Internal and Emergency Medicine最新文献

{"title":"U.S. healthcare provider risk perceptions of tobacco and nicotine-containing products.","authors":"Susan Martelle, Deena Battista, Michael Polster","doi":"10.1007/s11739-026-04321-1","DOIUrl":"https://doi.org/10.1007/s11739-026-04321-1","url":null,"abstract":"<p><p>U.S. healthcare providers (HCPs) are a valuable source of information about the health impact of using tobacco products and the health benefits of quitting cigarette smoking thus it is important to understand their perceptions of the absolute and relative risks of tobacco and nicotine-containing products (TNPs). The study objectives were to assess: (a) HCP perceptions about the relative risks of TNPs; (b) how much of the risk of smoking cigarettes HCPs attribute to combustion versus other factors; and (c) whether HCPs believe that partial or complete switching from cigarettes to using other TNPs can reduce health risks. A 15 min self-administered online survey was completed by 700 HCPs enrolled in a national online panel. Mean overall health risk ratings on a 100-point scale differ significantly for cigarettes (95.9), e-cigarettes (79.5), smokeless tobacco (76.4), nicotine pouches (60.3), and nicotine replacement therapy (40.3). HCPs attribute less than 40% of the risk of lung cancer associated with smoking cigarettes to combustion. Half of HCPs do not believe that switching completely from cigarettes to e-cigarettes or smokeless tobacco can reduce health risks. These findings indicate that HCPs are aware that not all TNPs present the same health risks, but that their perceptions of the relative risks of combustible and non-combustible products are not consistent with published estimates from authoritative sources. HCPs are generally unaware that the smoke from burning tobacco is the primary source of risk associated with cigarette smoking and most do not believe that switching completely from cigarettes to e-cigarettes or smokeless tobacco products can reduce health risks. Together, these findings suggest that many HCPs do not have accurate information about the relative risks of non-combustible TNPs and that broadening awareness about the harm reduction associated with those products is a vital step to ensuring that HCPs can provide their patients who smoke with accurate information about the benefit of switching completely from cigarettes to other types of non-combustible TNPs.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672885","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":"Flash pulmonary edema and blue toe syndrome in the management of patient with bilateral renal artery stenosis.","authors":"Maddalena Tesone, Ilaria Fucile, Carmine De Luca, Raffaele Piccolo, Costantino Mancusi","doi":"10.1007/s11739-026-04353-7","DOIUrl":"https://doi.org/10.1007/s11739-026-04353-7","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672928","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":"Idiopathic splanchnic vein thrombosis unmasking a clonal autoinflammatory disease.","authors":"Davide Santagata, Matteo Molteni, Elena Epis, Francesco Dentali, Leonardo Campiotti","doi":"10.1007/s11739-026-04346-6","DOIUrl":"https://doi.org/10.1007/s11739-026-04346-6","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645175","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":"Age-related decline in FMF activity: biological signal or modeling artifact?","authors":"Neeraj Singh, Monika Srivastav","doi":"10.1007/s11739-026-04342-w","DOIUrl":"https://doi.org/10.1007/s11739-026-04342-w","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147645158","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 splanchnic venous thrombosis revealing Biermer's disease: a case report.","authors":"Abdelghani Bachir Cherif, Salam Bennouar, Sara Benzaamia, Yousra Djebbar, Elayadi Nazli","doi":"10.1007/s11739-026-04347-5","DOIUrl":"https://doi.org/10.1007/s11739-026-04347-5","url":null,"abstract":"<p><p>Biermer's disease, or pernicious anemia, is an autoimmune condition marked by vitamin B12 deficiency due to intrinsic factor antibodies targeting gastric parietal cells. The relationship between Biermer's disease and increased thrombotic risk, while uncommon, represents a critical clinical concern necessitating heightened diagnostic awareness for patients presenting with unexplained thrombotic symptoms. This report details the case of a 57-year-old Mediterranean male, with a prior diagnosis of Graves' disease, who developed splanchnic venous thrombosis. An extensive etiological investigation revealed mild hyperhomocysteinemia, associated with an undiagnosed Biermer's disease. Our case underscores a critical association between Biermer's disease, hyperhomocysteinemia, and venous thrombosis, emphasizing the imperative for further research elucidating their interconnected pathogenesis.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638851","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":"Age differences in symptom burden of patients with advanced cancer admitted to an acute palliative care unit.","authors":"Sebastiano Mercadante, Yasmine Grassi, Sofia Settepani, Alessio Lo Cascio, Alessandra Casuccio","doi":"10.1007/s11739-026-04339-5","DOIUrl":"https://doi.org/10.1007/s11739-026-04339-5","url":null,"abstract":"<p><p>The aim of this study was to assess the differences in the pattern of symptoms and their changes after a comprehensive palliative care treatment in older patients in comparison with adults, who were admitted to an acute palliative care unit (APCU). Patients were categorized into three age ranges: adults (< 65 years, group A), old (65-74 years, group O), very old (75-84 years, group OO). The following parameters were collected: general characteristics, recent anticancer treatments, on/off treatment, previous care setting, Edmonton Symptom Assessment Scale (ESAS) and the Memorial Delirium Assessment Scale (MDAS), opioid doses, expressed as oral morphine equivalents (OME). Five-hundred-and-twenty patients were surveyed. Older patients had a lower Karnofsky level, were discharged on-therapy in a lower number of cases, and had a lower overall survival. The age-related differences in pain and dyspnea intensities recorded at admission, were nullified after a comprehensive palliative care treatment. Lower doses of opioids were effective. The APCU's consistency and the expertise of its team contributed to improved outcomes of the elderly.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638831","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 arterial-venous continuum: bridging atherosclerosis and chronic venous disease through endothelial dysfunction.","authors":"Elena Campello, Andrea Boccatonda, Angela Napolitano, Chiara Simion, Paolo Simioni","doi":"10.1007/s11739-026-04351-9","DOIUrl":"https://doi.org/10.1007/s11739-026-04351-9","url":null,"abstract":"<p><p>Atherosclerosis and chronic venous disease are among the most common vascular disorders worldwide and frequently coexist in the same individuals. Although traditionally regarded as distinct entities-one arterial and lipid-driven, and the other venous and pressure-related-emerging evidence suggests that they may share systemic determinants and overlapping biological pathways. This narrative review examines epidemiological and mechanistic evidence supporting potential links between atherosclerosis and chronic venous disease, and discusses implications for integrated vascular risk assessment. Observational studies report associations between the presence and clinical severity of chronic venous disease and a higher prevalence of atherosclerotic cardiovascular disease, peripheral artery disease, cerebrovascular disease, and increased all-cause mortality. Mechanistic research identifies converging processes-including systemic inflammation, oxidative stress, reduced nitric oxide bioavailability, extracellular matrix remodeling, and endothelial dysfunction-that affect both arterial and venous territories. Hemodynamic interactions between the arterial and venous systems may contribute to microvascular dysfunction and tissue hypoxia. Large-scale population analyses have also described associations between varicose veins and cognitive decline, including vascular dementia; however, these findings derive from observational data and do not establish causality. The concept of an arterial-venous continuum provides a biologically plausible and hypothesis-generating framework for understanding shared vascular vulnerability. Nevertheless, current evidence remains predominantly observational, and chronic venous disease should be regarded primarily as a potential marker of systemic endothelial dysfunction rather than a proven causal mediator of atherosclerotic progression. Further longitudinal and interventional studies are needed to clarify directionality and determine whether treatment of venous disease influences arterial outcomes.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638497","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":"Enhancing scientific output in Italian internal medicine: the responsibility of scientific societies.","authors":"Andrea Montagnani, Francesco Dentali, Nicola Mumoli","doi":"10.1007/s11739-026-04340-y","DOIUrl":"https://doi.org/10.1007/s11739-026-04340-y","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147638557","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":"Screening of osteoporosis in patients with ANCA-associated vasculitis (AAV) is quite low: results from a country-wide study.","authors":"Tuba Demirci Yildirim, Esra Erpek, Bahar Özdemir Ulusoy, Gullu Sandal Uzun, Ayten Yazici, Rıza Can Kardaş, Duygu Sahin, Duygu Sevinc Ozgur, Timucin Kasifoglu, Melih Kiziltepe, Pınar Akyüz Dağlı, Ozge Karakok, Emine Uslu, Arif Babayigit, Elif Durak Ediboglu, Ertugrul Cagri Bolek, Hasan Kocaayan, Gizem Ayan, Bugu Bulat, Busra Firlatan, Berkan Armagan, Gökçe Kenar, Abdulsamet Erden, Hamit Küçük, Ali Sahin, Cemal Bes, Askin Ates, Ayse Cefle, Fatma Alibaz-Oner, Mehmet Engin Tezcan, Haner Direskeneli, Ahmet Omma, Servet Akar, Omer Karadag, Fatos Onen","doi":"10.1007/s11739-026-04349-3","DOIUrl":"https://doi.org/10.1007/s11739-026-04349-3","url":null,"abstract":"<p><p>Patients with ANCA-associated vasculitis (AAV) are at increased risk of osteoporosis due to multiple disease- and treatment-related factors. However, real-world data on osteoporosis screening practices in this population remain limited. The aim of this study was to assess osteoporosis screening practices and the prevalence of reduced bone mineral density (BMD) in patients with AAV using a nationwide registry, and to identify factors associated with osteoporosis. This nationwide, retrospective, web-based study was conducted using the Turkish Vasculitis Study Group (TRVaS) database, including patients diagnosed with AAV between January 2000 and December 2023. Patients were evaluated for osteoporosis screening using dual-energy X-ray absorptiometry (DXA) and categorized according to BMD status. Clinical characteristics and potential risk factors were analyzed, and multivariable logistic regression was performed to identify independent predictors of osteoporosis. A total of 528 patients were included (median age 56 years [interquartile range 43-66]; 57.8% male). Of these, 36.2% underwent DXA screening; among screened patients, 40.8% had osteoporosis and 38.7% had osteopenia. In multivariable analysis, older age (odds ratio [OR] 1.03, p = 0.020) and the presence of at least one additional osteoporosis risk factor (OR 2.25, p = 0.049) were independently associated with osteoporosis. This nationwide registry-based study highlights a gap between the recognized risk of osteoporosis in patients with AAV and its implementation in real-world clinical practice. These findings underscore the need for improved screening and comprehensive bone health management strategies in this population.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147633295","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":"Structured CEUS-based diagnostic pathway for newly detected splenic lesions: impact on diagnostic latency and advanced imaging use in a multicenter quality improvement study, with exploratory discrimination between hematologic and non-hematologic disease.","authors":"Daniela Tirotta, Claudia Lena, Elena Magnani, Elisabetta Fabbri, Paolo Muratori","doi":"10.1007/s11739-026-04333-x","DOIUrl":"https://doi.org/10.1007/s11739-026-04333-x","url":null,"abstract":"<p><strong>Background: </strong>Newly detected splenic lesions represent a challenging diagnostic scenario in internal medicine, particularly when lymphoproliferative disease is suspected. Evidence on the role of contrast-enhanced ultrasound (CEUS) in this setting is limited, and its integration into structured clinical pathways has been poorly explored. This study evaluated the impact of a structured clinical-ultrasound diagnostic pathway incorporating CEUS on diagnostic latency and use of advanced imaging, as well as its exploratory ability to discriminate hematologic/lymphoproliferative from non-hematologic splenic lesions.</p><p><strong>Methods: </strong>We conducted a multicenter, procedure-based quality Improvement study including 100 patients with newly detected splenic lesions. Fifty patients underwent a structured pathway based on an integrated clinical, laboratory, and ultrasound tool (intervention group), while 50 received standard management (control group). Primary outcomes were diagnostic latency and number of advanced imaging examinations (CT, MRI, PET). Secondary outcomes included the diagnostic performance of CEUS and of the integrated tool for discriminating hematologic/lymphoproliferative versus non-hematologic splenic lesions.</p><p><strong>Results: </strong>Mean diagnostic latency was significantly shorter in the intervention group (13.8 ± 21.2 vs 32.4 ± 35.7 days; p = 0.004). Median latency was 5 [IQR 3-14] versus 14 [IQR 3-30] days (p = 0.002). Early diagnoses (≤ 7 days) were more frequent in the intervention group (58% vs 22%), while delayed diagnoses (> 30 days) were more common in controls (38% vs 10%; p < 0.001). Use of advanced imaging was reduced in the intervention group (CT: 46% vs 100%, p < 0.001; PET: 4% vs 20%, p = 0.018). For the discrimination of hematologic/lymphoproliferative versus non-hematologic lesions, CEUS showed high sensitivity (90.9%) and good specificity (79.5%), whereas the integrated tool improved specificity (94.9%) while maintaining good sensitivity (81.8%).</p><p><strong>Conclusions: </strong>A structured CEUS-centered diagnostic pathway appears to shorten diagnostic latency and reduce advanced imaging use while maintaining adequate diagnostic accuracy. The diagnostic performance findings should be interpreted as exploratory and limited to binary stratification of hematologic/lymphoproliferative versus non-hematologic lesions, rather than lesion-specific diagnosis.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147627598","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}