Internal and Emergency Medicine最新文献

{"title":"Selecting patients for ICU up-grade from general wards: role of prognostic tools.","authors":"Victor Galvani Vianna Amarilla, Isabel Mieko Miamoto, Daiane Dyba, João Manoel Silva-Jr, Brenno Cardoso Gomes","doi":"10.1007/s11739-025-03998-0","DOIUrl":"https://doi.org/10.1007/s11739-025-03998-0","url":null,"abstract":"<p><p>The decision to admit patients to the intensive care unit (ICU) can be difficult, especially when it is unclear which patients will benefit the most. Therefore, identifying the determinants of complications can aid in patient therapy. The aim of this study was to evaluate the characteristics of patients who were admitted late to the ICU and identify the main factors that contribute to their admission. This case‒control study was conducted in a tertiary hospital and included 4 years of follow-up (using medical records). The study included patients who were at risk for deterioration and admitted to clinical wards. The main measure, whether ICU admission was needed or not, was compared among the patients. We included 170 patients aged 60.6 ± 13.6 years. The multivariate analysis revealed that the qSOFA and CCI values were independent factors in determining whether a patient required ICU admission (OR = 8.25, CI 95% = 4.4-15.3 and OR = 1.37, CI 95% = 1.03-1.82, respectively); the ROC value was 0.89 (95% CI 0.83-0.93). The Cox regression model used to assess 90-day survival revealed that only the qSOFA value was strongly associated with shorter survival (qSOFA = 1, HR = 9.42, P = 0.03; qSOFA = 2, HR = 17.7, P = 0.005; and qSOFA = 3, HR = 73.7, P < 0.001). Although selecting high-risk patients for ICU admission is a difficult task, the qSOFA score appears to be a useful tool for differentiating patients.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225367","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 patient safety in alternative emergency pathways: a comparative study of Italian and United Kingdom systems.","authors":"Arian Zaboli, Tommaso Mocchi, Francesco Brigo, Gloria Brigiari, Magdalena Massar, Barbara Cleaver, Lorenzo Ghiadoni, Gianni Turcato","doi":"10.1007/s11739-025-03997-1","DOIUrl":"https://doi.org/10.1007/s11739-025-03997-1","url":null,"abstract":"<p><p>Emergency departments (EDs) worldwide face increasing crowding, largely due to non-urgent patients. Various strategies have been proposed to redirect these patients to alternative care pathways, such as Urgent Care Centers (UCCs) in the United Kingdom and \"Centri di Assistenza per le Urgenze\" [Centers for Urgent Care] (CAUs) in Italy. However, the safety of these models remain uncertain. This study aims to compare the criteria of UCCs and CAUs to evaluate their impact on clinical outcomes. This retrospective, single-center study analyzed ED patients at Merano Hospital from January 1 to December 31, 2023. A sample of 1772 patients was independently assessed by two trained professionals using CAU and UCC criteria. The primary outcome was hospitalization following an ED visit, while secondary outcomes included 30-day and 6-month mortality. Sensitivity, specificity, positive and negative predictive values were calculated for both systems. The CAU system identified 833 patients (47.0%) as eligible for redirection, while the UCC system identified 937 patients (52.9%). The CAU model misclassified 4.1% of patients who subsequently required hospitalization, compared to 1.8% in the UCC system. Furthermore, patients redirected using CAU criteria had higher 30-day and 6-month mortality rates. The UCC model demonstrated higher sensitivity (81.5% vs. 3.7%) and greater specificity in predicting hospitalizations. The UCC system outperforms CAU in both patient safety and clinical effectiveness. Implementing evidence-based criteria for non-urgent patients is essential to alleviating ED overcrowding while maintaining patient safety. Future research should focus on refining selection algorithms to optimize care pathway effectiveness.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215732","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":"Neuropsychiatric lupus or West Nile encephalitis? Diagnostic dilemmas in two SLE patients and literature review.","authors":"Hany Alatawna, Mahmoud Abu-Shakra, Tal Schlaeffer-Yosef, Iftach Sagy","doi":"10.1007/s11739-025-03993-5","DOIUrl":"https://doi.org/10.1007/s11739-025-03993-5","url":null,"abstract":"<p><p>Systemic lupus erythematosus (SLE) is an autoimmune disease that can involve the central nervous system (CNS), manifesting as a neuropsychiatric syndrome. Differentiating between neuropsychiatric systemic lupus erythematosus (NPSLE) and infections, such as West Nile encephalitis (WNE), as well as other etiologies, presents a significant diagnostic challenge and complicates the management of these patients. We present two cases of SLE patients with neuropsychiatric symptoms ultimately diagnosed as WNE and conducted a targeted literature review using bibliographic databases. We report two cases of SLE patients who presented with fever, cognitive decline, and rapid neurological deterioration. Both were considered to have NPSLE in the differential process, though later, they were found to have WNE after extensive and long diagnostic workups. Each case required subtle clinical management while awaiting confirmatory results. WNE can mimic CNS lupus, complicating the diagnosis and treatment. These cases emphasize the importance of considering infectious causes, especially in the face of the immunocompromised state of SLE patients, and balancing empirical treatments until definitive results are available. A literature review identified six additional cases of WNE in SLE patients. All cases involved diagnostic and management challenges similar to those in our cases, further underscoring the need to consider infectious etiologies in SLE patients presenting with neuropsychiatric symptoms.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215733","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":"Letter to the Editor of \"The impact of COVID‑19 pandemic on hospitalization rate, clinical impairment and mortality of cirrhotic patients\".","authors":"Han Zhang, Yulong Jiao, Yufeng Yang","doi":"10.1007/s11739-025-03992-6","DOIUrl":"https://doi.org/10.1007/s11739-025-03992-6","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144225366","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 two brain injury biomarkers, GFAP and UCH-L1, for the management of mTBI in the Emergency Department: an observational study.","authors":"Davide Campagna, Francesca Cucuzza, Giuseppe Fabio Martines, Lorena Amico, Monica Pennisi, Eva Francesca Aiello, Riccardo Polosa, Giuseppe Carpinteri","doi":"10.1007/s11739-025-04000-7","DOIUrl":"https://doi.org/10.1007/s11739-025-04000-7","url":null,"abstract":"<p><p>The management of the Emergency Department (ED) of patients with mild traumatic brain injury (mTBI) is currently challenging due to its clinical heterogeneity. The most rapid method to assess brain damage is to perform a brain computed tomography (CT) scan. Stratification scores, as the Canadian CT Head Rule or the New Orleans Criteria, can be used for a quick and safe rule-out for mTBI, but scientific literature highlights how these scores are misused in real life leading to perform useless brain CT scans with radiation exposure, even in patients who do not need it. In the last years, some scientific associations have suggested the use of a biomarker to help clinicians in decision-making in this field. Given these premises, in this study we evaluated the effectiveness of two biomarkers, the glial fibrillary acidic protein (GFAP) and the ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), in predicting the necessity of performing a CT scan of the brain in the study population calculated as Negative Predictive Value (NPV) compared to CT scan reports. From January 2023, we enrolled 101 participants with mTBI who underwent a brain CT scan and blood test to assess levels of two biomarkers at the ED of Policlinico Teaching Hospital of Catania, Italy. 17 participants had a positive brain CT scan report. Of these, 13 reported an \"elevated\" levels of biomarkers, and 4 a \"not elevated\" levels leading to an NPV of 86.6%. A specialist neuroradiologist reassessed, in blind, all CT scans leading to the re-evaluation of 9 CT scans, initially reported as positive by the ED radiologist, which were then reassessed as negative. The results yielded an NPV of 100%. Our study suggests that GFAP and UCH-L1 can be effectively used in the management of patients with mTBI for a rapid and safe rule-out of the patients.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215735","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 impact of right ventricular dysfunction in patients with severe aortic stenosis treated with trans-catheter aortic valve implantation.","authors":"Valentina Scheggi, Yohann Bohbot, Jasim Hasan, Pierre Vanhaecke, Carlo Fumagalli, Francesco Meucci, Manuel Garofalo, Ruggero Mazzotta, Samuele Salvi, Giorgia Panichella, Lucrezia Biagiotti, Matteo Orlandi, Angela Ilaria Fanizzi, Nicola Zoppetti, Renato Valenti, Alfredo Cerillo, Pier Luigi Stefàno, Carlo Di Mario, Dan Rusinaru, Anfani Mirode, Christophe Tribouilloy, Niccolò Marchionni","doi":"10.1007/s11739-025-03985-5","DOIUrl":"https://doi.org/10.1007/s11739-025-03985-5","url":null,"abstract":"<p><p>Transcatheter aortic valve implantation (TAVI) is a standard treatment for severe aortic stenosis (AS), especially in high-risk surgical patients. However, the impact of right ventricular (RV) dysfunction on TAVI outcomes remains unclear. This study aimed to evaluate RV function, measured by tricuspid annular plane systolic excursion (TAPSE), as a predictor of mortality post-TAVI. In a multicenter retrospective cohort study, 637 patients with severe AS who underwent TAVI were assessed for RV function using TAPSE measurements. Data were analyzed to explore the relationship between TAPSE and mortality at 30 days and 1 year, adjusting for demographic factors, comorbidities, and echocardiographic parameters. The prognostic value of the RV-pulmonary artery coupling parameter (TAPSE/PASP) was also investigated. A reduced TAPSE was identified as an independent predictor of 30-day mortality, with each 1-mm increase in TAPSE linked to a 14% reduction in mortality risk (HR 0.86 [95% CI 0.76-0.99]; p = 0.033). The association between TAPSE and 1-year mortality was weaker, with long-term outcomes more strongly influenced by the Charlson Comorbidity Index (CCI) (HR 1.2 [95% CI 1.0-1.3]; p = 0.007). In addition, TAPSE/PASP showed no significant correlation with mortality outcomes. Reduced TAPSE is a valuable predictor of early mortality following TAVI, suggesting that preoperative TAPSE assessments may enhance risk stratification and early post-procedural management. In contrast, long-term mortality in TAVI patients appears to depend more on overall comorbidity burden. Future research should consider integrating TAPSE into risk models to improve individualized TAVI patient care.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144215734","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":"Efficacy of high-flow nasal oxygen therapy in cancer patients with concurrent acute hypoxemic respiratory failure: a retrospective propensity score study.","authors":"Yun Ge, Bingwei Wang, Jingyuan Liu, Ruoyan Han, Changpeng Liu","doi":"10.1007/s11739-024-03777-3","DOIUrl":"10.1007/s11739-024-03777-3","url":null,"abstract":"<p><p>Acute respiratory failure is the leading cause of intensive care unit (ICU) admission of cancer patients. Studies of the efficacy of high-flow nasal cannula (HFNC) therapy were rarely conducted in cancer populations. We here compared the clinical effects of HFNC therapy and conventional oxygen therapy (COT) in cancer patients with concurrent acute hypoxemic respiratory failure (AHRF). In this single-center retrospective study, cancer patients with concurrent acute hypoxic respiratory failure either received initial oxygen therapy via HFNC (HFNC group, 68 patients) or received initial oxygen therapy via a nasal cannula, simple mask, or mask with reservoir bag (COT group, 133 patients). Groups were propensity score matched. Differences in respiratory rate (RR), heart rate (HR), and PaO₂/FiO₂ ratio before and after treatment in the two groups were compared using a mixed-effects model. The 28-day mortality risk was explored using a Cox proportional hazards model. The 24-h and 48-h PaO₂/FIO₂ ratios were significantly higher in the HFNC than in the COT group (210.5 mmHg vs. 178.5 mmHg; P < 0.01; 217.1 mm Hg vs. 181.6 mm Hg; P < 0.01, respectively). Differences in RR and HR between the groups at each time point were nonsignificant. The 28-day mortality rate was 17.4% vs. 38.1% for the HFNC and COT groups, respectively (P < 0.01). Hazard ratio was significantly higher for COT group (HR 2.6, 95% confidence interval 1.3, 5.3). Compared with COT, HFNC use for initial oxygen therapy can improve PaO₂/FIO₂ ratio and survival rate in cancer patients with AHRF.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1225-1233"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619749","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":"Nodular fasciitis. A rare, rapidly growing lesion of the parotid gland.","authors":"Nicola Flor, Jacopo Di Napoli, Luca Carsana, Laura Moneghini, Federico Biglioli","doi":"10.1007/s11739-025-03868-9","DOIUrl":"10.1007/s11739-025-03868-9","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1271-1272"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074224","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":"Summer-type hypersensitivity pneumonitis.","authors":"Kosuke Ishizuka, Masaki Yamamoto, Yoshiyuki Ohira, Mitsuyasu Ohta","doi":"10.1007/s11739-025-03913-7","DOIUrl":"10.1007/s11739-025-03913-7","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1273-1274"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572940","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":"Ulcerative colitis in the elderly.","authors":"Grigoriy E Gurvits","doi":"10.1007/s11739-024-03798-y","DOIUrl":"10.1007/s11739-024-03798-y","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1281-1282"},"PeriodicalIF":3.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499755","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}