July 2017
No Section
Prospective study of metabolic syndrome as a mortality marker in chronic coronary heart disease patients
We aimed to clarify the impact of metabolic syndrome (MetS) as assessed by different definitions on the cardiovascular mortality in patients with coronary heart disease (CHD).
An elderly man with hemolysis and myelophthisic anemia
A 64-year-old man with history of chronic anemia and dyspepsia presented with fatigue, exertional chest pain, pedal edema and dyspnea for 2weeks. His temperature was 37o C, heart rate 74/min, blood... more
Liver steatosis: The new epidemic of the Third Millennium. Benign liver state or silent killer?
Until the end of the 90′s of the last century, rather little attention was paid to the issue of the non-alcoholic fatty liver disease (NAFLD), perhaps due to the fact that the newly discovered... more
Thrombophilic and cardiovascular risk factors for retinal vein occlusion
The role of thrombophilic and cardiovascular risk factors in different manifestations of retinal vein occlusion (RVO), i.e., central or branch RVO, and at different ages is still debated.
Body mass index and all-cause mortality among type 2 diabetes mellitus patients: Findings from the 5-year follow-up of the MADIABETES cohort
To analyse the association between body mass index (BMI) and all-cause mortality in a 5-year follow-up study with Spanish type 2 diabetes mellitus (T2DM) patients, seeking gender differences.
Internal Medicine Flashcard
Black tongue
This 22years old woman was admitted for left upper lung pneumonia. She denied any systemic disease and never smoked. After antibiotic with ceftriaxone 2g per-day intravenous injection, the clinical... more
Acute chest pain in an anxious woman
A 63years old woman with past medical history of hypertension, osteoporosis, dyslipidaemia and anxiety, was admitted in the emergency room with acute chest pain after a family discussion, she... more
A memorable cause of ST elevation
A 46-year-old female with hypertension, presented to the hospital with syncope. She was found to have unprovoked submassive bilateral pulmonary embolism. Serum troponin was 0.61. Echocardiography... more
Something is not anymore there
A 86years old man, with past medical history of hypertension, ischemic cardiomyopathy and gallstones, that refused the cholecystectomy a year ago, was seen at the emergency room because dark vomiting... more
Painful rash on hospitalized patient with DKA
A 43year old Caucasian female was seen in the intermediate care unit with a rash on her right lower leg. It had been there for the past ten years. She notes that it is usually painful but sometimes... more
In search of albumin: An unusual case of lower limb edema
A 48-year-old man presented at our hospital with worsening edema of the lower limbs. He had been suffering from lower limb lymphedema, recurrent erysipelas infections, and disseminated warts since... more
Swelling of distal extremities with peripheral blood eosinophilia in a young Asian woman
A 27-year-old Japanese woman presented with a three-week history of swelling of her hands and lower extremities. She had no history of allergic diseases and had taken no medication prior to the... more
A bullous enigma
A 79-year-old Caucasian female presented with a three-week history of an intensely pruritic blistering eruption on the abdomen, chest, and extremities bilaterally. The lesions consisted of tense... more
A man with generalized weakness
A 63-year-old man, without any significant previous medical or surgical history, presented to the Internal Medicine service with a1-month history of generalized weakness, back pain, and repeated... more
A man with syncope
A 74-years-old man was admitted at our emergency department for syncope. His past medical history included hypertension, smoking, carotid and peripheral artery disease and hemodialysis for end-stage... more
A man with fever and rash
A man in his 60s presented with one-week history of fever, confusion and poor appetite. His past health is remarkable for well-controlled hypertension and dyslipidemia. On examination, he was... more
The ominous skin nodules
A 45-year old lady complained of small nodules on the skin and increase in size of the left breast for the last 5months. On examination, the left breast was grossly enlarged and skin overlying the... more
Letter to the Editor
Marketing masked as clinical research. The Phase IIIB studies and other sample cases
Clinical research should primarily aim at identifying interventions that provide patients with benefits or improve the efficiency of national health services – or both. However, more and more... more
Irisin – A potential contributor of insulin resistance in kidney failure
Impaired glucose-insulin homeostasis is a well-described metabolic disorder in chronic kidney disease (CKD) [1]. Early reports, using euglycemic insulin clamp technique, demonstrated the occurrence... more
Atrial fibrillation and patent foramen potentially share same atrial flow dynamic profile and thrombotic mechanism
An impairment of the left atrial function similar to that one generally observed by echocardiography in atrial fibrillation (AF) has been reported in patients with patent foramen ovale (PFO) and... more
Electronic clinical decision support system and multifactorial risk factor control in patients with type 2 diabetes in primary health care
A comprehensive approach targeting blood pressure (BP), low-density lipoprotein cholesterol (LDLc), and hyperglycaemia is crucial in patients with type 2 diabetes (T2DM) [1]. There is a significant... more
Unnecessary hospitalizations for DVT in the era of NOACs
Venous thromboembolism (VTE) includes deep vein thrombosis (DVT) and pulmonary embolism (PE), two closely connected conditions that involve similar pathophysiology, often co-exist at a different... more
Reply: Should a scientist be prevented from publishing in a journal for which he works?
In a recent letter to the editor, Charlier et al. debated the practice of some scholars that choose to publish their research in a journal they work for [1], and wondered whether the peer-reviewing... more
Malignancy risks after herpes zoster: Hospital-based matched cohort study
Herpes zoster is one of the most common infections among elderly people all over the world. Based on the previous study, the overall incidence rate of herpes zoster was 4.47 per 1000person-years,... more
Long-term sustainability of a multi-step intervention to reduce unnecessary diagnostic testing
In recent years many initiatives have been introduced in clinical practice to reduce unnecessary use of care, including unnecessary diagnostics with the aim of controlling the increasing costs of... more
Risk of bone fractures among users of oral anticoagulants: An administrative database cohort study
Warfarin is a traditional Oral AntiCoagulant (OAC) for stroke prevention in patients with Non Valvular Atrial Fibrillation (NVAF). The Non Vitamin K OACs (NOACs), firstly dabigatran (directly... more
Liraglutide preserves renal function in overweight diabetic patients with stage 3 chronic kidney disease
Chronic renal failure and albuminuria increase cardiovascular risk in patients with DM2 in proportion to the degree to which they occur and from their earliest stages [1]. At present, only two drugs... more
Triple therapy with dual antiplatelet treatment and direct oral anticoagulants
In their recent review, Dezsi et al. [1] summarize the evidence on antithrombotic treatment in patients with atrial fibrillation (AF) who have undergone percutaneous coronary intervention (PCI) with... more
Angiotensin-converting enzyme inhibitors, angiotensin II receptors antagonists, beta-blockers and ivabradine as supportive therapy in pulmonary hypertension: Drug safety and tolerability
According to the 2015 ESC guidelines for diagnosis and treatment of pulmonary hypertension (PH), the use of angiotensin-converting enzyme inhibitors (ACEi), angiotensin-II receptor blockers (ARBs),... more
An evaluation of medication reconciliation at an outpatient Internal Medicines clinic
Incomplete information transfer between healthcare settings could result in discontinuity in healthcare. Discrepancies between a patient's actual medication use and the medication that is listed in a... more
Does rhythm or rate control strategy influence anticoagulant treatment in older patients with atrial fibrillation? Data from REPOSI
The management of atrial fibrillation (AF) might be particularly cumbersome in complex older patients, barely represented in clinical trials. Rhythm control drugs often fail to provide sustained... more
Narrative Review
Patent foramen ovale closure to prevent secondary neurologic events
In October of 2016 the United States Food and Drug Administration approved the Amplatzer Patent Foramen Ovale (PFO) occluder device for use in patients with cryptogenic stroke, to reduce the risk of... more
Original Article
Uric acid level as predictor of mortality in the acute care setting of advanced age population
Uric acid (UA) is an organic heterocyclic compound (C5H4N4O3) with a molecular weight of 168Da [1]. UA is a product of the metabolism of purines such as adenosine and guanosine. Many enzymes are... more
Readmission to hospital of medical patients – A cohort study
The incidence of acute readmissions is higher among elderly medical patients than in the general population. Risk factor identification is needed in order to prevent readmissions.
Sodium levels on admission are associated with mortality risk in hospitalized patients
Abnormal sodium values are common among hospitalized patients. We aimed to investigate the association of admission sodium values and mortality.