019, and 2021 waves of the Scottish Health Survey. Current e-cigarette use was defined as self-reported use at the time of the survey. We used multivariable logistic regression to examine factors associated with current e-cigarette use among individuals with asthma, estimating adjusted odds ratios (aORs), 95% confidence intervals (CIs), and p values for age, sex, education, socio-economic deprivation, smoking status, alcohol consumption, and self-rated health. Overall, 193 participants (7.2%) reported current e-cigarette use. Current smokers had significantly higher odds of using e-cigarettes compared to never smokers (aOR: 38.9; 95% CI: 18.5-82.0; p < 0.001). Former smokers also had increased odds of e-cigarette use relative to never smokers (aOR: 32.0; 95% CI: 15.2-67.2; p < 0.001). Each one-category increase in age group (spanning approximately 10 years) was associated with a 23% reduction in the odds of current e-cigarette use (aOR: 0.77; 95% CI: 0.69-0.86; p < 0.001). Participants living in less deprived areas had 15% lower odds of current e-cigarette use for each one-quintile increase in the Scottish Index of Multiple Deprivation (aOR: 0.85; 95% CI: 0.74-0.97; p = 0.016). E-cigarette use was not significantly associated with sex, educational level, alcohol consumption, or self-rated health. These findings indicate that e-cigarette use among individuals with asthma is more prevalent among younger participants, those living in socioeconomically deprived areas, and those with a current or former smoking history. Further longitudinal research is needed to explore usage trajectories and respiratory health impacts in this clinical population.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144617413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutrophil to lymphocyte ratio (NLR) and short-term mortality risk in elderly acute medical patients admitted to a University Hospital Emergency Department: comment.","authors":"Xian Wen, Kaiyi Mao, Leibo Wang","doi":"10.1007/s11739-025-04049-4","DOIUrl":"https://doi.org/10.1007/s11739-025-04049-4","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608259","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Eosinophilic esophagitis in adults: expanding therapeutic options while still seeking precision medicine.","authors":"Michele Di Stefano, Giovanni Sarnelli","doi":"10.1007/s11739-025-04043-w","DOIUrl":"https://doi.org/10.1007/s11739-025-04043-w","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144608258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of suicides attempt by self-poisoning: the Pavia Emergency-Toxicologic Network experience before and after the COVID-19 pandemic years.","authors":"Azzurra Schicchi, Irene Ruvituso, Valeria M Petrolini, Ilaria Ferrari, Santi Di Pietro, Davide Lonati, Elisa Roda, Antonella Valli, Alberto L Malovini, Stefano Perlini, Carlo A Locatelli, Francesco Salinaro","doi":"10.1007/s11739-025-04040-z","DOIUrl":"https://doi.org/10.1007/s11739-025-04040-z","url":null,"abstract":"<p><p>In Italy, deliberate self-poisoning (DSP) represents a significant proportion of emergency department (ED) admissions for acute poisoning. This study examines the impact of the COVID-19 pandemic on the incidence, characteristics, and management of DSP in adults in Pavia, a region of Italy heavily affected during the initial outbreak. We conducted a retrospective observational study of DSP cases managed at the ED of IRCCS San Matteo Foundation University Hospital for which the advice of the Pavia Poison Control Centre (PPCC) was requested (January 1, 2019-December 31, 2022). Data were collected from the PPCC and ED electronic health records. We analyzed trends in DSPs in relation to Italian government-imposed COVID-19 restrictions. We included 324 cases, the 74.7% had a history of psychiatric disease. The trends in DSPs changed in relation to the phases of the COVID-19 pandemic. The number of DSPs increased during lockdown 2. A significant increase in DSPs has been found in patients with no prior history of psychiatric illness before COVID. The most used substances were drugs, covering 84.3% of all included cases with neuropsychotropic drugs as the most frequently used (222/273, 81.3%). The COVID-19 pandemic had an impact on DSP trends in the adult population, with an increase in cases among individuals without prior psychiatric history. The persistence of DSP cases throughout 2022 suggests that the psychological toll of the pandemic may have long-term consequences in the Pavia area, Italy. Future studies should aim to explore the long-term effects of the pandemic on mental health and suicidal behavior.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-related differences among patients with reflex neurally mediated syncope.","authors":"Vincenzo Russo, Erika Parente, Angelo Comune, Thao Huynh, Moiz Tariq, Tiziana Assante, Valentina Parisi, Maddalena Conte, Gerardo Nigro, Michele Brignole","doi":"10.1007/s11739-025-03972-w","DOIUrl":"https://doi.org/10.1007/s11739-025-03972-w","url":null,"abstract":"<p><p>Few studies have evaluated the effect of sex in patients with reflex neurally mediated syncope. The aim of our study was to describe the sex-related differences in clinical characteristics and responses to HUTT among a large population with syncope. 1845 consecutive patients who underwent HUTT for suspected or established reflex syncope were evaluated. The study population was dichotomized according to sex. The clinical characteristics, the HUTT positivity rate and responses were compared between the groups. The trends of blood pressure (BP) and heart rate (HR) and the HUTT positivity rate were analyzed across different age groups according to sex. 1845 patients (45 ± 20 years) were included; 938 were females. Females showed lower values of systolic BP with higher values of HR compared to males up to 49 years. The HUTT positivity rate was significantly lower in females compared to males (61.1% vs 66%; p = 0.03). After adjusting for age decades, females had a higher positivity rate than males until the age of 29 years. Females showed an overall significantly lower rate of cardioinhibitory response compared with males (22.2% vs 29.3%; p = 0.0005). Female patients with suspected reflex neurally mediated syncope showed a different hemodynamic profile characterized by lower BP values and higher HR values than males until the age of 49 years. The overall HUTT positivity rate was lower in females than in males; however, females had a higher positivity rate until the age of 29 years. The prevalence of cardioinhibitory response was lower in females.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144583784","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term left ventricular thrombosis resolution in patients receiving vitamin K antagonists: comment.","authors":"Khalil Ullah Khan, Muhammad Adnan, Soban Ahmed Qureshi, Shahrukh Rehman, Sohaib Raza","doi":"10.1007/s11739-025-04041-y","DOIUrl":"https://doi.org/10.1007/s11739-025-04041-y","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144567412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rethinking shifts: shift length, diurnal variability, and long-term health risks for emergency medicine physicians.","authors":"Nour Khatib, Anna Kempinska, Helen Levin, Tim Lynch, Nura Khattab, Kim DeSouza, Eric Heymann, Rodrick Lim","doi":"10.1007/s11739-025-04032-z","DOIUrl":"https://doi.org/10.1007/s11739-025-04032-z","url":null,"abstract":"<p><p>Emergency physicians are experts in managing critical conditions in a fast-paced everchanging environment. They deliver continuous 24/7 care and are the entry point to the healthcare system for many patients. It is essential to have healthy, alert and skilled emergency physicians at all times of the day and yet they face the physical and mental challenges of shift work. This article aims to explore the current literature on emergency department (ED) shiftwork, the mental well-being and physical implications of shift work and offer strategies to mitigate its detrimental effects on emergency physicians.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neutropenic patient with acute severe epigastric pain.","authors":"Hiroki Matsuura, Kazuhiko Yamamoto, Hiroyuki Kageyama, Aya Komura, Masayuki Kishida","doi":"10.1007/s11739-025-04030-1","DOIUrl":"https://doi.org/10.1007/s11739-025-04030-1","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144564759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}