Internal and emergency medicine
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It is well known that tobacco smoking worsens asthma. Conversely, few data are currently available in the literature on the effects of vaping in asthmatic patients. This work aims to investigate the effects of vaping on asthmatic patients and in asthmatic patients that switched from tobacco smoking to electronic cigarette (e-cig), in particular focusing on quality of life, asthma control, and pulmonary function. ⋯ In the second group, the analysis of variance in the questionnaires administered to the 10 asthmatics showed a significant improvement in ACQ, ACT and SF-36 for asthmatics that switched from tobacco to vaping, while PFT remained stable throughout the three visits. Almost all of the asthmatics who previously smoked would recommend switching to e-cig, and vaping did not worsen their asthma symptoms. Furthermore, switching from tobacco smoking to e-cigs showed a significant improvement in asthma control and quality of life, not showing, in the period studied, to affect pulmonary function tests.
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The History, Electrocardiogram, Age, Risk Factors, Troponin (HEART) score is a useful tool in the Emergency Department setting to identify those patients safe for outpatient evaluation of chest pain. Its utility for predicting cardiac interventions is unclear. Our objective was to evaluate the prognostic accuracy of the HEART score to predict the need for cardiac stent or coronary artery bypass grafting (CABG). ⋯ The area under the receiver operator curve reported as c-statistics was 0.877 [95% confidence interval (CI) 0.806-0.949] for the HEART score's ability to predict cardiac stent and 0.921 (95% CI 0.858-0.984) for CABG. There is a strong association between increasing HEART scores and the need for revascularization which may provide emergency physicians justification for expedited cardiology consultation and admission for these patients. These findings require further prospective validation.
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The AABB Choosing Wisely Campaign recommends "don't transfuse for iron deficiency without hemodynamic instability". However, the management of iron deficiency anemia (IDA) in the emergency department (ED) is heterogeneous and patients are often over-transfused. Intravenous iron is effective in correcting anemia and new formulations, including ferric carboxymaltose (FCM), allow the administration of high doses with low immunogenicity. ⋯ Sixteen FCM1 patients were evaluated at 52 ± 28 days (median 42, range 27-122): the average Hb increase was 5.3 ± 1.4 g/dL. In summary, we showed that FCM administration in the ED in hemodynamically stable patients was associated with fewer transfusions and hospital admissions compared to the FCM0 group; moreover, it succeeded in safely, effectively and rapidly increasing Hb levels after discharge from the ED. Further studies are needed to develop recommendations for IDA in the ED and to identify transfusion thresholds for non-hospitalized patients.
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Almost one third of patients with Behçet's syndrome (BS) display vascular involvement. However, data regarding the prevalence and management of venous thromboembolism (VTE) in BS are scanty. We assessed the differential characteristics between patients with and without VTE and the factors associated with VTE incidence. ⋯ All patients were treated with anticoagulation and 75% were treated with immunosuppressants after the first VTE event. The diagnosis of VTE usually precedes that of BS, with a high frequency of VTE recurrence. Erythema nodosum and fever were associated with a higher risk of VTE, while the immunosuppressants showed a protective role for the development of VTE.
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The frequency of premature atrial complexes (PACs) has been related with atrial fibrillation (AF) occurrence and adverse prognosis. Research objective was to evaluate whether temporal patterns of PACs are directly associated with AF onset in pacemaker patients with continuous monitoring of the atrial rhythm. Overall, 193 pacemaker patients (49% female, 72 ± 9 years old), enrolled in a national registry, were analyzed. ⋯ Cox model predictive analysis showed that the risk of AF was significantly higher in patients with a relative increase of the daily PACs higher than 30% compared with PACs average number in ten preceding days [hazard ratio (95% confidence interval) 3.67 (2.40-5.59), p < 0.001]. PACs frequency increases in the 5 days preceding AF onset. A relative increase of the daily PACs is significantly associated with the risk of AF occurrence.