Sepsis in internal wards: results of an Italian multicenter prospective study

Sepsis is a frequent inflammatory disease with a high mortality and morbidity rate. Most of the data about epidemiology, management and prognosis of patients with sepsis came mainly from studies conducted within Intensive Care Units (ICUs). A consistent number of studies suggest that a proportion of patients with sepsis and severe sepsis are admitted to internal medicine units, and not transferred to an ICU. In this article, we presented the data of an Italian study, a multicenter study, evaluating consecutive patients, with an objective diagnosis of sepsis treated in internal medicine units

New oral anticoagulants: key messages for clinicians

New oral anticoagulants are an effective and safe alternative to vitamin K antagonists in many fields of clinical practice. The use of the direct inhibitors of activated Factor II (dabigatran) and activated Factor X (apixaban and rivaroxaban), both in patients with non-valvular atrial fibrillation (NVAF) and those with acute venous thromboembolism (VTE), is of great interest for internal medicine physicians. This paper aims to give practical guidance on management (starting therapy, follow up and bleeding complications) of patients treated with dabigatran, rivaroxaban or apixaban for NVAF or acute VTE providing practical tables concerning the phases of therapy, management of complications, drug interaction and dose adjustment if renal impairment occurs

COVID-19 : high-resolution computed tomography findings in the first 64 patients admitted to the Hospital of Cremona, the epicentre of the pandemic in Europe

Purpose: In December 2019, a new coronavirus (SARS-CoV-2) was identified as being responsible for the pulmonary infection called COVID-19. On 21 February 2020, the first autochthonous case of COVID-19 was detected in Italy. Our goal is to report the most common chest computed tomography (CT) findings identified in 64 patients, in the initial phase of COVID-19. Methods: Sixty-four chest high-resolution computed tomography (HRCT) examinations performed at the Radiology Unit of the Hospital of Cremona, from 22 to 29 February 2020, of 64 patients during first week of hospitalization for COVID-19 were retrospectively evaluated. All cases were confirmed by real-time RT-PCR for SARS-CoV-2. Image analysis was independently conducted by 2 radiologists with 10 years and 1 year of experience in chest imaging. The inter-observer agreement was obtained by applying a Cohen’s κ test. Results: The average age of patients was 67.1 years (± 12.2); men 42 (66%). HRCT was performed on the 5th (± 1.5) day of hospitalization. More frequently, the initial CT changes of the lung show more or less extensive areas of ground-glass, as single pattern or with parenchymal consolidations. Coronavirus lung involvement appears very frequently multi-lobar, bilateral, and it concerns both subpleural and central regions. An excellent agreement (κ: 0.88-1, CI: 0.79-1.01, p < 0.05) concerning CT findings between the 2 operators was reached. Conclusions: Our data suggest that detection of the most frequent pulmonary CT-scan changes, in the early stages of COVID-19, can be performed, with excellent agreement, among readers with different experience, and consequently attribute their exact diagnostic value, in an appropriate clinical and environmental exposure setting

Sepsis and septic shock: a practical management according to Sepsis-3 diagnostic criteria

Not availabl

New oral anticoagulants: key messages for clinicians

New oral anticoagulants are an effective and safe alternative to vitamin K antagonists in many fields of clinical practice. The use of the direct inhibitors of activated Factor II (dabigatran) and activated Factor X (apixaban and rivaroxaban), both in patients with non-valvular atrial fibrillation (NVAF) and those with acute venous thromboembolism (VTE), is of great interest for internal medicine physicians. This paper aims to give practical guidance on management (starting therapy, follow up and bleeding complications) of patients treated with dabigatran, rivaroxaban or apixaban for NVAF or acute VTE providing practical tables concerning the phases of therapy, management of complications, drug interaction and dose adjustment if renal impairment occurs

Abdominal pain as pulmonary embolism presentation, usefulness of bedside ultrasound: A report of two cases

It is well known that a number of patients affected by hemodynamic stable pulmonary embolism are admitted to the emergency department presenting chest pain without further symptoms of pulmonary embolism, such as dyspnea, cough, hemoptysis, syncope, and tachycardia, but in a few cases, the presenting symptoms are even more unusual. The goldstandardforpulmonaryembolismdiagnosisiscomputed tomography pulmonary angiogram resulting in significant exposure to ionizing radiation and contrast, but recently bedside ultrasound has shown to be useful in diagnosing pulmonary embolism in the emergency department. We describe two cases of pulmonary embolism in young men evaluated in the emergency department for acute pain of the upper abdomen, preliminarily diagnosed as abdominal colic, in which bedside ultrasound ruled out abdominal diseases and showed basal pulmonary abnormalities consistent with infarction, suggesting the need of diagnostic completion with computed tomography pulmonary angiogram. Bedside ultrasound was useful as complementary imaging test in diagnosing pulmonary embolism in young patients admitted for abdominal pain of unknown origin

REACH, PATHOS and SIRIO: indications for managing atherothrombosis

BACKGROUND Atherothrombosis includes a broad spectrum of clinical manifestations (coronary artery disease, cerebrovascular disease and peripheral artery disease) and is associated with the main causes of morbility and mortality on a world-wide scale. Thus far, most of the available information on atherothrombosis has been derived especially from randomized clinical trials (RCTs). Due to their strict inclusion and exclusion criteria, RCTs not always provide an accurate view of the entire spectrum of atherosclerotic clinical syndromes and are not fully representative of the real-world situation. Recently, three important observational clinical studies performed in unselected populations (REACH, PATHOS, SIRIO) have described the demographic characteristics, risk profiles, management and prognosis of a very large cohort of patients suffering from atherothrombosis. AIM OF THE STUDY In this article we focus on the description of the main results of REACH, PATHOS and SIRIO studies and we discuss about their relevance in the daily clinical practice

Is Procalcitonin Really Useful for Diagnosis and Prognosis of COPD Exacerbations Requiring Mechanical Ventilation?

n/