June 2018
54 ArticlesNo Section
Rethinking the concept of sepsis and septic shock
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
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
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
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
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
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
Editorial
Redefining obesity toward classifying as a disease
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
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
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
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
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
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
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?
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
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
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
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
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)
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
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
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
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
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
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
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)
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
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
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
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
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
Nephrotic syndrome (NS) is characterized by hypoalbuminemia, proteinuria and edema [1].
The relationship of baseline fasting plasma glucose and cardiovascular morbidity and mortality
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
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
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
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
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
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
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
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?
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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