November 2015
29 ArticlesInternal Medicine Flashcard
Aspiration, quadriplegia, incontinence
A 64-year-old woman with hypertension and dyslipidemia was admitted for non-specific dizziness for 2days. Initial physical examination was unremarkable except a palpable bladder. Urinary... more
Unilateral pulmonary edema in acute coronary syndrome: A sinister sign
A 75 year-old man with no significant prior medical history was transferred to our hospital for emergent management of inferior ST-elevation myocardial infarction. He had presented to a regional... more
A woman with recurrent chest pain and ST-segment elevation
A 32-year-old female presents with recurrent episodes of unprovoked chest pain associated with inferior ST-segment elevation and reciprocal ST-segment depression. Coronary angiography during one of... more
Groove sign
A 72-year-old man with a history of arterial hypertension, diabetes mellitus and hypercholesterolemia presented to our outpatient clinic with a 6-month history of induration in both forearms and... more
A 28-year-old man with syncope, hypotension, and lethargy
A 28-year-old previously healthy man presented to the emergency department after an episode of syncope. He also complained of vomiting and diffuse abdominal pain for the past 1day and sore throat for... more
Chilaiditi's sign
A 79-year old male with a history of diabetes mellitus and systemic hypertension was admitted with cough and fever through the out-patient department of our hospital. In spite of his advanced age he... more
A man with breast discharge and headache.
A 44year old previously healthy man presented with gradual onset of discharge of whitish liquid from the nipples and a dull headache for last three years. The patient reported progressive erectile... more
A cause for craniocervical pain
An 82-year-old woman presented with craniocervical pain exacerbated by rotation of head with several months. Her physical examination yielded no unusual results except for local tenderness in the... more
Letter to the Editor
Thalassemia and acute coronary syndromes
The recent report on “risk of coronary artery disease in transfusion-naïve thalassemia populations [1]” is very interesting. In fact, thalassemia is a common congenital inherited hemoglobin disorder... more
Extra-pulmonary manifestations associated with pneumonia in adults
Mycoplasma pneumoniae is a well-recognized respiratory pathogen principally affecting children and younger adults. This organism is also responsible for producing a wide spectrum of extra-pulmonary... more
Cruising between Scylla and Charybdis … Just a hope?
I have read with interest the recent paper written by Macchi and Pavan1 concerning the problems about the quality of medical care at the time of economic crisis. I acknowledge that the efforts for “... more
Producing evidence in support of disinvestment: The experience of the Tuscany region in Italy
In this journal, Macchi and Pavan [1] have described how, in Italy, a research hospital can be managed at the times of a global economic crisis and have pointed out that, as a matter of fact,... more
Does acromegaly suffice to explain the origin of Pulcinella? A novel interpretation
Pulcinella, mainly known in the English-speaking world as Mr Punch (Fig. 1), is a character from the Italian Commedia dell'Arte, whose origins can be traced back to protagonists of Roman Atellan... more
Original Article
Chronic diseases and geriatric syndromes: The different weight of comorbidity
Comorbidity is a relevant health determinant in older adults. Co-occurrence of several diseases and other age-associated conditions generates new clinical phenotypes (geriatric syndromes [GS] as... more
Clinical findings of bacteremic septic arthritis according to the site of acquisition: The overlap between health care-related and community- and nosocomial-acquired cases
The site of acquisition of infection may have a major impact on outcome. The health care-related (HCR) environment has recently come under scrutiny. In a group of patients with bacteremic septic... more
Effectiveness of a Geriatric Care Model for frail older adults in primary care: Results from a stepped wedge cluster randomized trial
Primary care-based comprehensive care programs have the potential to improve outcomes in frail older adults. We evaluated the impact of the Geriatric Care Model (GCM) on the quality of life of... more
D-dimer and histamine in early stage bacteremia: A prospective controlled cohort study
Plasma histamine levels and D-dimer predict disease severity and mortality in advanced septic shock. We hypothesized that increased plasma histamine levels parallel coagulation activation and yield... more
Management of patients with type 2 diabetes and multiple chronic conditions: A Delphi consensus of the Spanish Society of Internal Medicine
To develop consensus-based recommendations for the management of chronic complex patients with type 2 diabetes mellitus using a two round Delphi technique.
Spring season birth is associated with higher emergency department admission for acute allergic reactions
Acute allergic reactions are important causes of emergency department (ED) admission, imposing a significant clinical and organizational burden. Since the season of birth is linked with early... more
Cholesterol absorption and synthesis markers in Portuguese hypercholesterolemic adults: A cross-sectional study
The dynamics of cholesterol homeostasis and the development of cardiovascular disease (CVD) are complex and multifactorial, to which adds individual variability in the proportion of cholesterol from... more
The syndrome of inappropriate antidiuretic hormone secretion: Distribution and characterization according to etiologies
To determine the distribution of etiologies for the syndrome of inappropriate antidiuretic hormone secretion (SIADH) in hospitalized patients and to characterize patients according to the different... more
Prolonged length of stay in hospitalized internal medicine patients
Targeting patients with prolonged hospitalizations may represent an effective strategy for reducing average hospital length of stay (LOS). Objective: We sought to characterize predictors of prolonged... more
The effect of smoking on carotid intima–media thickness progression rate and rate of lumen diameter reduction
The purpose of the study was to investigate the long-term associations between smoking habits, environmental tobacco smoke exposure (ETS), carotid intima–media thickness (IMT) progression rate, and... more
Cardiovascular outcomes and conventional risk factors in non-diabetic adult patients with GH deficiency: A long-term retrospective cohort study
To investigate the association between cardiovascular (CV) risk factors and cumulative CV events in patients with growth hormone deficiency (GHD) receiving GH replacement therapy (GHRT).
Clinical assessment of endothelial function in patients with rheumatoid arthritis: A meta-analysis of literature studies
Several studies reported an increased cardiovascular (CV) morbidity and mortality in patients with rheumatoid arthritis (RA). Flow-mediated (FMD) and nitrate-mediated dilation (NMD) are considered... more
Development of a new disease severity scoring system for patients with non-transfusion-dependent thalassemia
Patients with non-transfusion-dependent thalassemia (NTDT) present with a spectrum of disease severities. Since there are multiple pathophysiologies in such patients, tailoring treatment remains... more
Effect of salt intake on blood pressure in patients receiving antihypertensive therapy: Shimane CoHRE Study
Salt intake is recognized as an important risk factor for hypertension in the general population. On the other hand, the availability of various classes of antihypertensive drugs means that it is... more
Review Article
Association between particulate air pollution and venous thromboembolism: A systematic literature review
Air pollution is a leading global problem for public health. A number of ambient pollutants have been involved, including carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3... more
Efficacy and safety of haloperidol for in-hospital delirium prevention and treatment: A systematic review of current evidence
Haloperidol is generally considered the drug of choice for in-hospital delirium management. We conducted a systematic review to evaluate the evidence for the efficacy and safety of haloperidol for... more