1,721,066 research outputs found
A prognostic index for 1-year mortality can also predict in-hospital mortality of elderly medical patients
No full textElderly patients admitted to the hospital are at increased risk for both in-hospital and post-discharge mortality. Risk assessment models (RAMs) for in-hospital mortality are based mainly on physiological variables and a few laboratory data, whereas RAMs for late mortality usually include other domains such as disability and comorbidities. We aim to evaluate if a previous validated model for 1-year mortality (the Walter Score) would also work well in predicting in-hospital mortality. We retrospectively revised the medical records of patients admitted on our ward, from April to December, 2013. Data regarding gender, activities of daily living (ADLs), comorbidities, and routine laboratory tests were used to calculate a Modified Walter Score (MoWS). The main outcome measure was all cause, in-hospital mortality. The analysis involved 1,004 patients. Of these, 888 were discharged alive, and 116 (11.5 %) died during the hospitalization. The mean MoWS was 4.9 (±3.6) in the whole sample. Stratification into risk classes parallels with in-hospital mortality (Chi square for trend p < 0.001). When dichotomized, MoWS has a sensitivity of 97.4 % (95 % CI 92.1–99.3), and a specificity of 48.2 % (95 % CI 44.9–51.5) with a good prognostic accuracy (area under the ROC = 0.81; 95 % CI 0.78, 0.84). Subgroup analysis according to different age groups gives similar results. A simple RAM based on multiple domains, previously validated for predicting mortality of older adults within 1 year from the index hospitalization, can be useful at the moment of admission to Internal Medicine wards to accurately identify patients at low risk of in-hospital mortality
A new series on diagnostic echographic cases and living brief reviews: a potentially useful tool for clinicians edited by FADOI
No full text“To treat or not to treat very elderly naïve patients with atrial fibrillation with vitamin K antagonists”
No full textAre direct oral anticoagulants effective in reducing systemic embolism in patients with atrial fibrillation? A systematic review and meta-analysis of the literature
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How to predict short-and long-term mortality in patients with pulmonary embolism?
No full textPulmonary embolism (PE) is a common disease with a considerable short-and long-term risk of death. An adequate evaluation of the prognosis in patients with PE may guide decision making in terms of the intensity of the initial treatment during the acute phase, duration of treatment, and intensity of follow-up control visits in the long term. Patients with shock or persistent hypotension are at high risk of early mortality and may benefit from immediate reperfusion. Several tools are available to define the short-term prognosis of hemodynamically stable patients. The Pulmonary Embolism Severity Index (PESI) score, simplified PESI score, and N-terminal pro-B-type natriuretic peptide levels are particularly useful for identifying patients at low risk of early complications who might be safely treated at home. However, the identification of patients who are hemodynamically stable at diagnosis but are at a high risk of early complications is more challenging. The current guidelines recommended a multiparametric prognostic algorithm based on the clinical status and comorbidities. Unfortunately, only a few studies have evaluated the role of risk factors potentially affecting the long-term prognosis of these patients. The available studies suggest a potential role of the PESI score and troponin levels evaluated at the time of an index event. However, further studies are warranted to confirm these preliminary findings and to identify other long-term prognostic factors in this setting
Are direct oral anticoagulants equally effective in reducing deep vein thrombosis and pulmonary embolism?
No full textMultiple Myeloma in a patientWith fever of unknown origin and Cholestasis
No full textTHE DIFFERENTIAL DIAGNOSIS OF FEVER of unknown origin includes infectious diseases, malignancies and connective tissue diseases. Multiple myeloma is not usually included in the differential diagnosis, nor is it considered a frequent cause of cholestasis in the absence of amyloidosis. We report a case of multiple myeloma in a patient presenting with a long-standing fever and cholestasis. The patient underwent a long and unfruitful series of diagnostic procedures, including liver biopsy. The clue to the diagnosis, established with a marrow biopsy, was the presence of a paraprotein in the serum
Dabigatran in nonvalvular atrial fibrillation: From clinical trials to real-life experience
No full textAtrial fibrillation is the most common arrhythmia in over-midlife patients. In addition to systolic heart failure, cerebral thromboembolism represents the most dramatic complication of this rhythm disorder, contributing to morbidity and mortality. Traditionally, anticoagulation has been considered the main strategy in preventing stroke and systemic embolism in atrial fibrillation patients and vitamin K-dependent antagonists have been widely used in clinical practice. Recently, the development of direct oral anticoagulants has certainly improved the management of this disease, providing, for the first time, the opportunity to go beyond vitamin K-dependent antagonists limits. In the RE-LY trial, dabigatran 150mg twice daily was superior to warfarin in the prevention of stroke or systemic embolism and dabigatran 110mg twice daily was noninferior. Both doses greatly reduced hemorrhagic stroke, and dabigatran 110mg twice daily significantly reduced major bleeding compared with warfarin. Based on these results, dabigatran, a direct thrombin inhibitor, was the first direct oral anticoagulant to receive the regulatory approval for nonvalvular atrial fibrillation patients. To date, a specific reversal agent has just been approved as an antidote for this molecule. This review provides a summary of randomized trials, postmarket registries and specific clinical-settings summary on dabigatran in nonvalvular atrial fibrillation
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