Internal and Emergency Medicine最新文献

Preoperative anemia, transfusions, and simple hematological parameters like red blood cell distribution width (RDW) have been associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI), with some heterogeneity of results. Hemoglobin (Hb) levels are physiologically different in males and females, and sex differences are increasingly recognized to play an important role in the prognosis of many cardiovascular diseases, including aortic valve stenosis. We aimed to evaluate the prognostic role of preoperative anemia, RDW, and periprocedural transfusions in TAVI patients followed up to 2 years, especially focusing on sex-related differences. 609 patients (median age 83 years, 53.9% females) undergoing TAVI at Verona University Hospital between March 2010 and June 2019 were retrospectively evaluated. Anemia before TAVI was highly prevalent (55.0%) in our population, mostly mild to moderate. Females were less anemic than males (48.8% versus 62.3%, p = 0.001) but experienced more vascular complications and were more frequently transfused within 30 days of the procedure (43.3% versus 28.8%, p < 0.001). Overall, anemic patients at baseline had a 2-year survival lower than non-anemic patients (Log-rank 5.915, p = 0.015). Similarly, patients with baseline RDW > 15% had reduced survival at 2 years compared to patients with normal RDW (Log-rank 14.038, p < 0.001). Grouping for sex, these differences only persisted in males. Multivariable analyses showed that hematological variables, such as periprocedural transfusions and RDW, were significant predictors of 2-year mortality in males but not in females. Our study highlights significant sex-related differences in the role of hematological parameters as independent predictors of 2-year mortality after TAVI.

To construct a nomogram risk prediction model for disorders associated with sepsis comorbid with chronic obstructive pulmonary disease (COPD) and to test the calibration and discrimination of the model. Patients with sepsis and COPD in the MIMIC-III database were divided into a model group and a validation group. Certain risk factors of high importance were obtained via univariate and multivariate logistic regression analysis in each group. These risk factors of clinical importance were selected for constructing the 30-day mortality prediction nomogram for the population. 1077 sepsis patients with COPD were extracted from the MIMIC-III database and then retrospectively analyzed. Six independent risk factors for critical illness (age, MAP, respiratory rate, SAPS-II score, INR, and BUN) could be obtained from optimal subset regression analysis. The optimal subset regression coefficients for the 6 factors were 1.03 and P < 0.05; 0.98 and P < 0.05; 1.09 and P < 0.05; 1.03 and P < 0.05; 1.20 and P < 0.01; and 1.01 and P < 0.05, respectively. In the model cohort, the AUC was 0.742 (95% CI 0.704-0.780), and in the validation cohort, the AUC was 0.758 (95% CI 0.676-0.840). The internal and external calibration curves basically overlapped with the standard curve, which meant that the model was good at calibration. The nomogram had good discriminating ability and calibration, which is important for providing a reliable prediction of patients with sepsis and COPD and provides a basis for clinical decisions and timely diagnosis and treatment.

Retroperitoneal fibrosis (RPF) is usually idiopathic, although secondary forms also occur. To assess the clinical features, laboratory parameters, imaging findings, and treatment modalities in patients with RPF. Patients diagnosed with RPF at a tertiary care center between 2000 and 2024 were included. For the literature review, PubMed was searched to identify retrospective studies including more than 45 patients with RPF published in the past ten years. Twenty-six patients (11 females) with RPF were identified. The mean age at diagnosis was 59.7 ± 12.4 years. Seventeen patients had idiopathic RPF. In the remaining nine patients, RPF was secondary to: malignancy (19%), radiotherapy (8%), acute pancreatitis (4%), and IgG4-related disease (4%). Fifty percent were current or former smokers. Abdominal pain (65%) and low back pain (42%) were the most frequent symptoms. Elevated acute-phase reactants were observed in 75% of patients, and renal function deterioration in 40%. In the literature review, nine retrospective series with sample sizes > 45 patients were selected. The diagnosis of RPF was made by ultrasound (61%), CT (92%), MRI (8%), and PET/CT (23%). The most frequent pattern of involvement was periaortic-periiliac (50%) and hydronephrosis (50%). Glucocorticoids were the most frequently used medical therapy (69%). The most frequent interventional procedure was ureteral stenting (38%). RPF may be idiopathic or secondary to other etiologies. Abdominal and low back pain are common clinical features. Glucocorticoids remain the most frequently used medical treatment, and ureteral stenting is the most commonly used interventional procedure.

Prehospital emergency medical services (EMS) workers frequently face violence due to uncontrolled work environments, which may lead to burnout. This study aimed to examine workplace violence among paramedics and emergency medical technicians (EMTs) in Türkiye's prehospital EMS by analyzing its individual and occupational predictors, contextual features, and association with burnout subdimensions. This descriptive, cross-sectional survey was conducted between July and August 2024 among 1,013 paramedics and EMTs working in prehospital EMS across Türkiye. Verbal, physical, and sexual violence were assessed using the workplace violence questionnaire, and burnout was evaluated via the Maslach Burnout Inventory-human services survey. Of the participants, 64.4% (n = 652) were paramedics and 35.6% (n = 361) were EMTs. In the past 12 months, 85.5% (n = 866) of prehospital EMS workers experienced verbal violence, 26.5% (n = 268) experienced physical violence, and 12.5% (n = 127) experienced sexual violence at least once. Logistic regression analysis identified younger age, district-level work, and a higher number of monthly missions as significant predictors of workplace violence. Female participants and those with higher education levels had lower odds of physical and sexual violence, whereas low income increased the risk. Burnout levels among workers were moderate. Verbal, physical, and sexual violence increased emotional exhaustion and depersonalization, while verbal violence alone reduced personal accomplishment. Paramedics and EMTs working in chaotic, high-risk environments frequently face verbal, physical, and sexual violence from patients, relatives, and colleagues. Such violence has severe physical and psychological effects, heightening burnout levels. Protective security measures and social campaigns are essential to address this critical issue.

Myocardial injury following Viperidae snake envenomation significantly worsens clinical outcomes and healthcare burden, yet its early diagnostic predictors remain understudied. In this prospective cohort study from Chongqing, China, we analyzed 75 Viperidae-envenomed patients and 78 healthy controls within 24 h post-bite, assessing electrocardiographic abnormalities, cardiac biomarkers (high-sensitivity cardiac troponin I, creatine kinase), inflammatory markers (C-reactive protein), and echocardiographic right ventricular strain parameters. Results demonstrated a 14.7% incidence of myocardial injury, with 24.0% of patients exhibiting ECG abnormalities, alongside significant elevations in cardiac biomarkers and inflammatory markers (P < 0.05). The absolute values of Right Ventricular Free-wall Strain (RVFWS) and Global Longitudinal Strain (RVGLS) were significantly reduced in envenomed patients, especially in those with concomitant myocardial injury (P < 0.001). Both parameters demonstrated high diagnostic performance: RVFWS-area under the ROC curve 0.846 (95% CI 0.742-0.950); RVGLS-area under the ROC curve 0.825 (95% CI 0.700-0.950). Delayed hospitalization (> 1 h post-bite) independently predicted myocardial injury risk (OR = 1.178, P < 0.05), highlighting the critical need for rapid intervention. These findings identify RVFWS and RVGLS as sensitive early diagnostic markers for cardiac complications and underscore the importance of timely hospitalization to mitigate myocardial injury.

Familial Mediterranean Fever (FMF) is the most common hereditary monogenic autoinflammatory syndrome, with disease activity potentially influenced by aging. This study aimed to evaluate the clinical features, genetic background, treatment patterns, and disease course of FMF in older patients. This retrospective observational cohort study included 343 FMF patients aged 50 years or older. Demographic data, MEFV mutations, attack characteristics, and treatments were analyzed. Attack frequency and visual analog scale (VAS) scores were compared across three time points: before colchicine treatment, after treatment, and in the past year. Patients were stratified by recent attack status, and multivariate logistic regression was used to identify independent predictors of attack activity. The median number of attacks per year decreased from 12 (IQR: 4-24) before treatment to 1 (IQR: 0-4) after treatment, and 0 (IQR: 0-3) in the past year (p < 0.001). Patients with attacks in the past year had higher current and maximum colchicine doses (p = 0.002 and p = 0.02), while those without recent attacks were significantly older (p = 0.005). Multivariate analysis showed that age ≥ 60 years remained associated with a lower likelihood of attacks (OR = 0.60, 95% CI: 0.37-0.98, p = 0.042), as was male sex (p = 0.003). Attack frequency and colchicine requirements were lower in older FMF patients, suggesting milder disease activity in older individuals. These findings highlight the need for additional research into aging-related mechanisms in FMF and may help guide treatment strategies for older patients.

Tobacco harm reduction strategies aim to reduce the devastating health burden of smoking by providing lower-risk alternatives to those unable or unwilling to quit combustible cigarettes. Nicotine pouches have recently emerged as a novel, tobacco-free oral product category, evolving from the concept of Swedish snus but eliminating the tobacco leaf entirely. This narrative review assesses the current scientific evidence regarding the chemical composition, toxicological profile, nicotine delivery and smoking cessation efficacy, and potential public health impact of nicotine pouches. Chemical analyses and biomarker studies consistently demonstrate that these products occupy the lowest end of the toxicant risk continuum, with harmful constituents such as tobacco-specific nitrosamines being largely undetectable or present at negligible levels compared to snus and combustible cigarettes. Consequently, smokers who switch to nicotine pouches experience reductions in toxicant exposure comparable to complete smoking cessation. While specific long-term epidemiological data are currently unavailable, the extensive evidence on Swedish snus, which has not been linked to lung cancer or significant cardiovascular disease, provides a compelling "bridging" argument for the safety of these tobacco-free derivatives. Still, product-specific research and epidemiological surveillance is needed to confirm their long-term safety/risk profile, and healthcare professionals should consider recording the use of nicotine pouches in the medical history of patients. Furthermore, pharmacokinetic profiles suggest that modern pouches can deliver nicotine efficiently enough (although at a much slower rate than smoking) to alleviate cravings and displace combustible tobacco. There are some regulatory challenges that need to be explicitly addressed concerning labeling consistency, flavoring additives, and maximum nicotine limits. Current population data suggest they are unlikely to become a gateway to smoking, but continuous monitoring is warranted. In conclusion, nicotine pouches could represent a promising harm reduction tool with a risk profile likely adjacent to pharmaceutical nicotine replacement therapies, and could be considered by clinicians as substitutes for smoking in smokers unable or unwilling to quit with currently approved methods.