Internal and emergency medicine
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Internists are experts in complexity, and the COVID-19 pandemic is disclosing complex and unexpected interactions between communicable and non-communicable diseases, environmental factors, and socio-economic disparities. The medicine of complexity cannot be limited to facing comorbidities and to the clinical management of multifaceted diseases. Evidence indicates how climate change, pollution, demographic unbalance, and inequalities can affect the spreading and outcomes of COVID-19 in vulnerable communities. ⋯ This is the case when pandemic events hit vulnerable populations suffering from the increasing burden of chronic diseases, disabilities, and social and economic inequalities. Mastering the interplay of such events requires a change in overall strategy, to adequately manage not only the SARS-CoV-2 infection but also the growing burden of non-communicable diseases by a "one health" approach. In this context, experts in internal medicine have the knowledge and skills to drive this change.
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Multicenter Study
Hospital characteristics associated with COVID-19 mortality: data from the multicenter cohort Brazilian Registry.
The COVID-19 pandemic caused unprecedented pressure over health care systems worldwide. Hospital-level data that may influence the prognosis in COVID-19 patients still needs to be better investigated. Therefore, this study analyzed regional socioeconomic, hospital, and intensive care units (ICU) characteristics associated with in-hospital mortality in COVID-19 patients admitted to Brazilian institutions. ⋯ In-hospital mortality varied significantly among Brazilian hospitals. Private-funded hospitals and those located in municipalities with a high GDP had a lower mortality. When analyzing ICU-specific characteristics, hospitals with more experienced ICU teams had a reduced mortality.
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Frailty is a common condition present in older Emergency Department (ED) patients that is associated with poor health outcomes. The Clinical Frailty Scale (CFS) is a tool that measures frailty on a scale from 1 (very fit) to 9 (terminally ill). The goal of this scoping review was to describe current use of the CFS in emergency medicine and to identify gaps in research. ⋯ https://doi.org/10.17605/OSF.IO/W2F8N.
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New-onset altered level of consciousness (ALC) is a challenge in real-world clinical practice. Although its presentation is nonspecific and its etiology is intricate, the term ALC is frequently used in the emergency room (ER). This study aimed to clarify and classify the etiologies and outcomes of the ALC in the ER. ⋯ The majority of ALC in the ER was derived from extracranial etiology. ALC in the ER is a neurological manifestation of diverse etiologies; not all can be confirmed in the ER. Not only neurological but also critical systemic illnesses should be considered to assess the protean manifestations of ALC in the ER.
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Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) can trigger the apoptosis pathways through binding to relative death receptors. However, the relationship of TRAIL with community-acquired pneumonia (CAP) was unclear. This study aims at exploring the relationships between circulatory TRAIL with severity and prognosis in CAP patients through a prospective cohort study. The whole of 239 CAP patients was enrolled. ⋯ The predictive capacities of serum TRAIL for death were higher compared with CAP severity scores, inflammatory and infectious indicators. There are obviously positive dose-response relationships between circulatory TRAIL on admission with the severity and poor prognostic outcomes in CAP patients. Circulatory TRAIL on admission may be used as a potential biomarker in predicting the severity and poor prognosis for CAP patients.