Nathan Artom, Paola Maineri, Luca Paris, Chiara Lagasio, Francesco Artom, P. Artom, Alberto Artom
Traumatic pneumothorax is traditionally treated with tube thoracostomy. We report a case of conservative management of a large traumatic pneumothorax, due to the close collaboration between the physician, a Thoracic Surgeon and the patient, a retired Internist.
{"title":"Management of large traumatic pneumothorax: when the patient is an experienced Internist","authors":"Nathan Artom, Paola Maineri, Luca Paris, Chiara Lagasio, Francesco Artom, P. Artom, Alberto Artom","doi":"10.4081/itjm.2024.1677","DOIUrl":"https://doi.org/10.4081/itjm.2024.1677","url":null,"abstract":"Traumatic pneumothorax is traditionally treated with tube thoracostomy. We report a case of conservative management of a large traumatic pneumothorax, due to the close collaboration between the physician, a Thoracic Surgeon and the patient, a retired Internist.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":"18 9","pages":""},"PeriodicalIF":0.4,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Direct-Acting Oral Anticoagulants (DOACs) have revolutionized the management of Atrial Fibrillation (AF) and Venous Thromboembolism (VTE). However, recent audits reveal a significant burden of inappropriate dosages in the prescribing of direct-acting oral anticoagulants. Our aim is to identify the prevalence and predictors of such inappropriate dosing in our patients. This retrospective study was conducted from June 2016 to January 2018. Patients who received dabigatran, rivaroxaban, or apixaban for treatment of venous thromboembolism or atrial fibrillation were included. Appropriateness of direct-acting oral anticoagulants dosing was assessed using US Food and Drug Administration guidelines. Data was analyzed using IBM® SPSS Version 26. 337 patients were included, with a mean age of 62.9±18.7 years. The majority were female (196, 58.3%). Of the patients, 194 (57.6%) received apixaban, 99 (29.4%) received rivaroxaban, and 44 (13.1%) received dabigatran. A total of 242 (71.8%) patients were prescribed direct-acting oral anticoagulants appropriately. Under-dosing and over-dosing were identified in 74 (22%) and 21 (6.2%) patients, respectively. Predictors of inappropriate dosing were age greater than 75 years (OR: 2.76, 95% CI: 1.67-4.56, p<0.001) and creatinine clearance less than 50 ml/minute (OR: 0.38, 95% CI: 0.19-0.74, p: 0.005). Inappropriate dosing was significantly associated with mortality (p=0.010).One-third of our patients received an inappropriate dose of direct-acting oral anticoagulants, mostly from underdosing. Elderly age and low creatinine clearance are significant predictors of inappropriate dose administration.
{"title":"Assessment and predictors of inappropriate dose of direct oral anticoagulants","authors":"M. Almegren","doi":"10.4081/itjm.2024.1679","DOIUrl":"https://doi.org/10.4081/itjm.2024.1679","url":null,"abstract":"Direct-Acting Oral Anticoagulants (DOACs) have revolutionized the management of Atrial Fibrillation (AF) and Venous Thromboembolism (VTE). However, recent audits reveal a significant burden of inappropriate dosages in the prescribing of direct-acting oral anticoagulants. Our aim is to identify the prevalence and predictors of such inappropriate dosing in our patients. This retrospective study was conducted from June 2016 to January 2018. Patients who received dabigatran, rivaroxaban, or apixaban for treatment of venous thromboembolism or atrial fibrillation were included. Appropriateness of direct-acting oral anticoagulants dosing was assessed using US Food and Drug Administration guidelines. Data was analyzed using IBM® SPSS Version 26. 337 patients were included, with a mean age of 62.9±18.7 years. The majority were female (196, 58.3%). Of the patients, 194 (57.6%) received apixaban, 99 (29.4%) received rivaroxaban, and 44 (13.1%) received dabigatran. A total of 242 (71.8%) patients were prescribed direct-acting oral anticoagulants appropriately. Under-dosing and over-dosing were identified in 74 (22%) and 21 (6.2%) patients, respectively. Predictors of inappropriate dosing were age greater than 75 years (OR: 2.76, 95% CI: 1.67-4.56, p<0.001) and creatinine clearance less than 50 ml/minute (OR: 0.38, 95% CI: 0.19-0.74, p: 0.005). Inappropriate dosing was significantly associated with mortality (p=0.010).One-third of our patients received an inappropriate dose of direct-acting oral anticoagulants, mostly from underdosing. Elderly age and low creatinine clearance are significant predictors of inappropriate dose administration.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":"16 3","pages":""},"PeriodicalIF":0.4,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Blerim Myftiu, E. Komoni, Edita Malazogu, F. Jashari, Shpresa Beqiri Rashiti, Melihate Pushka, Adnan Biqku, Syzana Aliçkaj Prebreza, Valbona Rrahmani Spanca, Jehona Rrustemi Bytyqi, N. Shala, Afrim Blyta
Background. Because of side effects, adherence to the treatment with β interferons in multiple sclerosis (MS) is low, leading to decreased treatment efficacy. This can be challenging, especially in healthcare systems where these medications are the only therapeutic option for the treatment of MS. Materials and Methods. The number of missed doses was calculated as a difference between the number of doses a patient had to withdraw from the treatment start to the cut-off date and the real number of doses taken from the MS unit. Missed doses were compared to gender, age, time since the diagnosis, time from the diagnosis to the treatment start, clinical type of MS, expanded disability status scale (EDSS), and duration of the treatment. Results. The adherence rate during the follow-up period was 73.8%. Patients above 40 years of age (P<0.005), higher EDSS (P<0.001), longer duration of the disease (P<0.001), longer waiting time from the diagnosis to the treatment initiation (P<0.001), and longer time on interferons (P<0.001) had lower adherence rates to the treatment. Conclusions. The findings were in correlation with studies that have used similar criteria for the determination of adherence and supported reports that adherence rate decreases with time and poses a challenge to the overall efficacy of the treatment.
{"title":"Adherence to interferon β treatment in Kosovan multiple sclerosis registry","authors":"Blerim Myftiu, E. Komoni, Edita Malazogu, F. Jashari, Shpresa Beqiri Rashiti, Melihate Pushka, Adnan Biqku, Syzana Aliçkaj Prebreza, Valbona Rrahmani Spanca, Jehona Rrustemi Bytyqi, N. Shala, Afrim Blyta","doi":"10.4081/itjm.2024.1672","DOIUrl":"https://doi.org/10.4081/itjm.2024.1672","url":null,"abstract":"Background. Because of side effects, adherence to the treatment with β interferons in multiple sclerosis (MS) is low, leading to decreased treatment efficacy. This can be challenging, especially in healthcare systems where these medications are the only therapeutic option for the treatment of MS. Materials and Methods. The number of missed doses was calculated as a difference between the number of doses a patient had to withdraw from the treatment start to the cut-off date and the real number of doses taken from the MS unit. Missed doses were compared to gender, age, time since the diagnosis, time from the diagnosis to the treatment start, clinical type of MS, expanded disability status scale (EDSS), and duration of the treatment. Results. The adherence rate during the follow-up period was 73.8%. Patients above 40 years of age (P<0.005), higher EDSS (P<0.001), longer duration of the disease (P<0.001), longer waiting time from the diagnosis to the treatment initiation (P<0.001), and longer time on interferons (P<0.001) had lower adherence rates to the treatment. Conclusions. The findings were in correlation with studies that have used similar criteria for the determination of adherence and supported reports that adherence rate decreases with time and poses a challenge to the overall efficacy of the treatment.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":"27 26","pages":""},"PeriodicalIF":0.4,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139443405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Linea Guida Multisocietaria per il paziente adulto con diabete o con iperglicemia ricoverato in setting clinico non critico","authors":"R. Pastorelli, A. Maffettone, M. Nizzoli, G. Bordin","doi":"10.4081/itjm.q.2023.4","DOIUrl":"https://doi.org/10.4081/itjm.q.2023.4","url":null,"abstract":"\u0000Introduzione\u0000Gruppo di sviluppo della Linea Guida\u0000Caratteristiche di una Linea Guida dell’ISS pubblicata sul Sito Nazionale Linee Guida\u0000Elenco dei quesiti\u0000Quesito 1: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 2: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 3: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 4: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 5: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 6: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 7: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 8: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 9: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 10: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 11: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Quesito 12: premesse, sintesi delle evidenze, raccomandazione, commento\u0000Discussione\u0000Conclusioni","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":" 22","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138994574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
G. Mancia, Guido Grassi, Enrico Agabiti-Rosei, Claudio Borghi, M. Muiesan, Paolo Palatini, Gianfranco Parati, Stefano Taddei, Reinhold Kreutz
N/A
不适用
{"title":"The 2023 hypertension guidelines of the European Society of Hypertension: a commentary","authors":"G. Mancia, Guido Grassi, Enrico Agabiti-Rosei, Claudio Borghi, M. Muiesan, Paolo Palatini, Gianfranco Parati, Stefano Taddei, Reinhold Kreutz","doi":"10.4081/itjm.2023.1675","DOIUrl":"https://doi.org/10.4081/itjm.2023.1675","url":null,"abstract":"<jats:p>N/A</jats:p>","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":" 50","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138960952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Snežana R. Markovic-Jovanovic, Aleksandar N. Jovanovic, Marina Petrovic, Dragoslava Ristic, Gordana Dželetović, Ana Karanovic, Dejan Tabakovic, Danijela Jovanovic
Background. People with intellectual disabilities (ID) are susceptible to physical, mental and social implications of the COVID-19 pandemic. Aim. Learning the way young individuals with disabilities dealt with the COVID-19 pandemic and how it affected their lives. Materials and Methods. An epidemiological questionnaire including information on the person’s health, mental state, behavior, educational capabilities, and epidemiological and clinical features of the COVID-19 infection was completed by 41 children/young adults and their family members. Results. During the two-year period of the pandemic, we monitored the frequency of COVID-19 infection in children and adolescents with intellectual disorders, children’s mental condition, and the occurrence of post-COVID symptoms. We also discussed the role of society regarding economic stability and support for families with a disabled member. Conclusions. The severity of COVID-19 symptoms was the independent predictor of mental status deterioration. Children and adolescents with ID experienced a greater prevalence of COVID-19 infection as well as post-COVID sequelae.
{"title":"COVID-19 effects on mental health of children and adolescents with intellectual disabilities in North Kosovo","authors":"Snežana R. Markovic-Jovanovic, Aleksandar N. Jovanovic, Marina Petrovic, Dragoslava Ristic, Gordana Dželetović, Ana Karanovic, Dejan Tabakovic, Danijela Jovanovic","doi":"10.4081/itjm.2023.1667","DOIUrl":"https://doi.org/10.4081/itjm.2023.1667","url":null,"abstract":"Background. People with intellectual disabilities (ID) are susceptible to physical, mental and social implications of the COVID-19 pandemic. Aim. Learning the way young individuals with disabilities dealt with the COVID-19 pandemic and how it affected their lives. Materials and Methods. An epidemiological questionnaire including information on the person’s health, mental state, behavior, educational capabilities, and epidemiological and clinical features of the COVID-19 infection was completed by 41 children/young adults and their family members. Results. During the two-year period of the pandemic, we monitored the frequency of COVID-19 infection in children and adolescents with intellectual disorders, children’s mental condition, and the occurrence of post-COVID symptoms. We also discussed the role of society regarding economic stability and support for families with a disabled member. Conclusions. The severity of COVID-19 symptoms was the independent predictor of mental status deterioration. Children and adolescents with ID experienced a greater prevalence of COVID-19 infection as well as post-COVID sequelae.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":"18 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138603087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Carannante, S. Scarica, Raffaele Disarno, Gerardo Langella, P. Di Micco, G. Fiorentino
Pulmonary involvement occurs in 3 to 10% of the cases of Plasmodium falciparum malaria and represents the most severe complication of this infection, with a lethality of about 70%. The antigens released by the parasite play an important role in the induction and worsening of lung damage. Capillary endothelial cells, which control the flux of fluids to the interstitial space, appear to be the most complicated structures. The clinical manifestations of pulmonary involvement may start suddenly at any time during the course of malaria, even after the disappearance of the circulating parasite. Hyperparasitemia predisposes to these factors. Treatment with corticosteroids is optional, and that is not often a benefit.
{"title":"Lung damages of malaria: a differential diagnosis and treatment in emergency room of a rare case","authors":"N. Carannante, S. Scarica, Raffaele Disarno, Gerardo Langella, P. Di Micco, G. Fiorentino","doi":"10.4081/itjm.2023.1603","DOIUrl":"https://doi.org/10.4081/itjm.2023.1603","url":null,"abstract":"Pulmonary involvement occurs in 3 to 10% of the cases of Plasmodium falciparum malaria and represents the most severe complication of this infection, with a lethality of about 70%. The antigens released by the parasite play an important role in the induction and worsening of lung damage. Capillary endothelial cells, which control the flux of fluids to the interstitial space, appear to be the most complicated structures. The clinical manifestations of pulmonary involvement may start suddenly at any time during the course of malaria, even after the disappearance of the circulating parasite. Hyperparasitemia predisposes to these factors. Treatment with corticosteroids is optional, and that is not often a benefit.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":"179 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139210749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Among the elevated inflammatory mediators, blood Interleukin-6 (IL-6) level is highly correlated with COVID-19 mortality and predicts the need for mechanical ventilation. IL-6 is the major activator of signal transducers and activators of transcription-3 (STAT3) during inflammatory responses. The primary objective of the study is to explore STAT3 activation in different subsets of circulating cells derived from 25 COVID-19 patients (patients) admitted to an Internal Medicine department compared to 25 healthy donors (HD). Higher percentages of classical and intermediate monocytes were observed in patients, compared to HD (respectively P<0.01 and P<0.001). The active form of STAT3, phosphorylated STAT3 (pSTAT3) was significantly higher in patients, compared to HD, both in non-classical and in intermediate monocytes (P<0.001). Low-density neutrophils (LDN) count was significantly higher in patients compared to HD (P<0.001). The pSTAT3 was significantly higher in LDN derived from patients (P<0.05). High pSTAT3 was significantly directly related to d-dimer and inversely related to vitamin D levels (P<0.01). This study gives information about STAT3 activation and the possible role of Vitamin D as a tool against COVID-19.
在升高的炎症介质中，血液白细胞介素-6（IL-6）水平与 COVID-19 死亡率高度相关，并可预测是否需要机械通气。IL-6 是炎症反应过程中信号转导和转录激活因子-3（STAT3）的主要激活因子。本研究的主要目的是探讨与 25 名健康捐献者（HD）相比，25 名内科收治的 COVID-19 患者（患者）循环细胞中不同亚群的 STAT3 激活情况。与健康捐献者相比，患者体内典型单核细胞和中间单核细胞的比例更高（分别为 P<0.01 和 P<0.001）。与 HD 相比，患者非典型单核细胞和中间型单核细胞中 STAT3 的活性形式--磷酸化 STAT3（pSTAT3）明显更高（P<0.001）。与 HD 相比，患者的低密度中性粒细胞（LDN）数量明显增加（P<0.001）。来自患者的低密度中性粒细胞的 pSTAT3 明显更高（P<0.05）。高 pSTAT3 与 d-二聚体明显直接相关，与维生素 D 水平成反比（P<0.01）。这项研究提供了有关 STAT3 激活的信息，以及维生素 D 作为抗击 COVID-19 的工具可能发挥的作用。
{"title":"STAT3 eye-opener in COVID-19","authors":"C. Mozzini, Giuseppe Lucchini, Mauro Pagani","doi":"10.4081/itjm.2023.1650","DOIUrl":"https://doi.org/10.4081/itjm.2023.1650","url":null,"abstract":"Among the elevated inflammatory mediators, blood Interleukin-6 (IL-6) level is highly correlated with COVID-19 mortality and predicts the need for mechanical ventilation. IL-6 is the major activator of signal transducers and activators of transcription-3 (STAT3) during inflammatory responses. The primary objective of the study is to explore STAT3 activation in different subsets of circulating cells derived from 25 COVID-19 patients (patients) admitted to an Internal Medicine department compared to 25 healthy donors (HD). Higher percentages of classical and intermediate monocytes were observed in patients, compared to HD (respectively P<0.01 and P<0.001). The active form of STAT3, phosphorylated STAT3 (pSTAT3) was significantly higher in patients, compared to HD, both in non-classical and in intermediate monocytes (P<0.001). Low-density neutrophils (LDN) count was significantly higher in patients compared to HD (P<0.001). The pSTAT3 was significantly higher in LDN derived from patients (P<0.05). High pSTAT3 was significantly directly related to d-dimer and inversely related to vitamin D levels (P<0.01). This study gives information about STAT3 activation and the possible role of Vitamin D as a tool against COVID-19.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139218911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prolonged prothrombin time increases the risk of bleeding complications in proportion to prolongation severity. We reported the case of a 72-year-old woman with a recent hospitalization for methicillin-susceptible Staphylococcus aureus endocarditis complicated by spondylodiscitis who developed a severe prolongation of clotting time during treatment with cefazolin due to a vitamin K deficiency. Cefazolin is a first-generation cephalosporin active against gram-positive bacteria. Like other cephalosporins, it is potentially able to inhibit the enzymes involved in recycling vitamin K metabolites, leading to a fall in gamma-carboxylation of vitamin K-dependent clotting factors. Clinicians should be aware of the necessity of regular monitoring of clotting times for the duration of antimicrobial therapy, especially in those patients with several risk factors for a poor vitamin K nutritional status. Prompt detection of vitamin K deficiency should be recognized and adequately supplemented.
凝血酶原时间延长会增加出血并发症的风险，与延长的严重程度成正比。我们报告了一例 72 岁女性患者的病例，该患者近期因甲氧西林易感金黄色葡萄球菌心内膜炎并发脊柱盘炎症住院治疗，在使用头孢唑啉治疗期间因维生素 K 缺乏导致凝血时间严重延长。头孢唑啉是第一代头孢菌素，对革兰氏阳性菌具有活性。与其他头孢菌素一样，它可能会抑制参与维生素 K 代谢物循环的酶，导致依赖维生素 K 的凝血因子的γ-羧化作用下降。临床医生应认识到，在抗菌药物治疗期间定期监测凝血时间的必要性，尤其是对那些存在多种维生素 K 营养状况不良风险因素的患者。应及时发现维生素 K 缺乏症并给予适当补充。
{"title":"Prolonged prothrombin time in a rare case of vitamin K deficiency: a case report and a narrative review","authors":"Matteo Nicoletto, Eleonora Galli, Alice Cerato, Cristina Olivero, Francisca Bulai, Irene Praticò, Fulvio Pomero","doi":"10.4081/itjm.2023.1665","DOIUrl":"https://doi.org/10.4081/itjm.2023.1665","url":null,"abstract":"Prolonged prothrombin time increases the risk of bleeding complications in proportion to prolongation severity. We reported the case of a 72-year-old woman with a recent hospitalization for methicillin-susceptible Staphylococcus aureus endocarditis complicated by spondylodiscitis who developed a severe prolongation of clotting time during treatment with cefazolin due to a vitamin K deficiency. Cefazolin is a first-generation cephalosporin active against gram-positive bacteria. Like other cephalosporins, it is potentially able to inhibit the enzymes involved in recycling vitamin K metabolites, leading to a fall in gamma-carboxylation of vitamin K-dependent clotting factors. Clinicians should be aware of the necessity of regular monitoring of clotting times for the duration of antimicrobial therapy, especially in those patients with several risk factors for a poor vitamin K nutritional status. Prompt detection of vitamin K deficiency should be recognized and adequately supplemented.","PeriodicalId":43715,"journal":{"name":"Italian Journal of Medicine","volume":"72 4","pages":""},"PeriodicalIF":0.4,"publicationDate":"2023-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139252803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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