Internal and Emergency Medicine最新文献

{"title":"From inside to insight: using emotions to understand the interplay between inner experience and the outside world.","authors":"Marta Mocarelli, Marta Piria, Fabrizio Elia, Giorgio Costantino, Mara Gorli","doi":"10.1007/s11739-024-03841-y","DOIUrl":"10.1007/s11739-024-03841-y","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"221-223"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948153","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":"Clinical characteristics and prognostic impact of atrial fibrillation among older patients with heart failure with preserved ejection fraction hospitalized for acute heart failure.","authors":"Giuseppe De Matteis, Maria Livia Burzo, Amato Serra, Davide Antonio Della Polla, Maria Anna Nicolazzi, Benedetta Simeoni, Antonio Gasbarrini, Francesco Franceschi, Giovanni Gambassi, Marcello Covino","doi":"10.1007/s11739-024-03754-w","DOIUrl":"10.1007/s11739-024-03754-w","url":null,"abstract":"<p><p>Heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) are often coexisting conditions, but their interrelationship has not yet been clarified. This study investigated the clinical characteristics and prognostic impact of AF among older patients with HFpEF hospitalized for acute HF (AHF). The study included patients 65 years of age and older who were admitted to the Emergency Department due to AHF from 1 January 2016 to 31 December 2019. Patients were divided into two groups according to the presence of AF. The primary endpoint was all-cause, in-hospital mortality. Overall, 770 patients with HFpEF were included, mean age 82 years, 53% were females. Nearly, a third (30%) of these patients had a concomitant AF and they were significantly older and had higher N-Terminal pro-B-type natriuretic peptide (NT-proBNP) values. Overall, the in-hospital mortality rate was much higher among HFpEF patients with AF compared to those without AF (11.4% vs 6.9%, respectively; p = 0.037). At multivariate analysis, AF emerged as an independent risk factor for death (OR 1.73 [1.03-2.92]; p = 0.038). Among older patients with HFpEF admitted for AHF, the coexistence of AF was associated with a nearly twofold increased risk of all-cause in-hospital mortality. Patients with HFpEF and AF describe a phenotype of older and more symptomatic patients, with higher NT-proBNP, left atrial enlargement, right ventricular dysfunction, and higher CV mortality.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"95-104"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142119738","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}

{"title":"Integrative assessment of congestion in heart failure using ultrasound imaging.","authors":"Valerio Di Fiore, Lavinia Del Punta, Nicolò De Biase, Pierpaolo Pellicori, Luna Gargani, Frank Lloyd Dini, Silvia Armenia, Myriam Li Vigni, Davide Maremmani, Stefano Masi, Stefano Taddei, Nicola Riccardo Pugliese","doi":"10.1007/s11739-024-03755-9","DOIUrl":"10.1007/s11739-024-03755-9","url":null,"abstract":"<p><p>In heart failure (HF), congestion is a key pathophysiologic hallmark and a major contributor to morbidity and mortality. However, the presence of congestion is often overlooked in both acute and chronic settings, particularly when it is not clinically evident, which can have important clinical consequences. Ultrasound (US) is a widely available, non-invasive, sensitive tool that might enable clinicians to detect and quantify the presence of (subclinical) congestion in different organs and tissues and guide therapeutic strategies. In particular, left ventricular filling pressures and pulmonary pressures can be estimated using transthoracic echocardiography; extravascular lung water accumulation can be evaluated by lung US; finally, systemic venous congestion can be assessed at the level of the inferior vena cava or internal jugular vein. The Doppler evaluation of renal, hepatic and portal venous flow can provide additional valuable information. This review aims to describe US techniques allowing multi-organ evaluation of congestion, underlining their role in detecting, monitoring, and treating volume overload more objectively.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"11-22"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132628","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}

{"title":"A forgotten chapter in the history of immunotherapy: cancer therapy with Blastomyces extracts.","authors":"Francesco M Galassi, Domenico Ribatti","doi":"10.1007/s11739-024-03782-6","DOIUrl":"10.1007/s11739-024-03782-6","url":null,"abstract":"<p><p>This article recapitulates the discoveries and anti-tumoural therapeutical proposals by Francesco Sanfelice, who in 1931 published an essay entitled The Treatment of Cancer and Sarcoma with Cancrocidin (paraneoforming Blastomycetes). Sanfelice's discoveries are contextualised with subsequent scientific discoveries, especially with those by L. Scott McDaniel and G. Cozad, who evaluated the functionality of murine peritoneal macrophages previously sensitised precisely with Blastomyces dermatitidis antigen extracts. Finally, recent research on the topic of intratumoural microbiota is mentioned showing how Sanfelice's ideas, albeit partly outdated, can still inspire current biomolecular research.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"3-5"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142604371","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}

{"title":"Modulating patient output: rethinking the role of EM in the healthcare system.","authors":"Annmarie M Lang-Hodge, Melissa N Monaghan, Rodrick Lim, Eric P Heymann, Eddy Lang","doi":"10.1007/s11739-024-03774-6","DOIUrl":"10.1007/s11739-024-03774-6","url":null,"abstract":"<p><p>Overcrowding has become a significant issue in Emergency departments (EDs) around the world. Overcrowding contributes to a chaotic, unsafe and disorganized environment, increasing the burden on healthcare teams, and has led to deteriorating working conditions, with subsequent higher rates of burnout. This review aims to discuss different solutions to improve the process of patient discharge from the ED, either to an inpatient unit, another hospital, or to an outpatient setting, and the impact this component of patient flow can have on physician well being. The solutions presented in this paper have been chosen for their translatability to any setting, regardless of their geographical location.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"215-220"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286279","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":"From the inside to connecting out: awakening doctors' need to build an intersubjective dialogue with meaningful others.","authors":"Benedetta Colaiacovo, Chiara Corvino, Marta Mocarelli, Mara Gorli","doi":"10.1007/s11739-024-03826-x","DOIUrl":"10.1007/s11739-024-03826-x","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"295-296"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894169","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":"Predictors for the prescription of pharmacological prophylaxis for venous thromboembolism during hospitalization in Internal Medicine: a sub-analysis of the FADOI-NoTEVole study.","authors":"Alessia Abenante, Alessandro Squizzato, Lorenza Bertù, Dimitriy Arioli, Roberta Buso, Davide Carrara, Tiziana Ciarambino, Francesco Dentali","doi":"10.1007/s11739-024-03770-w","DOIUrl":"10.1007/s11739-024-03770-w","url":null,"abstract":"<p><p>Patients hospitalized in Internal Medicine Units (IMUs) may frequently experience both an increased risk for thrombosis and bleeding. The use of risk assessment models (RAMs) could aid their management. We present a post-hoc analysis of the FADOI-NoTEVole study, an observational, retrospective, multi-center study conducted in 38 Italian IMUs. The primary aim of the study was to evaluate the predictors associated with the prescription of thromboprophylaxis during hospitalization. The secondary objective was to evaluate RAMs adherence. Univariate analyses were conducted as preliminary evaluations of the variables associated with prescribing pharmacological thromboprophylaxis during hospital stay. The final multivariable logistic model was obtained by a stepwise selection method, using 0.05 as the significance level for entering an effect into the model. Thromboprophylaxis was then correlated with the RAMs and the number of predictors found in the multivariate analysis. Thromboprophylaxis was prescribed to 927 out of 1387 (66.8%) patients with a Padua Prediction score (PPS) ≥ 4. Remarkably, 397 in 1230 (32.3%) patients with both PPS ≥ 4 and an IMPROVE bleeding risk score (IBS) < 7 did not receive it. The prescription of thromboprophylaxis mostly correlated with reduced mobility (OR 2.31; 95% CI 1.90-2.81), ischemic stroke (OR 2.38; 95% CI 1.34-2.91), history of previous thrombosis (OR 2.46; 95% CI 1.49-4.07), and the presence of a central venous catheter (OR 3.00; 95% CI 1.99-4.54). The bleeding risk assessment using the IBS did not appear to impact physicians' decisions. Our analysis provides insight into how indications for thromboprophylaxis were determined, highlighting the difficulties faced by physicians with patients admitted to IMUs.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"151-158"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11794402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142345998","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}

{"title":"Severe hypocalcemia in the emergency department: a retrospective cohort study of prevalence, etiology, treatment and outcome.","authors":"Michael Haidinger, Emmanuel Putallaz, Svenja Ravioli, Aristomenis Exadaktylos, Gregor Lindner","doi":"10.1007/s11739-024-03659-8","DOIUrl":"10.1007/s11739-024-03659-8","url":null,"abstract":"<p><p>The aim of this study was to evaluate the prevalence of severe hypocalcemia in patients attending the emergency department. Symptoms, causes, treatment, and outcome of severe hypocalcemia as well as course of calcium concentrations were assessed. This retrospective case series included all adult patients with measurements of serum calcium concentrations presenting to the emergency department of the Bürgerspital Solothurn between January 01 in 2017 and December 31 in 2020. Medical record reviews were performed of all patients with severe hypocalcemia, defined by a serum calcium concentration < 1.9 mmol/L, to assess clinical presentation and management. 1265 (3.95%) patients had a serum calcium concentration of < 2.1 mmol/L of which 139 (11%) had severe hypocalcemia of < 1.9 mmol/L. 113 patients had at least one measurement of albumin. Of these, 43 (3.4%) had an albumin-corrected serum calcium < 1.9 mmol/L defining true, severe hypocalcemia. Hypocalcemia was identified and documented in 35% of all cases. The mean serum calcium concentration was 1.74 ± 0.14 mmol/L. Calcium concentrations in malignancy-related hypocalcemia were similar to non-malignancy-related hypocalcemia. The main symptoms attributed to hypocalcemia were cardiac and neurologic. 12% of patients with severe hypocalcemia received intravenous and 23% oral calcium replacement. Active malignancy was the main cause of severe hypocalcemia in 28%, while in most cases, the main cause remained unclear. 41.9% of severely hypocalcemic patients reattended the emergency department for another episode of hypocalcemia within 1 year. Hypocalcemia is common in patients attending the emergency department, however, appears to be neglected frequently. The disorder is often a manifestation of severe disease, triggered by multiple causes. Calcium replacement was administered in less than half of the patients with severe hypocalcemia in this study. Due to frequent readmissions to the emergency department and a high mortality, increased awareness of the disorder and careful follow-up are desirable.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"273-279"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141261957","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":"Thinking beyond the basic differential diagnosis of abdominal pain: a case of peritoneal coccidioidomycosis.","authors":"Jesús D Meléndez-Flores, Samantha González-Delgado, Cristina Rodríguez-Abrego, Emilio José Castillo-González, Jessica A Ortega-Balderas","doi":"10.1007/s11739-024-03750-0","DOIUrl":"10.1007/s11739-024-03750-0","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"315-317"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132631","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":"Association between depression and anxiety with the risk and flare of inflammatory bowel disease: a systematic review and meta-analysis.","authors":"Guowei Gong, Cong Xu, Zhenxia Zhang, Yuzhong Zheng","doi":"10.1007/s11739-024-03764-8","DOIUrl":"10.1007/s11739-024-03764-8","url":null,"abstract":"<p><p>Inflammatory bowel disease (IBD) is a chronic condition characterized by inflammation in the gastrointestinal tract. Previous studies have suggested a potential association between mental disorders, such as depression and anxiety, and the risk and flare of IBD. However, the findings have been inconsistent. This study aimed to conduct a systematic review and meta-analysis to assess the relationship between mental disorders and IBD. A comprehensive literature search was performed to identify relevant studies. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to determine the association between mental disorders and the risk and flare of IBD. Heterogeneity between studies was assessed using the I² statistic. Sensitivity analysis was conducted to evaluate the stability of the results. A total of seven studies met the inclusion criteria and were included in the meta-analysis. The pooled results demonstrated a significant association between symptoms of depression at baseline and an increased risk of disease activity flare during longitudinal follow-up, with an OR of 1.69 (95% CI 1.34, 2.13). However, there was high heterogeneity between studies (I² = 82%). Furthermore, patients who underwent surgery had a higher risk of disease activity flare (OR: 1.49, 95% CI 1.13, 1.95), and hospitalization was also identified as a contributing factor (OR: 1.22, 95% CI 1.10, 1.36). This meta-analysis provides evidence for a significant association between symptoms of depression and the risk of disease activity flare in IBD. However, the high heterogeneity observed between studies suggests the need for further research to explore potential moderators and underlying mechanisms. These findings highlight the importance of addressing mental health in the management and treatment of patients with IBD.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":"35-46"},"PeriodicalIF":3.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365147","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}