October 2017
32 ArticlesNo Section
Intox, detox, antidotes – Evidence based diagnosis and treatment of acute intoxications
Aim of this review is to describe the role of clinical toxicology in the context of acute medicine. A special focus is put on antidotes and important aspects of diagnosis and therapy of acute... more
Clinical outcomes of elderly patients with bloodstream infections due to extended-spectrum β-lactamase–producing Enterobacteriaceae in an Italian Internal Medicine ward
Infections caused by ESBL-producing Enterobacteriaceae (ESBL-EB) are a major health problem, but data regarding elderly patients is lacking.
Prognostic value of early warning scores in the emergency department (ED) and acute medical unit (AMU): A narrative review
A wide array of early warning scores (EWS) have been developed and are used in different settings to detect which patients are at risk of deterioration. The aim of this review is to provide an... more
Technological aided assessment of the acutely ill patient – The case of postoperative complications
Surgical interventions come with complications and highly reported mortality after major surgery. The mortality may be a result of delayed detection of severe complications due to lower monitoring... more
The assessment of acute kidney injury in critically ill patients
Acute kidney injury (AKI) is common in critically ill patients and is associated with high morbidity and mortality. The availability of several biomarkers of kidney injury offers new tools for its... more
Internal Medicine Flashcard
Dilation of duodenum, stomach and esophagus in a patient with weight loss
A 37-year-old man with no significant medical history presented to our emergency department with abdominal pain and vomiting since the previous day. He had experienced dysphagia when eating solids... more
A young patient with back pain
A 25year-old Nigerian woman, was admitted because of a 7month lasting lumbar pain irradiated to the abdomen. She's been in Italy for 5months. Her medical history was mute except for a malaria... more
Letter to the Editor
Ultrasound versus stethoscope in internal medicine: Do not skip steps
We read with interest the review by M.J Blans and F.H. Bosch entitled “Ultrasound in acute internal medicine; time to set a European standard?” published in the Journal [1]. We agree with the... more
Association between statin exposure and venous thromboembolism risk in cancer patients. Data from the EDITH case-control study
The occurrence of venous thromboembolism (VTE) in cancer patients is strongly associated with a poor cancer outcome irrespective of cancer stage [1]. Primary thromboprophylaxis with low-molecular... more
Superior safety of dual therapy with dabigatran and clopidogrel vs. triple therapy with warfarin, aspirin and clopidogrel in the RE-DUAL PCI trial: What is key, the strategy or the drug?
In line with the results of the PIONEER AF-PCI trial with rivaroxaban [1], those of the recent RE-DUAL PCI trial with dabigatran [2] further support the superior safety on bleeding events of dual... more
Quality of medication related information in discharge letters: A prospective cohort study
Transitions from one care setting to another is a well known risk factor for medication errors [1]. Inaccurate or delayed information transfer between settings could lead to serious harm to patients... more
Narrative Review
Obesity phenotypes and their paradoxical association with cardiovascular diseases
The pro-inflammatory state of the visceral adipose tissue (VAT) is supposed to accelerate cardiovascular (CV) and metabolic diseases in obese subjects. Some studies have recently reported an improved... more
Serology in autoimmune hepatitis: A clinical-practice approach
Serology is key to the diagnosis of autoimmune hepatitis (AIH). Clinicians need to be aware of which tests to request, how to interpret the laboratory reports, and be familiar with the laboratory... more
Recognising older frail patients near the end of life: What next?
Frailty is a state of vulnerability resulting from cumulative decline in many physiological systems during a lifetime. It is progressive and considered largely irreversible, but its progression may... more
Ultrasound in acute internal medicine; time to set a European standard
Nowadays point-of-care ultrasound (POCUS) is considered indispensable for critical care and emergency physicians. POCUS is a noninvasive tool, can be done at the bedside, leads to instant diagnostic... more
Pioneers in pulmonary medicine
In the final year of the American Civil War, 1865, Chevalier Jackson was born on the 4th of November in Pittsburgh, Pennsylvania to a livestock raising family [1]. The depiction of his youth by his... more
Original Article
Epidemiology and risk factors for mortality in bloodstream infection by CP-Kp, ESBL-E, Candida and CDI: A single center retrospective study
The incidence of C. difficile infection (CDI) and of bloodstream infection (BSI) caused by Candida spp., ESBL-E-producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing K. pneumoniae (CP-Kp... more
Comparing associations of different metabolic syndrome definitions with ischemic stroke in Chinese elderly population
Studies have showed the associations between different definitions of metabolic syndrome (MetS) and risk of ischemic stroke were inconsistent. In this study, we compared associations of different... more
Epidemiological trends of deep venous thrombosis in HIV-infected subjects (1997–2013): A nationwide population-based study in Spain
Chronic infections may be a triggering factor as well as a risk factor of deep venous thrombosis (DVT). The purpose of this study was to analyze the epidemiological trends of hospital admissions... more
Glomerular filtration rate is associated with free triiodothyronine in euthyroid subjects: Comparison between various equations to estimate renal function and creatinine clearance
Effects of variations in thyroid function within the euthyroid range on renal function are unclear. Cystatin C-based equations to estimate glomerular filtration rate (GFR) are currently advocated for... more
Systematically assessed symptoms as outcome predictors in emergency patients
It is known that symptoms are predictive of mortality in “nonsurgical” emergency patients. It is unknown whether a prospective, systematic, and “unscreened” assessment of all symptoms is of any... more
Mild water restriction with or without urea for the longterm treatment of SIADH: Can urine osmolality help the choice?
Treatment options for chronic SIADH include water restriction (WR) and urea. The usefulness of urine osmolality to guide the choice of the treatment option is not clearly defined. We hypothesized... more
An acute hospital admission greatly increases one year mortality – Getting sick and ending up in hospital is bad for you: A multicentre retrospective cohort study
For most of the population a serious acute illness that require an emergency admission to hospital is a rare “once in a life time” event. This paper reports the one year mortality of patients... more
Age-specific and year of birth changes in hospital admissions during a period of unexplained higher deaths in England
Policy makers have assumed that increase in medical demands and costs are attributable to the increasing age of the population and the inability of health and social care to limit demand.
Screening of the frail patient in the emergency department: A systematic review
Several frailty rating scales have been developed to detect and screen for the level of frailty. It is uncertain what diagnostic value screening of frailty level have in the emergency department.
Using scores to identify patients at risk of short term mortality at arrival to the acute medical unit: A validation study of six existing scores
“Early warning scores” (EWS) have been developed to quantify levels of vital sign abnormality. However, many scores have not been validated. The aim of this study was to validate six scores that all... more
Specific indications and clinical outcome in patients with subcutaneous ICD – A nationwide multicentre registry
Subcutaneous implantable cardioverter-defibrillators (S-ICD) are an innovative and less invasive alternative to transvenous ICD (TV-ICD) in selected patients. We aimed to investigate the underlying... more
Reflections in Internal Medicine
The professional in the lead?
After graduating in economics and political sciences, I subsequently worked for Shell, became a member of parliament, party leader and Finance Minister, then took up consultancy and now am the CEO of... more
The dynamics of the emergency medical readmission — The underlying fundamentals
Hospital readmissions are a perennial problem. We reviewed readmissions to one institution (2002–2015) and investigated their dynamics.
Review Article
Liver disease and heart failure: Back and forth
In their clinical practice, physicians can face heart diseases (chronic or acute heart failure) affecting the liver and liver diseases affecting the heart. Systemic diseases can also affect both... more
Gut microbiota and obesity: Concepts relevant to clinical care
The composition and function of gut microbiota play a role in obesity and metabolic disease, yet the mechanisms have not been fully described. As new discoveries and advances in the field have... more
Special Article
Acute Oncology Care: A narrative review of the acute management of neutropenic sepsis and immune-related toxicities of checkpoint inhibitors
Cancer care has become increasingly specialized and advances in therapy have resulted in a larger number of patients receiving care. There has been a significant increase in the number of patients... more