Italian Journal of Medicine最新文献

{"title":"Delayed diagnosis of plasma cell disorder-related Fanconi syndrome in young adults presenting as osteomalacia: report of two cases with normokalemia and normal haematological parameters at the time of presentation","authors":"Joel Franklin, Praveen V. Pavithran, Neeraj Sidharthan, Seethalkshmy NV, Nithya Abraham, V. Usha Menon, Vasantha Nair, Harish Kumar","doi":"10.4081/itjm.2023.1559","DOIUrl":"https://doi.org/10.4081/itjm.2023.1559","url":null,"abstract":"Adult-onset hypophosphatemic osteomalacia is rare and diagnosis is frequently delayed. Fanconi syndrome (FS) due to monoclonal gammopathy is a well-recognized, but rare cause of hypophosphatemia. The relatively young age of patients and normal routine hematological parameters often results in late recognition of this treatable disease entity. Low phosphorus, elevated alkaline phosphatase, mildly impaired renal function and hypokalemia are often the only abnormalities on routine evaluation. We summarize the clinico-pathological features of two cases who initially presented with fractures and proximal myopathy and were subsequently found to have FS secondary to light chain proximal tubulopathy. Atypical features like absence of hypokalemia at presentation and elevated Fibroblast Growth Factor 23(FGF 23), a marker of oncogenic osteomalacia were noted. Marked clinical improvement and recovery of renal parameters were evident with phosphate supplements and chemotherapy for the plasma cell disorder. FS due to monoclonal gammopathy may present with atypical features and diagnosis may be challenging","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136039260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atypical presentation of West Nile encephalitis","authors":"G. Cioni, A. Fedeli, G. Bellandi, Rossella Squillante, M. Zuccotti, G. Buffini","doi":"10.4081/itjm.2022.1535","DOIUrl":"https://doi.org/10.4081/itjm.2022.1535","url":null,"abstract":"West Nile virus (WNV) causes both sporadic infection and outbreaks that may be associated with severe neurologic involvement. The infection is transmitted to humans mainly by mosquito bites, and the virus is preserved in a cycle in which birds are the main host. The typical involvement of the central nervous system is completely indistinguishable from meningitis and encephalitis related to other pathogens. \u0000In this report we described the atypical presentation of a WNV meningoencephalitis in a 81-y.o. female patient, showing psychiatric manifestations at the onset. Anamnestic information was essential to progress to the correct diagnosis. Targeted search for the causative agent of meningoencephalitis was perfected after learning that the patient lived in an area adjacent to a nature reserve.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49060847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pattern and sweep visual evoked potential in the objective determination of visual acuity","authors":"Mualla Hamurcu","doi":"10.4081/itjm.2022.1556","DOIUrl":"https://doi.org/10.4081/itjm.2022.1556","url":null,"abstract":"Purpose: To investigate the effects of pattern visual evoked potential (pVEP) and sweep visual evoked potential (sVEP) on the accurate visual acuity (VA) measurement in adults. &#x0D; Methods: Medical files of 282 eyes of 141 patients who underwent VA measurement in our electrophysiology laboratory and did not undergo simulation were retrospectively analyzed. The VA was measured using the Snellen chart. Only those with a VA of higher than 1/10 on the Snellen chart were included in the study. The VA was assessed and reported by the pVEP (VA-pVEP) and sVEP test (VA-sVEP). The correlation analysis was performed using the Pearson correlation analysis.&#x0D; Results: Of 141 patients, 92 were males and 49 were females with a mean age of 37.7±18.4 years. There was a strong positive correlation between the VA measured by the Snellen chart and the VA measured by pVEP (VA-pVEP) (r=0.858, p<0.001). There was a weak positive correlation (r=0.267, p<0.001) between the VA measured by the Snellen chart and the VA measured by the sVEP (VA-sVEP). A weak positive correlation was found for the VA-pVEP and VA-sVEP (r=0.313, p<0.001).&#x0D; Conclusions: For the measurement of the degree of the VA, it seems reasonable to use pVEP initially, while sVEP should be used in cases with short attention span and those who are noncooperative and in infants.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135995379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interplay between lymphocyte subpopulation, inflammatory cytokines and their correlation with oxidative stress parameters in COVID-19","authors":"M. Petrusevska, D. Zendelovska, E. Atanasovska, K. Spasovska, K. Grozdanovski, S. Stojanovska, Irina Panovska Stavridis, A. Eftimov","doi":"10.4081/itjm.2022.1543","DOIUrl":"https://doi.org/10.4081/itjm.2022.1543","url":null,"abstract":"Our objective was to investigate the inflammatory and oxidative stress markers in patients with moderate and severe form of COVID-19. In addition, we show the correlation between changes in lymphocyte subsets and markers of oxidative stress as a tool for patient classification. IL-6 and VEGF were analysed by utilizing a High Sensitivity Evidence Investigator™ Biochip Array technology. The total antioxidant capacity (PAT) and the free radical concentrations (d-ROM) were measured in serum utilizing analytical photometric system FRAS5. Peripheral blood was used to determine CD45 + mononuclear, B, T, and NK cells using a multi-parameter flow cytometric immunophenotypic test. \u0000Statistically significant differences in IL-6 and VEGF levels were observed between the two patient groups. Decreased values of the absolute number of lymphocytes and their CD4 + and CD8 + positive T cells, NK cells, and CD8 were obtained. In the moderate group, good correlations were found between IL-6 and VEGF and NK cells (r = 0.6973, p <0.05; for IL6 and r = 0.6498, p <0, for VEGF. 05). Cytokines were correlated with CD45+ (r = 0.5610, p <0.05; for IL-6 and r = 0.5462, p <0.05 for VEGF). The oxidative stress index can be used as a cheaper alternative and as a triage tool between severe and moderate illnesses, after showing good correlation with more expensive patient classification analysis.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45000206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organizational actions to tackle distrust: Building Trust Italy.","authors":"D. Colimberti, R. Frediani","doi":"10.4081/itjm.2022.1554","DOIUrl":"https://doi.org/10.4081/itjm.2022.1554","url":null,"abstract":"According to the italian Code of Medical Deontology, mutual trust and mutual respect for values and rights are the care relationship foundation. To establish reciprocal trust and respect, the communication between care providers and patients must be skilled and appropriate, and the time devoted to communication must be considered time of care. But in Italy, in the last decades costs containment policy in the organizations of the National Health Service critically shortened the time available for care. Today, doctors and other healthcare professionals literally do not have the time to establish appropriate care relationships, and this causes a widespread and increasing distrust of patients and their families in the care system. During Covid-19 pandemic also vaccine hesitancy, defined by experts as a delay in acceptance or refusal of vaccination despite availability of vaccination services, was mainly due to a lack of confidence in care system and in scientific research. Slow Medicine ETS, an italian proactive movement of healthcare professional and citizen, following the example of the initiative “Building Trust” recently activated by the ABIM Foundation in the USA, launched a national initiative aimed to promote and plan concrete actions to restore and consolidate people’s trust in health professionals and organizations, in researchers, in scientific and rational approach to knowledge and in its use for the improvement of health and quality of life. Slow Medicine ETS, still successfully leading and supporting the “Choosing Wisely Italy” project, will be engaged in assembling the national network of the new project “Building Trust Italy”.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46760069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Le cure palliative nel malato internistico: focus sulle malattie croniche in fase avanzata","authors":"M. Carbone, Fabio Gilioli, R. Antonione","doi":"10.4081/itjm.q.2022.5","DOIUrl":"https://doi.org/10.4081/itjm.q.2022.5","url":null,"abstract":"\u0000Prefazione - Il ruolo del palliativista in medicina internaGino Gobber\u0000Il ruolo del medico internista nelle cure palliativeDario Manfellotto\u0000Le cure palliative nel malato non-oncologicoItalo Penco\u0000La cura del malato fragile alla fine della vitaAndrea Fontanella\u0000La scuola di specializzazione in Medicina e Cure PalliativeGino Gobber; Dario Manfellotto\u0000IntroduzioneFabio Gilioli\u0000Strumenti per identificare la complessità dei bisogni clinici-assistenziali dei malati e delle loro famiglieFilippo Canzani; Claudio Santini\u0000Gestione dei sintomi in fase avanzata: dispnea, delirium, rantolo, nausea e vomito, occlusione intestinaleMatteo Moroni\u0000Gestione dei sintomi in fase avanzata e nel fine vita: doloreGiuseppe Civardi\u0000Approccio assistenziale ai sintomi in fase avanzata e nel fine vitaGabriella Bordin; Michela Guarda\u0000De-prescrizione, rimodulazione e sospensione diagnostiche e terapeutiche in fase avanzata di malattiaCarlo Lorenzo Muzzulini; Michele Berardi; Alessandro Valle\u0000Antibioticoterapia nelle cure palliativeMatteo Moroni; Filippo Costanzo\u0000Emotrasfusioni in cure palliativeFilomena Panzone; Raffaella Antonione\u0000Terapia anticoagulante in cure palliativeMauro Silingardi; Raffaella Antonione\u0000Ventilazione non invasiva in cure palliativeFederico Lari; Raffaella Antonione\u0000Scelte terapeutiche in medicina interna: come non perdersi nella complessità del fine vitaMiriam Cappelli; Mauro Carbone\u0000Raccomandazioni conclusive","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41304824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La riscoperta della Medicina Narrativa come metodologia di intervento clinico-assistenziale: focus su dolore cronico e fine vita nel contesto pandemico","authors":"A. Fontanella, Stefania Polvani","doi":"10.4081/itjm.q.2022.4","DOIUrl":"https://doi.org/10.4081/itjm.q.2022.4","url":null,"abstract":"\u0000Il velo oltre le cucine. Lo spazio della Medicina Narrativa nel patrimonio dell'internistaM. Meschi\u0000Medicina Narrativa: una pratica comunicativa quotidiana dell’internistaM. Marinelli\u0000Il piano diagnostico terapeutico assistenziale (PDTA) per il dolore cronico nella Regione LazioG. Campagna, M. Di Carlo, M. Di Napoli, A. Toto\u0000A COVID-19 patient population in a palliative care and hospice ward: outcome of the careM. Saccò, E. Porta, A. Tedeschi, D. Cattaneo\u0000R-Esistere: linguaggi e storie al tempo della pandemiaM. Cerati, M. Testa, S. Polvani\u0000Il setting clinico-assistenziale del fine vitaG. Campagna, M. Di Napoli, A. Toto\u0000Medicina Narrativa nella cura integrale del fine vita e nella terapia del doloreP. Trenta, F. Bracco\u0000Medici narratoriA. Fontanella","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46428947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of a new mometasone furoate nasal spray formulation in patients with acute rhinosinusitis: a randomized clinical trial","authors":"Y. Mehmood, H. Shahid, Aysha Tariq, Syeda Omama Ali","doi":"10.4081/itjm.2022.1533","DOIUrl":"https://doi.org/10.4081/itjm.2022.1533","url":null,"abstract":"Common inflammatory airway disorders, such as seasonal and perennial allergic rhinitis, acute sinusitis, and nasal polyposis, can have a significant impact on patient health and quality of life. Intranasal corticosteroids are recommended as part of treatment plans for each of these illnesses because they reduce inflammation and thus symptoms. In order to compare the efficacy and safety of a new nano formulation of mometasone furoate nano-nasal spray (MF-NNS) with a commercially available nasal spray called mometasone furoate nasal spray (MFNS) for the treatment of allergic rhinitis, 20 rhinitis patients were enrolled in this randomized controlled trial (10 to 50 years). Patients were given 50 mcg MF-NNS doses in the morning and evening. This regimen was administered as a nasal spray for a 3-week efficacy and safety phase. The primary endpoints changed from baseline in the subjects’ congestion as determined by the physicians’ assessment of allergic rhinitis. Analysis of variance was used to evaluate all efficacy end points. More clinical trials have shown that MF-NNS reduces both objective and subjective markers of inflammation in adults, adolescents, and children.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48633242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low birth weight, nephron number and chronic kidney disease","authors":"D. Manfellotto, Monica Cortinovis, N. Perico, G. Remuzzi","doi":"10.4081/itjm.2022.1538","DOIUrl":"https://doi.org/10.4081/itjm.2022.1538","url":null,"abstract":"Chronic kidney diseases have a significant impact on morbidity and mortality worldwide. Low birth weight, fetal growth restriction and prematurity are indicators of fetal growth and development disorders associated with a congenital reduction in nephron number, which predisposes to an increased risk for chronic kidney disease. On an individual basis, a small nephron number at birth is not always enough to determine the onset of chronic kidney disease, but it decreases the ability of the kidneys to resist any insults to renal tissue that may occur later in life, such as exposure to nephrotoxic drugs or episodes of acute kidney injury. The high incidence of low birth weight and preterm birth globally suggests that, at the population level, the impact of alterations in fetal development on the subsequent onset of chronic kidney disease could be significant. The implementation of strategies aimed at reducing the incidence of prematurity, fetal growth restriction, as well as other conditions that lead to low birth weight and a reduced nephron number at birth, provides an opportunity to prevent the development of chronic kidney disease in adulthood. For these purposes the coordinated intervention of several specialists, including obstetricians, gynecologists, neonatologists, nephrologists, and family doctors, is necessary. Such strategies can be particularly useful in resource-poor countries, which are simultaneously burdened by maternal, fetal and child malnutrition; poor health; epidemics caused by communicable diseases; and little access to screening and primary care.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44371838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia and iron in internal medicine: an Italian survey and a review on iron intravenous therapy in medical patients","authors":"A. Montagnani, S. Frasson, G. Gussoni, F. Dentali, A. Fontanella, D. Manfellotto","doi":"10.4081/itjm.2022.1532","DOIUrl":"https://doi.org/10.4081/itjm.2022.1532","url":null,"abstract":"In Italy, Internal Medicine Units hospitalize approximately 1,300,000 patients, often elderly and comorbid. The prevalent diagnoses are respiratory diseases, heart failure, or pneumonia. As a matter of fact, anemia is probably underestimated in the compilation of the official discharge forms (SDO) according to ICD-9 diagnostic codes. We promoted a survey among the Members the Italian Scientific Society of Internal Medicine (FADOI) with the aim to investigate the prevalence of anemia and iron deficiency, over than certain aspects related to the therapeutic management of patients with anemia. Furthermore, we performed a review summarizing current evidence for iron intravenous therapy in these patients. According to the survey, anemia is present in around half of the patients hospitalized in Internal Medicine, and about a quarter of them shows iron metabolism alterations. In the evaluation of iron metabolism, the dosage of ferritin is the most requested exam, whereas transferrin saturation is less considered. By focusing on some categories of patients, the awareness of the usefulness of intravenous iron therapy in patients with heart failure seems to be sufficiently common (76% of physicians), while it seems lower (60%) in the management of patients with chronic kidney disease (CKD) and anemia. Finally, more than 75% of the physicians answered that, in their hospital, there are few outpatients’ offices or diagnostic pathways dedicated to patients with anemia. Anemia due to absolute or functional iron deficiency is particularly prevalent in Internal Medicine inpatients. For this reason, an accurate evaluation of iron profile and an adequate iron therapy is mandatory in these patients. Recent studies show that, in patients with heart failure, intravenous iron therapy is an effective way of improving patients’ health, regardless of the presence of anemia. Similarly, iron therapy results fundamental to optimize erythropoiesis-stimulating agent efficacy in patients with chronic renal failure. In the next future, other therapeutic aspects of intravenous iron therapy will be probably clarified by several interesting ongoing studies focused on these patients.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2022-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41960633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}