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

A new series on diagnostic echographic cases and living brief reviews: a potentially useful tool for clinicians edited by FADOI

Sonography – similar to what happened almost two centuries ago with the introduction of stethoscopes – has completely changed patients’ clinical management in Internal Medicine. The availability of performant, sometimes even small-sized and cost-effective machines, has allowed doctors in Internal-Medicine units to perform bedside-ultrasound examinations alongside regular clinical ones. [...

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

Emergence of SARS-COV-2 Spike Protein Escape Mutation Q493R after Treatment for COVID-19

7noWe report in vivo selection of a severe acute respiratory syndrome coronavirus 2 spike mutation (Q493R) conferring simultaneous resistance to bamlanivimab and etesivimab. This mutation was isolated from a patient who had coronavirus disease and was treated with these drugs.openopenFocosi, Daniele; Novazzi, Federica; Genoni, Angelo; Dentali, Francesco; Gasperina, Daniela Dalla; Baj, Andreina; Maggi, FabrizioFocosi, Daniele; Novazzi, Federica; Genoni, Angelo; Dentali, Francesco; Gasperina, Daniela Dalla; Baj, Andreina; Maggi, Fabrizi

Lipid profile changes in patients with rheumatic diseases receiving a treatment with TNF-α blockers: a meta-analysis of prospective studies.

Some studies showed an anti-atherogenic effect of TNF-α blockers on lipid profile, but these data have been challenged.To perform a meta-analysis on lipid profile changes induced by TNF-α blocker treatment.Prospective studies on rheumatic patients receiving TNF-α blockers and providing before-and-after treatment values of triglycerides (TGs), total cholesterol (TC), HDL-cholesterol (HDLc), LDL-cholesterol (LDLc), and atherogenic index (AI) were included. Standardized mean differences (SMD) in lipid profile were analyzed at short-term (2-12 weeks), middle-term (13-24 weeks), and long-term (25-52 weeks) assessments.Thirty articles (1707 patients) were included. TNF-α blockers determined an increase in TC at short-term, middle-term, and long-term assessments (SMD: 0.20 mmol/L [95% CI: 0.04, 0.35]; SMD: 0.27 mmol/L [95% CI: 0.08, 0.46]; SMD: 0.22 mmol/L [95% CI: 0.01, 0.43]). HDLc increased only at the short-term assessment (SMD: 0.19 mmol/L [95% CI: 0.10, 0.28]), and TGs achieved a significant increase at the long-term assessment (SMD: 0.19 mmol/L [95% CI: 0.04, 0.34]). LDLc and AI were not affected by TNF-α blocker treatment.Slight but significant increases in TC occurred without any significant change in LDLc and AI. Changes in HDLc and TGs were not consistent among the different time point assessments. These quantitative changes in lipid profile do not seem to be able to explain cardiovascular risk improvement reported in patients receiving TNF-α blockers. Further studies on other mechanisms are needed to address this issue

COVID-19 Detection from Mass Spectra of Exhaled Breath

According to the World Health Organization, the SARS-CoV-2 virus generated a global emergency between 2020 and 2023 resulting in about 7 million deaths out of more than 750 million individuals diagnosed with COVID-19. During these years, polymerase-chain-reaction and antigen testing played a prominent role in disease control. In this study, we propose a fast and non-invasive detection system exploiting a proprietary mass spectrometer to measure ions in exhaled breath. We demonstrated that infected individuals, even if asymptomatic, exhibit characteristics in the air expelled from the lungs that can be detected by a nanotech-based technology and then recognized by soft-computing algorithms. A clinical trial was ran on about 300 patients: the mass spectra in the 10-351 mass-to-charge range were measured, suitably pre-processed, and analyzed by different classification models; eventually, the system shown an accuracy of 95% and a recall of 94% in identifying cases of COVID-19. With performances comparable to traditional methodologies, the proposed system could play a significant role in both routine examination for common diseases and emergency response for new epidemics.Comment: 15 page

Outcome during and after anticoagulant therapy in cancer patients with incidentally found pulmonary embolism

Publisher Copyright: Copyright © 2016 ERS.Current guidelines suggest treating cancer patients with incidental pulmonary embolism comparably to patients with symptomatic pulmonary embolism. We used the Registro Informatizado de Enfermedad TromboEmbólica (RIETE) registry to compare the rate of major bleeding and symptomatic pulmonary embolism during the course of anticoagulation and after its discontinuation in cancer patients with incidental pulmonary embolism. As of March 2016, 715 cancer patients with incidental pulmonary embolism had been enrolled in RIETE. During the course of anticoagulant therapy (mean 235 days), the rate of major bleeding was higher than the rate of symptomatic pulmonary embolism (10.1 (95% CI 7.48-13.4) versus 3.17 (95% CI 1.80-5.19) events per 100 patient-years, respectively), and the rate of fatal bleeding was higher than the rate of fatal pulmonary embolism (2.66 (95% CI 1.44-4.52) versus 0.66 (95% CI 0.17-1.81) deaths per 100 patient-years, respectively). After discontinuing anticoagulation (mean follow-up 117 days), the rate of major bleeding was lower than the rate of symptomatic pulmonary embolism (3.00 (95% CI 1.10-6.65) versus 8.37 (95% CI 4.76-13.7) events per 100 patient-years, respectively); however, there were no differences in the rate of fatal events at one death each. The risk/benefit ratio of anticoagulant therapy in cancer patients with incidental pulmonary embolism is uncertain and must be evaluated in further studies.publishersversionPeer reviewe

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

Rivaroxaban Monotherapy in Patients with Pulmonary Embolism: Off-Label vs. Labeled Therapy

Oral anticoagulants; Rivaroxaban; Venpus thromboembolismAnticoagulantes orales; Rivaroxaban; Tromboembolismo de venpusAnticoagulants orals; Rivaroxaban; Tromboembolisme de venpusBackground: The use of rivaroxaban in clinical practice often deviates from manufacturer prescribing information. No studies have demonstrated an association between this practice and improved outcomes. Methods: We used the RIETE registry to assess the clinical characteristics of patients with pulmonary embolism (PE) who received off-label rivaroxaban, and to compare their 3-month outcomes with those receiving the labeled therapy. The patients were classified into four subgroups: (1) labeled therapy; (2) delayed start; (3) low doses and (4) both conditions. Results: From May 2013 to May 2022, 2490 patients with PE received rivaroxaban: labeled therapy—1485 (58.6%); delayed start—808 (32.5%); low doses—143 (5.7%); both conditions—54 (2.2%). Patients with a delayed start were more likely to present with syncope, hypotension, raised troponin levels and more severe abnormalities on the echocardiogram than those on labeled therapy. Patients receiving low doses were most likely to have cancer, recent bleeding, anemia, thrombocytopenia or renal insufficiency. During the first 3 months, 3 patients developed PE recurrence, 4 had deep-vein thrombosis, 11 had major bleeding and 16 died. The rates of major bleeding (11 vs. 0; p < 0.001) or death (15 vs. 1; OR: 22.5; 95% CI: 2.97–170.5) were higher in patients receiving off-label rivaroxaban than in those on labeled therapy, with no differences in VTE recurrence (OR: 1.11; 95% CI: 0.25–6.57). Conclusions: In patients with severe PE, the start of rivaroxaban administration was often delayed. In those at increased risk for bleeding, it was often prescribed at low doses. Both subgroups had a worse outcome than those on labeled rivaroxaban