Internal and emergency medicine
-
Detection of pulmonary embolism (PE) is not uncommon in patients undergoing computed tomography (CT) for routine staging of malignancy. Several studies have been conducted in recent years to evaluate the impact of unsuspected pulmonary embolism (UPE) on the prognosis and management of cancer patients. We aimed at summarizing the available evidence, to improve the understanding of the frequency and clinical significance of UPE in terms of survival, recurrent venous thromboembolism (VTE) and major bleeding. ⋯ In conclusion, UPE represents a non-infrequent finding on CT scans ordered for reasons other than suspected PE and is a challenging clinical situation in the management of cancer patients. Even if UPE is generally milder in the short term, it may share a similar impact on survival and recurrent VTE, as compared to symptomatic PE. Large collaborative projects and, hopefully, interventional trials are needed to clarify the best management strategies.
-
Gut microbiota is known to have a relevant role in our health, and is also related to both gastrointestinal and extradigestive diseases. Therefore, restoring the alteration of gut microbiota represents an outstanding clinical target for the treatment of gut microbiota-related diseases. The modulation of gut microbiota is perhaps an ancestral, innate concept for human beings. ⋯ Probiotics, instead, are not at all the same thing, and thinking in terms of different strains is probably the only way to improve clinical outcomes. Moreover, fecal microbiota transplantation has shown promising results, but stronger proofs are needed. Considerable efforts are needed to increase our knowledge in the field of gut microbiota, especially with regard to the future use in its modulation for therapeutic purposes.
-
Multicenter Study Observational Study
Drug-induced angioedema: experience of Italian emergency departments.
Acute angioedema represents a cause of admission to the emergency department requiring rapid diagnosis and appropriate management to prevent airway obstruction. Several drugs, including angiotensin-converting enzyme inhibitors (ACE-I), nonsteroidal anti-inflammatory drugs (NSAIDs) and oral antidiabetics, have been reported to induce angioedema. The aim of this prospective observational study conducted in a setting of routine emergency care was to evaluate the incidence and extent of drug-induced non-histaminergic angioedema in this specific clinical setting, and to identify the class of drugs possibly associated with angioedema. ⋯ Of the remaining patients, 15 received antibiotic treatment and 10 antihypertensive treatment. In addition, we observed in our series some cases of angioedema associated with drugs (such as antiasthmatics, antidiarrheal and antiepileptics) of which there are few descriptions in the literature. The present data, which add much needed information to the existing limited literature on drug-induced angioedema in the clinical emergency department setting, will provide more appropriate diagnosis and management of this potentially life-threatening adverse event.
-
Comparative Study
High-frequency transducers for point-of-care ultrasound applications: what is the optimal frequency range?
To compare images obtained using two linear transducers with a different range of frequencies, and to determine if there is a significant difference in the quality of images between the two transducers for medical decision-making. This was a single-blinded, cross-sectional study at an academic medical center. Twenty-five emergency medicine clinical scenarios with ultrasound images (using both 10-5 and 14-5 MHz transducers) covering a variety of point-of-care ultrasound applications were presented to four emergency physician sonographers. ⋯ The images obtained with a 14-5 MHz transducer were preferred over 10-5 MHz transducer in only 16 % (95 % CI 7.7-24.3 %) of the cases. The 14-5 MHz transducer has a slight advantage over 10-5 MHz transducer for ocular, upper airway, and musculoskeletal (tendon) ultrasound applications. A 10-5 MHz linear transducer is adequate to obtain images that can be used for medical decision-making for a variety of point-of-care ultrasound applications.