September 2015
90 ArticlesNo Section
Deprivation index and dependency ratio are key determinants of emergency medical admission rates
Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission; there has been debate as to the extent to which deprivation and population structure... more
Do statins prevent Alzheimer's disease? A narrative review
Alzheimer's disease is the most common cause of dementia and occurs commonly in patients 65 and older. There is an urgent need to find an effective management that could help prevent or at least slow... more
Rituximab in autoimmune thrombotic thrombocytopenic purpura: A success story
Despite a significant improvement of thrombotic thrombocytopenic purpura (TTP) prognosis since the use of plasma exchange, morbidity and mortality remained significant because of poor response to... more
Hyponatremia in hospitalised patients with heart failure in internal medicine: Analysis of the Spanish national minimum basic data set (MBDS) (2005–2011)
Hyponatremia is the most common electrolyte disorder seen in clinical practice. Numerous studies have reported increased inhospital mortality associated to this condition, which is also an... more
Gout is associated with organic and psychogenic erectile dysfunction
Gout is a deposition disease with an inflammatory response that can increase the risk of cardiovascular disease. Gout is stressful for affected individuals, and can cause erectile dysfunction (ED).... more
Commentary
Appropriateness of antithrombotic prophylaxis in the oldest old with non-valvular atrial fibrillation: ARAPACIS and REPOSI
In the frame of the Atrial Fibrillation Registry for Ankle–Brachial Index Prevalence Assessment-Collaborative Italian Study (ARAPACIS) involving 93 Internal Medicine wards, Pignatelli et al. [1]... more
Internal Medicine Flashcard
A deadly cause of syncope
A 64-year-old woman of good past health presented to the emergency department with syncope. She had upper respiratory symptoms and dizziness followed by worsening exertional dyspnea and palpitation... more
A young woman with a heart attack?
A 38year-old nulliparous woman with no cardiac risk factors abruptly developed chest discomfort during a routine exercise run. The discomfort recurred with minimal exertion for the next three days,... more
A 64-year old woman with right hand swelling and paresthesia
A 64-year old woman presented to the emergency department with a 6-month history of right lateral cervical pain and a 2-week history of erythema and swelling of her right hand and wrist, accompanied... more
Malignant syphilis
A previously healthy 54-year-old bisexual man presented with a 2-week history of generalized nonpruritic skin rash and painless genital ulcerations. He reported low-grade fever, and admitted having... more
Unilateral calf swelling
An 81-year-old man presented to the emergency department with left calf painful swelling for 4days. He has a history of hypertension and ischemic heart disease. He denied any injury. Physical... more
Memory of an exotic holiday
A 66-year-old man with no particular medical history and back from a 10-day trip to South Africa, consulted for headache, myalgia, odynophagia and low-grade fever (38°), which had lasted for 3days.... more
An umbilical nodule in a patient with enlarged uterus
A previously healthy 59-year-old female presented with weakness in the lower extremities and abdominal distension of one month. She also experienced unintentional weight loss of 20 pounds within... more
An unusual emphysema
An 87year-old woman with a history of hypertension, type 2 diabetes and post-menopausal osteoporosis presented with a 5-day history of low-grade intermittent fever, epigastric pain and shortness of... more
The brain of STEMI
An 83y/o African American male with a history of hypertension and chronic kidney disease presented following a fall. The fall occurred while he was trying to get up from a sitting position. The... more
Back pain: An old cause in a young adult
A 23-year-old man from the Philippines was admitted to our emergency department for a three-weeks-lasting thoracic back pain, followed by an onset of postural instability; he also complained about... more
An uncommon case of post partum seizures
A 30-year-old woman was admitted for headaches and altered somnolence and agitation few days after uncomplicated vaginal delivery. No complications occurred during this first pregnancy. Four days... more
Calcified pulmonary nodules
A 78-year-old female with stroke and hydrocephalus post-ventriculo-peritoneal shunt insertion presented with shortness of breath, productive cough, and fever that had been present for several days.... more
Internal Medicine Flashcards
A patient presenting with an acute shortness of breath
A 37-year-old woman presented with shortness of breath, cough, and fever that began a few days earlier. Her pulse rate was high (110bpm) with a body temperature of 38.6°C. Pulmonary auscultation... more
Letter to the Editor
More on Scylla and Charybdis
At the onset of their article: “Managing a research hospital at the time of a global economics crisis: cruising between Scylla and Charybdis” Macchi and Pavan [1] cite the interesting paper published... more
Circadian aspects of myocardial infarction among young STEMI patients
We read with interest the letter by Fournier and Muller [1] in which few issues have been raised regarding our work [2].
Diabetes care for the Hajj
Hajj, the annual pilgrimage to Makkah (https://goo.gl/maps/47x1l), attracts two million Muslim men and women, including over 45,000 Hajjis (pilgrims) from the European Union [1,2]. It is an arduous... more
Mesenteric panniculitis: A controversial entity. Many unanswered questions
In the last years, we have observed an increase of clinicopathological knowledge and, therefore, a more accurate diagnosis of diseases. However, sometimes there are confused diagnoses without... more
Efficacy but not effectiveness of sublingual immunotherapy for grass pollen allergy: Time to avoid waste in health-care expenditure
Last June JAMA Internal Medicine published an excellent systematic review and meta-analysis of clinical trials of sublingual immunotherapy for grass pollen allergy [1]. The team of Di Lorenzo of the... more
Anticholinergic risk: Use and limitations of anticholinergic scales
The side effects of anticholinergic drugs are well known. Peripheral adverse effects are, amongst others: dry mouth, dry eyes, blurred vision, constipation, fecal impaction, urinary retention and... more
Circadian aspects of myocardial infarction among young STEMI patients
We read with interest the recent publication of Rallidis et al. [1] reporting the circadian pattern of symptoms onset in patients presenting with ST-segment elevation myocardial infarction (STEMI).... more
Depressive symptomatology in patients with metabolic syndrome: A cross-sectional study of stable coronary artery disease patients
The metabolic syndrome is a common disorder, which includes the presence of at least 3 out of 5 metabolic risk factors according to the National Cholesterol Education Program Adult Treatment Panel... more
Next Accreditation System outcomes and Special Review as part of Graduate Medical Oversight of Internal Medicine Programs in the United States: A review
The Accreditation Council on Graduate Medical Education (ACGME) previously evaluated programs with direct site visits, every 1–5years. The length of time between visits would depend on program data... more
The value of software that provides clinically relevant information on drug interactions
Potential drug–drug interactions (pDDIs) are critical issues in the management of the elderly. The development of multiple diseases with increasing age leads to therapies based upon many concomitant... more
History of alcohol abuse after major non-cardiac surgery and postoperative cognitive dysfunction
The risk factors for postoperative cognitive dysfunction (POCD) after non-cardiac surgery include advanced age and preexisting cognitive impairment.
Proton pump inhibitors and risk of hypomagnesemia
Proton pump inhibitors (PPIs) are among the most commonly prescribed medicines and overuse is widespread in both primary and secondary care [1]. Although generally well tolerated, PPIs can cause... more
Deprescribing in patients with multimorbidity: A necessary process
As featured in several publications, the term deprescribing has not yet been standardized [1], and different points of view have thus been used to define it. One of the first concepts came from... more
Whatever happened to the doctor's opinion?
A year or so ago I spent a short while in Africa collaborating on a validation study of the National Early Warning Score [1]. As I went over the results of the study it was clear that African... more
Fibromyalgia is frequent in obstructive sleep apnea and responds to CPAP therapy
Fibromyalgia is a common disorder characterized by widespread musculoskeletal pain, stiffness, paresthesia and proneness to fatigue. The prevalence has been reported to be 3.4 percent in women and 0.... more
Lights and shadows in the management of old and new oral anticoagulants in the real world of atrial fibrillation by Italian internists. A survey from the Atrial Fibrillation Registry for Ankle-Brachial Index Prevalence Assessment-Collaborative Italian...
Atrial fibrillation (AF) is the most frequent cardiac arrhythmia, which is associated with an enhanced risk for stroke and myocardial infarction [1–3]. Vitamin K antagonists (VKAs) have been the... more
Sarcopenia evaluated by fat-free mass index in patients with chronic heart failure
The article published by Narumi et al. is important as they reveal a connection between fat-free mass index (FFMI) and cardiac prognosis in cardiac failure patients [1]. However, we think that there... more
Prognostic value of multidimensional indices in ambulatory COPD patients
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) advocates the use of multidimensional prognostic indices for staging, monitoring and guiding decision-making in chronic obstructive... more
More on homeopathy
Finally a government body has had the courage to express a clear opinion on homeopathy. The Australian National Health and Medical Research Council has declared that homeopathy is not an effective... more
Association of tuberculosis and deep venous thromboembolism in patients with autoimmune diseases
Tuberculosis (TB) can complicate the course of various autoimmune diseases, especially with prolonged use of immunosuppressive treatment [1–9]. Limited data are currently available regarding risk... more
Letters to the Editor
Hypervitaminemia B12 in elderly patients: Frequency and nature of the associated or linked conditions. Preliminary results of a study in 190 patients
Hypervitaminemia B12 is a common laboratory abnormality, frequently unknown. Hypervitaminemia B12 has been associated or linked with a range of conditions, the majority of which are serious, with a... more
The issue of dual infection with m.tuberculosis and non-mycobacterial pathogens
In order to address more fully the mortality rate associated with pneumonia in the elderly, attention should be paid, not only to adherence to guidelines [1], but, also to the misdiagnosis of... more
Simple measurement popularizes sarcopenia evaluation in patients with heart failure
Dear Editor.
Choosing ACE-inhibitors instead of sartans: Encouraging results of an evidence-based policy in Emilia-Romagna, Italy
Pharmaceutical policies favoring appropriate prescribing must be based on solid evidence on drug effectiveness and safety, better if shared with relevant stakeholders [1]. To translate this knowledge... more
Original Article
Sitagliptin use and risk of acute pancreatitis in type 2 diabetes mellitus: A population-based case-control study in Taiwan
There is still lack of definite evidence to establish the association between sitagliptin use and acute pancreatitis. The study aimed to test this issue in Taiwan.
Non-steroidal anti-inflammatory drugs and risk of heart failure exacerbation: A systematic review and meta-analysis
The association between exacerbation of heart failure (HF) and use of non-steroidal anti-inflammatory drugs (NSAIDs) has long been recognized but the data on this adverse effect are limited.
Celiac disease detection in hypothyroid patients requiring elevated thyroid supplementation: A prospective cohort study
Celiac disease (CD) is associated with hypothyroidism, but the disease prevalence is not thought to be great enough to warrant testing all hypothyroid patients. We hypothesized that hypothyroid... more
Association of macrolides with overall mortality and cardiac death among patients with various infections: A meta-analysis
A large body of evidences suggested that macrolide therapy could improve the survival of patients with various infections. While in the same time, macrolides are known to increase fatal... more
Clinical profile, management, and mortality in very-elderly patients hospitalized with acute decompensated heart failure: An analysis from the ATTEND registry
Acute decompensated heart failure (ADHF) is a leading cause of hospitalization among the elderly. Discussion of optimal management of ADHF in older patients is a growing health care priority. The aim... more
Trends in referral patterns, invasive management, and mortality in elderly patients referred for exercise stress testing
Scarce data are available on the temporal patterns in clinical characteristics and outcomes of elderly patients referred for exercise stress testing. We aimed to assess the trends in baseline... more
Social deprivation, population dependency ratio and an extended hospital episode — Insights from acute medicine
Patients from deprived backgrounds have a higher in-patient mortality following an emergency medical admission; this study aimed to investigate the extent to which Deprivation status and the... more
Thromboembolic events in patients with severe pandemic influenza A/H1N1
The 2009 pandemic influenza A/H1N1 developed as a novel swine influenza which caused more diseases among younger age groups than in the elderly. Severe hypoxemic respiratory failure from A/H1N1... more
Approvals of drugs with uncertain benefit–risk profiles in Europe
This paper examines conditional approvals that allow the marketing of medicines with unsettled benefit–risk profiles in the European Union.
Under-detection of delirium and impact of neurocognitive deficits on in-hospital mortality among acute geriatric and medical wards
Delirium is a neuropsychiatric disorder, triggered by medical precipitants causes. Study aims were to describe the prevalence and impact on in-hospital mortality of delirium identified through ICD-9... more
Medical teleconsultation to general practitioners reduces the medical error vulnerability of internal medicine patients
e-Health strategies are supposed to improve the performance of national health systems. Medical teleconsultation (MT) is an important component of such e-Health strategies.
Functional status and mortality at month and year in nonagenarians hospitalized due to acute medical illness
To analyze risk factors associated with short and long-term mortality in nonagenarians hospitalized due to acute medical conditions.
Incremental value of exercise echocardiography over exercise electrocardiography in a chest pain unit
Limited data are available on the added value of exercise echocardiography (ExEcho) over exercise electrocardiography (ExECG) in patients with suspected acute coronary syndromes (ACS) referred to a... more
Cost-effectiveness analysis of preoperative treatment of acromegaly with somatostatin analogue on surgical outcome
There is no uniform standard of care for acromegaly. Due to the high costs involved, steps must be taken to ensure the cost-effective delivery of treatment.
Clinical implications and outcome prediction in chronic hemodialysis patients with lower serum potassium×uric acid product
The aims of this study were to evaluate correlations between serum potassium (S[K]) and uric acid (S[UA]) in hemodialysis patients and to determine whether lower levels of both S[K] and S[UA] were... more
Comparison of risk factors for acute worsening renal function in heart failure patients with and without preserved ejection fraction
We compared the risk factors for acute worsening renal function (AWRF) in patients with acute decompensated heart failure with preserved ejection fraction (HFpEF) versus those with reduced ejection... more
Perceived stress status and sympathetic nervous system activation in young male patients with coronary artery disease in China
Young Chinese male adults have faced increasing psychological stress. Whether this is associated with the increased risk of coronary artery disease (CAD) in young Chinese males remains unclear. This... more
Increased circulating adiponectin in males with chronic HCV hepatitis
Increased levels of adiponectin, a major adipokine with insulin sensitizing properties showing a strong sexual dimorphism, have been reported in individuals with chronic HCV infection (CHC), but data... more
Malignant transformation and overall survival of morphological subtypes of intraductal papillary mucinous neoplasms of the pancreas: A network meta-analysis
Emerging evidence suggests the predictive role of morphological subtypes (gastric, intestinal, pancreatobiliary, and oncocytic) of intraductal papillary mucinous neoplasms (IPMNs) in malignant... more
Prognostic significance of changes in red cell distribution width in an internal medicine ward
The prognostic significance of red cell distribution width (RDW) during hospitalization in internal medicine wards was not sufficiently investigated.
The effect of statins on the occurrence of peptic ulcer
This study was to determine the association between the use of statins and the occurrence of peptic ulcer diseases (PUD).
Gender difference in drug use in hospitalized elderly patients
The aims of this study were to evaluate whether or not there are gender differences in drug use at hospital admission and prescription at discharge and to evaluate the effect of hospitalization on... more
Development and multi-centre evaluation of a method for assessing the severity of potential harm of medication reconciliation errors at hospital admission in elderly
Medication reconciliation is a powerful process to correct medication errors (ME) resulting from miscommunicated information at transitions of care. This study aims to develop and evaluate a scoring... more
The diagnostic usefulness of fecal lactoferrin in the assessment of Crohn's disease activity
Diagnosis and monitoring of Crohn's disease (CD) is difficult and time-consuming. In recent years, diagnostic usefulness of fecal calprotectin has been proven. However, data on the utility of other... more
Online combination algorithm for non-invasive assessment of chronic hepatitis B related liver fibrosis and cirrhosis in resource-limited settings
The use of commercially available noninvasive markers for chronic hepatitis B (CHB) related fibrosis is not widely available in developing countries so clinicians in those countries frequently use... more
The influence of gender on the communication skills assessment of medical students
Opinions on the interaction between the genders of standardized patients and examinees are controversial. Our study sought to determine the influence of gender on communication skills assessment in... more
Oral health information from the dentist to the diabetologist
Diabetes care includes annual evaluation of micro- and macrovascular complications, however, oral pathologies are not included. We studied retrieving oral health information, in particular... more
Duration of clopidogrel-based dual antiplatelet therapy and clinical outcomes after endeavor sprint zotarolimus-eluting stent implantation in patients presenting with acute coronary syndrome
The optimal duration of dual antiplatelet therapy (DAPT) remains controversial in patients with acute coronary syndrome (ACS). We sought to compare outcomes after the implantation of zotarolimus-... more
Venous thromboembolism and preoperative steroid use: Analysis of the NSQIP database to evaluate risk in surgical patients
Despite several prophylactic strategies, postoperative venous thromboembolism (VTE) remains a major cause of morbidity and mortality. Therefore, the search for modifiable preoperative risk factors is... more
Long-term risk of pancreatitis and diabetes after cholecystectomy in patients with cholelithiasis but no pancreatitis history: A 13-year follow-up study
Patients with biliary pancreatitis are suggested to undergo cholecystectomy to prevent the recurrence of pancreatitis. However, it remains controversial whether cholecystectomy is associated with... more
Predicting prolonged length of hospital stay in older emergency department users: Use of a novel analysis method, the Artificial Neural Network
To examine performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR], area under receiver operating characteristic... more
Reducing weight in an internal medicine outpatient clinic using a lifestyle medicine approach: A proof of concept
Chronic non-communicable diseases represent the major drivers of disease burden, being responsible for the majority of health care cost and deaths. Almost half of premature deaths is due to behaviors... more
Circadian pattern of symptoms onset in patients ≤35years presenting with ST-segment elevation acute myocardial infarction
There are scarce data regarding the circadian pattern of symptoms onset in young patients presenting with acute myocardial infarction (AMI). We explored whether young patients with ST-segment... more
Is chronic neutropenia always a benign disease? Evidences from a 5-year prospective study
To evaluate infections and oncohematologic evolution in adult patients with chronic idiopathic and autoimmune neutropenia in a prospective study.
Thalassemia and risk of dementia: A nationwide population-based retrospective cohort study
This study is a nationwide population-based retrospective cohort study to investigate the risk for developing dementia in thalassemia population.
Hypermagnesemia is a strong independent risk factor for mortality in critically ill patients: Results from a cross-sectional study
Patients with electrolyte imbalances or disorders have a high risk of mortality. It is unknown if this finding from sodium or potassium disorders extends to alterations of magnesium levels.
Prognostic role of atrial fibrillation in patients affected by chronic heart failure. Data from the MECKI score research group
Atrial fibrillation (AF) is common in heart failure (HF). It is unclear whether AF has an independent prognostic role in HF. The aim of the present study was to assess the prognostic role of AF in HF... more
Risk of psychiatric disorders following gastroesophageal reflux disease: A nationwide population-based cohort study
Recent studies have shown that the peripheral inflammation may cause the up-regulation of central nervous system inflammation and therefore possibly plays a vital role in the pathophysiology of... more
Eosinophilic granulomatosis with polyangiitis (Churg–Strauss) (EGPA) Consensus Task Force recommendations for evaluation and management
To develop disease-specific recommendations for the diagnosis and management of eosinophilic granulomatosis with polyangiitis (Churg–Strauss syndrome) (EGPA).
Initiation of rivaroxaban in patients with nonvalvular atrial fibrillation at the primary care level:
Rivaroxaban has become an alternative to vitamin-K antagonists (VKA) for stroke prevention in non-valvular atrial fibrillation (AF) patients due to its favourable risk–benefit profile in the... more
Reflections in Internal Medicine
Reducing the risk of hospital admission: A call to action from the Italian Society of Internal Medicine
The belief that hospital stays may constitute per se a risk for patients is not widespread among patients and health care professionals. In the balance between advantages and disadvantages of... more
Review Article
Acute Complex Care Model: An organizational approach for the medical care of hospitalized acute complex patients
Chronic diseases are the major cause of death (59%) and disability worldwide, representing 46% of global disease burden. According to the Future Hospital Commission of the Royal College of Physicians... more
Thyroid disorders and gastrointestinal and liver dysfunction: A state of the art review
Thyroid disorders commonly impact on the gastrointestinal system and may even present with gastrointestinal symptoms in isolation; for example, metastatic medullary thyroid carcinoma typically... more
Peripheral neuropathy: An underreported neurologic manifestation of inflammatory bowel disease
One of the most frequent neurologic complications reported in inflammatory bowel disease population is peripheral neuropathy; however, clinical aspects of peripheral nerve damage are not well... more
Multidisciplinary care in patients with chronic kidney disease: A systematic review and meta-analysis
Multidisciplinary care (MDC) was widely used in multiple chronic illnesses but the effectiveness of MDC in patients with chronic kidney disease (CKD) was inconclusive. The aim of this meta-analysis... more
Effect of routine diagnostic imaging for patients with musculoskeletal disorders: A meta-analysis
The increasing use of diagnostic imaging has led to high expenditures, unnecessary invasive procedures and/or false-positive diagnoses, without certainty that the patients actually benefit from these... more
Challenges and misconceptions in the aetiology and management of atrial fibrillation-related strokes
Strokes, whether ischaemic or haemorrhagic, are the most feared complications of atrial fibrillation (AF) and its treatment. Vitamin K antagonists have been the mainstay of stroke prevention.... more