European Journal of Internal Medicine最新文献_第9页

Beta-cell function and glucose metabolism in patients with chronic pancreatitis 慢性胰腺炎患者的β细胞功能和葡萄糖代谢。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.06.007

{"title":"Beta-cell function and glucose metabolism in patients with chronic pancreatitis","authors":"","doi":"10.1016/j.ejim.2024.06.007","DOIUrl":"10.1016/j.ejim.2024.06.007","url":null,"abstract":"<div><h3>Aims</h3><div>Chronic pancreatitis (CP) is – along with acute pancreatitis - the most frequent cause of diabetes of the exocrine pancreas (DEP). Although insulin deficiency is widely accepted as the major feature of DEP, it is still unclear whether diabetes associated with CP is characterized by additional or different functional defects of the insulin secretory machinery. To identify possible functional defects specifically induced by CP, we performed a cross-sectional study in individuals with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and diabetes mellitus (DM) comparing patients with and without CP (CP vs. NCP).</div></div><div><h3>Methods</h3><div>We administered an oral glucose tolerance test (OGTT) to all participants and, according to their glucose tolerance, classified them as NGT, IGT and DM. Insulin sensitivity and beta-cell functional parameters were derived from OGTT, hyperglycemic clamp and hyperinsulinemic euglycemic clamp.</div></div><div><h3>Results</h3><div>Studying 146 subjects, we found that beta-cell function and insulin secretion were significantly lower in CP compared to NCP patients. However, when we classified the subjects according to OGTT-derived glucose tolerance, we found no differences in beta-cell function or in insulin sensitivity between CP and NCP with the same glucose tolerance status. Of note, we found that arginine-stimulated insulin secretion is reduced only in subjects with CP and DM compared to NCP subjects with DM.</div></div><div><h3>Conclusions</h3><div>Patients with CP had no specific alterations in insulin secretion and beta-cell function. However, in patients diagnosed with diabetes, we found a lower arginine-stimulated insulin secretion, a marker of reduced functional mass.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"128 ","pages":"Pages 112-118"},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318889","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}

引用次数: 0

Internal medicine in the 21st century: Back to the future 21 世纪的内科医学：回到未来。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.07.038

Ricardo Gómez-Huelgas , George N. Dalekos , Dror Dicker , Nicola Montano

{"title":"Internal medicine in the 21st century: Back to the future","authors":"Ricardo Gómez-Huelgas , George N. Dalekos , Dror Dicker , Nicola Montano","doi":"10.1016/j.ejim.2024.07.038","DOIUrl":"10.1016/j.ejim.2024.07.038","url":null,"abstract":"<div><div>Healthcare systems face multiple challenges arising from demographic factors (population aging) and epidemiological factors (rise of chronic diseases and patients with multimorbidity) as well as threats to their financial sustainability when maintaining equitable access to medical and technological advances. Current healthcare models, based on specialized medical care, lead to fragmented care that can be harmful to the patient and is inefficient for the system due to the overuse of redundant, low-value medical acts. Internal medicine is the hospital-centered general medical specialty <em>par excellence</em>, providing a comprehensive and holistic vision that is centered on the patient and not on the disease. Internists should be the leading physicians in the hospital setting for complex patients with or those with an uncertain diagnosis. Internists must play a key role, as hospitalists do, in the continued care of acute patients hospitalized for medical or surgical diseases, establishing shared care models in multidisciplinary teams. Likewise, to guarantee continuity of care for chronic patients, internists must establish mechanisms for collaboration with primary care and nursing, participating in the development of new out-of-hospital care models that use the available technological resources. Internal medicine should play a leading role in graduate and postgraduate medical education to promote a holistic vision among medical students and residents in medical subspecialties.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"128 ","pages":"Pages 26-29"},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141890749","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}

引用次数: 0

Diagnostic challenge of hemoptysis in a hemodialysis patient 血液透析患者咯血的诊断难题。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.07.022

Fullana Martin , Aliaga Leandro , Verni Giuliana

引用次数: 0

Exploring Cardiovascular Risk Factors and Atherosclerosis in Rheumatoid Arthritis 探索类风湿关节炎的心血管风险因素和动脉粥样硬化。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.07.016

Alexandros A. Drosos, Aliki A. Venetsanopoulou, Eleftherios Pelechas, Paraskevi V. Voulgari

{"title":"Exploring Cardiovascular Risk Factors and Atherosclerosis in Rheumatoid Arthritis","authors":"Alexandros A. Drosos, Aliki A. Venetsanopoulou, Eleftherios Pelechas, Paraskevi V. Voulgari","doi":"10.1016/j.ejim.2024.07.016","DOIUrl":"10.1016/j.ejim.2024.07.016","url":null,"abstract":"<div><div>Rheumatoid arthritis (RA) is a chronic inflammatory disease mainly affecting the peripheral diarthrodial joints symmetrically and also presenting many extra-articular manifestations. Morbidity and mortality in RA patients are higher compared to the general population. Cardiovascular (CV) disease is one of the most common causes of death in these patients. Classical or traditional risk factors for atherosclerosis<span> development occur more frequently in RA patients compared to those without this condition. Studies have showed that RA patients often present comorbidities such as hypertension, dyslipidemia, diabetes mellitus and obesity. However, the high incidence of CV events occurring in RA patients is not explained by the presence of traditional risk factors. Systemic inflammation, as it is expressed with the presence of proinflammatory cytokines and increased acute phase reactants, may contribute to the development of premature atherosclerosis in these patients. In this review, we explore the risk factors for CV disease, the generation of dyslipidemia, the lipid paradox and the role of systemic inflammation in the atherosclerotic process in RA. We discuss also the role of early therapeutic intervention that suppresses inflammation which may have beneficial effects on CV disease in RA patients.</span></div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"128 ","pages":"Pages 1-9"},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141762337","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}

引用次数: 0

Treatment of systemic lupus erythematosus in real life. 在现实生活中治疗系统性红斑狼疮。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.09.019

Giuseppe Barilaro, Ricard Cervera

引用次数: 0

Deprescribing in reflex syncope 在反射性晕厥中取消处方。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.08.019

Alessandra Fusco , Monica Solbiati , Giorgio Costantino

引用次数: 0

The association between long-acting muscarinic antagonist-based therapy and the risk of urinary tract infection in patients with chronic obstructive pulmonary disease 基于长效毒蕈碱拮抗剂的治疗与慢性阻塞性肺病患者尿路感染风险之间的关联。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.05.022

引用次数: 0

Association between socioeconomic and psychosocial factors with use of interventional and surgical treatments and outcomes in patients with myocardial infarction – Inpatient data of the largest European health care system 心肌梗死患者的社会经济和社会心理因素与介入治疗和手术治疗的使用及结果之间的关系 - 欧洲最大医疗保健系统的住院患者数据。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.05.032

{"title":"Association between socioeconomic and psychosocial factors with use of interventional and surgical treatments and outcomes in patients with myocardial infarction – Inpatient data of the largest European health care system","authors":"","doi":"10.1016/j.ejim.2024.05.032","DOIUrl":"10.1016/j.ejim.2024.05.032","url":null,"abstract":"<div><h3>Background</h3><div>Myocardial infarction (MI) is an important driver of both morbidity and mortality on a global scale. Elucidating social inequalities may help to identify vulnerable groups as well as treatment imbalances and guide efforts to improve care for MI.</div></div><div><h3>Methods</h3><div>All hospitalized patient-cases with confirmed MI 2005-2020 in Germany were included in the study and stratified for socioeconomic or psychosocial factors (SPF) and the impact of SPF on treatment usage and adverse in-hospital events was analyzed.</div></div><div><h3>Results</h3><div>Overall, 4,409,597 hospitalizations of MI patients were included; of these, 17,297 (0.4 %) were coded with SPF. These patients were more often of female sex (49.4 % vs. 36.9 %, P<0.001), older (median 77.0 [IQR: 65.0–84.0] vs. 73.0 [62.0–81.0] years, P<0.001) and revealed an aggravated cardiovascular profile. Although SPF were independently associated with increased usage of cardiac catheterization (OR 1.174 [95 %CI 1.136-1.212]) and percutaneous coronary intervention (OR 1.167 [95 %CI 1.130-1.205]), they were accompanied by higher risk for a prolonged length of in-hospital stay >7 days (OR 1.236 [95 %CI 1.198-1.276]) and >10 days (OR 1.296 [95 %CI 1.254-1.339]). While SPF were associated with increased risk for deep venous thrombosis and/or thrombophlebitis (OR 1.634 [95 %CI 1.427-1.870]), pulmonary embolism (OR 1.337 [95 %CI 1.149-1.555]), and acute renal failure (OR 1.170 [95 %CI 1.105-1.240), these SPF were inversely associated with in-hospital case-fatality (OR 0.461 [95 %CI 0.433-0.490]).</div></div><div><h3>Conclusions</h3><div>This study demonstrates that SPF in hospitalized MI patients have significant impacts on treatments and outcomes. Fortunately, our data did not revealed an underuse of interventional treatments in MI patients with SPF.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"128 ","pages":"Pages 71-80"},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263407","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}

引用次数: 0

Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study 利用超声波和 d-二聚体诊断急性主动脉综合征：PROFUNDUS 研究。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.05.029

{"title":"Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study","authors":"","doi":"10.1016/j.ejim.2024.05.029","DOIUrl":"10.1016/j.ejim.2024.05.029","url":null,"abstract":"<div><h3>Background</h3><div>In patients complaining common symptoms such as chest/abdominal/back pain or syncope, acute aortic syndromes (AAS) are rare underlying causes. AAS diagnosis requires urgent advanced aortic imaging (AAI), mostly computed tomography angiography. However, patient selection for AAI poses conflicting risks of misdiagnosis and overtesting.</div></div><div><h3>Objectives</h3><div>We assessed the safety and efficiency of a diagnostic protocol integrating clinical data with point-of-care ultrasound (POCUS) and <span>d-</span>dimer (single/age-adjusted cutoff), to select patients for AAI.</div></div><div><h3>Methods</h3><div>This prospective study involved 12 Emergency Departments from 5 countries. POCUS findings were integrated with a guideline-compliant clinical score, to define the integrated pre-test probability (iPTP) of AAS. If iPTP was high, urgent AAI was requested. If iPTP was low and <span>d</span>-dimer was negative, AAS was ruled out. Patients were followed for 30 days, to adjudicate outcomes.</div></div><div><h3>Results</h3><div>Within 1979 enrolled patients, 176 (9 %) had an AAS. POCUS led to net reclassification improvement of 20 % (24 %/-4 % for events/non-events, <em>P</em> < 0.001) over clinical score alone. Median time to AAS diagnosis was 60 min if POCUS was positive <em>vs</em> 118 if negative (<em>P</em> = 0.042). Within 941 patients satisfying rule-out criteria, the 30-day incidence of AAS was 0 % (95 % CI, 0–0.41 %); without POCUS, 2 AAS were potentially missed. Protocol rule-out efficiency was 48 % (95 % CI, 46–50 %) and AAI was averted in 41 % of patients. Using age-adjusted <span>d</span>-dimer, rule-out efficiency was 54 % (difference 6 %, 95 % CI, 4–9 %, vs standard cutoff).</div></div><div><h3>Conclusions</h3><div>The integrated algorithm allowed rapid triage of high-probability patients, while providing safe and efficient rule-out of AAS. Age-adjusted <span>d</span>-dimer maximized efficiency.</div><div><strong>CLINICAL TRIAL REGISTRATION:</strong> Clinicaltrials.gov, NCT04430400</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"128 ","pages":"Pages 94-103"},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318890","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}

引用次数: 0

Red flags for clinical suspicion of eosinophilic granulomatosis with polyangiitis (EGPA) 临床怀疑嗜酸性粒细胞肉芽肿伴多血管炎（EGPA）的警示。

IF 5.9 2区医学

European Journal of Internal Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.ejim.2024.06.008

{"title":"Red flags for clinical suspicion of eosinophilic granulomatosis with polyangiitis (EGPA)","authors":"","doi":"10.1016/j.ejim.2024.06.008","DOIUrl":"10.1016/j.ejim.2024.06.008","url":null,"abstract":"<div><h3>Background</h3><div>Eosinophilic granulomatosis with polyangiitis (EGPA), is a rare ANCA-associated systemic vasculitis. Its overlapping features with other vasculitic or eosinophilic diseases, and the wide and heterogeneous range of clinical manifestations, often result in a delay to diagnosis.</div></div><div><h3>Objective</h3><div>To identify red flags that raise a suspicion of EGPA to prompt diagnostic testing and to present an evidence-based clinical checklist tool for use in routine clinical practice.</div></div><div><h3>Methods</h3><div>Systematic literature review and expert consensus to identify a list of red flags based on clinical judgement. GRADE applied to generate a strength of recommendation for each red flag and to develop a checklist tool.</div></div><div><h3>Results</h3><div>86 studies were included. 40 red flags were identified as relevant to raise a suspicion of EGPA and assessed by the experts as being clinically significant. Experts agreed that a diagnosis of EGPA should be considered in a patient aged ≥6 years with a blood eosinophil level >1000 cells/µL if untreated and >500 cells/µL if previously treated with any medication likely to have altered the blood eosinophil count. The presence of asthma and/or nasal polyposis should reinforce a suspicion of EGPA. Red flags of asthma, lung infiltrates, pericarditis, cardiomyopathy, polyneuropathy, biopsy with inflammatory eosinophilic infiltrates, palpable purpura, digital ischaemia and ANCA positivity, usually anti-myeloperoxidase, among others, were identified.</div></div><div><h3>Conclusion</h3><div>The identification of a comprehensive set of red flags could be used to raise a suspicion of EGPA in patients with eosinophilia, providing clinicians with an evidence-based checklist tool that can be integrated into their practice.</div></div>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"128 ","pages":"Pages 45-52"},"PeriodicalIF":5.9,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141332421","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}

引用次数: 0