Internal and Emergency Medicine最新文献

Exertional heatstroke (EHS) often leads to multiple organ dysfunction syndrome (MODS) with high mortality. The liver is frequently early damaged in EHS, presenting as acute liver injury (ALI), including acute liver disease (ALD) and acute liver failure (ALF). This study investigates liver enzyme changes in EHS patients, assesses whether ALF independently predicts in-hospital mortality, and tries to create an ALF-based predictive model for EHS. This was a single-center retrospective study. The medical records of EHS patients admitted to the intensive care unit (ICU) of a tertiary hospital from January 1, 2008 to December 31, 2023, were recorded and analyzed. The characteristics of liver damage were analyzed by reviewing the enzymatic indices of EHS patients from day 1 to day 9 after admission. There were 176 male patients ultimately analyzed, comprising 160 survivors and 16 non-survivors. Univariate and multivariate logistic regression analysis showed that prolonged activated partial thromboplastin time (APTT) (OR = 1.029, P = 0.018), increased γ-glutamyltransferase (γ-GGT) (OR = 1.032, P = 0.013), and ALF (OR = 57.238, P = 0.002) were independent risk factors for predicting in-hospital mortality. Approximately half of the patients (48.3%) were diagnosed as ALI. Notably, 81.8% of the ALF cases were diagnosed within 5 days after EHS onset. The predictive model based on increased heart rate (HR) (OR = 1.065, P < 0.001), increased platelet (PLT) count (OR = 0.989, P = 0.034), and increased fibrinogen (Fib) (OR = 0.216, P = 0.002) level had a higher specificity and better predictive performance (SEN = 86.4%, SPE = 90.8%, AUC = 0.936) for occurrence of ALF in EHS. During the early stages of EHS, patients exhibited multiple organ injuries, with a high ALI incidence rate. ALF, prolonged APTT, and elevated γ-GGT levels were the independent risk factors for in-hospital mortality in EHS patients. The predictive model based on HR, PLT, and Fib levels was potentially suitable and practical for early identification and timely management of ALF in EHS patients.

Frailty is a complex syndrome marked by diminished physiological reserves and heightened susceptibility to negative health outcomes. The Atherogenic Index of Plasma (AIP), an indicator of lipid-associated cardiovascular and metabolic risk, has been widely studied in metabolic and cardiometabolic disorders; however, its relationship with frailty remains underexplored. This study seeks to investigate the association between AIP and frailty, as well as evaluate its viability as a predictive biomarker for frailty in older adults. This cross-sectional study encompassed 174 older adults from a geriatrics outpatient clinic. Frailty was evaluated with the Clinical Frailty Scale (CFS) version 2.0, whereas AIP was computed using the formula log(TG/HDL-C). Multivariable logistic regression analysis was conducted to determine independent factors that contribute to frailty. The efficacy of AIP in identifying frailty was assessed by receiver operating characteristic (ROC) curve analysis. Frailty was present in 29.3% (n = 51) of the participants. Logistic regression analysis identified AIP as an independent predictor of frailty (OR: 6.65, 95% CI 1.87-23.64, p = 0.003), along with lower Lawton-Brody Instrumental Activities of Daily Living (IADL) scores and lower Standardized Mini-Mental State Examination (SMMSE) scores. ROC analysis indicated that AIP predicted frailty with an AUC of 0.741 (95% CI 0.669-0.804, p < 0.0001). AIP serves as an independent predictor of frailty, highlighting the significance of lipid metabolism in the pathophysiology of frailty. Due to its significant correlation with dyslipidemia, systemic inflammation, and oxidative stress, AIP may serve as an important biomarker for the early identification of frailty and risk assessment.

The primary objective of this article is to provide an overview of studies in humans that evaluate and compare the effects of heated tobacco products (HTPs) with those of conventional cigarette smoking on cardiovascular and respiratory diseases. To address this research question, a scoping review methodology was employed.A comprehensive literature search was conducted in the PubMed, Scopus, Web of Science, and Cochrane Library databases to identify relevant articles published between January 2014 and March 2025. Two reviewers independently screened all articles. This process resulted in the identification of 34 articles deemed appropriate to the aims of this scoping review.Despite the heterogeneity of the available data, the current evidence suggests that HTPs are associated with a lower harmful impact on the cardiovascular and respiratory systems as compared to conventional cigarettes. However, considering the relatively recent introduction of HTPs, in contrast to the long latency periods typically required for the development of smoking-related chronic diseases, as well as the evolving design and composition of these products, it is not surprising that definitive conclusions regarding their clinical, and public health impact bring up the need to be integrated by long-term evidence derived from independently conducted studies.

Delirium in elderly inpatients needs to be prevented being associated with worse clinical outcome and higher cost burden. Effects of a structured intervention aimed at cognitive stimulation and reorientation to prevent delirium occurrence were tested. A nonrandomized stepped-wedge study was conducted. Patients were consecutively enrolled from 07/05/2024 to 03/10/2024 at an Internal Medicine Unit. Eligibility was verified based on inclusion criteria: age ≥ 65 years; hospitalization at the Unit; and exclusion criteria: personal history of dementia or cognitive impairment; delirium at admission. Demographic and clinical data were collected at enrollment. Delirium was assessed daily via the 4AT. Inpatients received a protocol-driven intervention aimed at cognitive stimulation and reorientation (cases) or usual care (controls). The intervention was administered daily from day 1 of hospitalization to discharge. A total of 222 subjects were evaluated (104 received the intervention, 118 had usual care). Males and females were equally distributed (54 males under the intervention, 62 males under usual care). Mean age was 81·54 ± 8·28 yrs among those who received the intervention and 81·24 ± 8·84 yrs among those under usual care. The two groups differed for delirium incidence: 7·69% (n = 8) among those who received the intervention and 22·03% (n = 26) among those who received usual care. The findings of the pilot study should be interpreted as preliminary feasibility results rather than evidence of efficacy. They need replication in larger samples, being promising in terms of implementation of the intervention in real life of Internal Medicine Units.

Chronic pain may elevate the risk of frailty in older adults, but its characteristics in age and sex remains unclear, and the mediators of this relationship are largely unknown. We analyzed cross-sectional data from the Comprehensive Geriatric Assessment Database of Tongji Hospital and explored the relationship between chronic pain and frailty in adults aged ≥ 60 years through multiple linear regression, binary logistic regression, restricted cubic spline regression and mediation analysis. Covariates comprised age, sex, education, marital status, smoking, drinking, body mass index, hypertension, diabetes, cardiovascular disease, and stroke, while sleep quality, activities of daily living, anxiety, and depression were regarded as potential mediators. Among 1951 adults aged ≥ 60 years (mean age 77.86 ± 9.74 years, 45.7% female), the prevalence of frailty increased with chronic pain severity, with the odds of frailty being 1.28 (95% CI 1.06-1.54), 1.35 (95% CI 1.18-1.55), 1.39 (95% CI 1.19-1.61), and 1.71 (95% CI 1.39-2.11) times higher among participants aged 60-69, 70-79, 80-89, and ≥ 90 years, respectively, compared to those without pain. Additionally, the increase in frailty prevalence with rising pain severity was more pronounced in females than in males. Mediation analysis suggested that poor sleep quality (28.63%), depression (27.64%), and anxiety (43.73%) partially explained the association between chronic pain and frailty. These findings underscore the importance of addressing chronic pain and its associated factors (such as poor sleep quality, depression, and anxiety) in interventions aimed at managing frailty, particularly among females.

Global smoking prevalence remains high, underscoring the need for strategies that complement conventional cessation. Tobacco harm reduction (THR) offers a pragmatic strategy by promoting substitution of combustible cigarettes with substantially less harmful alternatives. Oral nicotine pouches (ONPs) have emerged as a promising option. Modeled on the Scandinavian success of snus, ONPs deliver pharmaceutical-grade nicotine without tobacco leaf or combustion, eliminating thousands of toxicants and lowering exposure to carcinogens such as tobacco-specific nitrosamines to near-undetectable levels. Epidemiological evidence from snus users provides a strong precedent for ONPs' potential impact on population health. Preclinical, toxicological, and biomarker studies consistently demonstrate a favorable safety profile for ONPs, with minimal cytotoxic or inflammatory effects. Their discreet, odorless, and spit-free design may further promote adherence compared with traditional nicotine replacement therapies. Despite this promise, skepticism persists within public health, particularly concerning youth uptake and the potential renormalization of nicotine use. Yet current evidence indicates that ONPs are primarily adopted by adult smokers and smokeless users seeking lower-risk options. Regulatory responses are uneven: while the U.S. Food and Drug Administration has authorized their marketing, other jurisdictions have enacted prohibitions that risk perpetuating cigarette consumption. Incorporating ONPs into tobacco control frameworks, especially in low- and middle-income countries where cessation support is scarce, represents both an urgent and ethical opportunity to accelerate progress toward ending combustible tobacco use.

Rapid differentiation between variceal and non-variceal upper gastrointestinal hemorrhage (UGIH) in the emergency department (ED) is critical for guiding vasoactive therapy, antibiotic use, and timely endoscopy. However, endoscopy is often delayed, deferring these key management decisions and potentially impacting patient outcomes. We aimed to study the utility of portal vein ultrasound by the emergency physician for the prediction of variceal etiology in UGIH. We also studied the diagnostic accuracy of laboratory markers and fibrosis scores for differentiating between variceal and non-variceal hemorrhage. In our prospective observational study, we enrolled patients with UGIH presenting to the ED. Portal vein indices were studied using bedside point-of-care ultrasound (POCUS) by the emergency physician. Laboratory results were noted, and fibrosis scores were calculated. The upper gastrointestinal endoscopy findings were noted for the presence and grade of varices. Out of 181 patients included in the study, 106 patients (58.56%) had varices. Multivariable logistic regression analysis identified spleen diameter, platelet count, PT, ascites, and portal vein flow velocity (PVFV) were significant predictors of variceal etiology. SCoPE score (Splenomegaly, Coagulopathy, PVFV Evaluation) which is a composite that includes spleen diameter, PT, and PVFV is a useful ED-based tool for early identification of variceal bleed (AUC = 0.843, OR = 1.633). Fibrosis scores (AAR, APRI, Fib-4, King, Lok) were also useful in identifying variceal hemorrhage (p < 0.001). Integrating POCUS parameters and laboratory markers into clinical decision algorithms may enhance the ability of emergency physicians to predict variceal etiology of UGIH. Novel ED-based composite SCoPE score can help the physicians predict varices and enable them to tailor the management plan and optimize resuscitation strategies.