Internal and Emergency Medicine最新文献

{"title":"Intravenous ibuprofen versus ketorolac for acute low back pain in the emergency department: a triple-blind randomized clinical trial.","authors":"Mona Jafarkhani, Maryam Bahreini, Fatemeh Rasooli","doi":"10.1007/s11739-026-04570-0","DOIUrl":"https://doi.org/10.1007/s11739-026-04570-0","url":null,"abstract":"<p><p>Considering the frequency of recurrence in low back pain (LBP), there is no single medication group with promising efficacy in acute settings. Non-steroidal anti-inflammatory drugs (NSAIDs) provide better pain relief with rather low complications. Since ketorolac has been relatively effective, we compared its safety and efficacy with ibuprofen as an alternative for pain relief in acute LBP. In this multi-centric triple-blind randomized clinical trial, we compared intravenous (IV) ibuprofen and ketorolac in patients with acute LBP presenting to the EDs of three university hospitals. Group 1 received IV ibuprofen (800 mg), and group 2 received IV ketorolac (30 mg), based on a computerized random sequence. Trained head nurses prepared analgesics in blocks of four. Neither patients nor the researcher or the statistician knew about the medication. We applied Visual Analog Scale (VAS) for patients to score their pain at baseline and 10 and 30 min after pain medications. Of 73 enrolled patients, 39 were in the ketorolac group and 34 participants in the ibuprofen group. Pain scores were significantly lower in the ibuprofen group at both 10 min (49.6 vs 57.4; p =0.013) and 30 min (32.2 vs 40.7; p =0.038). Based on the pain intensity after 30 min, the majority of patients in the ibuprofen group (70.6%) rated their pain as mild, while only 35.9% of the ketorolac group reported pain relief to a mild level (p <0.001). The mean ED length of stay was significantly lower in the ibuprofen group, whereas rescue analgesia and adverse events were comparable between the groups. Pain intensity was significantly lower in the ibuprofen group than in the ketorolac group after 10 and 30 min, without a significant difference in side effects. Intravenous ibuprofen can serve as an acceptable alternative and might be more effective than ketorolac in acute LBP in the ED.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227888","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":"Estimated plasma volume status (ePVS) as a prognostic marker in polytrauma: predicting 30-day mortality and coagulation support needs.","authors":"Greta Barbieri, Alessandro Cipriano, Camilla Cremonini, Gianni Turcato, Alessandro Ranalli, Arial Zaboli, Massimo Santini, Massimo Chiarugi, Alessandro Mazzoni, Lorenzo Ghiadoni, Federico Coccolini","doi":"10.1007/s11739-026-04537-1","DOIUrl":"https://doi.org/10.1007/s11739-026-04537-1","url":null,"abstract":"<p><p>Estimated plasma volume status (ePVS), derived from a simple formula based on haematocrit and haemoglobin values, has been associated with an unfavourable prognosis in many cardiovascular conditions, demonstrating a correlation with volume overload and the haemodynamic status of the patient. Indeed, ePVS was demonstrated to estimate the degree of congestion and was independently associated with cardiovascular outcomes, rehospitalization, and death in patients with heart failure (HF), confirming its prognostic value also in inflammatory pathologies. Due to its easy and immediate availability even in the emergency department (ED), ePVS may be useful in trauma patients to improve their initial evaluation and management. The aim of this retrospective observational study was to evaluate the role of ePVS at ED admission in predicting mortality and blood products use, red blood cells (RBC) and fresh frozen plasma (FFP), in trauma. We included 790 patients, of whom 67.7% were male; mean age 43.9 years; median Injury Severity Score (ISS) 7.5. The 30-day mortality rate was 2.8% (22/790). The median ePVS was significantly increased in deceased as compared to survivors (5.76; 4.79-8.36 versus 4.41; 3.92-5.05; p < 0.001). Multivariable logistic regression analysis demonstrated that ePVS is an independent risk factor even after adjusting for other variables associated with 30-day mortality (odds radio, OR of 1.23; 95% confidence interval, CI 1.016-1.478, p = 0.034). Prediction of 30-day mortality for ePVS showed an AUROC of 0.776 (95% CI 0.666-0.887). Moreover, ePVS showed a positive correlation with the number of packed RBC and FFP units transfused, both during ED management, within the first 24 h, and over the entire hospital stay. The present findings suggest ePVS as a quick and easy tool to predict 30-day mortality and the need for blood resuscitation in trauma patients. Future studies may validate ePVS as a quick and easy tool for trauma victims' stratification and for predicting resource needs and mortality.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149224039","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":"Systemic nicotine exposure following switching to heated tobacco products: a category-level analysis of urinary nicotine equivalents.","authors":"Jacqueline Miller-Holt, Grant O'Connell, Maurane Charriere, Sylvain Larroque, Karin Jacobson","doi":"10.1007/s11739-026-04562-0","DOIUrl":"https://doi.org/10.1007/s11739-026-04562-0","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207020","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":"Recurrent cardiac tamponade in a young man unmasking an endocrine surprise: a case record.","authors":"Abdelraouf Fahmy, Abdulrahman Al Husil, Moustafa Eldeib, Mohsen Salah AbdelAzim, Sayed M Abdou","doi":"10.1007/s11739-026-04560-2","DOIUrl":"https://doi.org/10.1007/s11739-026-04560-2","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192804","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":"The role of low muscle strength in predicting mortality in patients with liver cirrhosis and hepatocellular carcinoma.","authors":"Paolo Gallo, Valentina Flagiello, Antonio De Vincentis, Simone Di Cola, Andrea Falcomatà, Maryam Motamedrad, Francesca Terracciani, Eliodoro Faiella, Antonio Picardi, Raffaele Antonelli-Incalzi, Aldo J Montano-Loza, Umberto Vespasiani-Gentilucci","doi":"10.1007/s11739-026-04548-y","DOIUrl":"https://doi.org/10.1007/s11739-026-04548-y","url":null,"abstract":"<p><p>Sarcopenia is a prevalent complication in chronic liver disease (CLD), traditionally assessed by muscle mass. Recent paradigm shifts focus to dynapenia as the primary determinant of adverse outcomes. This study aims to evaluate the role of dynapenia, as measured by handgrip strength (HGS) and ultrasound-derived diaphragmatic excursion, in predicting mortality in this population. This prospective study included consecutive outpatients with cirrhosis and hepatocellular carcinoma history attending a tertiary hepatology unit. Muscle mass was assessed in subgroups using bioimpedance analysis (BIA) and computed tomography (CT). Associations between sarcopenia proxies and 24-month all-cause mortality were analyzed with adjusted Cox regression models, and survival was estimated using Kaplan-Meier curves. Ninety-one patients were included (age 73.4 ± 8.1 years; 71 [78%] male); 20 (22%) had dynapenia. Twenty-two deaths occurred at two years (24.2%). Over 24 months, dynapenia (by HGS) and diaphragmatic excursion were associated with mortality in adjusted models (aHR 1.68, 95% CI 1.12-2.53, p = 0.012; aHR 0.58, 95% CI 0.34-0.97, p = 0.042). In subgroups, they remained the only muscle parameters associated with mortality, while muscle mass indices were not significant. Finally, Kaplan-Meier estimates showed lower 24-month survival in dynapenic patients across groups (in overall population 65% vs. 79%, p = 0.05). Low muscle strength is a key prognostic parameter in patients with cirrhosis and HCC. In our small cohort, it was the only muscle-related measure significantly associated with mortality. These findings support further evaluation of muscle strength assessment as a potential tool for risk stratification in this population.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206942","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":"Fasting before elective abdominal ultrasound: a systematic review and meta-analysis-comment.","authors":"Yu Jiang, Ruisi Chen, Peng Li","doi":"10.1007/s11739-026-04564-y","DOIUrl":"https://doi.org/10.1007/s11739-026-04564-y","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207015","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":"Altered cholangiocyte subsets with neural pathway enrichment in metabolic dysfunction-associated steatotic liver disease.","authors":"Lianyong Liu, Guiying Hu, Fang Gu, Qingyun Zhu, Chenxi Li, Xin Di, Mei Zou, Xiangqi Li","doi":"10.1007/s11739-026-04553-1","DOIUrl":"https://doi.org/10.1007/s11739-026-04553-1","url":null,"abstract":"<p><p>Hepatocytes have been extensively studied in metabolic dysfunction-associated steatotic liver disease (MASLD), yet the role of cholangiocytes remains underexplored. We utilized a comprehensive approach that integrates high-dimensional weighted gene co-expression network analysis (hdWGCNA), cellular interaction evaluation, machine learning techniques, immune cell infiltration analysis, and Mendelian randomization to investigate both single-cell sequencing data and bulk sequencing datasets. Single-cell analysis identified significant alterations in cholangiocyte subpopulations in metabolic dysfunction-associated steatohepatitis (MASH) patients, including an increase in cholangiocytes with elevated SEMA3 pathway expression. The hdWGCNA analysis identified the green module, which is enriched with genes associated with neural pathways pertinent to MASH. Seven machine learning models assessed the diagnostic feasibility of key genes in the green module for MASLD spectrum. Immune infiltration analysis highlighted complex interactions between cholangiocytes enriched for neural-related pathways and immune cells, particularly neutrophils and monocytes. Patient stratification identified two distinct subtypes within the MASLD spectrum, with subtype 2 exhibiting enhanced activity in neural-related pathways. Mendelian randomization analysis identified PLEKHA5 as a candidate causal gene for MASLD, suggesting a potential role in neural mechanisms (SEL1L3 showed a suggestive association, P = 0.0413). Collectively, this hypothesis-generating bioinformatics study elucidates distinct characteristics of cholangiocyte subpopulations in MASH, revealing neural pathway alterations that may contribute to disease pathogenesis and providing a foundation for future investigation into cholangiocyte-related mechanisms in MASLD.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192458","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":"Comparison of low volume versus high-volume polyethylene glycol-based bowel preparation for colonoscopy in people receiving haemodialysis: a randomized non-inferiority trial.","authors":"Andrea Iannone, Giuseppe Losurdo, Milena Di Leo, Luca De Luca, Giuseppe Iabichino, Gianluca Esposito, Gianpiero Manes, Francesco Squeo, Angela Marotti, Daniele Angelillo, Mariabeatrice Principi, Nicla Campobasso, Simona Simone, Anna Maria Di Palma, Loreto Gesualdo, Giovanni F M Strippoli, Alfredo Di Leo","doi":"10.1007/s11739-026-04549-x","DOIUrl":"https://doi.org/10.1007/s11739-026-04549-x","url":null,"abstract":"<p><strong>Background: </strong>Colonoscopy in chronic kidney disease patients undergoing haemodialysis is crucial. Some concerns have been raised about the use of oral bowel cleansing agents for colonoscopy. We compared the efficacy, safety and tolerability of a low volume versus a high-volume polyethylene glycol-based bowel preparation for colonoscopy in such patients.</p><p><strong>Methods: </strong>A multicentre, parallel-arm, randomized, phase IV trial with 15% non-inferiority margin was conducted. Eligible subjects were allocated to either the low volume (2 L) or high-volume (4 L) bowel preparation group in 1:1 ratio. The primary outcome was the proportion of participants with adequate bowel cleansing. Secondary outcomes were polyp/adenoma detection rate (PDR/ADR), cecal intubation rate, patient tolerability/compliance and adverse events.</p><p><strong>Results: </strong>Sixty-nine patients were randomized in four centres, 35 to low and 34 to high-volume groups. No difference in caecal intubation rate, in patients with adequate preparation, was observed (96.7% vs 100%, p = 1). As per-protocol, adequate bowel preparation was achieved in the 69.7 and 63.0% of low and high-volume groups, respectively (p = 0.58). The mean Boston Bowel Preparation Scale was similar in the two groups (5.6 ± 2.4vs 5.4 ± 2.4, p = 0.51). The PDR was 39.4% in low volume and 37.0% in high volume (p = 1). No differences in adverse events were observed. No emergency dialysis sessions were required. Serum creatinine levels remained stable before and after preparation in both groups.</p><p><strong>Conclusions: </strong>Optimal cleansing was difficult to obtain in haemodialysis patients. Both low and high-volume preparations were equally effective and safe. The small sample size is a limit underpowering our research. Larger studies are, therefore, required. Trial registration number The trial was approved by the Central ethic committee (protocol approval no. 0089971/23/11/2020) and registered on ClinicalTrials.gov NCT04709770.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149192741","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":"Work productivity and psychological well-being in patients affected by type 1 diabetes mellitus.","authors":"Veruscka Leso, Mariarosaria De Luca, Salvatore Della Notte, Raimondo Leone, Giancanio Mancaniello, Andrea Giovanni Pavia, Lavinia Saldamarco, Vincenzo Guardasole, Antonio Cittadini, Eduardo Bossone, Ivo Iavicoli","doi":"10.1007/s11739-026-04531-7","DOIUrl":"https://doi.org/10.1007/s11739-026-04531-7","url":null,"abstract":"<p><p>Type 1 diabetes mellitus (T1D) is a lifelong autoimmune condition that, when diagnosed during childhood or adolescence, may influence educational attainment, employment trajectories, and occupational functioning in adulthood. This observational cross-sectional study, conducted between June and September 2024 at the \"Federico II\" University Hospital in Naples, Italy, assessed work ability, work productivity, activity impairment, and psychological well-being in 70 adults with T1D. Sociodemographic, clinical, and occupational data were collected through structured interviews and medical record review. Work ability was evaluated using the Work Ability Index (WAI), productivity and activity impairment using the Work Productivity and Activity Impairment questionnaire (WPAI), and psychological well-being using the Psychological General Well-Being Index (PGWBI). Overall, 49% of participants were unemployed. Among employed individuals, work ability was generally preserved, with 72% reporting good or excellent WAI scores, although WAI declined significantly with age (p = 0.040). WPAI results showed low absenteeism (5.5%) but relevant presenteeism (26.7%) and activity impairment (42.7%). Activity impairment was higher among unemployed than employed participants (61.2% vs. 25.3%; p < 0.0001). Mean PGWBI scores indicated preserved psychological well-being (66.8 ± 20.3) but declined with increasing age (p = 0.001) and unemployment (p = 0.003). Higher PGWBI scores correlated with greater work ability (rs = 0.72, p < 0.0001) and lower activity impairment (rs = -0.79, p < 0.0001). Glycated hemoglobin, body mass index, occupational category, and insulin delivery technology were not significantly associated with outcomes. Overall, age and employment status emerged as relevant correlates of functional and psychological outcomes. These findings support integrated occupational strategies beyond glycemic control and appropriate targeted workplace accommodations.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193026","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":"Treating the acute, missing the trajectory: the internist's dilemma in older, frail patients.","authors":"Silvia Elli, Chiara Aloise, Alberto Benetti","doi":"10.1007/s11739-026-04507-7","DOIUrl":"https://doi.org/10.1007/s11739-026-04507-7","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.1,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181221","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}