La progressione della malattia renale cronica

La progressione della malattia renale cronica G. Pinna Basso peso alla nascita, numero di nefroni e malattia renale cronica D. Manfellotto, M. Cortinovis, N. Perico, G. Remuzzi Malattia renale in corso di diabete mellito: vecchi e nuovi paradigmi E. Gatti, I. Pellicelli, A. Bovino, D. Fasano, E. Gnappi, L. Zerbini, A. Magnano, S. Pioli, L. Bianchi, A. Caiazza, T.M. Attardo, M. Meschi Il ruolo dell’ipertensione arteriosa nella malattia renale cronica: vittima e colpevole A. De Pascalis, D. Vetrano, A. Tomassetti, S. Bianchi, G. Cianciolo Il ruolo dell’autoimmunità nelle malattie renali M. Giliberti, V. Di Leo, E.D. Stea, A. Mitrotti, L. Gesualdo Transizione dal danno renale acuto alla malattia renale cronica F. Di Mario, M.C. Pacchiarini, E. Fiaccadori Le frontiere del trattamento dell’iperpotassiemia A. Montagnani, M. Caselli, S. Cappell

Position Paper FADOI – SIGG

Il presente documento è stato redatto nell'ambito del progetto di sensibilizzazione sul tema di Fondazione Onda

L'ablazione dei nervi renali: una prospettiva reale nella cura delle ipertensioni resistenti?

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Progetto FADOI “EUCLIDE”. Clinica, comunicazione, telemedicina e governance: le esperienze da COVID-19 per il futuro della Medicina Interna

Introduzione Dario Manfellotto, Francesco Dentali, Andrea Fontanella Materiali e Metodi Dario Manfellotto, Francesco Dentali, Andrea Fontanella Gestione clinica del paziente complesso con patologie cardiovascolari e comorbilità Giuseppe Campagna, Claudia Ferrigno, Franco Mastroianni Gestione clinica del paziente complesso con diabete e comorbilità Ada Maffettone, Ernesto De Menis, Maria Serena Fiore Cura e comunicazione: l’esperienza nella pandemia e le prospettive future Luigi Magnani, Lara Bellardita, Salvatore Lenti Gestione a distanza del paziente complesso: la medicina digitale Filippo Pieralli, Flavio Tangianu, Maria Gabriella Coppola Governance per la Medicina Interna Andrea Montagnani, Roberta Re, Ilario Stefani Considerazioni conclusive Dario Manfellotto, Francesco Dentali, Andrea Fontanell

Further Evidence on the Role of Thyroid Autoimmunity in Women with Recurrent Miscarriage

It has been twenty years since the first paper reporting the association between thyroid antibodies (TAIs) and spontaneous miscarriage was published. Following this observation, several studies have clearly demonstrated an increased prevalence of TAI in patients with recurrent miscarriage (RM). However, the exact mechanism underlying this association remains a matter of debate. The aim of the present study was to evaluate the thyroid function, throughout a specific test, in patient with RM and TAI focusing on the hypothesis that TAI should be an indirect sign of a mild thyroid dysfunction. 46 patients with RM and TAI were included in the study. All patients underwent short TRH stimulation test showing an abnormal response in the vast majority of cases (65%). Normal FT4 and FT3 mean values were found whereas TSH values were in the upper normal range (2.64 ± 1.3 mUI/L). Our data support the hypothesis that in patients with RM the presence of TAI is an indirect sign of a subtle thyroid dysfunction detectable by a specific test. This test give the possibility to identify women with RM in which specific therapeutic approaches could effectively improve the possibility for a successful pregnancy

Low birth weight, nephron number and chronic kidney disease

Chronic kidney diseases have a significant impact on morbidity and mortality worldwide. Low birth weight, fetal growth restriction and prematurity are indicators of fetal growth and development disorders associated with a congenital reduction in nephron number, which predisposes to an increased risk for chronic kidney disease. On an individual basis, a small nephron number at birth is not always enough to determine the onset of chronic kidney disease, but it decreases the ability of the kidneys to resist any insults to renal tissue that may occur later in life, such as exposure to nephrotoxic drugs or episodes of acute kidney injury. The high incidence of low birth weight and preterm birth globally suggests that, at the population level, the impact of alterations in fetal development on the subsequent onset of chronic kidney disease could be significant. The implementation of strategies aimed at reducing the incidence of prematurity, fetal growth restriction, as well as other conditions that lead to low birth weight and a reduced nephron number at birth, provides an opportunity to prevent the development of chronic kidney disease in adulthood. For these purposes the coordinated intervention of several specialists, including obstetricians, gynecologists, neonatologists, nephrologists, and family doctors, is necessary. Such strategies can be particularly useful in resource-poor countries, which are simultaneously burdened by maternal, fetal and child malnutrition; poor health; epidemics caused by communicable diseases; and little access to screening and primary care

Anemia and iron in internal medicine: an Italian survey and a review on iron intravenous therapy in medical patients

In Italy, Internal Medicine Units hospitalize approximately 1,300,000 patients, often elderly and comorbid. The prevalent diagnoses are respiratory diseases, heart failure, or pneumonia. As a matter of fact, anemia is probably underestimated in the compilation of the official discharge forms (SDO) according to ICD-9 diagnostic codes. We promoted a survey among the Members the Italian Scientific Society of Internal Medicine (FADOI) with the aim to investigate the prevalence of anemia and iron deficiency, over than certain aspects related to the therapeutic management of patients with anemia. Furthermore, we performed a review summarizing current evidence for iron intravenous therapy in these patients. According to the survey, anemia is present in around half of the patients hospitalized in Internal Medicine, and about a quarter of them shows iron metabolism alterations. In the evaluation of iron metabolism, the dosage of ferritin is the most requested exam, whereas transferrin saturation is less considered. By focusing on some categories of patients, the awareness of the usefulness of intravenous iron therapy in patients with heart failure seems to be sufficiently common (76% of physicians), while it seems lower (60%) in the management of patients with chronic kidney disease (CKD) and anemia. Finally, more than 75% of the physicians answered that, in their hospital, there are few outpatients' offices or diagnostic pathways dedicated to patients with anemia. Anemia due to absolute or functional iron deficiency is particularly prevalent in Internal Medicine inpatients. For this reason, an accurate evaluation of iron profile and an adequate iron therapy is mandatory in these patients. Recent studies show that, in patients with heart failure, intravenous iron therapy is an effective way of improving patients' health, regardless of the presence of anemia. Similarly, iron therapy results fundamental to optimize erythropoiesis-stimulating agent efficacy in patients with chronic renal failure. In the next future, other therapeutic aspects of intravenous iron therapy will be probably clarified by several interesting ongoing studies focused on these patients

Clinical nutrition in internal medicine: An Italian survey by the scientific societies FADOI and SINPE

Objectives: Patients hospitalized in internal medicine are frequently malnourished or at risk for malnutrition. The aim of this study, conducted by the Federation of Associations of Hospital Internists (FADOI) and the Italian Society of Artificial Nutrition and Metabolism (SINPE) was to assess the nutritional management of internal medicine inpatients in Italy, to identify critical issues and formulate practical proposals to improve nutritional treatment.Methods: From February to April 2021, FADOI and SINPE conducted a national web-based survey, including a 13 multiple-choice item questionnaire related to three key areas:screening and assessment of malnutrition and associated/overlapping sarcopenia and dysphagia;specialist consultations; andmanagement of nutritional support.Results: Responding to the questionnaire were 266 physicians among FADOI members (10.76%). Screening for malnutrition is performed with validated tests, within standardized care pathways, or routinely, only by 22% of participants. Global Leadership Initiative on Malnutrition criteria for diagnosis of malnutrition are little used (20%). Screening for sarcopenia was insufficient as the systematic use of assessment tools (handgrip/chair test) was minimal (3%). Screening for dysphagia is not a routine procedure for at-risk patients according to 33% of participants. Systematic involvement of clinical nutrition services/units in the management of malnourished/sarcopenic patients was reported by only 17% of internists.Conclusions: To overcome the critical issues that emerged from the present study, FADOI and SINPE experts proposed practical solutions to promote the application of the most recent guidelines and to improve awareness and sensitivity to nutritional management in internal medicine real-life settings

Pengaruh Kuat Arus Dan Waktu Pengelasan Pada Proses Las Titik (Spot Welding) Terhadap Kekuatan Tarik Dan Mikrostuktur Hasil Las Dari Baja Fasa Ganda (Feritte-Martensite)

This research was conducted to investigate the appropiate spot welding variable to get the maximum tensile strength. The highest of tensile strength referred as good quality of weldment.The plate was made from low carbon steel with phase ferrite and martensite. The current of welding used 0.9 kA, 1.6 kA, dan 1.85 kA with welding time were 0.25, 0.5 , 0.75 and 1 second. Mechanical properties testing done involved tensile strength to know shear strength of weld joint. Microstructure test used optical microscope.The results show that spot welding with thecurrent of 1.85kA and welding time of 1 second has the highest tensile strength (about 237.04N/mm2). On the other hand, the lowest tensile strength (150 N/mm2) was produced by combination of 0.9 kA and 0.25 second welding time. It was caused by recrystallization phasedeformation on steel

LDL-cholesterol control in the primary prevention of cardiovascular diseases. An expert opinion for clinicians and health professionals

Aims: Although adequate clinical management of patients with hypercholesterolemia without a history of known cardiovascular disease is essential for prevention, these subjects are often disregarded. Furthermore, the scientific literature on primary cardiovascular prevention is not as rich as that on secondary prevention; finally, physicians often lack adequate tools for the effective management of subjects in primary prevention and have to face some unsolved relevant issues. This document aims to discuss and review the evidence available on this topic and provide practical guidance. Data synthesis: Available algorithms and risk charts represent the main tool for the assessment of cardiovascular risk in patients in primary prevention. The accuracy of such an estimate can be substantially improved considering the potential contribution of some additional risk factors (C-reactive protein, lipoprotein(a), family history of cardiovascular disease) and conditions (environmental pollution, sleep quality, socioeconomic status, educational level) whose impact on the cardiovascular risk has been better understood in recent years. The availability of non-invasive procedures to evaluate subclinical atherosclerosis may help to identify subjects needing an earlier intervention. Unveiling the presence of these conditions will improve cardiovascular risk estimation, granting a more appropriate intervention. Conclusions: The accurate assessment of cardiovascular risk in subjects in primary prevention with the use of algorithms and risk charts together with the evaluation of additional factors will allow physicians to approach each patient with personalized strategies, which should translate into an increased adherence to therapy and, as a consequence, a reduced cardiovascular risk