European journal of internal medicine
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Eur. J. Intern. Med. · Aug 2024
The interplay between subclinical hypothyroidism and poor sleep quality: A systematic review.
The relationship between subclinical hypothyroidism (SHYPO) and sleep disturbances is still poorly investigated. This systematic review aims to critically appraise the existing literature to provide more insights in understanding whether SHYPO favors sleep disturbances or it is the sleep disturbance per se that affects the hypothalamus-pituitary-thyroid axis regulation. ⋯ Overall, the existing literature data suggest a link between SHYPO and sleep disturbances, but further studies on larger populations of patients with homogeneous study designs and outcomes are warranted.
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Eur. J. Intern. Med. · Aug 2024
ReviewSingle-pill combination for treatment of hypertension: Just a matter of practicality or is there a real clinical benefit?
Elevated blood pressure (BP) is the largest contributor to the incident cardiovascular disease worldwide. Despite explicit guideline recommendations for the diagnosis and management of hypertension, a large proportion of patients remain undiagnosed, untreated, or treated but uncontrolled. Inadequate BP control is associated with many complex factors including patient preference, physician's inertia, health systems disparities, and poor adherence to prescribed antihypertensive drug treatment. ⋯ Initiation of treatment for hypertension with a two-drug regimen, preferably in a single pill combination (SPC), is recommended for most patients. Preferred combinations should comprise a RAS blocker (either an ACEi or an ARB) with a CCB or thiazide/thiazide-like diuretic. These strategies are supported by robust evidence that combination therapy produces greater BP reductions than monotherapy, reduces side effects of the individual components, improves therapeutic adherence and long-term persistence on treatment, and permits achievement of earlier BP control.
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Eur. J. Intern. Med. · Aug 2024
ReviewWhat should I eat today? Evidence, guidelines, dietary patterns and consumer's behavior.
Over the past century, dietary recommendations emphasizing food patterns as means to deliver essential nutrients have garnered widespread acceptance. The necessity for foods supplying vital nutrients and energy throughout various life stages requires the involvement of local resources and cultural practices to prevent nutrient deficiency diseases. Since the 1980s, dietary guidelines aimed at adverting chronic diseases have relied on epidemiological research to predict which dietary patterns correlate with reduced risk of chronic disease or links to health outcomes. ⋯ Consumers have become skeptical of dietary guidelines, because media coverage of new studies is often in conflict with accepted nutrition dogma. Indications to align individual and planet's health have been issued supporting the concept of sustainable dietary patterns. Whether we really have a science-based databank to support dietary guidelines is still a matter of ongoing debate, as presented in this paper.
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Eur. J. Intern. Med. · Aug 2024
Multicenter StudyPrognostic value of cognitive impairment, assessed by the Clock Drawing Test, in emergency department patients presenting with non-specific complaints.
Cognitive impairment (CI) is common among older patients presenting to the emergency department (ED). The failure to recognize CI at ED presentation constitutes a high risk of additional morbidity, mortality, and functional decline. The Clock Drawing Test (CDT) is a well-established cognitive screening test. ⋯ The early identification of patients with CI may lead to improved patient management and resource allocation. The CDT could be used as a risk stratification tool for older ED patients presenting with NSCs, as it is a predictor for 30-day mortality and LOS.
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Eur. J. Intern. Med. · Aug 2024
Observational StudyRelation of plasma neuropeptide-Y with myocardial function and infarct severity in acute ST-elevation myocardial infarction.
Acute myocardial infarction is associated with the release of the co-transmitter neuropeptide-Y (NPY). NPY acts as a potent vasoconstrictor and is associated with microvascular dysfunction after ST-elevation myocardial infarction (STEMI). This study comprehensively evaluated the association of plasma NPY with myocardial function and infarct severity, visualized by cardiac magnetic resonance (CMR) imaging, in STEMI patients revascularized by primary percutaneous coronary intervention (PCI). ⋯ High plasma levels of NPY, measured 24h after STEMI, were independently associated with lower LVEF, decreased GLS, larger IS as well as presence of MVO, indicating plasma NPY as a novel clinical risk marker post STEMI.