Internal and Emergency Medicine最新文献_第4页

Drug prescription appropriateness in hospitalized older patients: 15-year results and lessons from a countrywide register. 住院老年患者的药物处方适当性：一项全国性登记的 15 年结果和经验教训。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-21 DOI: 10.1007/s11739-024-03645-0

Alessandro Nobili, Pier Mannuccio Mannucci

引用次数: 0

Agreement of point of care ultrasound and final clinical diagnosis in patients with acute heart failure, acute coronary syndrome, and shock: POCUS not missing the target. 急性心力衰竭、急性冠状动脉综合征和休克患者的护理点超声检查与最终临床诊断的一致性：POCUS 并未错过目标。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 Epub Date: 2024-06-12 DOI: 10.1007/s11739-024-03639-y

José Atilio Núñez-Ramos, Dagoberto Duarte-Misol, María Andrea Burgos Petro, Keren Jemima Sarmiento Pérez, Vanessa Paola Gutiérrez Echeverry, Sergio Velasco Malagón

{"title":"Agreement of point of care ultrasound and final clinical diagnosis in patients with acute heart failure, acute coronary syndrome, and shock: POCUS not missing the target.","authors":"José Atilio Núñez-Ramos, Dagoberto Duarte-Misol, María Andrea Burgos Petro, Keren Jemima Sarmiento Pérez, Vanessa Paola Gutiérrez Echeverry, Sergio Velasco Malagón","doi":"10.1007/s11739-024-03639-y","DOIUrl":"10.1007/s11739-024-03639-y","url":null,"abstract":"Point-of-care ultrasound (POCUS) is an important tool for clinical diagnosis and decision-making in critical and non-critical scenarios. Dyspnea, chest pain, and shock are conditions susceptible to evaluation with ultrasound considering diagnostic accuracy and clinical impact already proven. There is scarce evidence in diagnosis agreement using ultrasound as an extension of physical examination. We aimed to evaluate ED patients in whom POCUS was performed, to analyze agreement between clinical initial diagnosis using ultrasound images and final diagnosis. Furthermore, we analyze failed diagnosis, inconclusive POCUS exams, and discuss details. A cross-sectional analytical study was conducted on adults who visited the emergency department with any of these three chief complaints: dyspnea, chest pain, and shock. All were evaluated with ultrasound at admission. Agreement between initial diagnosis using POCUS and final definite diagnosis was calculated. Failed diagnosis and inconclusive exams were analyzed. A total of 209 patients were analyzed. Populations: mostly males, mean age 64 years old, hypertensive. Agreement on patients with dyspnea and suspicion of acute decompensated heart failure was 0.98; agreement on chest pain suspicion of non-ST acute coronary syndrome was 0.96; agreement on type of shock was 0.90. Among the population, 12 patients had an inconclusive POCUS exam, and 16 patients had a failed diagnosis. The use of POCUS in the emergency department shows almost perfect agreement when compared with the final diagnosis in individuals experiencing acutely decompensated heart failure, acute coronary syndrome, and shock. Prospective studies are needed to evaluate the impact of this tool on mortality and prognosis when there are diagnostic errors.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405453/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141305888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Inside out. Opening narrative spaces in the healthcare professional community. 由内而外。在医疗保健专业团体中打开叙事空间。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 DOI: 10.1007/s11739-024-03704-6

Fabrizio Elia, Mara Gorli, Marta Mocarelli, Marta Piria, Giorgio Costantino

引用次数: 0

Risk of early clinical deterioration and 30-day mortality in pulmonary embolism intermediate-high-risk patients with patent foramen ovale. 卵圆孔未闭的肺栓塞中高危患者早期临床恶化和 30 天死亡率的风险。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1007/s11739-024-03657-w

Marco Zuin, Gianluca Rigatelli, Claudio Bilato, Amedeo Bongarzoni, Pietro Zonzin, Franco Casazza, Loris Roncon

{"title":"Risk of early clinical deterioration and 30-day mortality in pulmonary embolism intermediate-high-risk patients with patent foramen ovale.","authors":"Marco Zuin, Gianluca Rigatelli, Claudio Bilato, Amedeo Bongarzoni, Pietro Zonzin, Franco Casazza, Loris Roncon","doi":"10.1007/s11739-024-03657-w","DOIUrl":"10.1007/s11739-024-03657-w","url":null,"abstract":"We assess the prognostic role of patent foramen ovale (PFO) for the estimation of 30-day mortality and risk of 48-h clinical deterioration since admission, in intermediate-high-risk pulmonary embolism (PE) patients. A post-hoc analysis of intermediate-high-risk PE patients enrolled in the Italian Pulmonary Embolism Registry (IPER) (Trial registry: ClinicalTrials.gov; No.: NCT01604538) was performed. The entire cohort was divided according to the presence or absence of PFO after transthoracic echocardiography (TTE) evaluation. Among 450 intermediate-high-risk PE patients (mean age 71.4 ± 13.8 years, 298 males), PFO was diagnosed in 68 (15.1%) cases. A higher mortality rate (29.4% vs. 3.1%, p < 0.001) as well as occurrence of clinical deterioration within 48 h from admission (38.2% vs. 3.6%, p < 0.001) were observed in intermediate-high-risk PE patients with PFO compared to those without multivariate Cox regression analysis showed that the presence of a PFO predicts 30-day mortality (HR: 3.21, 95% CI 3.16-3.27, p < 0.001) and was also associated with a significantly higher risk of 48-h clinical deterioration [HR: 2.24 (95% CI 2.20-2.29), p < 0.0001] in intermediate-high-risk PE patients. The presence of a PFO in intermediate-high-risk PE patients is associated with a higher risk of clinical deterioration within 48 h from admission and 30-day mortality.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141183664","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}

引用次数: 0

Safety and effectiveness of oral anticoagulants in patients with atrial fibrillation and stage 4 chronic kidney disease: a real-world experience. 心房颤动和慢性肾病 4 期患者口服抗凝剂的安全性和有效性：真实世界的经验。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 Epub Date: 2024-06-28 DOI: 10.1007/s11739-024-03658-9

Rosa Talerico, Elisa Brando, Lorenzo Luzi, Maria Cristina Vedovati, Michela Giustozzi, Melina Verso, Leonardo Di Gennaro, Maria Basso, Antonietta Ferretti, Angelo Porfidia, Erica De Candia, Roberto Pola, Giancarlo Agnelli, Cecilia Becattini

{"title":"Safety and effectiveness of oral anticoagulants in patients with atrial fibrillation and stage 4 chronic kidney disease: a real-world experience.","authors":"Rosa Talerico, Elisa Brando, Lorenzo Luzi, Maria Cristina Vedovati, Michela Giustozzi, Melina Verso, Leonardo Di Gennaro, Maria Basso, Antonietta Ferretti, Angelo Porfidia, Erica De Candia, Roberto Pola, Giancarlo Agnelli, Cecilia Becattini","doi":"10.1007/s11739-024-03658-9","DOIUrl":"10.1007/s11739-024-03658-9","url":null,"abstract":"It is still uncertain whether direct oral anticoagulants (DOACs) perform better than vitamin K antagonists (VKAs) in subjects with non-valvular atrial fibrillation (NVAF) and advanced chronic kidney disease (CKD). The aim of the study was to compare safety and effectiveness of DOACs and VKAs in patients with NVAF and stage 4 CKD (creatinine clearance 15-29 mL/min). We searched the hospital databases of two academic centers to retrospectively identify patients with stage 4 CKD who were on treatment with DOACs or VKAs for NVAF. Safety was the primary outcome of the study and was assessed in terms of incidence of major bleeding (MB). Secondary outcomes were clinically relevant non-major bleeding (CRNMB) and death for any cause. A total of 176 patients (102 on DOACs and 74 on VKAs) were found and included in the analysis. The incidence rate of MB was not statistically different between groups (8.6 per 100 patients-year in the DOAC group and 5.6 per 100 patients-year in the VKA group). Rates of IS/SSE and CRNMB were statistically similar in the two treatment groups, as well. There were less deaths for any cause in the DOAC group than in the VKA group (8.6 and 15.8 per 100 patients-year, respectively), but the difference was not statistically significant. This study found no difference in terms of safety and effectiveness between patients with NVAF and stage 4 CKD treated with DOACs and VKAs. Larger prospective or randomized studies are needed to confirm these findings.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rapid diagnostic testing for GAS necrotizing fasciitis. 坏死性筋膜炎的快速诊断检测。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 Epub Date: 2024-07-17 DOI: 10.1007/s11739-024-03643-2

Shinnosuke Fukushima, Hideharu Hagiya, Mami Okura, Koji Iio

引用次数: 0

4C mortality score and COVID-19 mortality risk score: an analysis in four different age groups of an Italian population. 4C 死亡率评分和 COVID-19 死亡率风险评分：对意大利四个不同年龄组人群的分析。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 Epub Date: 2024-02-23 DOI: 10.1007/s11739-024-03551-5

Lorenzo Pelagatti, Ginevra Fabiani, Anna De Paris, Alessia Lagomarsini, Elisa Paolucci, Francesco Pepe, Maurizio Villanti, Francesca Todde, Simona Matteini, Francesca Caldi, Riccardo Pini, Francesca Innocenti

{"title":"4C mortality score and COVID-19 mortality risk score: an analysis in four different age groups of an Italian population.","authors":"Lorenzo Pelagatti, Ginevra Fabiani, Anna De Paris, Alessia Lagomarsini, Elisa Paolucci, Francesco Pepe, Maurizio Villanti, Francesca Todde, Simona Matteini, Francesca Caldi, Riccardo Pini, Francesca Innocenti","doi":"10.1007/s11739-024-03551-5","DOIUrl":"10.1007/s11739-024-03551-5","url":null,"abstract":"To evaluate the prognostic stratification ability of 4C Mortality Score and COVID-19 Mortality Risk Score in different age groups. Retrospective study, including all patients, presented to the Emergency Department of the University Hospital Careggi, between February, 2020 and May, 2021, and admitted for SARS-CoV2. Patients were divided into four subgroups based on the quartiles of age distribution: patients < 57 years (G1, n = 546), 57-71 years (G2, n = 508), 72-81 years (G3, n = 552), and > 82 years (G4, n = 578). We calculated the 4C Mortality Score and COVID-19 Mortality Risk Score. The end-point was in-hospital mortality. In the whole population (age 68 ± 16 years), the mortality rate was 19% (n = 424), and increased with increasing age (G1: 4%, G2: 11%, G3: 22%, and G4: 39%, p < 0.001). Both scores were higher among non-survivors than survivors in all subgroups (4C-MS, G1: 6 [3-7] vs 3 [2-5]; G2: 10 [7-11] vs 7 [5-8]; G3: 11 [10-14] vs 10 [8-11]; G4: 13 [12-15] vs 11 [10-13], all p < 0.001; COVID-19 MRS, G1: 8 [7-9] vs 9 [9-11], G2: 10 [8-11] vs 11 [10-12]; G3: 11 [10-12] vs 12 [11-13]; G4: 11 [10-13] vs 13 [12-14], all p < 0.01). The ability of both scores to identify patients at higher risk of in-hospital mortality, was similar in different age groups (4C-MS: G1 0.77, G2 0.76, G3 0.68, G4 0.72; COVID-19 MRS: G1 0.67, G2 0.69, G3 0.69, G4 0.72, all p for comparisons between subgroups = NS). Both scores confirmed their good performance in predicting in-hospital mortality in all age groups, despite their different mortality rate.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139931022","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}

引用次数: 0

Low-dose azithromycin prophylaxis in patients with atrial fibrillation and chronic obstructive pulmonary disease. 心房颤动和慢性阻塞性肺病患者的小剂量阿奇霉素预防治疗。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1007/s11739-024-03653-0

Tommaso Bucci, Dennis Wat, Sarah Sibley, Dan Wootton, David Green, Pasquale Pignatelli, Gregory Y H Lip, Freddy Frost

{"title":"Low-dose azithromycin prophylaxis in patients with atrial fibrillation and chronic obstructive pulmonary disease.","authors":"Tommaso Bucci, Dennis Wat, Sarah Sibley, Dan Wootton, David Green, Pasquale Pignatelli, Gregory Y H Lip, Freddy Frost","doi":"10.1007/s11739-024-03653-0","DOIUrl":"10.1007/s11739-024-03653-0","url":null,"abstract":"Low-dose azithromycin prophylaxis is associated with improved outcomes in people suffering frequent exacerbations of chronic obstructive pulmonary disease (COPD), but the use of macrolides in patients with cardiovascular disease has been debated. To investigate the risk of adverse events after COPD exacerbations in patients with atrial fibrillation (AF) treated with azithromycin prophylaxis. Retrospective cohort study within the TriNetX Platform, including AF patients with COPD exacerbations. Risks of primary and secondary outcomes were recorded up to 30 days post-COPD exacerbations and compared between azithromycin users and azithromycin non-users. The primary outcomes were the risks for a composite of (1) cardiovascular (all-cause death, heart failure, ventricular arrhythmias, ischemic stroke, myocardial infarction, and cardiac arrest), and (2) hemorrhagic events (intracranial hemorrhage (ICH), and gastro-intestinal bleeding). Cox-regression analyses compared outcomes between groups after propensity score matching (PSM). After PSM, azithromycin users (n = 2434, 71 ± 10 years, 49% females) were associated with a lower 30-day risk of post-exacerbation cardiovascular (HR 0.67, 95% CI 0.61-0.73) and hemorrhagic composite outcome (HR 0.45, 95% CI 0.32-0.64) compared to azithromycin non-users (n = 2434, 72 ± 11 years, 51% females). The beneficial effect was consistent for each secondary outcomes, except ICH. On sensitivity analyses, the reduced risk of adverse events in azithromycin users was irrespective of smoking status, exacerbation severity, and type of oral anticoagulation. Azithromycin prophylaxis is associated with a lower risk of all-cause death, thrombotic and hemorrhagic events in AF patients with COPD. The possible role of azithromycin prophylaxis as part of the integrated care management of AF patients with COPD needs further study.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141179433","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Food contamination and cardiovascular disease: a narrative review. 食品污染与心血管疾病：叙述性综述。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-14 DOI: 10.1007/s11739-024-03610-x

Gerardo Mancuso, Francesco Violi, Cristina Nocella

{"title":"Food contamination and cardiovascular disease: a narrative review.","authors":"Gerardo Mancuso, Francesco Violi, Cristina Nocella","doi":"10.1007/s11739-024-03610-x","DOIUrl":"10.1007/s11739-024-03610-x","url":null,"abstract":"Cardiovascular disease is a significant cause of morbidity and mortality among non-communicable diseases worldwide. Evidence shows that a healthy dietary pattern positively influences many risk factors of cardiometabolic health, stroke, and heart disease, supported by the effectiveness of healthy diet and lifestyles for the prevention of CVD. High quality and safety of foods are prerequisites to ensuring food security and beneficial effects. Contaminants can be present in foods mainly because of contamination from environmental sources (water, air, or soil pollution), or artificially introduced by the human. Moreover, the cross-contamination or formation during food processing, food packaging, presence or contamination by natural toxins, or use of unapproved food additives and adulterants. Numerous studies reported the association between food contaminants and cardiovascular risk by demonstrating that (1) the cross-contamination or artificial sweeteners, additives, and adulterants in food processing can be the cause of the risk for major adverse cardiovascular events and (2) environmental factors, such as heavy metals and chemical products can be also significant contributors to food contamination with a negative impact on cardiovascular systems. Furthermore, oxidative stress can be a common mechanism that mediates food contamination-associated CVDs as substantiated by studies showing impaired oxidative stress biomarkers after exposure to food contaminants.This narrative review summarizes the data suggesting how food contaminants may elicit artery injury and proposing oxidative stress as a mediator of cardiovascular damage.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11405437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140922003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Correction: Subclinical hypothyroidism predicts outcome in heart failure: insights from the T.O.S.CA. registry. 更正：亚临床甲状腺功能减退症可预测心力衰竭的预后：T.O.S.CA.登记的启示。

IF 3.2 3区医学

Internal and Emergency Medicine Pub Date : 2024-09-01 DOI: 10.1007/s11739-024-03717-1

Mariarosaria De Luca, Roberta D'Assante, Massimo Iacoviello, Vincenzo Triggiani, Giuseppe Rengo, Alfredo De Giorgi, Giuseppe Limongelli, Daniele Masarone, Maurizio Volterrani, Antonio Mancini, Andrea Passantino, Pasquale Perrone Filardi, Angela Sciacqua, Olga Vriz, Roberto Castello, Michela Campo, Giuseppe Lisco, Pietro Amedeo Modesti, Stefania Paolillo, Toru Suzuki, Andrea Salzano, Alberto Maria Marra, Eduardo Bossone, Antonio Cittadini

引用次数: 0