Internal and Emergency Medicine最新文献_第7页

Impact of recombinant erythropoietin on anemia, physical function, and cognitive assessment in hospitalized older adults. 重组红细胞生成素对住院老年人贫血、身体功能和认知评估的影响

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-09-02 DOI: 10.1007/s11739-025-04038-7

Roberto Castelli, Pier Mannuccio Mannucci, Alessandro Palmerio Delitala, Sebastiana Atzori, Luigi Bergamaschini, Gemma Lisa Sechi, Roberto Manetti, Chiara Budroni, Antonio Gidaro

{"title":"Impact of recombinant erythropoietin on anemia, physical function, and cognitive assessment in hospitalized older adults.","authors":"Roberto Castelli, Pier Mannuccio Mannucci, Alessandro Palmerio Delitala, Sebastiana Atzori, Luigi Bergamaschini, Gemma Lisa Sechi, Roberto Manetti, Chiara Budroni, Antonio Gidaro","doi":"10.1007/s11739-025-04038-7","DOIUrl":"10.1007/s11739-025-04038-7","url":null,"abstract":"Anemia is frequent in older adults. The essential mechanisms underlying its pathogenesis and relationship with clinical outcomes have been investigated. Erythroid-stimulating agents, particularly recombinant erythropoietin (EPO), corrected anemia in older adults and improved their clinical outcomes. Notwithstanding, many questions remain unanswered. The aim of this study was to correlate a few components of the comprehensive geriatric assessment, such as frailty index, time to up and go test, and mini mental state examination with hemoglobin levels (Hb) after treatment with EPO and blood transfusion, and to determine improvements in outcomes after treatment. 256 patients with anemia aged 65 or older were evaluated, but only 101 hospitalized cases completed the follow-up. They were allocated to three groups: group 1 received recombinant EPO 40,000 U/week, group 2 EPO 4000 U three times a week, and group 3 transfusions as needed. No statistically significant difference was observed between group 1 and group 2. All patients underwent a geriatric evaluation based on the time up and go test (TUGT), the mini mental test, the frailty index, and the occurrence of events such as delirium and falls. EPO resulted in erythroid response in nearly 70% of the treated cases and increased Hb (p < 0.001). There was no correlation between anemia and mortality or adverse events, except for such cardiovascular events as heart failure, angina, and syncope. There was a correlation of Hb levels with less frailty and falls (p < 0.001). EPO treatment was also associated with functional improvement, as indicated by TUGT. These findings indirectly support the view that anemia is an independent risk factor for executive function impairment in hospitalized older adults.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1815-1822"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953077","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

Introduction of a LAT gel and low-dose midazolam sedo-analgesia protocol for pediatric skin suture in the emergency department: simpler is better. 介绍LAT凝胶和低剂量咪达唑仑镇痛方案在急诊科儿科皮肤缝合：越简单越好。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2024-12-09 DOI: 10.1007/s11739-024-03825-y

Eleonora Maria Pisano, Marco Barchiesi, Eugenia Belotti, Marta Mazzoleni, Erika Diani, Michela Franzin, Roberto Cosentini

{"title":"Introduction of a LAT gel and low-dose midazolam sedo-analgesia protocol for pediatric skin suture in the emergency department: simpler is better.","authors":"Eleonora Maria Pisano, Marco Barchiesi, Eugenia Belotti, Marta Mazzoleni, Erika Diani, Michela Franzin, Roberto Cosentini","doi":"10.1007/s11739-024-03825-y","DOIUrl":"10.1007/s11739-024-03825-y","url":null,"abstract":"Background: skin lacerations are one of the main causes of children's referral to the emergency department (ED). We introduced in our general ED a pediatric sedo-analgesia protocol (SAP) for suturing skin wounds using LAT gel, a local anesthetic solution of lidocaine, adrenaline and tetracaine, with or without low-dose oral midazolam according to patient's age, to improve the experience of laceration repair.Methods: Primary outcomes were improvement of suturing experience for ED operators (as a reduction in the desire to avoid the procedure) and of the adequacy of sedo-analgesia provided, investigated through two different surveys administered to the ED staff before and after the introduction of the SAP. Children's parents were asked about satisfaction with the sedo-analgesia provided. Data were collected prospectively.Results: The analysis included 85 and 60 healthcare professionals involved in the suture of skin wounds in children, respectively before and after the introduction of our SAP. The introduction of the SAP reduced ED operators' stress and improved the entire suturing experience. The pre-post analysis showed a statistically significant improvement in the perceived adequacy of the provided sedo-analgesia (p < 0.0001) and a significant reduction of operators who would have avoided the procedure (p < 0.0001). The great majority of children's parents expressed a high level of satisfaction.Conclusions: The introduction of a LAT gel and low-dose oral midazolam SAP allows an improvement of both the sedo-analgesia provided and the ED operators' suturing experience of skin lacerations in children. Our SAP appeared to be safe and effective, with low cost and high tolerability.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1949-1958"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800657","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

Novel perspectives on trunk-to-peripheral fat ratio in hospitalized patients with chronic obstructive pulmonary disease. 慢性阻塞性肺疾病住院患者躯干与外周脂肪比的新观点

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-06-23 DOI: 10.1007/s11739-025-04005-2

Yiben Huang, Siyao Chen, Zicong Dai, Xinran Li, Ruizi Xu, Zihan Ye, Yiting Yu, Chunyan Liu, Xianjing Chen, Yage Xu, Beibei Yu, Xiaodiao Zhang

{"title":"Novel perspectives on trunk-to-peripheral fat ratio in hospitalized patients with chronic obstructive pulmonary disease.","authors":"Yiben Huang, Siyao Chen, Zicong Dai, Xinran Li, Ruizi Xu, Zihan Ye, Yiting Yu, Chunyan Liu, Xianjing Chen, Yage Xu, Beibei Yu, Xiaodiao Zhang","doi":"10.1007/s11739-025-04005-2","DOIUrl":"10.1007/s11739-025-04005-2","url":null,"abstract":"Malnutrition plays a considerable role in the deterioration of chronic obstructive pulmonary disease (COPD). Nevertheless, current research indicates body mass index may not fully capture alterations in nutritional status. Trunk-to-peripheral fat ratio, measured by dual-energy x-ray absorptiometry (DXA) offers a more precise approach. This research aims to investigate the association between trunk-to-peripheral fat ratio and the severity of COPD as measured by COPD Assessment Test (CAT) scale, along with its related intermediary factors. We incorporated 168 patients admitted for COPD and obtained body composition data through DXA. The main outcome was 1-year CAT scale score, with 6-month CAT scale score serving as the secondary outcome. Significant disparities were observed between trunk-to-appendicular fat ratio (TAR) and trunk-to-leg fat ratio (TLR) across different groups with a 6-month CAT (all p < 0.05) and a 1-year CAT (all p < 0.05). After adjusting for covariates, TAR (OR = 0.330, p = 0.013) and TLR (OR = 0.525, p = 0.026) were independently correlated with one-year CAT. Upon inclusion of TAR in the initial model, the area under the curve (AUC) was 0.739 (95% CI 0.663-0.815, p < 0.001), along with an elevated Net Reclassification Improvement (NRI) of 37.81 (95% CI 7.85-67.77, p = 0.013) and Integrated Discrimination Improvement (IDI) of 3.39 (95% CI 0.63-6.14, p = 0.016). Similarly, the previous model's AUC and IDI climbed with the addition of TLR. Mediation analysis indicated that triglyceride levels partly influenced the correlation. Trunk-to-peripheral fat ratio was associated with the severity of COPD, which was partly mediated by triglycerides.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1731-1740"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475099","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

Ending nuclear weapons, before they end us. 在核武器终结我们之前终结它们。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 DOI: 10.1007/s11739-025-04075-2

Kamran Abbasi, Parveen Ali, Virginia Barbour, Marion Birch, Inga Blum, Peter Doherty, Andy Haines, Ira Helfand, Richard Horton, Kati Juva, Jose F Lapena, Robert Mash, Olga Mironova, Arun Mitra, Carlos Monteiro, Elena N Naumova, David Onazi, Tilman Ruff, Peush Sahni, James Tumwine, Carlos Umaña, Paul Yonga, Chris Zielinski

引用次数: 0

The effect of SGLT2 inhibitors on hepatic steatosis detected by MRI-PDFF in patients with type 2 Diabetes mellitus and metabolic-associated steatotic liver disease: comment. MRI-PDFF检测SGLT2抑制剂对2型糖尿病和代谢性脂肪变性肝病患者肝脂肪变性的影响：评论

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-22 DOI: 10.1007/s11739-025-04056-5

Yunlong Song, Rongchao Fang, Bo Yu

引用次数: 0

What did you have? 你吃了什么？

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-24 DOI: 10.1007/s11739-025-04046-7

Zhaohui Su

引用次数: 0

Prescription of ACE-Is/ARBs in patients with cardio-renal disease: a multicenter retrospective cohort study from the REPOSI registry. 心肾疾病患者ACE-Is/ arb处方：来自REPOSI注册中心的多中心回顾性队列研究

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-15 DOI: 10.1007/s11739-025-04026-x

Paolo Lido, Silvia Cantiero, Antonio Galluccio, Annalisa Noce, Luca Di Lullo, Roberto Bei, Ferdinando Iellamo, Pier Mannuccio Mannucci, Alessandro Nobili, Mauro Tettamanti

{"title":"Prescription of ACE-Is/ARBs in patients with cardio-renal disease: a multicenter retrospective cohort study from the REPOSI registry.","authors":"Paolo Lido, Silvia Cantiero, Antonio Galluccio, Annalisa Noce, Luca Di Lullo, Roberto Bei, Ferdinando Iellamo, Pier Mannuccio Mannucci, Alessandro Nobili, Mauro Tettamanti","doi":"10.1007/s11739-025-04026-x","DOIUrl":"10.1007/s11739-025-04026-x","url":null,"abstract":"Cardio-renal disease is a common clinical condition leading to increased morbidity and mortality. Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin II receptor blockers (ARBs) are the cornerstone of treatment of chronic cardio-renal disease. Using data from the REPOSI register, we performed a multicenter, observational, retrospective study to determine which factors are associated with the non-prescription or discontinuation of ACE-Is/ARBS in a cohort of 889 cardio-renal patients hospitalized in 109 Italian internal medicine and geriatric wards. Only 55% of the patients with cardio-renal disease of the investigated cohort were on treatment with ACE-Is or ARBs at admission. The primary end point was ACE-Is/ARBs use at discharge. Patients with lower probability of receiving ACE-Is/ARBs at discharge were older and hospitalized for longer periods. Furthermore, patients with advanced chronic kidney disease (advanced CKD: eGFR ≤ 29 mL/min/1.73m²) had a much lower (54%) probability of being discharged or continuing ACE-Is/ARBs treatment than those with eGFR ≥ 60 mL/min/1.73m². A more prominent lower probability was found comparing advanced CKD patients with G3 stage CKD patients (eGFR: 59-30 mL/min/1.73m²) in multivariate analyses (OR and 95%CI: 0.37, 0.24-0.57. multivariate p-value < 0.001). The probability of stopping treatment in patients already on treatment with ACE-Is/ARBs at hospital admission (secondary end point) almost reached a threefold increase (OR and 95%CI: 2.82, 1.69-4.71. multivariate p-value < 0.001) when the advanced CKD group was compared with G3 CKD patients. The data of our study are not in line with the recently published updated KDIGO 2024 Guidelines, which recommend patients with advanced CKD to continue treatment with ACE-Is/ARBs.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1787-1801"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144642512","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

Short and long-term outcomes of COVID-19-associated venous thromboembolism: a propensity score-matched cohort study. covid -19相关静脉血栓栓塞的短期和长期结局：一项倾向评分匹配的队列研究

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2025-07-03 DOI: 10.1007/s11739-025-04042-x

Rubén Alonso-Beato, Pablo Demelo-Rodríguez, Lucía Ordieres-Ortega, Marina López-Rubio, Marta-Olimpia Lago-Rodríguez, Crhistian-Mario Oblitas, Luis Antonio Alvarez-Sala Walther, Francisco Galeano-Valle

{"title":"Short and long-term outcomes of COVID-19-associated venous thromboembolism: a propensity score-matched cohort study.","authors":"Rubén Alonso-Beato, Pablo Demelo-Rodríguez, Lucía Ordieres-Ortega, Marina López-Rubio, Marta-Olimpia Lago-Rodríguez, Crhistian-Mario Oblitas, Luis Antonio Alvarez-Sala Walther, Francisco Galeano-Valle","doi":"10.1007/s11739-025-04042-x","DOIUrl":"10.1007/s11739-025-04042-x","url":null,"abstract":"Venous thromboembolism (VTE) is a recognized complication of SARS-CoV-2 infection, but its clinical features and both sort- and long-term outcomes remain incompletely characterized. We aimed to compare the clinical profile and outcomes of patients with VTE with and without recent COVID-19. We conducted a prospective cohort study including 2012 patients with objectively confirmed VTE. COVID-19-associated VTE was defined as VTE diagnosed within 30 days of a microbiologically confirmed SARS-CoV-2 infection. Clinical characteristics, treatment, and outcomes were compared between groups. Propensity score matching (1:1) and competing risk models were used to adjust for confounding. The primary outcomes-assessed at both 30 days and 365 days-included all-cause mortality, major bleeding, and VTE recurrence. A total of 272 patients (13.5%) had COVID-19-associated VTE. Compared with non-COVID cases, these patients more often had pulmonary embolism, higher D-dimer levels, and greater use of unfractionated heparin. At 30 days, COVID-19 was associated with increased mortality (HR 2.29; 95% CI 1.19-4.40) and major bleeding (HR 2.11; 95% CI 1.06-4.21). At one year, the bleeding risk remained higher (HR 1.54; 95% CI 1.02-2.33), while VTE recurrence was lower (HR 0.34; 95% CI 0.13-0.94). These results were consistent after propensity score matching. COVID-19-associated VTE is linked to worse short-term outcomes, including early mortality and bleeding, and to a persistently elevated bleeding risk at one year. Lower recurrence rates support the consideration of COVID-19 as a transient provoking factor.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1835-1846"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476387/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144553457","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

Euglycemic ketoacidosis in a non-diabetic patient with Duchenne muscular dystrophy on dapagliflozin. 应用达格列净治疗杜氏肌营养不良的非糖尿病患者的正糖酮症酸中毒。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 DOI: 10.1007/s11739-025-04058-3

Ana María Gutiérrez-Baena, Mariona Tegido Mateu, Paula Álvarez Schlegel, Sandra Clotet-Vidal

{"title":"Euglycemic ketoacidosis in a non-diabetic patient with Duchenne muscular dystrophy on dapagliflozin.","authors":"Ana María Gutiérrez-Baena, Mariona Tegido Mateu, Paula Álvarez Schlegel, Sandra Clotet-Vidal","doi":"10.1007/s11739-025-04058-3","DOIUrl":"10.1007/s11739-025-04058-3","url":null,"abstract":"Euglycemic ketoacidosis (EKA) is an uncommon but potentially life-threatening condition characterized by ketoacidosis with normal or mildly elevated blood glucose levels. We report the case of a 24-year-old male with advanced Duchenne muscular dystrophy and cardiomyopathy treated with dapagliflozin, who developed EKA triggered by reduced food intake due to dysphagia and delayed intestinal motility. The patient presented with metabolic acidosis and elevated ketones but maintained normal glucose levels. Discontinuation of dapagliflozin, along with intravenous bicarbonate and dextrose administration, led to clinical and biochemical resolution without the need for insulin therapy. This case highlights the importance of recognizing SGLT2 inhibitor-associated EKA in non-diabetic patients, especially during fasting or stress conditions, to prevent misdiagnosis and ensure prompt management. Increased clinical vigilance and patient education are essential given the expanding use of these agents in non-diabetic populations.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1865-1867"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953015","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

Clinical profile, inhaler technique, and predictors of inhaler adherence among asthma and COPD patients who attended the outpatient emergency department for acute exacerbation. 哮喘和慢性阻塞性肺病急性加重门诊急诊患者的临床概况、吸入器使用技巧以及吸入器依从性的预测因素。

IF 3.8 3区医学

Internal and Emergency Medicine Pub Date : 2025-09-01 Epub Date: 2024-11-05 DOI: 10.1007/s11739-024-03810-5

Hock Peng Koh, Paula Suen Suen Teoh, Nurul Liana Roslan

{"title":"Clinical profile, inhaler technique, and predictors of inhaler adherence among asthma and COPD patients who attended the outpatient emergency department for acute exacerbation.","authors":"Hock Peng Koh, Paula Suen Suen Teoh, Nurul Liana Roslan","doi":"10.1007/s11739-024-03810-5","DOIUrl":"10.1007/s11739-024-03810-5","url":null,"abstract":"Understanding the patients' clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. Convenience sampling was used in this study. The inhaler techniques and adherence of all subjects were evaluated. Regression analysis was used to identify predictors of inhaler adherence. We recruited 120 subjects with a mean age of 47.8 ± 16.0 and were predominantly asthma patients (n = 85, 70.8%). Most were on regular follow-up (n = 72, 60.0%) and adhered to their inhaler(s) (n = 86, 71.7%). Less than half of the subjects use their inhaler(s) correctly (n = 45, 37.5%). Three predictors of inhaler adherence were identified: regular follow-up (aOR 2.072, p = 0.041), correct inhaler technique (aOR 3.071, p = 0.039), and ability to explain inhalers' mode of action (aOR 10.906, p = 0.031). The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"1909-1916"},"PeriodicalIF":3.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580982","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