Search Results (220)

Hepatocellular injury syndrome represents a pathological process with a broad etiological spectrum, including viral infections, autoimmune diseases, or intoxications. Clinicians must identify the potential cause using both anamnestic data and available paraclinical examinations. We present the case of a 55-year-old female patient, admitted to the Internal Medicine 1 Department at the Clinical County Emergency Hospital Bihor, Oradea, Romania. The patient exhibited nonspecific complaints and insignificant pathological antecedents, but from a biochemical perspective, substantial changes in liver transaminase levels were evident. To establish differential diagnoses, a series of biochemical and immunological tests were performed, along with a thorough medical history. It was concluded that the patient regularly consumes herbal infusions, specifically Laurus nobilis leaves, commonly known as Bay Laurel. Although this might be easily overlooked at first glance, a closer examination could explain the current clinical picture. In April 2024, a 55-year-old female patient with no history of liver pathology was admitted. She complained of asthenia fatigue, anorexia, mixed dyspeptic symptoms, diffuse abdominal pain, and a weight loss of 12 kg. The pathology had insidiously started approximately 3 months prior. On examination, the patient had altered general status, anorexia, and was overweight. Biochemically, the patient had elevated liver transaminase values (AST = 196 U/L and ALT = 357 U/L) that continued to rise during hospitalization, despite hepatoprotective treatment. Various paraclinical examinations were performed to exclude other potential causes of hepatic aggression, having excluded ordinary causes. Consequently, a liver biopsy was performed, and the histopathological examination leaned toward a toxic hepatitis etiology. Application of the updated RUCAM scale yielded a score of eight points (“probable” HILI—Herb-Induced Liver Injury). Clinical and biochemical improvement was observed after complete cessation of bay leaf tea consumption. This case highlights the potential hepatotoxicity of commonly used culinary herbs when consumed in large quantities or as concentrated infusions and emphasizes the importance of detailed anamnesis regarding herbal product use. Full article

Background/Objectives: Patients with complex chronic disorders constitute a growing share of the general population and are frequently hospitalised for acute care in Internal Medicine Departments. Little is known about long-term rates and predictors of post-discharge mortality, possibly contributing to suboptimal and discontinuous care, including delayed referral to palliative programmes. Methods: To assess the long-term post-discharge mortality of patients admitted to Internal Medicine Departments and its predictors, we analysed a cohort of old, multi-morbid subjects, corresponding to the whole population of patients admitted to an Internal Medicine Department over 12 months (February 2016–March 2017). Public health registries were interrogated to assess the five-year mortality (up to 2022) of patients discharged alive. Results: Post-discharge mortality was 57% at follow-up end, with an early peak rate of 32% at year 1, a 10–14% intermediate rate at years 2–4, and a 7% late rate, approaching expected figures in the general population. Cancer, neurological and liver disorders, and respiratory failure were significantly associated with early and intermediate mortality, while renal disorders, dependence for daily activities, and immunodepression were selectively relevant for death in the first year. Cardiovascular and upper gastrointestinal disorders were associated with late mortality. Surrogate measures of frailty, intensity of care, and patient complexity were also able to predict early-, intermediate-, and late-mortality risk. Conclusions: A relevant fraction of patients hospitalised in Internal Medicine Departments might require palliative care. Dissecting the differential contribution of clinical and healthcare-associated variables for short, medium-, and long-term mortality might facilitate patient management and identify subjects in need of early or simultaneous palliative care. Full article

Background and Objectives: The growing number of patients seeking medical care in the internal medicine departments over the past decades has been accompanied by an increase in the bed occupancy rate. This is associated with a heavier work burden among the professional staff members, which may lead to a lower quality of care. Therefore, this study aimed to evaluate the association between the bed occupancy rate and staff compliance with hand hygiene regulations. Materials and Methods: This ecological study included 9 internal medicine departments (~300 beds) in a single medical center between 01/2017 and 12/2019. Routine hand hygiene performance was evaluated randomly, and the association between the bed occupancy rate and the staff’s compliance with the hospital regulations was studied. Univariate and multivariable analyses were performed by the generalized estimating equation model. Results: The study included 12,736 episodes that warranted hand hygiene practices (“opportunities”). The overall hand hygiene performance rate was 78.3% (physicians 76.2%, nurses 80.7%, and healthcare assistants 76.9%). There was an approximately 2% decline in staff compliance for each 10% increase in bed occupancy rate (adjusted IRR 0.98, 95%CI 0.97–0.99, p < 0.001). Stratification by staff members showed a significant decline in routine hand hygiene practices among physicians (adjusted IRR 0.97, 95%CI 0.95–0.99, p < 0.001) and healthcare assistants (adjusted IRR 0.97, 95%CI 0.96–0.99, p < 0.001) but not among nurses (adjusted IRR 0.99, 95%CI 0.98–1.01, p = 0.392). Conclusions: An increase in bed occupancy rate is associated with a decrease in the hospital staff’s compliance with hand hygiene and therefore may lead to a lower quality of care. Full article

Background: Heart failure (HF) patients with a ‘reduced’ ejection fraction (HFrEF) have several proven treatment options, but for those with a ‘preserved’ ejection fraction (HFpEF) there are very few. However, recent trials such as the EMPEROR-Preserved and DELIVER have shown that sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly reduce HF hospitalization in HFpEF patients, and these are now supported by both Australian and international guidelines. Methods: We undertook a narrative review using a structured multi-database search (MEDLINE, Embase, CINAHL, Scopus) and key Australian sources (AIHW, ABS, Department of Health and Aged Care) without geographic or publication-year restrictions. Results: In Australia there were approximately 179,000 hospitalizations in 2020–2021 due to HF equating to a rate of 697 per 100,000 population. The age-standardized hospitalization rate for HF in remote and very remote areas was 1.8 times higher than in major cities. Likewise, since 2000 the prevalence of diabetes has nearly tripled, from 460,000 to 1.3 million. In remote areas, there were 47,600 diabetes hospitalizations in 2021–2022, with residents being 2.5 times more likely to be hospitalized for diabetes compared to those in major cities. Conclusions: In rural Australia, reducing preventable hospitalizations and premature mortality from heart failure and type 2 diabetes requires a stronger rural generalist and general practitioner workforce, improved access to essential medicines and telehealth, and equity-focused evaluation. Full article

Adverse effects of chemotherapeutic agents remain a significant clinical challenge in the management of gastric cancer. Across the literature, discussions of chemotherapy consistently document a range of toxicities, underscoring that even when treatment halts disease progression, it can leave substantial clinical sequelae. Chemotherapy can impact virtually every organ system, producing multiorgan toxicity with meaningful implications for patient quality of life and treatment feasibility. When initiating a new chemotherapy regimen, prior lack of therapeutic benefit is often associated with difficult recovery or inability to tolerate subsequent chemotherapy, thereby constraining future therapeutic options. Given these considerations and the current absence of universally personalized treatment, a multidisciplinary team—comprising a medical oncologist, gastroenterologist, and internist—is essential to the planning and execution of chemotherapy regimens. We recommend that these chemotherapy regimens be administered within internal medicine departments, in collaboration with the medical oncologist and gastroenterologist, because in many cases the adverse effects outweigh the potential benefits of chemotherapy. Full article

Background: Glycated hemoglobin (HbA1c) is a parameter commonly used in clinical practice to assess glycemic control in patients with diagnosed diabetes. Hyperglycemia is a strong risk factor for developing cardiovascular (CV) disease. Although there is some evidence that this parameter could also help assess CV health in patients without known carbohydrate metabolism disorders, this is not entirely clear. The purpose of this study was to investigate the relationship between HbA1c and selected echocardiographic parameters in patients without diabetes. Methods: This study was a retrospective analysis of data from 59 patients (females: 72.88%) with a mean age of 54.82 ± 17.34 years without any features of acute illness or exacerbation of chronic diseases hospitalized in the Department of Internal Medicine, Angiology and Physical Medicine of the Medical University of Silesia in Katowice (Poland) in the period between June 2022 and May 2024. Only individuals with HbA1c levels and who have undergone transthoracic echocardiography were included in the analysis. Spearman’s rank correlation test was used for statistical analysis, and a multivariate analysis model was then constructed (adjusted for age, sex, body mass index, low-density lipoprotein cholesterol, systolic blood pressure, hypertension, and smoking). Results: In univariate analysis, HbA1c was found to be significantly correlated with selected parameters relating to left ventricular dimensions and mass, left atrial dimensions, right ventricular systolic function, mitral inflow profile parameters, and tissue Doppler echocardiography. Multivariate analysis did not confirm a significant association between HbA1c and the assessed echocardiographic parameters. Conclusions: Although HbA1c significantly correlates with some echocardiographic parameters, the observed relationships are entirely explained by confounding variables. Full article

Objectives: Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of vasculitides sharing a common pathophysiology, which affects small and medium blood vessels. Sinonasal involvement is one of the most common manifestations of AAV. The goal of this study was to find the most suitable method to assess paranasal sinus changes in a group of patients with ANCA-associated vasculitis and renal involvement. Subjective scales like Lund–Mackay and Zinreich were compared with a three-dimensional (3D) volumetric method. Pre- and post-treatment computer tomography were compared. Methods: Computer tomography, nasal symptoms, and endoscopy of 28 patients hospitalized at the Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine—National Research Institute were assessed retrospectively. Paranasal sinus tomography was performed during treatment induction and after achieving disease remission (BVAS = 0) to assess treatment effectiveness. Radiological analysis was performed with the Lund–Mackay scoring system, Zinreich scoring system, and 3D volumetric scoring system with the usage of Slicer 3D analysis. The radiologic scoring systems were compared. Results: The statistically significant differences in treatment effectiveness were observed for the Zinreich scale on both the right and left side. Similar to the 3D volumetric scoring system, the right and left maxillary sinuses demonstrated statistically significant differences. On the other hand, no statistically significant differences were found between the first and second visits for the Lund–Mackay or total Global Osteitis scores on either side. The strongest correlation was achieved between the Zinreich scoring system and 3D volumetric scale. Conclusions: The three-dimensional CT volumetric analysis demonstrated higher SRM (standardized response mean) values than the Zinreich score on both sides, but the differences were not statistically significant. The Zinreich scoring system should be used instead of the Lund–Mackay scale in everyday clinical practice. Full article

Background/Objectives: The Developing and Evaluating a Machine Learning Opioid Prediction & Risk-Stratification E-Platform (DEMONSTRATE) trial aims to assess the usability, acceptability, feasibility, and effectiveness of implementing a machine learning (ML)-based clinical decision support (CDS) tool—the Overdose Prevention Alert—which predicts a patient’s risk of opioid overdose within three months. Methods: This single-arm study uses a pre–post implementation design with mixed-methods evaluation in 13 University of Florida Health, Gainesville, internal medicine and family medicine clinics. Eligible patients are aged ≥18 years, received an opioid prescription within the year prior to their upcoming primary care visit, are not receiving hospice care, do not have a malignant cancer diagnosis, and are identified by the ML algorithm as high risk for overdose. The Overdose Prevention Alert triggers when a primary care provider (PCP) signs an opioid order in electronic health records. We will evaluate effectiveness by comparing pre- and post-implementation outcomes using a composite patient-level measure defined by the presence of any of the following 6 favorable indicators: (1) evidence of naloxone access; (2) absence of opioid overdose diagnoses and naloxone administration; (3) absence of emergency department (ED) visits or hospitalizations due to opioid overdose or opioid use disorder (OUD); (4) absence of overlapping opioid and benzodiazepine use within a 7-day window; (5) absence of opioid use ≥50 morphine milligram equivalent daily average; (6) receipt of referrals to non-pharmacological pain management. Additional quantitative metrics will include alert penetration, usage patterns, and clinical actions taken. Usability and acceptability will be assessed using a 12-item questionnaire for PCPs and semi-structured interviews. Expected Results: The trial will provide insights into real-world ML-driven CDS implementation and inform future strategies to reduce opioid-related harm. Full article

Background: Hereditary hemorrhagic telangiectasia (HHT) is an inherited vascular bleeding disorder. The most common symptoms are recurrent, severe nosebleeds that occasionally necessitate intervention by an ENT (Ear, Nose, and Throat) specialist, as well as iron-deficiency anemia. Telangiectasia is typically located in the nasal cavity, lips, tongue, fingertips, and the gastrointestinal mucosa. Arteriovenous malformations (AVMs) are located in internal organs (brain, lungs, liver, etc.). The family history is positive for HHT. The diagnosis is based on the Curacao criteria. The endoglin and activin receptor-like kinase 1 genes (ENG and ACVRL1) are the most common mutation sites, leading to elevated endothelial growth factor (VEGF) levels. Methods: We conducted a retrospective analysis in the Department of Internal Medicine, Division of Hematology, and Center of Expertise for Rare Diseases at the University of Debrecen, spanning the period from 2010 to 2025. Records of patients referred with HHT were reviewed concerning demographic data, clinical presentations, laboratory findings, and treatment approaches. To evaluate management options, epistaxis severity was assessed using the Epistaxis Severity Score (ESS). Results: 48 HHT patients (21 male and 27 female) were included in this retrospective study. Genetic testing was positive in each case, showing mutations in the ENG (HHT1 subgroup) or ACVRL1 (HHT2 subgroup) genes. Most of the patients are followed-up with in our department. ESS was calculated at baseline and 6 months after antiangiogenic treatment by two independent physicians. Detailed computed tomography (CT) was performed in all patients. Seven patients were administered desmopressin, a synthetic analog of antidiuretic hormone (ADH), based on our previous experience in reducing bleeding in von Willebrand disease. Antiangiogenic therapy with thalidomide (50 mg oral tablets) was used in 24 patients, while bevacizumab was administered to 5 patients. Most patients experienced a remarkable decrease in epistaxis severity and a reduction in the need for transfusions (ESS before treatment: HHT1 patients, 4.15 ± 1.91 vs. ESS after treatment, 2.62 ± 0.99; HHT2 patients, 3.79 ± 3.19 vs. 2.02 ± 1.91). Subgroup analysis using paired ESS data showed a significant reduction in ESS in both HHT1 and HHT2 patients (p = 0.003 and p = 0.043, respectively). Bevacizumab further reduced the ESS, but the few cases were not suitable for statistical analysis. Serum iron levels significantly increased after antiangiogenic treatment in the HHT2 group (p = 0.01). Conclusions: HHT is a rare vascular bleeding disorder. Daily nosebleeds impair the patients’ quality of life and sometimes lead to severe transfusion-dependent iron-deficient anemia. Frequent hospitalization places a significant burden on the healthcare system. Thus, we have used treatment options for HHT patients that primarily act by inhibiting VEGF, and these treatment modalities have yielded successful results in our hands. Full article

Background/Objectives: Timely diagnosis of infective endocarditis (IE) remains a significant challenge, and IE poses significant morbidity and mortality. Modified Duke criteria (MDC) are used for the clinical evaluation and diagnosis of IE, but their current use is dichotomous. There are no studies that associate the amount of positive MDC with the patient’s outcome. This study intends to analyze whether the amount of MDC on initial presentation can be used for prognostic assumptions. Methods: We conducted a retrospective data analysis on patients with confirmed and suspected IE who were treated at the Department of Internal Medicine II at Ulm University Heart Center from December 2009 to December 2019. Univariable and multivariable logistic regression models were used to find correlations between 90-day mortality and the number of MDC. Results: 130 patients with confirmed IE were included in the analysis. Less minor MDC (OR 1.718; 95%-CI 1.096–3.268; p = 0.022) and a history of coronary artery disease (OR 4.711; 95%-CI 1.791–12.393; p = 0.002) were independently associated with higher 90-day mortality in patients with ultimately confirmed IE. Fewer minor MDC on presentation were associated with later diagnosis (b 2.341; 95%-CI 0.312–4.370; p = 0.024) and antibiotic therapy (b 2.953; 95%-CI 0.82–5.084; p = 0.007) for IE. Conclusions: Early diagnosis of IE is essential for favorable outcomes. Fewer minor MDC on initial presentation may lead to delayed diagnosis, antibiosis, and worse outcomes. Full article

Background: Antimicrobial Resistance (AMR) and the emergence of multidrug-resistant organisms (MDROs) represent major public health threats. Although traditionally linked to hospital-acquired infections (HAIs), MDROs are becoming gradually more prevalent in community-onset infections. Objectives: The objective of this study is to identify major risk factors associated with community-onset MDRO infections among patients admitted to the hospital. Methods: This is a retrospective study of patients admitted to the Internal Medicine Departments of the University General Hospital of Ioannina from July 2022 to August 2023 and had a microbiologically confirmed infection. Patients with HAIs were excluded. Data were extracted from both electronic and paper-based medical records and included variables such as demographics, baseline comorbidities, previous antibiotic use, previous hospitalizations, the type of MDRO and infection, and clinical outcomes. Statistical analysis included descriptive statistics, univariate analyses, and subsequently multiple binary regression models. Each regression model was adjusted for age and sex. Results: Our cohort included 125 participants with a mean age of 77.9 years, with the majority (58.4%) being female. The overall prevalence of MDRO infections was 43.2% (54/125). Notably, the presence of a permanent urinary catheter was associated with a nearly fourfold increase in the risk of community-onset MDRO infections (OR = 3.69; 95% CI: 1.35–10.05; p = 0.011), while prior hospitalization (OR = 3.33; 95% CI: 1.48–7.51; p = 0.004), the Charlson index score (OR = 3.08; 95% Cl: 1.1–8.68; p = 0.033) and previous antibiotic use (OR = 2.18; 95% CI: 0.98–4.84; p = 0.057) were also significant potential risk factors. Conclusions: The identification of key risk factors associated with community-onset MDRO infections in patients admitted to the hospital can assist clinicians in early stratification and rational selection of initial empirical antimicrobial treatment, support antimicrobial stewardship programs, promote targeted public health interventions, and encourage more judicious antibiotic use. Full article

Background: Nutritional therapy improves prognosis by reducing morbidity and mortality in malnourished hospitalised patients. To determine the occurrence of hospital malnutrition, it is essential to verify healthcare organisations’ ability to identify at-risk patients, considering that malnutrition is often hard to recognise without adequate screening. Methods: The aim of this study is to analyse the temporal evolution in hospitalised patients’ malnutrition, documented as diagnosis discharge letters, over an 11-year period (2014–2024) in four acute care hospitals, with a combined mean of 38,000 inpatients per year. Binomial regression and interrupted time series analysis were used to evaluate temporal evolution in the identification of malnutrition, particularly in relation to the introduction of a nutritional service in 2017. Results: Malnutrition diagnoses increased steadily across hospitals and within internal medicine and surgery departments. Interrupted time series analysis showed a significant rise in diagnostic odds post-intervention, especially in internal medicine. A plateau was observed in the last 3 years, with a mean prevalence of malnutrition of 18.2% for internal medicine (95% CI: 13.6–22.9) and 4.1% for surgery (95% CI: 0.5–7.6). Without the nutritional service, these results likely only would have been reached by 2031 in internal medicine and 2024 in surgery, suggesting an advancement of about eight years in medical wards. Conclusions: The introduction of a nutritional team has probably accelerated and improved the ability to quickly identify and therefore treat malnourished inpatients. Full article

Background: Sleep bruxism (SB), a sleep behavior, is one of the most common sleep pathologies. Tenascin-C (TnC) and thrombospondin-1 (TSP-1) are involved in the pathogenesis of cardiovascular disease. The aim of our study was to assess the relationship between SB and TSP-1 and TnC. Methods: A total of 80 participants, who were hospitalized in the Sleep Laboratory of the Department of Internal Medicine, Occupational Diseases, Hypertension, and Clinical Oncology at Wroclaw Medical University, were enrolled in the study. Polysomnographic examination was conducted following the standard sleep evaluation criteria set by the American Academy of Sleep Medicine, utilizing the Nox-A1 device. Serum TnC and TSP-1 concentrations were determined using Elisa Kits. Results: The study showed an increased concentration of TnC in the group of patients with a BEI (bruxism episode index) >10.3, compared to <10.3 (6786.79 ± 5655.62 vs. 1585.16 ± 2526.56). In regression analysis, higher values of phasic bruxism, smoking, and older age were independently associated with increased concentrations of TnC in the serum. Moreover, higher values of tonic bruxism, as well as smoking, were independently associated with TSP-1. Conclusions: Since tenascin-C and thrombospondin-1 levels are associated with sleep bruxism, atherosclerosis may be a potential consequence of SB. This relationship is especially noticeable in severe bruxism. Therefore, monitoring for clinical signs of atherosclerosis should be considered in patients with severe bruxism. Full article

Background: Periodontitis is linked to a range of systemic non-communicable diseases, including hepatic diseases. The aim of this study was to investigate whether periodontal health status is associated with liver cirrhosis (LC). Methods: Patients were recruited from the Department of Internal Medicine at the University Clinical Hospital “Sestre Milosrdnice” and categorized into two groups. The case group comprised patients with LC, while age-matched individuals without LC served as controls. Systemic health status was evaluated through laboratory tests, medical history, and clinical parameters, and the Model for End-Stage Liver Disease (MELD) score was calculated for each participant. A comprehensive clinical periodontal assessment was conducted, measuring bleeding on probing (BoP), probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), and the Periodontal Inflamed Surface Area (PISA) score. Stepwise logistic regression was employed to assess possible predictors of LC, including periodontal status. Results: A total of 100 patients were included in the analysis, consisting of 50 cases with LC and 50 controls. The mean age was 56.79 years (SD = 11.16) of participants, and 58% were male. The majority of LC cases were attributed to alcohol abuse (41/50, 82%), and the median MELD score was 16 (IQR 6–33). Comparison of the two groups revealed significantly worse clinical periodontal parameters in the LC group and a higher prevalence of periodontitis (p = 0.012). Among the 50 LC patients, 46 (92%) exhibited severe forms of periodontitis (stages III and IV). Logistic regression analysis identified alcohol consumption and the PISA score as independent predictors of LC (OR = 23.81, 95% CI 4.48–126.47, p < 0.001; OR = 1.006, 95% CI 1.003–1.01, p < 0.001, respectively). Conclusions: Within the limits of the present study, the higher prevalence of periodontal disease in the LC group suggests an association between LC and periodontitis. Full article

Background: Obstructive sleep apnea (OSA) is prevalent and often underdiagnosed, linking to cardiovascular disease, type 2 diabetes mellitus (T2DM), dyslipidemia, and cognitive decline. Coexistence with T2DM worsens patient outcomes. Positive airway pressure (PAP) therapy has demonstrated benefits in improving metabolic parameters and reducing comorbidities. Methods: This study examined the association between OSA and T2DM, focusing on therapy adherence. Overall, 73 patients from the pulmonology department, with diagnosed OSA and T2DM or prediabetes (PD) were compared to 72 OSA patients without diabetes. All underwent cardio-respiratory polygraphy. Data on demographics, comorbidities, and adherence were collected to evaluate disease severity and compliance. Results: Only 24% of patients were referred from cardiology or internal medicine. The STOP-BANG questionnaire accurately identified 83.4% of cases. Of the study group, 65.75% had T2DM, 34.2% had PD, and 16.5% received new diagnoses. T2DM patients had the highest BMI (40.19 kg/m²). Smoking prevalence exceeded European averages. These patients experienced more severe OSA and multiple comorbidities. PAP adherence increased from 73% to 86% after full financial coverage. Conclusions: Polygraphy remains an effective diagnostic tool. Patients with T2DM tend to have more severe OSA and comorbidities, underscoring the importance of early screening and increased awareness to improve management and outcomes. Full article