European Journal of Internal Medicine最新文献

{"title":"Aspirin-free strategies after percutaneous coronary intervention: Old habits, consolidated evidence and future perspectives","authors":"Antonio Landi ,&nbsp;Stefano De Servi ,&nbsp;Leonardo De Luca","doi":"10.1016/j.ejim.2025.01.012","DOIUrl":"10.1016/j.ejim.2025.01.012","url":null,"abstract":"<div><div>For almost two decades, dual antiplatelet therapy (DAPT) has been considered the cornerstone of pharmacological treatment in patients undergoing percutaneous coronary intervention (PCI). DAPT composition and duration have considerably evolved in the last decade moving from fixed treatment durations to tailored strategies based on the individual ischemic and bleeding risks. The increasing awareness of the prognostic relevance of bleeding events after PCI and the need for tailoring DAPT according to the individual bleeding and ischemic risks paved the way to newer DAPT modulation strategies by early aspirin withdrawal which have been shown to decrease bleeding without affecting therapeutic efficacy. There is mounting evidence suggesting that P2Y₁₂ inhibitor monotherapy is associated with lower risks of adverse ischemic events without bleeding risk trade-off in patients with a history of myocardial infarction or PCI compared with aspirin. These findings suggest that aspirin-free strategies at short and long-term after PCI might be associated with net benefit in presence of potent P2Y₁₂ receptor inhibition. In this Viewpoint, we provide a contemporary overview of available evidence on aspirin-free strategies, moving from the latest guidelines recommendations to future perspectives on modulation of antiplatelet therapy after PCI.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"133 ","pages":"Pages 35-38"},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practical management of severe acute pancreatitis","authors":"Karim Hamesch ,&nbsp;Marcus Hollenbach ,&nbsp;Lucía Guilabert ,&nbsp;Tobias Lahmer ,&nbsp;Alexander Koch","doi":"10.1016/j.ejim.2024.10.030","DOIUrl":"10.1016/j.ejim.2024.10.030","url":null,"abstract":"<div><div>Acute pancreatitis (AP) represents one of the most common reasons for hospital admission and intensive care treatment in internal medicine. The incidence of AP is increasing, posing significant financial burden on healthcare systems due to the necessity for frequent medical interventions. Severe acute pancreatitis (SAP) is a potentially life-threatening condition with substantial morbidity and mortality. The management of SAP requires prolonged hospitalization and the expertise of a multidisciplinary team, comprising emergency physicians, intensivists, internists, gastroenterologists, visceral surgeons, and experts in nutrition, infectious disease, endoscopy, as well as diagnostic and interventional radiology. Effective management and beneficial patient outcomes depend on continuous interdisciplinary collaboration.</div><div>This review synthesizes recent evidence guiding the practical management of SAP, with a particular focus on emergency and intensive care settings. Both established as well as new diagnostic and therapeutic paradigms are highlighted, including workup, risk stratification, fluid management, analgesia, nutrition, organ support, imaging modalities and their timing, along with anti-infective strategies. Furthermore, the review explores interventions for local and vascular complications of SAP, with particular attention to the indications, timing and selection between endoscopic (both endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS)), percutaneous and surgical approaches. Similarly, the management of biliary AP due to obstructive gallstones, including the imaging, timing of ERCP and cholecystectomy, are discussed. By integrating new evidence with relevant guidance for everyday clinical practice, this review aims to enhance the interdisciplinary approach essential for improving outcomes in SAP management.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"133 ","pages":"Pages 1-13"},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142755790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Length of hospital stay, delayed pneumonia diagnosis and post-discharge mortality. The Pneumonia in Italian Acute Care for Elderly units (PIACE)-SIGOT study","authors":"Filippo Luca Fimognari ,&nbsp;Paolo Fabbietti ,&nbsp;Francesco Baffa Bellucci ,&nbsp;Andrea Corsonello ,&nbsp;Roberto Ricchio ,&nbsp;Massimo Rizzo ,&nbsp;Olga Cuccurullo ,&nbsp;Alberto Ferrari ,&nbsp;Lorenzo Palleschi","doi":"10.1016/j.ejim.2024.12.014","DOIUrl":"10.1016/j.ejim.2024.12.014","url":null,"abstract":"<div><h3>Background</h3><div>High-income countries are currently decreasing length of hospital stay (LOS), with the aim of improving resource utilization. Little is known about the contribution of LOS to short-term post-discharge mortality in older patients with pneumonia.</div></div><div><h3>Aim</h3><div>to identify factors independently associated with LOS and to determine whether LOS predicts 3-month post-discharge death in older patients hospitalized for pneumonia.</div></div><div><h3>Method</h3><div>Prospective observation of 318 consecutive patients in the Pneumonia In Italian Acute Care for Elderly units (PIACE) study. Geriatric risk factors and the time between the onset of symptoms and pneumonia diagnosis (time to diagnosis, TTD) were included in the analysis.</div></div><div><h3>Results</h3><div>Long TTD (odds ratio [OR] 1.104, 95 % confidence interval [CI] 1.008–1.210) and hypoalbuminemia (0.606, 0.392–0.937) were significant correlates of longer LOS (≥ 11 days) in the logistic regression analysis. TTD was shorter in more severe patients, and healthcare associated pneumonia was inversely related to TTD &gt; 1 day (0.471, 0.258–0.859). At Cox regression analysis, longer LOS independently predicted 3-month post-discharge death (hazard ratio [HR] 2.309, 95 % CI 1.229–4.341), together with severity of pneumonia (or of acute illness), comorbidity, disability at discharge and not being discharged to home. LOS was not anymore significant after adjustment for hypoalbuminemia (0.210, 0.118–0.375) and longer TTD (1.103, 1.020–1.193), that independently predicted post-discharge death together with comorbidity and disability at discharge.</div></div><div><h3>Conclusion</h3><div>Longer LOS characterizes patients with severe hospital presentation and consequently predicts post-discharge death, but delayed pneumonia diagnosis, a modifiable process of care measure, may contribute to both longer LOS and increased post-discharge death.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"133 ","pages":"Pages 48-54"},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142866114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic obstructive pulmonary disease: A narrative synthesis of its hallmarks for palliative care clinicians","authors":"Jacopo D'Andria Ursoleo ,&nbsp;Alice Bottussi ,&nbsp;Donald R. Sullivan ,&nbsp;Corrado D'Andria ,&nbsp;Natalia Smirnova ,&nbsp;William E. Rosa ,&nbsp;Stefano Nava ,&nbsp;Fabrizio Monaco","doi":"10.1016/j.ejim.2024.12.033","DOIUrl":"10.1016/j.ejim.2024.12.033","url":null,"abstract":"<div><div>Chronic obstructive pulmonary disease (COPD) is a life-limiting condition and the third leading cause of death worldwide. People with COPD experience physical and psychological symptoms and functional limitations that impair their quality of life. Their caregivers face adverse clinical outcomes due to personal, social, and financial demands. As such, recent emphasis has been placed on early referral to palliative care services to enhance prognostic awareness, clarify goals of care, and manage symptoms. In this narrative synthesis of key aspects of COPD care, we propose practical, evidence-based strategies to integrate palliative care principles with conventional disease-directed treatments throughout the illness trajectory. We emphasize the importance of equipping clinicians caring for people with COPD with a thorough understanding of both the inherent disease complexities and the cornerstones of its multimodal management, including palliative care, to address the unique psychosocial and physical needs of this patient population.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"133 ","pages":"Pages 25-34"},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Some comments on Tecovirimat and mpox.","authors":"Salvatore Chirumbolo, Umberto Tirelli","doi":"10.1016/j.ejim.2025.02.031","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.02.031","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female patient with telangiectasia, epistaxis and pulmonary arteriovenous malformation","authors":"Fırat Akagunduz ,&nbsp;Feride Yagmur Akagunduz ,&nbsp;Fergun Yılmaz ,&nbsp;Haner Direskeneli","doi":"10.1016/j.ejim.2024.11.025","DOIUrl":"10.1016/j.ejim.2024.11.025","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"133 ","pages":"Pages 113-114"},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing hypertension prevention research: Insights and opportunities for social work interventions. Author's reply","authors":"Rikuta Hamaya ,&nbsp;Eric B Rimm","doi":"10.1016/j.ejim.2024.12.012","DOIUrl":"10.1016/j.ejim.2024.12.012","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"133 ","pages":"Page 133"},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internists at the frontline of epidemic viral illnesses: From tiredness to preparedness","authors":"Fabian Patauner,&nbsp;Raffaella Gallo,&nbsp;Emanuele Durante-Mangoni,&nbsp;Lorenzo Bertolino","doi":"10.1016/j.ejim.2025.01.003","DOIUrl":"10.1016/j.ejim.2025.01.003","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"133 ","pages":"Pages 121-122"},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Opt-In versus opt-out for the secondary use of routinely recorded health data: A randomized controlled trial","authors":"Merel Hermus ,&nbsp;Celinde H. Scharloo-Karels ,&nbsp;M. Arfan Ikram ,&nbsp;Eleni-Rosalina Andrinopoulou ,&nbsp;Dimitris Rizopoulos ,&nbsp;Dennis H. Marck ,&nbsp;Michelle Michels ,&nbsp;Folkert van Kemenade","doi":"10.1016/j.ejim.2025.01.017","DOIUrl":"10.1016/j.ejim.2025.01.017","url":null,"abstract":"<div><div>Importance: Optimal data availability for secondary use is crucial for continuous improvement in healthcare. At the same time, it is imperative to uphold patients’ rights to be informed, to control the use of their health data and to protect their privacy. To balance these two needs, we investigated which consent procedure (opt-in or opt-out) would be most supportive of data availability.</div><div>Objective: This study explores an opt-in procedure versus an opt-out procedure as a consent procurement method for secondary use of routinely recorded health data, images and tissues for scientific research purposes.</div><div>Design/Setting: A randomized controlled trial was performed in Erasmus Medical Center, a large tertiary hospital in the Netherlands. New, first time patients were recruited from 16 outpatient clinics and randomily assigned to either the opt-in (intervention group) or the opt-out procedure (control group), until the equally balanced sample size of 2228 was reached.</div><div>Results: Patient inclusion spanned from December 2022 to September 2023. The opt-out procedure resulted in higher consent rates compared to the opt-in procedure. Differences were found for gender, socioeconomic status and country of birth.</div><div>Conclusions: An opt-out procedure appears to be more effective in ensuring optimal data availability with less bias for the secondary use of health data compared to opt-in. To uphold patient control over data, it is pivotal that patients are well-informed about the consent procedure.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"133 ","pages":"Pages 100-105"},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of different triggers in patients with Takotsubo syndrome and chronic obstructive pulmonary disease","authors":"Anna Litwińska-Kmiecik ,&nbsp;Agnieszka Zalewska ,&nbsp;Alicja Wiśniewska","doi":"10.1016/j.ejim.2024.11.013","DOIUrl":"10.1016/j.ejim.2024.11.013","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"133 ","pages":"Page 128"},"PeriodicalIF":5.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}