Internal and Emergency Medicine最新文献

{"title":"Ultrasound-guided comparison of needle decompression sites in obese patients: a prospective observational study.","authors":"Furkan Alkan, Volkan Ülker, Şükrü Koçkan, Hikmet Kılınç, Şahin Kaymaz Seher, Asim Enes Ozbek, Hüseyin Cahit Halhallı","doi":"10.1007/s11739-025-04110-2","DOIUrl":"https://doi.org/10.1007/s11739-025-04110-2","url":null,"abstract":"<p><p>The optimal site for needle decompression in tension pneumothorax patients with a body mass index (BMI) over 30 remains debated. This study aimed to identify the most suitable site-second intercostal space at the midclavicular line (2nd ICS in the MCL) or fifth intercostal space at the midaxillary line (5th ICS in the MAL)-by comparing skin-to-pleura distances using point-of-care ultrasound (POCUS). Skin-to-pleura distance measurements at the right 2nd ICS-MCL and the right 5th ICS in the MAL, assessed by three different operators. The primary outcome was to compare the skin-to-pleura distances at the 2nd ICS in the MCL and the 5th ICS in the MAL using POCUS in volunteers with a BMI over 30. The secondary outcome was to evaluate the consistency of different operators in determining the most appropriate site for needle decompression in the management of tension pneumothorax among healthy volunteers with a BMI over 30, using bedside ultrasonography. A total of ninety-one volunteers were enrolled. The skin-to-pleura distance at the 5th ICS in the MAL was found to be statistically significantly greater than that at the 2nd ICS in the MCL in the measurements performed by each operator (Operator 1: p = 0.016; Operator 2: p = 0.002; Operator 3: p = 0.006). The MCL measurements obtained by all three operators demonstrated statistically significant agreement. In obese patients, the 2nd ICS-MCL may be considered the preferred site for needle decompression. Nevertheless, individualized assessment of both sites using bedside ultrasonography is recommended to optimize procedural success and reduce complications.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075365","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":"A sudden appearance of pink-yellow papules: the grave and pressing significance underlying skin lesions.","authors":"Yinghui Zhou, Cheng Tan","doi":"10.1007/s11739-025-04116-w","DOIUrl":"https://doi.org/10.1007/s11739-025-04116-w","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069334","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":"Assessment of mortality risk by respiratory rate-specific quartiles in mechanically ventilated patients with acute respiratory distress syndrome in Mexico.","authors":"Jesús S Sánchez-Díaz, Karla G Peniche-Moguel, José Manuel Reyes-Ruiz, Luis Del Carpio-Orantes, Diego Escarramán-Martínez, Éder I Zamarrón-López, Orlando R Pérez-Nieto, María Veronica Calyeca-Sánchez","doi":"10.1007/s11739-025-04112-0","DOIUrl":"https://doi.org/10.1007/s11739-025-04112-0","url":null,"abstract":"<p><strong>Objective: </strong>The respiratory rate (RR) is a fundamental parameter in the setting of mechanical ventilation (MV) in acute respiratory distress syndrome (ARDS), where an increase in RR may be associated with higher energy delivered to the lungs, thereby augmenting lung injury and inflammation, which can lead to death. The establishment of RR ranges that allow for the identification of ARDS patients at risk of mortality is required. Therefore, this study aimed to assess the association between the RR quartiles and mortality in a Mexican cohort of patients with ARDS who received MV.</p><p><strong>Material and methods: </strong>This retrospective, observational, longitudinal study was conducted in the intensive care unit at a tertiary care center. One hundred ninety patients admitted between January 1, 2016, and December 31, 2022, were diagnosed with ARDS according to the Berlin criteria, of which 158 met the inclusion criteria. Univariable and multivariable Cox regression models, along with Kaplan-Meier survival analysis and the log-rank test, were used to evaluate the impact of clinical prognostic factors on mortality.</p><p><strong>Results: </strong>Multivariable Cox regression revealed that the body mass index [BMI] (Hazard Ratio [HR] = 1.05, 95% confidence interval [CI] 1.012-1.08; p = 0.008) and RR were risk factors (HR = 1.13, 95% CI 1.004-1.26; p = 0.043) to predict mortality in patients with ARDS and MV. When the predictive power of RR was confirmed, the patients were stratified according to RR quartiles (Q1: 18-23 breaths per min (bpm), Q2: 24 bpm, Q3: 25-26 bpm, and Q4: 27-35 bpm) and analyzed separately. The RR Q4 was independently associated with poor outcomes (HR = 1.959, 95% CI 1.221-3.142; p = 0.005). In a Cox proportional hazards model adjusting for the impact of BMI and smoking, RR Q4 was an independent risk factor for predicting mortality (HR = 1.944, 95% CI 1.208-3.129; p = 0.006).</p><p><strong>Conclusion: </strong>These results suggested that a Q4 of RR (27-35 bpm) has a substantial predictive value and could be a marker of disease severity and a potential modifiable target in patients with ARDS and MV.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069359","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":"Comparing the effectiveness of point-of-care ultrasound and conventional triage in patients presenting to the emergency department with abdominal pain.","authors":"Mehmet Alperen Biçer, Necip Gökhan Güner, Onur Karakayalı, Sacit Akdeniz, Yusuf Yürümez, Murat Özsaraç, Fatih Güneysu","doi":"10.1007/s11739-025-04115-x","DOIUrl":"https://doi.org/10.1007/s11739-025-04115-x","url":null,"abstract":"<p><p>Abdominal pain constitutes approximately 10% of all emergency department (ED) presentations, representing a frequent and diagnostically complex complaint. Point-of-care ultrasound (POCUS) has become an essential tool in the ED, supporting resuscitation, interventional procedures, diagnosis, and follow-up. This prospective, randomized-controlled study aimed to assess the impact of POCUS-integrated triage compared to conventional triage (without ultrasound) on diagnostic accuracy, treatment initiation, and ED management in patients with non-traumatic abdominal pain. A total of 262 adult patients were enrolled and randomized in a 1:1 ratio using computer-assisted methods, with 127 allocated to conventional triage and 135 to POCUS triage. The researcher did not intervene in clinical decisions. Primary outcomes included additional imaging requests, time to initial analgesia, consultation requests, ED length of stay, and overall outcome, while the secondary outcome was the effect on triage categorization. Statistical analysis was performed using IBM SPSS Statistics version 21.0. The mean age of participants was 30 years, with 55.7% being female. The POCUS triage group required significantly fewer additional imaging studies (p < 0.001) and had shorter times to analgesia administration, consultation, and ED discharge (all p < 0.001). Moreover, POCUS triage significantly altered patient categorization compared to the Emergency Severity Index (ESI) system (p < 0.001). When compared against final imaging reports, POCUS demonstrated a sensitivity of 87%, specificity of 55%, positive predictive value of 81.6%, and negative predictive value of 64.7%. In conclusion, POCUS triage enhances clinical efficiency by reducing imaging needs and expediting key interventions, offering significant advantages for emergency department workflow and patient care.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145069400","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":"Prevalence and clinical implications of altered mental status in patients with infection presenting to the emergency department.","authors":"Takayuki Otani, Toshihisa Ichiba, Yuji Okazaki, Hiroshi Naito","doi":"10.1007/s11739-025-04108-w","DOIUrl":"https://doi.org/10.1007/s11739-025-04108-w","url":null,"abstract":"<p><p>The prevalence and clinical implications of altered mental status among patients presenting with infection to the emergency department (ED) remain unclear. This retrospective cohort study, which enrolled consecutive patients with infection aged ≥ 15 years who presented to the ED between January and June 2024 and underwent blood culture collection, was aimed at determining the prevalence of altered mental status, identifying associated clinical factors, and assessing its impact on mortality outcomes. Patients were stratified according to the presence or absence of altered mental status at ED presentation. Clinical characteristics were compared between groups and multivariable logistic regression analysis was performed to identify factors independently associated with altered mental status. Of the 767 patients included, 152 (20%) presented with altered mental status. In-hospital mortality was significantly higher in this group than in the control group (15 vs. 4%; P < 0.001). Multivariable logistic regression analysis identified the following independent predictors of altered mental status: advanced age [odds ratio (OR), 1.04; 95% confidence interval (CI), 1.02-1.06], history of cerebrovascular disease (OR, 2.52; 95% CI 1.45-4.36), dementia (OR, 3.57; 95% CI 2.04-6.23), mental disorders (OR, 3.90; 95% CI 1.17-13.00), bacteremia (OR, 2.49; 95% CI 1.39-4.46), and higher Sequential Organ Failure Assessment scores (OR, 1.31; 95% CI 1.20-1.42). Altered mental status is common among ED patients with infection, reflecting both infection severity and baseline patient vulnerability. Its association with increased in-hospital mortality highlights the importance of early recognition and comprehensive assessment of mental status changes in this patient population.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058475","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":"Eyes on fire: a diagnostic and therapeutic dilemma.","authors":"Angelica Napoletano, Alba Chiara Termite, Florenzo Iannone, Silvana Guerriero, Giuseppe Lopalco","doi":"10.1007/s11739-025-04113-z","DOIUrl":"https://doi.org/10.1007/s11739-025-04113-z","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052847","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":"Management of bile acid diarrhea in Italy: a survey.","authors":"Giovanni Marasco, Giovanni Barbara, Massimo Bellini, Piero Portincasa, Vincenzo Stanghellini, Bruno Annibale, Antonio Benedetti, Giovanni Cammarota, Walter Fries, Paolo Usai Satta, Enrico Stefano Corazziari","doi":"10.1007/s11739-025-04060-9","DOIUrl":"https://doi.org/10.1007/s11739-025-04060-9","url":null,"abstract":"<p><p>Bile acid diarrhea (BAD) is a common, under-investigated cause of chronic diarrhea. We aimed to assess the current management of BAD among a group of Italian physicians. A survey was developed by a task force of experts and distributed via the Internet to Italian physicians members of the main Italian gastroenterological associations. Ninety-four physicians accepted to participate, of whom 44% were females. The majority of participants were gastroenterologists (63%) and the mean age was 50.5 years. No differences in the rate of BAD diagnosis among patients with chronic diarrhea were found according to medical specialization. Gastroenterologists reported a higher prevalence of BAD compared with other physicians/general practitioners (1% vs 0.3%). BAD suspicion is mostly raised in the presence of watery stools and > 3 bowel movements/day and the exclusion of organic/drug-related diseases. BAD diagnosis was assessed with 75SeHCAT (67.8% of gastroenterologists and 51.4% of other physicians), followed by a trial of cholestyramine (30.5% of gastroenterologists and 31.4% of other physicians). Therapies most prescribed for BAD were cholestyramine, a low-fat diet, and stool thickeners. BAD is a common condition generally suspected in the presence of chronic watery diarrhea. 75SeHCAT availability influences the awareness of this disease. Therapies currently are often not able to guarantee adequate symptom relief.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040038","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":"Ecthyma gangrenosum of atypical origin.","authors":"Margarita Pich-Aguilera, Laura Nájera, Marcos López-Dosil, Mercè Grau-Pérez","doi":"10.1007/s11739-025-04079-y","DOIUrl":"https://doi.org/10.1007/s11739-025-04079-y","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023259","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":"Health professions in Europe: more or less?","authors":"Livio Garattini, Antonino Mazzone, Marco Badinella Martini, Alessandro Nobili","doi":"10.1007/s11739-025-04100-4","DOIUrl":"https://doi.org/10.1007/s11739-025-04100-4","url":null,"abstract":"<p><p>Health systems in Europe are under growing budgetary pressures to provide appropriate and affordable healthcare for their populations. At the same time, there is a worsening workforce crisis from the supply side among clinical roles, and there has been an expansion of new health professions in many countries. The current shortage of physicians in many European countries has become a matter of widespread concern at political and societal level. Meanwhile, the shortage of nurses has become an even higher concern. Allied health professionals are the third largest healthcare workforce, and the WHO has promoted their training as a priority to compensate the increasing shortage of physicians and nurses. The workforce crisis in the European health systems could somehow reflect the growing issue of dual practicing followed by many professionals working inside them. Although legally allowed, any form of dual practice inevitably raises financial conflicts of interest. Moreover, the workforce organization in health care is quite peculiar because of the greater influence that health professionals placed at the delivery of care have over daily decision-making. Since a hierarchical approach is not recommended in health care, the increasing number of health professions could undermine multi-professional team building and deter inter-professional knowledge. Finally, clinical activity is expected to be a professional mission aimed at caring patients. Since the most productive and fulfilling strategy for health professionals is to work together in integrated workplaces, the growing number of graduations and specializations in health professions is likely to favor fragmentation.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015131","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":"An unexpected cause of chest pain: thoracic gout in the emergency setting.","authors":"Francesco Ursini, Jacopo Ciaffi, Giuliano Peta, Simone Quarchioni, Giancarlo Facchini","doi":"10.1007/s11739-025-04107-x","DOIUrl":"https://doi.org/10.1007/s11739-025-04107-x","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000483","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}