European journal of internal medicine
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Eur. J. Intern. Med. · Feb 2022
Hematuria and subsequent long-term risk of end-stage kidney disease: A Danish population-based cohort study.
Hematuria is a frequent incidental clinical finding and may be a symptom of pre-existing underlying benign or malignant urinary tract or kidney disease. However, in patients with no apparent underlying cause of hematuria, long-term prognosis of hematuria remains unknown. ⋯ A hospital-based hematuria diagnosis in patients with no apparent underlying cause of hematuria is a marker of an increased risk of future ESKD.
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Eur. J. Intern. Med. · Feb 2022
EditorialPulmonary embolism - An EFIM guideline critical appraisal and adaptation for practicing clinicians.
Several trials have been conducted in the last decades that challenged the management of patients with acute pulmonary embolism (PE) in terms of diagnosis and treatment. Updated international clinical practice guidelines (CPGs) endorsed the evidence from these trials. The aim of this document was to adapt recommendations from existing CPGs to assist physicians in decision making concerning specific and complex scenarios related to acute PE. ⋯ By the use of proper methodology for the adaptation process, this document offers a simple and updated guide for practicing clinicians dealing with complex patients.
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This is a brief overview of toxic nephropathy, which is an increasingly recognised problem with the continual introduction of new drugs and novel drug modalities, especially in oncology, and the risks associated with polypharmacy in many patients; although it is important to remember that it may not always be caused by a drug. It is also important to note that several possibly harmful drugs are now available without prescription ('over-the-counter') and can be purchased easily over the internet, including some poorly characterised herbal remedies. ⋯ This article will summarise some key aspects of drug nephrotoxicity and provide a few clinical pointers to consider, bearing in mind that there is rarely any antidote available, and effective treatment relies on early detection, prompt drug withdrawal, and supportive care. This short review is intended only as a primer to highlight some of the more practical aspects of toxic nephropathy; its content is based on a lecture delivered during the 2021 European Congress of Internal Medicine.
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Eur. J. Intern. Med. · Feb 2022
Meta AnalysisLeft ventricular global longitudinal strain in secondary hypertension: A meta-analysis of echocardiographic studies.
Information on systolic dysfunction, as assessed by left ventricular (LV) mechanics in secondary hypertension is still largely limited. We performed a systematic meta- analysis of 2D/3D speckle tracking studies in order to provide an updated comprehensive information on this topic. ⋯ The present meta-analysis adds a new piece of evidence by showing that GLS performs better than EF in identifying systolic dysfunction in the setting of secondary hypertension. In particular, this is true in patients with pheochromocytoma in whom conventional EF suggests a normal or even super-normal systolic function.
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Colchicine is an old, inexpensive, and relatively safe anti-inflammatory drug traditionally used in gout and over the last 50 years in familial Mediterranean fever. A search of all high-hierarchy studies (randomized controlled trials [RCTs], systematic reviews and meta-analysis of RCTs) over the last 20 years revealed myriad other evidence-based applications. Colchicine seems efficacious in the treatment of acute pericarditis and prevention of recurrences and in the prevention of postcardiac injury syndrome and atrial fibrillation following cardiac surgery or percutaneous interventions. ⋯ Colchicine in the low doses used in most trials (≤ 1 mg/d) was generally safe and well-tolerated, excepting diarrhea (approximately 10%) which sometimes led to drug discontinuation. Further RCTs are required to confirm these results, and will likely lead to expanding indications for low-dose colchicine. Increasing numbers of patients will be treated with colchicine in the near future, with improved health outcomes, as long as basic caveats are heeded.