Internal and Emergency Medicine最新文献

{"title":"Fostering interconnected care in heart failure: a call to action for a comprehensive assessment and management of the patient's journey.","authors":"Ignazio Cusmano, Monica Loguercio, Francesca Di Salvo, Stefano Gonella, Marco Ambrosetti, Nuccia Morici","doi":"10.1007/s11739-025-04102-2","DOIUrl":"https://doi.org/10.1007/s11739-025-04102-2","url":null,"abstract":"<p><p>A growing body of evidence underscores the importance of investigating the patient journey in managing systemic disorders. This is particularly relevant in heart failure (HF), a condition in which achieving long-term outcomes requires advancements in the early detection, accurate diagnosis, and comprehensive treatment of HF throughout the patient's care experience. Addressing this challenge necessitates tackling critical barriers, including workforce shortages, insufficient funding, and limited awareness of HF care among both healthcare providers and patients. Cardiac rehabilitation (CR) plays a pivotal role within the continuum of care, serving as a cornerstone for engaging and motivating patients and caregivers. Despite its recognized value, gaps persist in the integration of CR into interconnected care networks and the broader healthcare system. This paper seeks to highlight the essential role of CR as a \"bridging tool\" to promote patient stabilization, emphasizing the implementation of guideline-directed medical therapy, as well as fostering patient education and empowerment. Achieving this integration requires embedding CR as a central component within the comprehensive management pathway for patients with HF.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953055","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":"A case of diabetic foot with severe vascular disease in an elderly no-option patient undergoing lower limb arterialization: a clinical case report.","authors":"Adriano Massacesi, Gioia Palmonella, Cristina Gatti, Michela Fichetti, Enrico Paci","doi":"10.1007/s11739-025-04106-y","DOIUrl":"https://doi.org/10.1007/s11739-025-04106-y","url":null,"abstract":"<p><p>This clinical case report describes an 80-year-old no-option diabetic patient with chronic limb-threatening ischemia and severe vascular disease. The patient presented with wet gangrene and underwent an unsuccessful revascularization attempt, followed by minor amputation complicated by poor wound healing. Due to persistent ischemia and surgical dehiscence, the patient underwent a transcatheter deep venous arterialization procedure, resulting in improved perfusion, wound healing, and limb salvage. This case highlights the potential of venous arterialization as a limb-saving option in carefully selected elderly patients, emphasizing the importance of a multidisciplinary and individualized approach.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953023","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":"Updating the International Early Warning Score with frailty and comparing to gestalt for prediction of 3-day critical illness and mortality in emergency department patients.","authors":"Bart G J Candel, Lars I Veldhuis","doi":"10.1007/s11739-025-04096-x","DOIUrl":"https://doi.org/10.1007/s11739-025-04096-x","url":null,"abstract":"<p><p>The International Early Warning Score (IEWS) showed strong prediction of mortality in all ages, but its performance compared to clinical gestalt remains uncertain. Furthermore, it is unknown whether frailty improves prediction besides age. This study aimed to compare IEWS with gestalt, and assess whether updating with frailty improved prediction. This secondary analysis of a prospective study enrolled 774 adult ED patients transported by ambulance to Amsterdam University Medical Centre between March and October 2021. The primary outcome was the performance of IEWS (± frailty) and clinical gestalt of paramedics, nurses, and physicians in predicting critical illness and 28-day mortality. Critical illness included serious adverse events, ICU admission, or mortality within 72 h. Critical illness occurred in 14.1% (n = 109) and 28-day mortality was 7.1% (n = 55). Both gestalt and IEWS had low accuracy predicting mortality with substantial underestimation of risk in all patients and low clinical usefulness. Gestalt performed better than IEWS in terms of discrimination and calibration for critical illness, with AUROC for physicians' gestalt of 0.83 (0.80-0.86), of nurses' gestalt of 0.84 (0.81-0.87), and paramedics' gestalt of 0.78 (0.75-0.81) compared to AUROC for IEWS of 0.64 (0.60-0.69) and IEWS + frailty of 0.64 (0.60-0.69). However, gestalt was only clinically useful for patients in whom an acceptable risk threshold for critical illness was above 5%. In these high-risk patients who arrived by ambulance to an Academic Hospital, clinical gestalt performed better than IEWS plus or minus frailty but was only useful if a risk threshold above 5% was acceptable.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953013","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":"Commentary on ACE‑Is/ARBs in patients with cardio‑renal disease.","authors":"Seyed Alireza Jafarnia, Reza Ghasemian, Hossein Zare","doi":"10.1007/s11739-025-04098-9","DOIUrl":"https://doi.org/10.1007/s11739-025-04098-9","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952995","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":"Mortality and recurrence in acute ischemic stroke of all etiologies according to ultrasonographic assessment of carotid and aortic arch plaques: a prospective study.","authors":"Giuseppe Miceli, Maria Grazia Basso, Alessandra Casuccio, Andrea Roberta Pennacchio, Elena Cocciola, Mariagiovanna Cuffaro, Martina Profita, Chiara Pintus, Giuliana Rizzo, Antonino Tuttolomondo","doi":"10.1007/s11739-025-04088-x","DOIUrl":"https://doi.org/10.1007/s11739-025-04088-x","url":null,"abstract":"<p><p>Carotid duplex ultrasound helps to determine the degree of stenosis or occlusion and characterizes plaque composition and vulnerability, which is crucial for stroke risk stratification. Recurrent ischemic stroke poses a significant risk to individuals, with about one-third of stroke survivors experiencing a repeat event within 5 years. Large-artery atherosclerosis, such as carotid, aortic, and femoral arteries, further increases the risk of recurrent strokes and influences prognosis. Moreover, stroke can result in worse outcomes, including higher morbidity, mortality, and cardiovascular complications in the 3 years after. In recent years, a simple, non-invasive ultrasound evaluation through the suprasternal notch has been proposed for identifying atherosclerosis of the aortic arch, with good sensitivity and specificity. Despite its non-invasive nature and growing clinical relevance, the prognostic utility of aortic arch ultrasound in the context of ischemic stroke of all etiologies remains underexplored. This study aims to evaluate the link between ultrasound characteristics of aortic and carotid plaques and the risk of mortality and recurrent stroke among patients with acute ischemic stroke. One hundred-eight patients with first-episode acute ischemic stroke, a mean age of 71.3 (13.4) years, underwent carotid Duplex and transthoracic aortic arch ultrasounds. They were followed up every 6 months for 3 years. The results revealed that while carotid plaques and stenosis were not significantly associated with recurrent stroke, the absence of plaques was associated with higher survival rates (p = 0.008). Conversely, the simultaneous presence of plaques in both the common and internal carotid arteries was associated with increased mortality (p = 0.004). Finally, echo-lucent intimal lesions, according to the Gray-Weale classification, are considered high-risk plaques and showed good sensitivity (89.6%) but poor specificity in predicting outcomes at 3 years (AUC = 0.63, p = 0.0164). These findings suggest that routine non-invasive ultrasound evaluation of both carotid and aortic arch can be beneficial in stratifying patients for secondary prevention and improving stroke care.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952986","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":"Predictive accuracy of velocity time integral in predicting in-hospital outcomes in patients with intermediate-risk pulmonary embolism: a systematic review and meta-analysis.","authors":"Gunaseelan Rajendran, Sasikumar Mahalingam, Anitha Ramkumar, Ezhilkugan Ganessane, Yuvaraj Krishnamoorthy, P T Kumaresh, Vijayanthi Vijayan, Rajkumar Elanjaeran, K Aswin","doi":"10.1007/s11739-025-04089-w","DOIUrl":"https://doi.org/10.1007/s11739-025-04089-w","url":null,"abstract":"<p><p>Intermediate-risk pulmonary embolism (IRPE) is a critical clinical entity with significant mortality risk due to normotensive shock, a condition marked by low cardiac index despite maintained blood pressure. Accurate and timely detection of hemodynamic compromise in IRPE remains a challenge. Velocity Time Integral (VTI), a Doppler echocardiographic parameter, has emerged as a potential non-invasive tool for predicting hospital outcomes, but the evidence remains fragmented. This systematic review and meta-analysis aim to evaluate the diagnostic accuracy of VTI in this context. A systematic literature search encompassing PubMed, EMBASE, and SCOPUS Databases was conducted from inception till December 2024. Studies assessing VTI's diagnostic accuracy for predicting hospital outcomes in IRPE were included. A bivariate random-effects model was used to pool sensitivity and specificity, with heterogeneity analyzed via I² statistics and meta-regression. Literature search yielded 9 studies with 2038 patients. Pooled sensitivity and specificity of VTI for predicting hospital outcomes in IRPE were 79% (95% CI 69-86%) and 81% (95% CI 70-88%), respectively. Diagnostic odds ratio was 15.58 (95% CI: 7.42-32.69). Heterogeneity was moderate to high (I² = 66.59%), with specificity showing greater variability. Meta-regression identified study-level characteristics, including risk of bias and VTI measurement site (LVOT vs. RVOT), as sources of variability. VTI demonstrates moderate sensitivity and specificity in predicting hospital outcomes such as mortality, in-hospital mortality, resuscitated cardiac arrest, hemodynamic instability or the need for reperfusion therapy.  VTI, offers a non-invasive, real-time diagnostic option. However, study heterogeneity and methodological limitations highlight the need for further research.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953034","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":"Blind eyes.","authors":"Tommaso Lupia, Giacomo Stroffolini","doi":"10.1007/s11739-025-04099-8","DOIUrl":"https://doi.org/10.1007/s11739-025-04099-8","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953010","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":"Hypertensive urgency: is it a homogeneous condition to be managed in the same way?","authors":"Francesca Coccina, Sante D Pierdomenico","doi":"10.1007/s11739-025-04101-3","DOIUrl":"https://doi.org/10.1007/s11739-025-04101-3","url":null,"abstract":"","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952983","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":"Respiratory failure, underlying acute illnesses, and hospital outcomes: the S. Giovanni-Addolorata-SIGOT GRACE Study.","authors":"Filippo Luca Fimognari, Angelo Scuteri, Elena Del Giudice, Francesco Baffa Bellucci, Umberto Giuseppe Galasso, Andrea Cavalli, Mariagiovanna Cozza, Elvira Clausi, Lorenzo Palleschi","doi":"10.1007/s11739-025-04074-3","DOIUrl":"https://doi.org/10.1007/s11739-025-04074-3","url":null,"abstract":"<p><p>Although respiratory failure (RF) is frequent among older medical patients admitted to non-intensive hospital units, inherent data are scarce. We determined whether RF predicted adverse hospital outcomes independently of its causative illnesses. In a retrospective observational study from the Geriatric Risk Assessment and Care Evaluation database, we included 1093 patients consecutively admitted to a geriatric hospital unit (2022-2024). Study outcomes included hospital death, length of hospital stay (LOS) and post-discharge institutionalization (discharge to nursing homes or other long-term facilities). RF was diagnosed according to admission peripheral oxygen saturation ≤ 91%, or oxygen therapy/non-invasive ventilation during hospitalization, or specific diagnostic discharge codes. The predictive role of RF was investigated controlling for RF causative illnesses, frailty measured by the Multidimensional Prognostic Index (MPI), and C-reactive protein. The RF prevalence was 43%. Compared to controls, RF patients had higher hospital mortality (25.4% vs. 6.0%) and longer LOS, but comparable institutionalization rate. The fully adjusted odds ratio (OR) of RF for hospital mortality was 3.98 (95% Confidence Interval [CI] 2.53-6.28) and further increased after exclusion of 106 acute-on-chronic RF patients (4.71, CI 2.96-7.49). MPI, C-reactive protein, and sepsis emerged as additional significant predictors of mortality. RF also predicted longer LOS (F 6.78, p 0.009) in a linear regression model, along with age, MPI, pneumonia, pulmonary embolism, stroke, and sepsis. RF was highly prevalent and predicted hospital mortality and longer LOS per se, independently of its causative acute illnesses, frailty, and systemic inflammation. Older patients should be actively screened for RF during hospitalization.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953000","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":"HFpEF and HFmrEF in acute heart failure: isolated diastolic dysfunction or alternative cardiac pathologies?","authors":"Maria Giulia Bellicini","doi":"10.1007/s11739-025-04097-w","DOIUrl":"10.1007/s11739-025-04097-w","url":null,"abstract":"<p><p>A significant proportion of acute heart failure (AHF) hospitalizations involve patients with heart failure with preserved or mildly reduced ejection fraction (HFpEF or HFmrEF). According to the current Guidelines, these HF phenotypes exclude patients with major cardiac pathologies, such as severe valvular disease, cardiomyopathies, or isolated precapillary pulmonary artery hypertension, and their aetiology is attributed to diastolic dysfunction alone. However, whether HFpEF or HFmrEF-when defined in this way-can independently cause fluid overload remains unproved. We retrospectively analyzed 773 consecutive cardiology admissions for AHF between January 2022 and November 2023. Of these, 323 patients presented with left ventricular ejection fraction (LVEF) > 40% were included. Systemic venous congestion was defined as an inferior vena cava diameter > 21 mm with reduced inspiratory collapse. A structured diagnostic approach was used to identify the prevalence of major cardiac structural abnormalites and rhythm abnormalities, classified as HFpEF mimics, in patients with preserved or mildly reduced LVEF and peripheral congestion. Among 323 patients with LVEF>40%, 252 (78%) showed systemic congestion. Of these, 206 (81.7%) had severe valvular dysfunction, 26 (10.3%) had other relevant structural or rhythmic cardiac pathology (such as cardiomyopathy) or had V stage renal failure, and only 20 patients (8%) had no identifiable HFpEF mimic, thereby fulfilling the strict guideline-based definition of these entities. In patients with LVEF >40%, systemic venous congestion was almost invariably associated with significant structural or rhytm heart disease or advanced renal failure. Cases without such alternative explanations were extremely rare, suggesting that guideline-defined HFpEF/HFmrEF, as an independent cause of acute decompensation, may represent an uncommon or even non-existent clinical entity. These findings challenge the validity of current definitions and support a more comprehensive diagnostic approach in this patient population.</p>","PeriodicalId":13662,"journal":{"name":"Internal and Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":3.8,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144953067","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}