Internal and emergency medicine
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SGLT-2 inhibitors (SGLT-2i) are linked to a higher risk of diabetic ketoacidosis (DKA). However, it is still unclear whether the severity of SGLT-2i associated DKA is higher. This is a retrospective cohort study with patients admitted for DKA at a tertiary hospital (2013-2024). ⋯ No significant differences were found in diabetes type, ketonemia, creatinine, or DKA precipitating factors. DKA in patients with diabetes treated with SGLT-2i is associated with more severe acidosis with quicker onset, leading to higher risk of ICU admission compared to patients not receiving this treatment. We recommend temporary discontinuation of SGLT-2i during any acute event until resolution, regardless of diabetes type or the patient's glycemic control.
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The aging global population and the increasing use of antithrombotic agents have made spontaneous intramuscular hematomas (SIH) a growing concern. The association between the settings of SIH onset and clinical outcomes remains unclear. The aim of this study was to determine these associations. ⋯ In addition, one subject (1.6%) with out-of-hospital onset and three subjects (14%) with in-hospital onset died during hospitalization. In-hospital onset was associated with a high rate of in-hospital mortality (OR 25, 95% CI 6.3-240) in the IPTW cohort. SIH with in-hospital onset had a poorer prognosis than that of SIH with out-of-hospital onset, suggesting that onset setting might be a novel predictor of clinical outcomes for SIH.
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The health implications of e-cigarette use compared to traditional cigarette smoking continue to attract significant public health interest. This study examines self-rated health (SRH) outcomes among exclusive e-cigarette users versus exclusive traditional cigarette smokers, using data from the Health Survey for England 2019. From an initial sample of 10,299 participants, the study focused on 8204 adults, excluding those aged 0-15. ⋯ As a sensitivity analysis, a generalized ordered logistic regression model was performed using the original five SRH categories. The adjusted model confirmed consistent results, with exclusive e-cigarette users showing higher odds of reporting better health across the full range of SRH outcomes (OR = 1.40, 95% CI: 1.08-1.82, p = 0.011). These findings suggest that exclusive e-cigarette users perceive their health more positively than traditional cigarette smokers, contributing useful insights to the discussions around harm reduction strategies.
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The diagnosis of venous thromboembolism (VTE) is complex, and many cases of pulmonary embolism (PE) and deep vein thrombosis (DVT) go undetected despite validated diagnostic algorithms. This study evaluated the diagnostic performance of compression ultrasound (CUS) when systematically performed in patients admitted to an internal medicine department for dyspnea and/or respiratory failure. We conducted a prospective observational cohort study of consecutive adult hospitalized patients admitted for dyspnea and/or respiratory failure with at least one of the following: tachycardia (> 100 bpm), tachypnea (> 20/min), chest pain, cough, syncope, or hemoptysis. ⋯ Using the Wells score for DVT (cut-off ≥ 2), only 8 patients (25.8%) were at high risk. The accuracy of the Wells score in identifying PE was suboptimal, as 5 of 9 patients (55.5%) with confirmed PE were in the low-risk group (three-level interpretation) and 8 (89.9%) were in the "EP unlikely" group (two-level interpretation). The systematic use of CUS as a point-of-care tool can improve the diagnostic accuracy for VTE in patients admitted to internal medicine departments with dyspnea/respiratory failure.
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Understanding the patients' clinical profile, barriers to optimal inhaler use, and adherence are crucial in achieving the treatment goal for asthma and chronic obstructive pulmonary disease (COPD). This study aimed to assess the inhaler technique and identify the predictors of inhaler adherence among asthma and COPD patients who presented to the Emergency Department (ED). This prospective cross-sectional study recruited patients who presented to the outpatient ED of a tertiary hospital for mild-to-moderate exacerbation from March 2022 to February 2023. ⋯ The high rate of wrong inhaler techniques among asthma and COPD patients is worrisome. Identified predictors of inhaler adherence should be targeted when managing this group of patients. In addition to the exacerbation treatment in the ED, referrals to public primary health clinics for regular follow-ups, evaluation of inhaler techniques, and counseling to enhance patient knowledge are crucial.