European journal of internal medicine
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Eur. J. Intern. Med. · Jul 2020
Review Meta AnalysisAntithrombotic treatment in patients with atrial fibrillation undergoing coronary angioplasty: rational convincement and supporting evidence.
The management of antithrombotic therapy in patients undergoing percutaneous coronary intervention (PCI) with an indication for long-term oral anticoagulant therapy (OAT) is still a matter of debate. We aim to evaluate the safety and the efficacy of dual therapy (DT) compared to triple therapy (TT) in this clinical setting. ⋯ Our findings suggest that DT is safer than TT with regard to occurrence of major bleeding. DT with a direct oral anticoagulant plus clopidogrel at discharge could be effective in most patients, maintaining aspirin in periprocedural phase and as longer "tailored" treatment for patients at higher ischemic risk.
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Eur. J. Intern. Med. · Jul 2020
Meta AnalysisCoffee Consumption is Associated with a Decreased Risk of Incident Chronic Kidney Disease: A Systematic Review and Meta-analysis of Cohort Studies.
Recent studies have suggested a renal protective effect of coffee consumption against development of chronic kidney disease (CKD) although the results remain inconclusive. This systematic review and meta-analysis aimed to comprehensively investigate this association by summarizing all available data. ⋯ A total of 4 cohort studies comprising of 25,849 participants met the inclusion criteria and were analyzed in the meta-analysis. The meta-analysis found a significantly decreased risk of incident CKD among coffee-drinkers compared with non-drinkers with the pooled risk ratio of 0.87 (95% CI, 0.81-0.95; I2 of 57%). The funnel plot of this study was relatively symmetric and was not indicative of publication bias CONCLUSIONS: A significant association between coffee consumption and a lower risk of incident CKD was demonstrated in this study.
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Eur. J. Intern. Med. · Jul 2020
Multicenter StudyA new simplified model for predicting 30-day mortality in older medical emergency department patients: The rise up score.
Currently, accurate clinical models that predict short-term mortality in older (≥ 65 years) emergency department (ED) patients are lacking. We aimed to develop and validate a prediction model for 30-day mortality in older ED patients that is easy to apply using variables that are readily available and reliably retrievable during the short phase of an ED stay. ⋯ We developed and externally validated an accurate and simplified prediction model for 30-day mortality in older ED patients. This model may be useful to identify patients at risk of short-term mortality and to apply personalised medical care.
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Eur. J. Intern. Med. · Jul 2020
ReviewTherapeutic strategies for virus-negative myocarditis: a comprehensive review.
Virus-negative or autoimmune myocarditis(VNM) is an inflammatory disease affecting the myocardium that may occur as a distinct disease with exclusive cardiac involvement, or in the context of systemic autoimmune or inflammatory disorders. The pathogenesis of VNM involves both innate and acquired immunity and is not completely elucidated: an early immune-mediated pathogenic process lead to subacute and chronic stages and eventually results in tissue remodeling, fibrosis, contractile dysfunction, dilated cardiomyopathy and arrhythmic burden, accounting for a dismal prognosis. Treatment interventions effectively curbing the acute inflammatory process at an early stage can prevent late cardiac remodeling and improve patient's outcome. ⋯ Thus, second-line targeted therapeutic strategies to treat VNM are eagerly awaited. Recent data on the pathogenic mechanisms underlying myocardial inflammation are paving the way to novel, promising treatment strategies for myocarditis, which could reformulate future treatment strategies for VNM. In this review, we summarize the current therapeutic opportunities, beyond corticosteroids, to treat VNM, including conventional and biologic immunosuppressive drugs and cytokine blocking agents.
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Eur. J. Intern. Med. · Jul 2020
ReviewHepatic consequences of COVID-19 infection. Lapping or biting?
The outbreak of coronavirus disease 2019 (COVID-19) starting last December in China placed emphasis on liver involvement during infection. This review discusses the underlying mechanisms linking COVID-19 to liver dysfunction, according to recent available information, while waiting further studies. The manifestations of liver damage are usually mild (moderately elevated serum aspartate aminotransferase activities), and generally asymptomatic. ⋯ If liver involvement appears during COVID-19 infection, however, attention is required. This is particularly true if patients are older or have a pre-existing history of liver diseases. During COVID-19 infection, the onset of liver damage impairs the prognosis, and hospital stay is longer.