Internal and Emergency Medicine最新文献

{"title":"Life-course obesity and heart failure: a two-sample Mendelian randomization study.","authors":"Haili Wang, Jie Min, Lei Zhong, Jinyu Zhang, Lili Ye, Chunrong Chen","doi":"10.1007/s11739-024-03772-8","DOIUrl":"https://doi.org/10.1007/s11739-024-03772-8","url":null,"abstract":"<p><p>Heart failure is a multifaceted clinical syndrome, with obesity identified as a significant modifiable risk factor. This study employed a two-sample Mendelian randomization (MR) design, incorporating obesity data across life stages, to elucidate the causal link between obesity and heart failure. Data on heart failure from the 2023 Finngen database and genetic predictors of obesity from the IEU OpenGWAS project were analyzed using the IVW method, MR-Egger regression, weighted median, simple mode, weighted mode, and scatter plots. Heterogeneity was assessed with Cochran's Q test, and horizontal pleiotropy with MR-Egger intercept test. Sensitivity to single-nucleotide polymorphisms (SNPs) was tested via leave-one-out analysis, and funnel plots were utilized for visual inspection of horizontal pleiotropy. Statistical powers were also calculated. The MR analysis findings indicate a significant relationship between birth weight and the likelihood of developing heart failure (Odds Ratio [OR] 1.134, 95% Confidence Interval [CI] 1.033-1.245, P = 0.008). In addition, a heightened childhood BMI was found to be a significant predictor of heart failure risk (OR 1.307, 95% CI 1.144-1.494, P = 8.51E-05), as was childhood obesity (OR 1.123, 95% CI 1.074-1.173, P = 2.37E-07). Furthermore, adult BMI sex-combined exhibited a strong correlation with the risk of heart failure (OR 2.365, 95% CI 2.128-2.629, P = 1.91E-57). Sensitivity analyses provided further support for the reliability of these results, with no significant indication of horizontal pleiotropy observed. This study shows that obesity, including childhood obesity, is linked to a higher risk of heart failure. These findings highlight the urgent need for early weight management interventions in public health and clinical settings to reduce heart failure rates.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142307703","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":"Modulating patient output: rethinking the role of EM in the healthcare system.","authors":"Annmarie M Lang-Hodge, Melissa N Monaghan, Rodrick Lim, Eric P Heymann, Eddy Lang","doi":"10.1007/s11739-024-03774-6","DOIUrl":"https://doi.org/10.1007/s11739-024-03774-6","url":null,"abstract":"<p><p>Overcrowding has become a significant issue in Emergency departments (EDs) around the world. Overcrowding contributes to a chaotic, unsafe and disorganized environment, increasing the burden on healthcare teams, and has led to deteriorating working conditions, with subsequent higher rates of burnout. This review aims to discuss different solutions to improve the process of patient discharge from the ED, either to an inpatient unit, another hospital, or to an outpatient setting, and the impact this component of patient flow can have on physician well being. The solutions presented in this paper have been chosen for their translatability to any setting, regardless of their geographical location.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286279","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":"Cardiometabolic risk reduction at population level: a utopia or a challenge?","authors":"Arrigo F G Cicero,Federica Fogacci","doi":"10.1007/s11739-024-03775-5","DOIUrl":"https://doi.org/10.1007/s11739-024-03775-5","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262105","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":"Umbilical hernia with uncommon content; herniated paraumbilical collateral veins","authors":"Onur Taydas, Hayri Ogul, Mecit Kantarci","doi":"10.1007/s11739-024-03768-4","DOIUrl":"https://doi.org/10.1007/s11739-024-03768-4","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262098","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":"Chest wall muscle area, ventilatory efficiency and exercise capacity in systemic sclerosis","authors":"Nicola Galea, Amalia Colalillo, Serena Paciulli, Chiara Pellicano, Martina Giannetti, Emanuele Possente, Gregorino Paone, Antonella Romaniello, Maurizio Muscaritoli, Edoardo Rosato, Antonietta Gigante","doi":"10.1007/s11739-024-03751-z","DOIUrl":"https://doi.org/10.1007/s11739-024-03751-z","url":null,"abstract":"<p>To investigate the potential contribution of chest wall muscle area (CWMA) to the ventilatory efficiency and exercise capacity in patients with Systemic Sclerosis (SSc) without interstitial lung disease (ILD). Forty-four consecutive SSc patients [<i>F</i> = 37, median age 53.5 years (IQR 43.5–58)] were examined using chest high-resolution computed tomography (HRCT), pulmonary function tests and cardiopulmonary exercise testing (CPET). The CWMA was evaluated at the level of the ninth thoracic vertebra on CT images by two independent evaluators blinded to the patient information. CPET parameters analyzed were maximum oxygen uptake (VO2 max) and VO2 at anaerobic threshold (VO₂@AT); minute ventilation (VE); maximum tidal volume (VT). A statistically significant positive correlation was found between CWMA and maximum workload (r = 0.470, <i>p</i> &lt; 0.01), VO2 max ml/min (<i>r</i> = 0.380, <i>p</i> &lt; 0.01), VO2@AT (<i>r</i> = 0.343, <i>p</i> &lt; 0.05), VE (<i>r</i> = 0.308, <i>p</i> &lt; 0.05), VT (<i>r</i> = 0.410, <i>p</i> &lt; 0.01) and VO2/heart rate (<i>r</i> = 0.399, <i>p</i> &lt; 0.01). In multiple regression analysis, VO2 max (ml/min) was significantly associated with CWMA [<i>β</i> coefficient = 5.226 (95% CI 2.824, 7.628); <i>p</i> &lt; 0.001], diffusing capacity for carbon monoxide (DLco) [<i>β</i> coefficient = 6.749 (95% CI 1.460, 12.039); <i>p</i> &lt; 0.05] and body mass index (BMI) [<i>β</i> coefficient = 41.481 (95% CI 8.802, 74.161); <i>p</i> &lt; 0.05]. In multiple regression analysis, maximum workload was significantly associated with CWMA [<i>β</i> coefficient = 0.490 (95% CI 0.289, 0.691); <i>p</i> &lt; 0.001], DLco [<i>β</i> coefficient = 0.645 (95% CI 0.202, 1.088); <i>p</i> &lt; 0.01] and BMI [<i>β</i> coefficient = 3.747 (95% CI 1.013, 6.842); <i>p</i> &lt; 0.01]. In SSc-patients without ILD, CWMA represents an important variable in exercise capacity and can be evaluated by the mediastinal window available in the HRCT images required for lung disease staging.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262097","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":"Anakinra in the management of adult-onset still’s disease: a single-center experience","authors":"Berkay Kilic, Kerem Parlar, Sejla Karup, Admir Ozturk, Kardelen Karaahmetli, Serdal Ugurlu","doi":"10.1007/s11739-024-03766-6","DOIUrl":"https://doi.org/10.1007/s11739-024-03766-6","url":null,"abstract":"<p>Adult-onset Still’s disease (AOSD) is a rare systemic autoinflammatory disorder of unknown etiology characterized by systemic inflammation, high fever, salmon-colored skin rash, arthralgia, and arthritis. Patients with AOSD may also present with elevated inflammatory markers, hyperferritinemia, anemia, leukocytosis, hepatosplenomegaly, and lymphadenopathy. Glucocorticoids and biological disease-modifying anti-rheumatic drugs, including the anti-interleukin-1 agent anakinra, are used in the management of AOSD. This retrospective single-center study included patients with AOSD who were registered at our tertiary center, and received anakinra treatment. The primary outcome of our study was the proportion of patients who achieved complete remission of disease-related clinical and laboratory complications. The glucocorticoid treatment profiles of the included patients before and after anakinra treatment were also analyzed. The occurrence of serious and non-serious adverse events was recorded to analyze the safety profile of anakinra. Thirty-four patients with AOSD, including 25 females (73.5%), were enrolled in the study. Twelve patients (35.3%) achieved complete remission and 14 patients (41.2%) achieved partial remission after anakinra treatment. Eight patients (23.5%) did not response to anakinra. Anakinra significantly decreased the number of patients receiving glucocorticoid treatment [33 (97%) vs. 22 (64.7%), <i>p</i> &lt; 0.001] and the mean daily glucocorticoid dose [19 ± 13.5 mg vs. 4.6 ± 5.8 mg, <i>p</i> &lt; 0.001]. Mild adverse events occurred in 11 patients (32.3%) with injection site reactions being the most common. One patient (2.9%) was diagnosed with tuberculosis within the treatment period. Anakinra is an effective and generally safe option for biological treatment initiation in the management of AOSD.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142262099","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":"Venous thrombosis and obesity: from clinical needs to therapeutic challenges","authors":"Federica La Rosa, Fabrizio Montecucco, Luca Liberale, Marta Sessarego, Federico Carbone","doi":"10.1007/s11739-024-03765-7","DOIUrl":"https://doi.org/10.1007/s11739-024-03765-7","url":null,"abstract":"<p>Weight bias and stigma have limited the awareness of the systemic consequences related to obesity. As the narrative evolves, obesity is emerging as a driver and enhancer of many pathological conditions. Among these, the risk of venous thromboembolism (VTE) is a critical concern linked to obesity, ranking as the third most common cardiovascular condition. Obesity is recognized as a multifactorial risk factor for VTE, influenced by genetic, demographic, behavioral, and socio-economic conditions. Despite established links, the exact incidence of obesity related VTE in the general population remains largely unknown. The complexity of distinguishing between provoked and unprovoked VTE, coupled with gaps in obesity definition and assessment still complicates a tailored risk assessment of VTE risk. Obesity reactivity, hypercoagulability, and endothelial dysfunction are driven by the so-called ‘adiposopathy’. This state of chronic inflammation and metabolic disturbance amplifies thrombin generation and alters endothelial function, promoting a pro-thrombotic environment. Additionally, the inflammation-induced clot formation—also referred to as ‘immunothrombosis’ further exacerbates VTE risk in people living with obesity. Furthermore, current evidence highlights significant gaps in the management of obesity related VTE, particularly concerning prophylaxis and treatment efficacy of anticoagulants in people living with obesity. This review underscores the need for tailored therapeutic approaches and well-designed clinical trials to address the unique challenges posed by obesity in VTE prevention and management. Advanced research and innovative strategies are imperative to improve outcomes and reduce the burden of VTE in people living with obesity.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219013","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":"How histopathological diagnosis interacts with kidney ultrasound parameters and glomerular filtration rate","authors":"Simeone Andrulli, Antonietta Gigante, Michele Rossini, Pierluigi D’Angio’, Gisella Vischini, Franca Luchetta, Filippo Aucella, Giovanni Valsecchi, Barbara Infante, Maria Giovanna Vario, Domenico Giannese, Antonio Granata, Elisabetta Moggia, Guido Gembillo, Rosario Cianci, Mario Bonomini, Flavia Manenti, Roberta Lazzarin, Brigida Di Renzo, Fulvia Zanchelli, Maurizio Garozzo, Massimo Manes, Yuri Battaglia, Raffaela Sciri, Marco De Fabritiis, Marco Quaglia, Gioacchino Li Cavoli, Enrica Gintoli, Maria Maddalena Conte, Maurizio Borzumati, Luisa Benozzi, Giovanna Pasquariello, Giovanni Andrulli, Marco Leoni, Giuseppe Seminara, Valentina Corbani, Gianmarco Sabiu, Arcangelo Di Maggio, Rosa Maria Pollastro, Loreto Gesualdo","doi":"10.1007/s11739-024-03711-7","DOIUrl":"https://doi.org/10.1007/s11739-024-03711-7","url":null,"abstract":"<p>The evaluation of estimated GFR (eGFR) is a pivotal staging step in patients with chronic kidney disease (CKD), and renal ultrasound plays an important role in diagnosis, prognosis and progression of CKD. The interaction between histopathological diagnosis and ultrasound parameters in eGFR determination has not been fully investigated yet. The study examined the results of native kidney biopsies performed in 48 Italian centers between 2012 and 2020. The primary goal was if and how the histopathological diagnosis influences the relationship between ultrasound parameters and eGFR. After exclusion of children, patients with acute kidney injury and patients without measure of kidney length or parenchymal thickness, 2795 patients have been selected for analysis. The median values were 52 years for patient age, 11 cm for bipolar kidney diameter, 16 mm for parenchymal thickness, 2.5 g/day for proteinuria and 70 ml/min/1.73 m² for eGFR. The bipolar kidney diameter and the parenchymal thickness were directly related with eGFR values (R square 0.064). Diabetes and proteinuria were associated with a consistent reduction of eGFR, improving the adjusted R square up to 0.100. Addition of histopathological diagnosis in the model increased the adjusted R square to 0.216. There is a significant interaction between histopathological diagnosis and longitudinal kidney diameter (<i>P</i> 0.006). Renal bipolar length and parenchymal thickness are directly related with eGFR. The magnitude of proteinuria and histopathological kidney diagnosis are associated with eGFR. The relationship between kidney length and the level of eGFR depends on the nature of the kidney disease.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219017","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":"Prognostic thresholds of outcome predictors in severe accidental hypothermia","authors":"Konrad Mendrala, Tomasz Darocha, Tomáš Brožek, Sylweriusz Kosiński, Martin Balik, Evelien Cools, Beat Walpoth, Ewelina Nowak, Wojciech Dąbrowski, Bartosz Miazgowski, Kacper Reszka, Aleksander Rutkiewicz, Guillaume Debaty, Nicolas Segond, Michał Dudek, Stanisław Górski, Paweł Podsiadło","doi":"10.1007/s11739-024-03741-1","DOIUrl":"https://doi.org/10.1007/s11739-024-03741-1","url":null,"abstract":"<p>Hemodynamically unstable patients with severe hypothermia and preserved circulation should be transported to dedicated extracorporeal life support (ECLS) centers, but not all are eligible for extracorporeal therapy. In this group of patients, the outcome of rewarming may sometimes be unfavorable. It is, therefore, crucial to identify potential risk factors for death. Furthermore, it is unclear what criterion for hemodynamic stability should be adopted for patients with severe hypothermia. The aim of this study is to identify pre-rewarming predictors of death and their threshold values in hypothermic patients with core temperature ≤ 28 °C and preserved circulation, who were treated without extracorporeal rewarming. We conducted a multicenter retrospective study involving patients in accidental hypothermia with core temperature 28 °C or lower, and preserved spontaneous circulation on rewarming initiation. The data were collected from the International Hypothermia Registry, HELP Registry, and additional hospital data. The primary outcome was survival to hospital discharge. We conducted a multivariable logistic regression and receiver operating characteristic curve (ROC) analysis. In the multivariate analysis of laboratory tests and vital signs, systolic blood pressure (SBP) adjusted for cooling circumstances and base excess (BE) were identified as the best predictor of death (OR 0.974 95% CI 0.952–0.996), AUC ROC 0.79 (0.70–0.88). The clinically relevant cutoff for SBP was identified at 90 mmHg with a sensitivity of 0.74 (0.54–0.89) and a specificity of 0.70 (0.60–0.79). The increased risk of death among hypothermic patients with preserved circulation occurs among those with an SBP below 90 mmHg and in those who developed hypothermia in their homes.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142227400","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":"Interventions to improve the quality of low back pain care in emergency departments: a systematic review and meta-analysis","authors":"Pippa Flanagan, Robert Waller, Ivan Lin, Karen Richards, Piers Truter, Gustavo C. Machado, Vinicius Cavalheri","doi":"10.1007/s11739-024-03736-y","DOIUrl":"https://doi.org/10.1007/s11739-024-03736-y","url":null,"abstract":"<p>Low back pain (LBP) is a common reason people visit Emergency Departments (ED). However, the care provided is often not aligned with guideline recommendations. Despite increasing research aiming to promote guideline-based care in EDs, interventions to best implement recommendations are unknown. This study aimed to identify ED LBP implementation interventions that have been trialed and evaluate their effects on ED-relevant outcomes. A systematic review and meta-analysis, including studies that evaluated interventions to improve the quality of care provided to adults presenting to ED with LBP. Databases searched until May 2023 were Cochrane Library, CINAHL, EMBASE (via OVID), and PEDro. Interventions were categorized according to whether they had a patient, clinician, health service, or multiple-level focus. Where possible, meta-analysis was undertaken. Certainty around the results was assessed using the GRADE criteria. Twenty-eight studies were included. Interventions were categorized as patient (<i>n</i> = 2), clinician (<i>n</i> = 8), health service (<i>n</i> = 12), or multiple-level (<i>n</i> = 6) targeted. Overall, interventions successfully reduced the likelihood of receiving an opioid in ED (OR 0.65; 95% CI 0.55–0.75). However, no significant effect on lumbar imaging was demonstrated (OR 0.85; 95% CI 0.64–1.12). Subgroup analyses showed that studies reporting high baseline imaging rates ≥ 36% and those that included systems-based changes significantly reduced imaging (OR 0.60; 95% CI 0.39–0.93; and OR 0.65; 95% CI 0.45–0.94, respectively). A small reduction in ED length of stay was observed in the group exposed to the LBP interventions (mean difference − 0.38 h; 95% CI − 0.58 to − 0.17). Overall, certainty of evidence was deemed low to very low. Interventions were mostly single-system focused with a preference for education-based implementation strategies targeting patients or clinicians. The interventions reduced the use of opioid medication for LBP in ED, but the effects on lumbar imaging rates were uncertain. Further high-quality research is needed to improve LBP care in this setting.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":4.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142219015","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}