Internal and emergency medicine
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According to the Global Burden of Disease Study 2017, between 1990 and 2017, Italy experienced a more attenuate reduction in cardiovascular deaths than Western Europe. When considering risk factors, our Country experienced a reduction in the prevalence of hypertension in the last few decades, especially in women. On the other hand, the prevalence of obesity, abdominal obesity and hypercholesterolemia in Italy is on the rise. ⋯ The goal was to highlight the health needs related to the growth of metabolic diseases in the area. The observed changes bring the two coasts of the Mediterranean closer together. It is time to work together to build more effective strategies for identifying and reaching population subgroups that have still remained little sensitive to prevention and specially to lifestyles changes.
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In the last 2-3 decades internists have confronted dramatic changes in the pattern of patients acutely admitted to hospital wards. Internists observed a shift from younger subjects affected by a single organ disease to more complex patients, usually older, with multiple chronic conditions, attended by different specialists, with poor integration and treated with multiple drugs. In this regard, the concept of complex patients is addressed daily in clinical practice even if there is no agreed definition of patient complexity. ⋯ CIRS-SI was also the best predictor of all-cause of post-discharge mortality corrected for age and sex [OR: 2.12 (1.53-2.95)]. CIRS-SI (coefficient ± standard error: 1.23 ± 0.59; p < 0.0381) and CIRS-CI (coefficient ± standard error: 0.27 ± 0.10; p < 0.011) were strong predictors of LOS in comparison with NoC that did not result statistically significant (coefficient ± standard error: 0.04 ± 0.06 p < 0.0561). In conclusion, CIRS assessment of comorbidity burden is a better clinical tool in comparison with the simple count of comorbidities especially considering the length of hospital stay and all-cause mortality in hospitalized elderly patients.
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Observational Study
Infections in out-of-hospital and in-hospital post-cardiac arrest patients.
This study aims to describe infectious complications in both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients with sustained return of spontaneous circulation (ROSC) and to compare differences in antimicrobial treatment and outcomes between the two groups. This was a retrospective, single-center, observational study. Adult patients (≥ 18 years) with OHCA or IHCA who had sustained ROSC between December 2007 to March 2015 were included. ⋯ We found significantly more infections in IHCA compared to OHCA patients. The most common infection category was respiratory and the most common organism isolated from sputum cultures was Staphylococcus aureus coagulase-positive. The incidence of culture-positive bacteremia was similar in both OHCA and IHCA cohorts but overall lower than previously reported.