Internal and Emergency Medicine最新文献

{"title":"Added value of inflammatory markers to vital signs for predicting mortality in patients with suspected infection: external validation and model development: comment.","authors":"Cengiz Beyan","doi":"10.1007/s11739-025-03900-y","DOIUrl":"https://doi.org/10.1007/s11739-025-03900-y","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467984","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":"Demographic and regional trends in systemic and cardiovascular amyloidosis-related mortality among older adults in the United States from 1999 to 2020.","authors":"Jasninder Singh Dhaliwal, Fatima Hussain, Hamza Ahmed, Abeer T M A Khan, Abdullah Aslam Khan, Maha Asghar Memon, Maha Arshad, Sayed Maisum Mehdi, Anum Touseef Hussain, Ayesha Ali Rind, Syeda Umbreen Munir, Bilal Ali, Kashaf Nadeem, Ahmed Mustafa Rashid","doi":"10.1007/s11739-025-03893-8","DOIUrl":"https://doi.org/10.1007/s11739-025-03893-8","url":null,"abstract":"<p><p>Despite therapy advancements, amyloidosis mortality rates for older adults (aged ≥ 65) are rising. This study analyzes trends in amyloidosis-related mortality among older adults in the U.S. We conducted a cross-sectional analysis of death certificates from the CDC WONDER database for amyloidosis-related deaths from 1999 to 2020. Age-adjusted mortality rates (AAMRs) per 100,000 persons and annual percent change (APC) were calculated by age, race/ethnicity, urban-rural classification, and region. From 1999 to 2020, AAMR for amyloidosis in older adults (aged ≥ 65) in the U.S. increased from 2.7 to 5.6. Men consistently had higher AAMRs than women (men: 3.7 vs. women: 2.2 in 1999; men: 8.5 vs. women: 3.5 in 2020). In 2020, Non-Hispanic Blacks had the highest AAMR at 11.8, with an APC of 19.8 (95% CI 10.5-25.5). Regional differences were notable, with AAMRs highest in the Northeast (6.9) and lowest in the South (4.2). Large metropolitan areas had a higher AAMR (6.3) than non-metropolitan areas (4.6). Cardiac amyloidosis accounted for 68.8% of deaths, with AAMR rising from 1.7 to 4.2. There has been a significant increase in AAMRs for amyloidosis in the U.S. from 1999 to 2020, particularly among males, Non-Hispanic Blacks, and those in large metropolitan and Northeast areas. These findings stress the need for enhanced prevention and treatment strategies for older adults.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467987","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":"Optimal hemoglobin threshold for blood transfusions in sepsis and septic shock: a retrospective analysis.","authors":"Chairat Permpikul, Jakpanee Tanksinmankhong, Surat Tongyoo, Thummaporn Naorungroj, Tanuwong Viarasilpa, Khemajira Karaketklang","doi":"10.1007/s11739-025-03889-4","DOIUrl":"https://doi.org/10.1007/s11739-025-03889-4","url":null,"abstract":"<p><p>Transfusions of red blood cells (RBCs) are crucial for improving tissue oxygenation in anemic patients with sepsis. Nevertheless, the debate continues over the ideal hemoglobin level for transfusions. This study aimed to assess the impact of different hemoglobin levels on the outcomes of patients with sepsis who received transfusions. This retrospective analysis included adult patients with sepsis treated in the general medical ward and intensive care unit at a University affiliate hospital. Patients needing RBC transfusions were included. The primary outcome was the 28-day mortality rate. From March 2018 to January 2022, 806 patients were studied. Of these, 480 (59.6%) were transfused at hemoglobin levels of 7-9 g/dL (\"liberal group\"), while 326 (40.4%) received RBC transfusions when their hemoglobin was < 7 g/dL (\"restrictive group\"). Mean hemoglobin levels at transfusion were 8.1 ± 0.8 g/dL and 6.3 ± 0.8 g/dL for each group, respectively(P < 0.001). On day 28, the liberal group had a mortality rate of 51.2% (246 patients), compared to 59.2% (193 patients) in the restrictive group (Odds ratio [OR] 0.88, 95% confidence interval [CI] 0.79-0.98, P = 0.031). Adjusted comparisons showed 46.8% mortality in the liberal group (141/301patients) versus 59.3% in the restrictive group (178/300patients) at 28 days (OR 0.78, 95% CI 0.66-0.92, P = 0.002). Multivariate analysis revealed transfusion at hemoglobin 7-9 g/dL as an independent variable linked to lower 28-day mortality (OR 0.70, 95% CI 0.49-0.99, P = 0.042). Other factors correlated with 28-day mortality were platelet counts ≤ 150 × 10³/µL, albumin ≤ 2.5 g/dL, shock, mechanical ventilation, and renal replacement therapy. This retrospective study suggests that RBC transfusion at hemoglobin levels of 7-9 g/dL associates with lower 28-day mortality in sepsis patients compared to transfusion at hemoglobin levels below 7 g/dL.Clinical trial registrationThe study was registered with the Thai Clinical Trials Registry (identification number TCTR20231003003). ( https://www.thaiclinicaltrials.org/show/TCTR20231003003 ).</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143467993","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 chick embryo chorioallantoic membrane as an experimental model to study immune checkpoint inhibitors.","authors":"Domenico Ribatti","doi":"10.1007/s11739-025-03904-8","DOIUrl":"https://doi.org/10.1007/s11739-025-03904-8","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448906","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":"Causes and predictors of recurrent unplanned hospital admissions in heart failure patients: a cohort study: a comment.","authors":"Yonathan Freund, Gad Cotter, Beth Davison, Oscar Mirò","doi":"10.1007/s11739-025-03891-w","DOIUrl":"https://doi.org/10.1007/s11739-025-03891-w","url":null,"abstract":"<p><p>We read with great interest the article authored by Kalter-Leibovici et al. Initial treatment in acute heart failure (AHF) is crucial in shaping short-term outcomes. Administered in the prehospital phase or emergency department (ED), early interventions-such as timing and dose of intravenous diuretics or vasodilators-may impact stabilization and decongestion. However, most predictive models, including the one discussed here, often omit these parameters, potentially missing an opportunity to refine risk stratification and anticipate complications.Beyond the ED, in-hospital treatment remains critical. The STRONG-HF trial demonstrated that intensifying medical therapy during hospitalization improves post-discharge outcomes, yet readmission rates remain high. This raises questions about the endpoint itself-whether it fully captures the benefits of optimized early care-or whether it reflects the inherent complexity of AHF as a progressive disease. Most ED-based studies focus on short- to mid-term readmissions (30-90 days), overlooking longer-term trajectories.Additionally, biomarkers such as NT-proBNP and renal function indicators, alongside advanced risk stratification tools, could enhance therapy guidance and discharge decisions. Yet, they remain underutilized in predictive models. Incorporating these parameters in future analyses may provide more actionable insights and improve long-term care strategies for AHF patients.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440712","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 comparison of endotracheal intubation and laryngeal tube insertion with face-to-face method in in-vehicle traffic accidents.","authors":"Merve Arslan, Ali Ekşi","doi":"10.1007/s11739-025-03885-8","DOIUrl":"https://doi.org/10.1007/s11739-025-03885-8","url":null,"abstract":"<p><p>Emergency airway management is a critical focus in prehospital emergency healthcare. The right technique and the right equipment may increase survival. The study aimed to compare endotracheal intubation and laryngeal tube insertion with the face-to-face method in difficult conditions such as in-vehicle traffic accidents in which the injured person is trapped inside the vehicle. The population of the study, which was carried out as experimental research, consisted of emergency health workers currently working in Bursa 112 Ambulance Services (n: 383). The study compared two different airway applications with face-to-face techniques using a simulator mannequin. Data were collected between February and May 2023 and the IBM Statistical Package for Social Sciences for Windows (SPSS 25) computer program was used for statistical data analysis. The suitability of the numerical variables for normal distribution was tested by the Shapiro-Wilk test. Since the variables did not conform to the normal distribution, they were given as median (Q1-Q3) values. Participants' preparation, implementation, and total times for ETI and LT were compared using the Wilcoxon test. The duration of face-to-face ETI and LT times were compared regarding participants' personal characteristics, experience status, and the training they received with the Mann-Whitney U test and the Kruskal-Wallis test. Categorical variables are given as number and percentage values. p < 0.05 was considered significant. In face-to-face endotracheal intubation, 24.3% of the participants were successful in the first attempt, 30% in the second attempt, 27.1% in the third attempt, 18.6% failed in all three attempts, and 38.6% performed esophageal intubation. 87.1% of the participants were successful in face-to-face laryngeal tube insertion in the first and 12.9% in the second attempt. The duration of face-to-face laryngeal tube placement was found to be significantly shorter than the duration of endotracheal intubation (p < 0.05). In face-to-face airway conduct, the length of endotracheal intubation time and the high risk of esophageal intubation make the laryngeal tube more advantageous than endotracheal intubation. Furthermore, the high number of attempts required for successful face-to-face endotracheal intubation may pose additional risks by causing destabilization in trauma patients requiring cervical stabilization.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143440715","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":"Lower albumin levels are associated with 1-year mortality in older patients hospitalized for acute heart failure: THE ALBIMED-HF study.","authors":"Riccardo Barbiero, Martina Baccillieri, Davide Santagata, Marta Biancucci, Benedetta Pennella, Flavio Tangianu, Eleonora Nicolini, Andrea Maria Maresca, Francesco Dentali, Aldo Bonaventura","doi":"10.1007/s11739-025-03882-x","DOIUrl":"https://doi.org/10.1007/s11739-025-03882-x","url":null,"abstract":"<p><p>Hypoalbuminemia (i.e., albumin levels ≤ 3.5 g/dL) is a negative prognostic marker in several conditions, including acute heart failure (AHF). Hypoalbuminemia is common in patients hospitalized in Internal Medicine (IM) divisions. However, its role in predicting long-term mortality in AHF patients hospitalized in this setting is not clear. In THE ALBIMED-HF study, all patients hospitalized for AHF in the First Division of Internal Medicine at Ospedale di Circolo and Fondazione Macchi (ASST Sette Laghi, Varese, Italy) between January 1st and December 31st 2022 were retrospectively included. Clinical information was retrieved from patient electronic medical records. Four hundred and ninety-eight patients were considered for the present study (median age 85 [78-89] years). Median Charlson Comorbidity Index was 6 [5-7]. Heart failure (HF) with preserved ejection fraction was found in 40.6% of patients (N = 202/498). Median albumin levels were 3.2 [2.8-3.5] g/dL and hypoalbuminemia was recorded in 76.5% of patients (N = 381/498). At 12 months, 221 out of 498 patients (44.4%) died, and mortality was significantly higher in patients with hypoalbuminemia than in those without (N = 185/381 [48.6%] vs. N = 36/117 [30.8%], p < 0.001). Patients who died within 12 months were older, suffered more frequently from chronic kidney disease and active cancer, and exhibited higher C-reactive protein levels. At the multivariable analysis, hypoalbuminemia was independently associated with 12-month all-cause mortality (HR 2.41, 95% confidence interval 1.20-4.83). Hypoalbuminemia was independently associated with 12-month all-cause mortality in older patients with multiple comorbidities hospitalized for AHF in an IM division.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414051","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":"Severe burn injuries and the impact of mental health: insights from 7 years at Switzerland's leading burn center.","authors":"Michael-Alexander Pais, Mauro Vasella, Oliver Matthes, Elena Millesi, Alexander Kobler, Tabea Breckwoldt, Gregory Reid, Lukas Naef, Luzie Hofmann, Jennifer Ashley Watson, Philipp Karl Bühler, Pietro Giovanoli, Bong-Sung Kim","doi":"10.1007/s11739-025-03887-6","DOIUrl":"https://doi.org/10.1007/s11739-025-03887-6","url":null,"abstract":"<p><p>Severe burn injuries present significant global healthcare challenges, with outcomes significantly influenced by factors such as socioeconomic status, mental health conditions, and substance use, which vary across regions and healthcare systems. This study investigates the etiologies, treatment outcomes, and the impact of psychiatric conditions and controlled substance use on burn injuries in patients admitted to the intensive care unit at Switzerland's largest Burn Center. Data were retrospectively analyzed from 438 patients admitted to the University Hospital Zurich Burn Center ICU between 2016 and 2022. Variables assessed included baseline characteristics, burn etiologies, injury mechanisms, treatment modalities, complications, discharge outcomes, and mortality. Statistical analyses employed generalized linear models and logistic regression. Most burns occurred at home/leisure activities (43.4%), 21.2% at work. Pre-existing psychiatric conditions were present in 38.8% of patients, and 24.4% were under influence of controlled substances at the time of injury. These factors were associated with higher complication rates, increased surgeries, longer hospital stays, and lower survival rates. The overall in-hospital mortality rate was 15.8%, significantly linked to a history of controlled substance use. These findings highlight the significant impact of psychiatric conditions and use of controlled substances on burn injury outcomes, underscoring the importance of an interdisciplinary approach to treatment and management, particularly for patients with mental health and substance abuse histories.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407324","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":"Cytisine for smoking cessation in hospitalised smokers with cardiovascular diseases: an observational study.","authors":"Tedesco Erika, Ceccato Sofia, Torazzi Alessandro, Santin Laura, Losso Lorenzo, Bottardi Andrea, Casari Rebecca, Melchiori Silvia, Secchettin Erica, Ferrero Valeria, Arzenton Elena, Marini Paola, Lugoboni Fabio, Chiamulera Cristiano","doi":"10.1007/s11739-025-03888-5","DOIUrl":"https://doi.org/10.1007/s11739-025-03888-5","url":null,"abstract":"<p><p>Cigarette smoke is a significant risk factor for cardiovascular diseases (CVD). Among pharmacotherapy for smoking cessation, the plant alkaloid cytisine (CYT) -a nicotinic receptors partial agonist- has been shown to have a safe profile, with a minimal risk for drug interactions. Since previous studies have excluded CVD patients, there are few existing data examining CYT safety in this critical population. An observational prospective study was conducted in the Verona University Hospital (AOUI), Italy, to assess the safety and efficacy of CYT for smoking cessation. Thirty-six hospitalised participants from the Cardiology Department received oral CYT 1.5 mg for 25 days, according to the West Dosing Schedule (6 capsules for the first 3 days, gradually decreased up to 2 capsules on the last 6 days), in combination with supportive care. The primary endpoint was CYT safety, with 11 mild-moderate Adverse Drug Reactions (ADRs) reported by 9 (25%) participants. Initial insomnia (11%), nausea (6%), sleep disorders (6%), headache (3%), gastritis (3%), and diarrhoea (3%) were the most frequent symptoms. No serious or unexpected ADRs were identified, with no increase in cardiovascular events. Efficacy was assessed as self-reported 7-day point prevalence abstinence (PPA) at 3, 6 and 12 months post-quit. At the first follow-up, abstinence was also biochemically verified by exhaled carbon monoxide (CO) measurement, which was confirmed for 36% of participants. Considering lost to follow-up as relapsed patients, the PPA was 50%, 47% and 36% at 1st, 2nd and 3rd follow-up, respectively. These results may suggest that CYT has a well-established safety profile in hospitalised CVD patients, but further investigation is needed.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407321","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":"Comanagement of surgical patients between neurosurgeons and internal-medicine clinicians: observational cohort study.","authors":"Ombretta Para, Joel Byju Valuparampil, Irene Merilli, Lorenzo Caruso, Asim Raza, Alberto Parenti, Carolina Angoli, Mohammed Al Refaie, Marzia Onesto, Lorenzo Barbacci, Carlo Nozzoli, Alessandro Della Puppa","doi":"10.1007/s11739-025-03866-x","DOIUrl":"https://doi.org/10.1007/s11739-025-03866-x","url":null,"abstract":"<p><p>The rising prevalence of chronic diseases have contributed to a population with high complexity of care. There has been an increasing need for a new organizational model based on the interaction in the same department between the specialist skills of surgical and medical disciplines. This study aims to describe the implementation of a hospitalist co-management program in a Neurosurgery Department (ND) and its impact on the incidence of medical complications, 30 days readmission rate for medical causes, number of transfers to Intensive Care Units (ICU)/Neurosurgical Intensive Care Unit (NICU) or to medical wards (MW), length-of stay (LOS), mortality and satisfaction of health workers. We conducted an observational study comparing changes before and after the Internal medicine-Neurosurgical Comanagement (INC) intervention. We conducted a retrospective evaluation of patients enrolled before the INC intervention and a prospective evaluation of those enrolled after the INC intervention was implemented. We defined the pre-INC intervention group as 380 patients admitted to the ND for neurosurgical disease between January 2022 and April 2022 and the post-INC intervention group as 367 patients admitted to the ND between January 2023 and April 2023. INC intervention was associated with a significant decrease in medical complications during the hospital stay (OR 0.52; 95% CI; 0.39-0.70, p < 0.001), 30 days in-hospital readmission for medical reasons (OR 0.95; 95% CI 0.93-0.97, p < 0.001) and numbers of transfers to ICU/NICU (OR 0.31; 95% CI; 0.17-0.55, p < 0.001) or MW (OR 0.51; 95% CI 0.33-0.77, p = 0.002). During the INC intervention period, we observed a high satisfaction rate in health workers, evaluated by standardized questionnaire. In our study, LOS, in-hospital mortality and 30-day mortality were not significantly associated with INC. Hospitalist co-management in Neurosurgical Departments was associated with a reduced incidence of medical complications, 30-days in-hospital readmission and numbers of transfers to ICU/NICU or MW with a high satisfaction rate among healthcare workers, but without a significant decrease in LOS and mortality rate.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143399108","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}