European journal of internal medicine
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Eur. J. Intern. Med. · Sep 2024
ReviewIschemia with non-obstructive coronary artery (INOCA): Non-invasive versus invasive techniques for diagnosis and the role of #FullPhysiology.
Ischemia with non-obstructive coronary arteries (INOCA) is an increasingly recognized entity. It encompasses different pathophysiological subtypes (i.e., endotypes), including coronary microvascular dysfunction (CMD), vasospastic angina (VSA) and mixed entities resulting from the variable combination of both. ⋯ A breadth of diagnostic technique is available, ranging from non-invasive approaches to invasive coronary angiography adjuvated by functional assessment and provocative tests. This review summarizes the strength and limitations of these methodologies and provides the rationale for the routine referral for invasive angiography and functional assessment in this subset of patients.
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Eur. J. Intern. Med. · Sep 2024
ReviewExploring the nexus: The place of kidney diseases within the cardiovascular-kidney-metabolic syndrome spectrum.
Cardiovascular-kidney-metabolic (CKM) syndrome and chronic kidney disease (CKD) are two significant comorbidities affecting a large proportion of the general population with considerable crosstalk. In addition to substantial co-incidence of CKD and CKM syndrome in epidemiological studies, clinical and pre-clinical studies have identified similar pathophysiological pathways leading to both entities. ⋯ Furthermore, such patients are less likely to receive kidney transplantation in addition to the higher allograft dysfunction risk. We hereby aim to evaluate the association in-between kidney diseases and CKM syndrome, including epidemiological data, pre-clinical studies with pathophysiological pathways, and potential therapeutic perspectives.
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Eur. J. Intern. Med. · Sep 2024
Multicenter StudyCombining loop with thiazide diuretics in patients discharged home after a heart failure decompensation: Association with 30-day outcomes.
To investigate the association of the addition of thiazide diuretic on top of loop diuretic and standard of care with short-term outcomes of patients discharged after surviving an acute heart failure (AHF) episode. ⋯ The combination of thiazide and loop diuretics was not associated with changes in risk of death, hospitalization or a combination of both.
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Eur. J. Intern. Med. · Sep 2024
Multicenter StudyDirect oral anticoagulant-associated bleeding complications in patients with gastrointestinal cancer and venous thromboembolism.
Direct oral anticoagulants (DOACs) have become widely used for cancer-associated venous thromboembolism (VTE). However, DOAC-associated bleeding complications remain challenging, especially in patients with gastrointestinal (GI) cancer. This study aimed to compare the bleeding outcomes between patients with upper or lower GI cancers and those without GI cancer. ⋯ URL: http://www.umin.ac.jp/ctr/index.htm Unique identifier: UMIN000044816.
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Eur. J. Intern. Med. · Sep 2024
Acute kidney injury predicts mortality in very elderly critically-ill patients.
The increasing admissions of very elderly patients to intensive care units (ICUs) over recent decades highlight a growing need for understanding acute kidney injury (AKI) in this population. Although these individuals are potentially at high risk for AKI and adverse outcomes, data on AKI in this population is scarce. This study investigates the AKI incidence and outcomes of critically-ill patients aging at least 90 years. ⋯ AKI is a frequent complication in very elderly critically-ill patients. Occurrence of AKI at any stage was associated with increased mortality. Predictive ability applied to AKI defined by creatinine but not urine output. Careful attention of creatinine dynamics is essential in very elderly ICU-patients.