June 2018

54 Articles

No Section

Rethinking the concept of sepsis and septic shock

16 June 2018
Author(s): Joana A. Cabrita, Isabel Pinheiro, L. Menezes Falcão

Sepsis is a major global health problem and represents a challenge for physicians all over the world. The knowledge of sepsis and septic shock is a topic of interest among the scientific community... more

Recipient liver function before liver transplantation influences post-transplantation survival in patients with HCC

30 May 2018
Author(s): Friedrich Foerster, Jens Mittler, Felix Darstein, Michael Heise, Jens U. Marquardt, Marcus-Alexander Wörns, Arndt Weinmann, Lina Sälter, Maria Hoppe-Lotichius, Stefan Heinrich, Roman Kloeckner, Michael B. Pitton, Jörn M. Schattenberg, Martin F. Sprinzl, Christoph Düber, Gerd Otto, Hauke Lang, Peter R. Galle, Tim Zimmermann

Liver transplantation (LT) is a complex yet curative treatment for a subset of patients with hepatocellular carcinoma (HCC). Due to donor organ shortage, patients with HCC need to be carefully... more

Clinical-features analysis on 926 patients with virological breakthrough in chronic hepatitis B receiving nucleos(t)ide analogues

23 May 2018
Author(s): Cheng Huang, Xiang-hui Yang, You-lan Yang, Ai-long Huang, Xiao-Feng Shi

We read with interest several studies regarding correlated adherence to nucleos(t)ide analogues treatment with the occurrence of resistance or virological breakthrough(VB) [1–3]. These studies showed... more

Chronic myeloproliferative neoplasms in the elderly

22 May 2018
Author(s): Margherita Maffioli, Ester Orlandi, Francesco Passamonti

This review focuses on the management of elderly patients with chronic myeloid leukemia and chronic myeloproliferative neoplasms, including polycythemia vera, essential thrombocythemia and primary... more

Significant mitral regurgitation worsens the prognosis and favors the decision of conservative treatment in octogenarians with severe symptomatic aortic stenosis

17 May 2018
Author(s): Juan José Gómez-Doblas, Miguel Antonio López-Garrido, Víctor Manuel Becerra-Muñoz, Hugo Nelson Orellana-Figueroa, Amelia Carro Hevia, Bernardo García de la Villa, Luis Cornide, Manuel Martínez-Sellés, PEGASO registry group

The coexistence of significant mitral regurgitation (MR) and severe aortic stenosis is prevalent, has a prognostic impact and makes treatment in the elderly population a complex issue. The aim of... more

The “BIOmarkers associated with Sarcopenia and PHysical frailty in EldeRly pErsons” (BIOSPHERE) study: Rationale, design and methods

10 May 2018
Author(s): Riccardo Calvani, Anna Picca, Federico Marini, Alessandra Biancolillo, Matteo Cesari, Vito Pesce, Angela Maria Serena Lezza, Maurizio Bossola, Christiaan Leeuwenburgh, Roberto Bernabei, Francesco Landi, Emanuele Marzetti

Sarcopenia, the progressive and generalised loss of muscle mass and strength/function, is a major health issue in older adults given its high prevalence and burdensome clinical implications. Over the... more


Redefining obesity toward classifying as a disease

26 May 2018
Author(s): Abdelaziz Ghanemi, Jonny St-Amand

Obesity has been pointed since the medical diagnosis and scientific observation was developed and according to the World Health Organization, it has an epidemic evolution nowadays [1]. The simple... more

Large databases (Big Data) and evidence-based medicine

25 May 2018
Author(s): Andrea Damiani, Graziano Onder, Vincenzo Valentini

Evidence-based medicine (EBM) is more than 30 years old and has led to enormous changes in medical approaches through the development of increasingly objective guidelines, based on the results of... more

Internal Medicine Flashcard

Identify the triad

28 May 2018
Author(s): Divya Kamat, Pinaki Dutta, Muthu Sendhil Kumaran

A 46 year old man presented with a 15 year history of generalized excessive sweating and palpitations. He also had progressive redness of both eyes along with blurred vision. Clinical examination... more

Woman with headache and retro-orbital pain

12 May 2018
Author(s): Pierrick Le Borgne, Claudia Brunhuber

A 54-year-old woman, presented to the Emergency Departement (ED) with a 10-days unilateral headache and progressive pain behind the left eye. The patient had normal vital parameters and no medical... more

Dysphagia in an elderly patient

11 May 2018
Author(s): Sien Hui Tan, Rekha Balachandran, Narayanan Prepageran

A 75-year-old female presented to the Otolaryngology department with a history of sudden onset dysphagia and choking sensation while having chicken rice for lunch. She was edentulous and had no... more

A middle-aged woman with microscopic hematuria detected at a medical check-up

11 May 2018
Author(s): Yusaku Kajihara

A 56-year-old woman presented to the author's hospital with microscopic hematuria detected at a medical check-up. Vital signs were normal, and the patient had no symptoms. Laboratory evaluation... more

Painful fingernails in a patient with chronic fibrosing pulmonary aspergillosis

11 May 2018
Author(s): Anuradha Bishnoi, Ritesh Agarwal, Sanjeev Handa, Inderpaul Singh Sehgal

A middle aged male, farmer by occupation was diagnosed with chronic fibrosing pulmonary aspergillosis due to Aspergillus flavus. He was started on oral voriconazole (400 mg/day) after he had poor... more

Shortness of breath after thoracentesis: Did we do something wrong?

10 May 2018
Author(s): Abdul Wahab, Raseen Tariq, Richard Alweis

A 73-year-old male presented to the emergency department (ED) with worsening shortness of breath (SOB) and cough over two weeks. One week ago, he was seen in clinic for similar symptoms and was... more

Painful lesions on the arms of a teenage wrestler

10 May 2018
Author(s): Daniel Morse, Ramya Vangipuram, Stephen K. Tyring

A previously healthy 16-year-old female wrestler presented with a 2-week history of a tender and pruritic rash involving the right anterior upper arm. She had not experienced fevers, chills, or... more

Young woman with dyspnea and upper abdominal pain

10 May 2018
Author(s): Philipp Jud, Norbert Watzinger, Thomas Gary

A 21-year-old woman presented to the emergency department with severe dyspnea, hypotension (83/46 mmHg), tachycardia (152 beats/min) and upper abdominal pain. Her medical history included familial... more

Invited Article

Monoclonal gammopathies of unknown significance and smoldering myeloma: Assessment and management of the elderly patients

12 June 2018
Author(s): Verónica González-Calle, María Victoria Mateos

Monoclonal gammopathy of unknown significance (MGUS) is the most frequent plasma cell disorder that commonly affects elderly patients. Although it is an asymptomatic condition, as well as smoldering... more

Management of the elderly patient with AL amyloidosis

22 May 2018
Author(s): Mario Nuvolone, Paolo Milani, Giovanni Palladini, Giampaolo Merlini

Systemic immunoglobulin light chain (AL) amyloidosis is an aging-associated protein misfolding and deposition disease. This condition is caused by a small and otherwise indolent plasma cell (or B... more

Letter to the Editor

An analysis of medical visits at a primary health care center in Kinshasa, Democratic Republic of the Congo (DRC)

1 July 2018
Author(s): Michael Dandoulakis, Andreas D. Mavroudis, Akilina Karagianni, Stergianni Stefani, Matthew E. Falagas

The Democratic Republic of the Congo (DRC) is one of the poorest countries in the world [1] and it is classified globally at the rank 176 out of 188 countries based on the 2016 Human Development... more

A meritorious move against homeopathy

22 June 2018
Author(s): Silvio Garattini, Vittorio Bertele'

We welcome the move against homeopathy of the highest medical deontological authority in Italy (Federation of the Associations of Physicians, Surgeons, and Odontologists, FNOMCeO). Early in May this... more

Association between presenting complaints of acutely admitted medical patients and mortality: A cohort study

22 June 2018
Author(s): Marie Krogh Nielsen, Daniel Pilsgaard Henriksen, Karin Brøchner Østergaard, Jan Dahlin, Mikkel Brabrand

In 2012, more than 1 million patients were acutely admitted to Danish hospitals, [1] accounting for 76% of all admitted patients. From 2006 to 2012 the number of acute admissions in Denmark increased... more

Evaluation of antibiotic prescribing in Kabul, Afghanistan

16 June 2018
Author(s): S.H. Mousavi, R. Roien, A.A. Ramozi

Antibiotics are the most commonly used drugs which should be prescribed appropriately and with optimum care, otherwise the emergence of resistant organisms will interfere with the treatment result [1... more

Drug related bleeding as a cause of emergency department visits; a Lebanese tertiary care center experience

14 June 2018
Author(s): Nour M. Moukalled, Phillipe T. Zakhia El-Doueihi, Rana J. Salem, Ali T. Taher

Bleeding remains a common cause of emergency department (ED) visits and hospitalization around the world. A significant percentage of these bleeding events are drug induced. Anticoagulants were among... more

Therapeutic monitoring response of pulmonary arterial hypertension using a combined computed tomography- computational fluid analysis strategy

11 June 2018
Author(s): Gianluca Rigatelli, Marco Zuin

Pulmonary arterial hypertension (PAH) is a progressive disease of the small pulmonary arteries characterized by vascular proliferation and remodelling, increased pulmonary vascular resistances (PVR)... more

Mathematics and thrombolysis: Role of the mathematical modelling in understanding and developing blood clot fragmentation

9 June 2018
Author(s): Marco Zuin, Gianluca Rigatelli, Giuseppe Faggian, Loris Roncon

Nowadays, systemic thrombolysis remains the cornerstone in the treatment of different life-threatening arterial occlusive disease as ischemic stroke and pulmonary embolism (PE). Conversely, its use... more

Pulmonary embolism in young adults (18–45 years)

6 June 2018
Author(s): Matthew Hewitt, Christopher Devine, Laura Gonzalez

Although it is well recognised that incidence of pulmonary embolism (PE) increases with age, PE has been shown to be an important cause of mortality in younger age groups. A study by Sakuma et al. in... more

Unplanned readmissions among patients presenting with nonspecific complaints

6 June 2018
Author(s): J.J.H. Wachelder, L.S. van Galen, J. Kellett, C.H. Nickel, H.R. Haak, safer@home consortium

Unplanned readmissions are often caused by patients with multiple comorbidities and functional impairment [1]. This subgroup partly consists out of patients presenting with nonspecific complaints. It... more

The role of qSOFA compared to other prognostic scores in septic patients upon admission to the emergency department

4 June 2018
Author(s): Ilaria Francesca Martino, Virginia Figgiaconi, Elena Seminari, Alba Muzzi, Marta Corbella, Stefano Perlini

Sepsis is a life-threatening, high-mortality syndrome that is still lacking a validated standard diagnostic test, although it is widely recognised that early identification of these conditions is a... more

Commentary: No correlation between health care expenditure and mortality in the European Union

22 May 2018
Author(s): Mwoya Byaro, Abel Kinyondo

The correlation analysis in time series has received considerable attention [1]. Its use plays an important role in the social sciences, finance and medical sciences. Spearman's or Pearson... more

The remains of Adolf Hitler: A biomedical analysis and definitive identification

18 May 2018
Author(s): P. Charlier, R. Weil, P. Rainsard, J. Poupon, J.C. Brisard

The biomedical analysis of Adolf Hitler's alleged remains in Moscow, Russia, is a scientific and historical fantasy since the death of the dictator in Berlin on April 30, 1945 (Appendix 1). In this... more

Heart rate variability in nephrotic syndrome: Role of sympathetic and parasympathetic system

17 May 2018
Author(s): Antonietta Gigante, Edoardo Rosato, Marco Proietti, Rosario Cianci, Gianluca Di Lazzaro-Giraldi, Luigi Tubani, HRV Study Group

Nephrotic syndrome (NS) is characterized by hypoalbuminemia, proteinuria and edema [1].

The relationship of baseline fasting plasma glucose and cardiovascular morbidity and mortality

14 May 2018
Author(s): Kathryn Evans Kreider, Mark Feinglos

It is clear that diabetes has strong implications for cardiovascular morbidity and mortality, although an increasing number of studies have suggested that fasting plasma glucose (FPG) values below... more

Narrative Review

Mitigation of air pollution by greenness: A narrative review

28 June 2018
Author(s): Massimo Franchini, Pier Mannuccio Mannucci

Air pollution represents one of the world's most important environmental health risks, being associated with an increased rate of multiple diseases (mainly cardiopulmonary) and of premature deaths. A... more

Narrative Review Article

The adipose organ and multiple myeloma: Impact of adipokines on tumor growth and potential sites for therapeutic intervention

30 May 2018
Author(s): Alessandro Allegra, Vanessa Innao, Demetrio Gerace, Andrea Gaetano Allegra, Doriana Vaddinelli, Oriana Bianco, Caterina Musolino

In addition to its capacity to store lipids the adipose tissue is now identified as a real organ with both endocrine and metabolic roles.Preclinical results indicate that modifying adipose tissue and... more

Original Article

Association between reduced renal function and cardiovascular mortality in patients hospitalized with infection: A multi-center cohort study

27 June 2018
Author(s): Guobin Su, Yanjun Xu, Xiaojun Xu, Hong Xu, Liming Lu, Gaetano Marrone, Bengt Lindholm, Zehuai Wen, Xusheng Liu, David W. Johnson, Juan-Jesus Carrero, Cecilia Stålsby Lundborg

Infection is one of the main reasons for hospitalization worldwide, and is associated with an increased risk of cardiovascular mortality. It is unclear whether this association is modified by the... more

Added value of the DIC score and of D-dimer to predict outcome after successfully resuscitated out-of-hospital cardiac arrest

26 June 2018
Author(s): N. Buchtele, A. Schober, C. Schoergenhofer, A.O. Spiel, L. Mauracher, C. Weiser, F. Sterz, B. Jilma, M. Schwameis

Recent Korean data suggest a high prevalence of overt disseminated intravascular coagulation (DIC) and a good predictive performance of the ISTH DIC score in successfully resuscitated out-of-hospital... more

Frailty predicts short-term survival even in older adults without multimorbidity

24 June 2018
Author(s): Alberto Zucchelli, Davide L. Vetrano, Alessandra Marengoni, Giulia Grande, Giuseppe Romanelli, Amaia Calderón-Larrañaga, Laura Fratiglioni, Debora Rizzuto

Frailty and multimorbidity are both strongly associated with poor health-related outcomes, including mortality. Being multimorbidity one of the major determinants of frailty, we aimed to explore... more

Estimated glomerular filtration rate and functional status among older people: A systematic review

20 June 2018
Author(s): Andrea Corsonello, Regina Roller-Wirnsberger, Mirko Di Rosa, Paolo Fabbietti, Gerhard Wirnsberger, Tomasz Kostka, Agnieszka Guligowska, Lisanne Tap, Francesco Mattace-Raso, Pedro Gil, Lara Guardado-Fuentes, Itshak Meltzer, Ilan Yehoshua, Rada Artzi-Medevdik, Francesc Formiga, Rafael Moreno-González, Christian Weingart, Ellen Freiberger, Johan Ärnlöv, Axel C. Carlsson, Fabrizia Lattanzio, Screening for Chronic Kidney Disease among Older people across Europe (SCOPE) Study Investigators

The association between chronic kidney disease (CKD) and functional status may change as a function of the equation used to estimate glomerular filtration rate (eGFR). We reviewed the predictive... more

Living alone as an independent predictor of prolonged length of hospital stay and non-home discharge in older patients

19 June 2018
Author(s): P. Agosti, M. Tettamanti, F.S. Vella, P. Suppressa, L. Pasina, C. Franchi, A. Nobili, P.M. Mannucci, C. Sabbà, REPOSI Investigators

In-hospital mortality, prolonged length of hospital stay and institutionalization at discharge of older adults are widely discussed in the medical literature, because of their implications on... more

Is the clinical presentation of chronic heart failure different in elderly versus younger patients and those with preserved versus reduced ejection fraction?

13 June 2018
Author(s): Eva Steinmann, Hans-Peter Brunner-La Rocca, Micha T. Maeder, Beat A. Kaufmann, Matthias Pfisterer, Peter Rickenbacher

Whether the clinical presentation and in particular prevalence of symptoms and signs of heart failure (HF) is different in elderly versus younger patients and in those with reduced (HFrEF) versus... more

Prediction of prognosis in chronic obstructive pulmonary disease patients with respiratory failure: A comparison of three nutritional assessment methods

12 June 2018
Author(s): Ruiqi Chen, Lu Xing, Chao You, Xuemei Ou

Due to their increased energy expenditure, chronic obstructive pulmonary disease (COPD) patients with respiratory failure are susceptible to malnutrition. This study aimed to compare the predictive... more

Implementation of the Frailty Index in hospitalized older patients: Results from the REPOSI register

12 June 2018
Author(s): M. Cesari, C. Franchi, L. Cortesi, A. Nobili, I. Ardoino, P.M. Mannucci, the REPOSI collaborators

Frailty is a state of increased vulnerability to stressors, associated to poor health outcomes. The aim of this study was to design and introduce a Frailty Index (FI; according to the age-related... more

The new bedside ROCky score to predict the complications in patients with intermediate-risk pulmonary embolism

1 June 2018
Author(s): Elena A. Kochmareva, Valentin A. Kokorin, Ivan G. Gordeev

Pulmonary embolism (PE) remains one of the leading causes of mortality among cardiovascular diseases. We aimed at investigating risk factors of PE complications in patients with intermediate risk and... more

Surgery changes prognosis in infective endocarditis: The importance of post-surgical clinical evolution

29 May 2018
Author(s): Pablo Elpidio García-Granja, Javier López, Isidre Vilacosta, Cristina Sarriá, Raquel Ladrón, Carmen Olmos, Carmen Saéz, Itziar Gómez, J. Alberto San Román

Left-sided infective endocarditis (LSIE) bears a grim prognosis and surgery is needed in more than half of the patients to improve survival. Our hypothesis has been that clinical complications... more

Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards

28 May 2018
Author(s): Nicole Corsi, Anna Roberto, Laura Cortesi, Alessandro Nobili, Pier Mannuccio Mannucci, Oscar Corli, REPOSI Investigators

Chronic pain is a frequent characteristic of elderly people and represents an actual and still poorly debated topic.

A disease looking for innovative drugs: The case of pulmonary arterial hypertension

25 May 2018
Author(s): Roberta Joppi, Chiara Gerardi, Vittorio Bertele', Silvio Garattini

Pulmonary arterial hypertension (PAH) is a life-threatening rare disease. Between 2001 and 2016 the European Medicines Agency (EMA) approved nine drugs to treat PAH. Considering the poor prognosis of... more

Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries

17 May 2018
Author(s): Marco Proietti, Cécile Laroche, Robby Nieuwlaat, Harry J.G.M. Crijns, Aldo P. Maggioni, Deirdre A. Lane, Giuseppe Boriani, Gregory Y.H. Lip, EORP-AF General Pilot Registry, Euro Heart Survey on AF Investigators

In 2002, the European Society of Cardiology conducted the Euro Heart Survey (EHS), while in 2014concluded 1-year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry.

The association between eGFR in the normal or mildly impaired range and incident cadiovascular disease: Age and sex analysis

15 May 2018
Author(s): Alon Eisen, Avital Porter, Moshe Hoshen, Ran D. Balicer, Orna Reges, Yardena Rabi, Morton Leibowitz, Zaza Iakobishvili, David Hasdai

Worse renal function, even in the normal or mildly impaired range, is associated with incident cardiovascular disease (CVD). Whether this association exists in both sexes across all ages is not known...

Incremental risk of long-term mortality with increased burden of comorbidity in hospitalized patients with pneumonia

10 May 2018
Author(s): Mohammed Yousufuddin, Jessica Shultz, Taylor Doyle, Hamid Rehman, Murad M. Hassan

Patients hospitalized for pneumonia often have concurrent comorbid conditions (CCs). The influence of CCs on the risk of subsequent death is not fully understood.

Review Article

What the internist should know about stem cell transplant in the elderly patient

28 June 2018
Author(s): Michael Medinger, Jakob Passweg

Most hematological malignancies are increasing in frequency with age. Allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative therapeutic option for patients with malignant... more

Special issue frailty - frailty and atrial fibrillation: A systematic review

21 June 2018
Author(s): Emanuele R. Villani, Anita M. Tummolo, Katie Palmer, Ester Manes Gravina, Davide L. Vetrano, Roberto Bernabei, Graziano Onder, Nicola Acampora

Atrial fibrillation (AF) is a common cardiac arrhythmia and its prevalence increases with age. There is a significant correlation between frailty, morbidity and mortality in elderly patients with... more

β-Thalassemia heterozygote state detrimentally affects health expectation

19 June 2018
Author(s): Luciano Graffeo, Angela Vitrano, Salvatore Scondotto, Gabriella Dardanoni, Walter Sebastiano Pollina Addario, Antonino Giambona, Massimiliano Sacco, Rosario Di Maggio, Disma Renda, Federico Taormina, Andrea Triveri, Massimo Attanasio, Christian Gluud, Aurelio Maggio

Thalassemia minor (Tm) individuals, are generally considered healthy. However, the prognosis of Tm individuals has not been extensively studied.The aim of this study was to evaluate the prognosis of... more

Autoimmunity and B-cell dyscrasia in acute and chronic Q fever: A review of the literature

13 June 2018
Author(s): Anne F.M. Jansen, Ruud P.H. Raijmakers, Stephan P. Keijmel, Renate G. van der Molen, Gerald M. Vervoort, Jos W.M. van der Meer, Marcel van Deuren, Chantal P. Bleeker-Rovers

Q fever infection can lead to chronic Q fever, a potentially lethal disease occurring in 1–5% of patients infected with Coxiella burnetii, characterized by the persistence of this intracellular... more

The essence of frailty: A systematic review and qualitative synthesis on frailty concepts and definitions

31 May 2018
Author(s): Ulrike Junius-Walker, Graziano Onder, Dagmar Soleymani, Birgitt Wiese, Olatz Albaina, Roberto Bernabei, Emanuele Marzetti, ADVANTAGE JA WP4 group

One of the major threats looming over the growing older population is frailty. It is a distinctive health state characterised by increased vulnerability to internal and external stressors. Although... more


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