Internal and emergency medicine
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Internists are experts in complexity, and the COVID-19 pandemic is disclosing complex and unexpected interactions between communicable and non-communicable diseases, environmental factors, and socio-economic disparities. The medicine of complexity cannot be limited to facing comorbidities and to the clinical management of multifaceted diseases. Evidence indicates how climate change, pollution, demographic unbalance, and inequalities can affect the spreading and outcomes of COVID-19 in vulnerable communities. ⋯ This is the case when pandemic events hit vulnerable populations suffering from the increasing burden of chronic diseases, disabilities, and social and economic inequalities. Mastering the interplay of such events requires a change in overall strategy, to adequately manage not only the SARS-CoV-2 infection but also the growing burden of non-communicable diseases by a "one health" approach. In this context, experts in internal medicine have the knowledge and skills to drive this change.
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New-onset altered level of consciousness (ALC) is a challenge in real-world clinical practice. Although its presentation is nonspecific and its etiology is intricate, the term ALC is frequently used in the emergency room (ER). This study aimed to clarify and classify the etiologies and outcomes of the ALC in the ER. ⋯ The majority of ALC in the ER was derived from extracranial etiology. ALC in the ER is a neurological manifestation of diverse etiologies; not all can be confirmed in the ER. Not only neurological but also critical systemic illnesses should be considered to assess the protean manifestations of ALC in the ER.
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Abdominal pain is a common reason for presentation in the emergency department and for calling emergency medical services. The complexity of abdominal pain also influences the analgesia strategy. However, there are almost no data on the use of ketamine for abdominal pain. ⋯ With ketamine, analgesia comparable to fentanyl can be achieved. Ketamine appears to be a safe and effective option for the treatment of patients with abdominal pain in emergency medicine. Trial registration number DRKS00027343, date of registration: 09.12.2021, retrospectively registered.
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The relationship between albumin corrected anion gap (ACAG) and mortality in acute kidney injury (AKI) patients who received continuous renal replacement therapy (CRRT) has not been investigated in any previous studies. This study aimed to investigate the relationship between ACAG at CRRT initiation and all-cause mortality among these patients in the intensive care unit (ICU). Patients diagnosed with AKI and treated with CRRT in the ICU from the Medical Information Mart for Intensive Care-IV version 1.0 (MIMIC IV) database and Huzhou Central Hospital were retrospectively enrolled. ⋯ In the multivariate COX regression analyses, patients with higher ACAG (> 20 mmol/L) levels at the time of CRRT initiation in the MIMIC IV database and Huzhou Central Hospital were significantly correlated with ICU all-cause mortality after adjusting multiple potential confounding factors with hazard ratios of 2.852 (95% CI 1.718-4.734) and 2.637(95% CI 1.584-4.389), respectively. In critically AKI patients who undergo CRRT, higher ACAG (> 20 mmol/L) level at the initiation of CRRT was significantly correlated with ICU all-cause mortality. Therefore, clinicians should pay more attention to those patients with a higher ACAG value.
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The aim of this study was to determine the relationship between physical fitness, cardiopulmonary function and patient-reported severity of symptoms in people with post-COVID-19 condition. We examined ambulatory patients (n = 72) with post-COVID-19 condition who had a chronic symptomatic phase lasting > 12 weeks from the onset of symptoms, but had not been hospitalized for acute COVID-19. A comprehensive medical screening was conducted, including clinical history, symptomatology, comorbidities, body composition and physical activity levels. ⋯ Greater physical activity levels were associated with fewer symptoms and less-severe fatigue and dyspnea. In conclusion, preserving better cardiopulmonary health and physical condition during the course of the disease-even in mild cases-was related to a lower intensity of symptoms in non-hospitalized people with post-COVID-19 condition. It is probable that exercise and physical conditioning are valuable pre- and post-COVID-19 countermeasures that could help decrease the severity, not only of acute infection, but of post-COVID-19 persistent symptoms and prognosis.