European journal of internal medicine
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Eur. J. Intern. Med. · Mar 2013
Comparative StudyCirculating sICAM-1 and sE-Selectin as biomarker of infection and prognosis in patients with systemic inflammatory response syndrome.
Vascular endothelium activation is a key pathogenic step in systemic inflammatory response syndrome (SIRS) that can be triggered by both microbial and sterile proinflammatory stimuli. The relevance of soluble adhesion molecules as clinical biomarkers to discriminate between infectious and non-infectious SIRS, and the individual patient prognosis, has not been established. ⋯ Patients with SIRS secondary to infectious or non-infectious etiology show distinctive patterns of disturbance in serum soluble adhesion molecules. Serum ICAM-1 is a reliable biomarker for classifying patients with infectious SIRS from those with non-infectious SIRS. In addition, soluble E-Selectin is a prognostic biomarker with higher levels in patients with SIRS and fatal outcome.
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Eur. J. Intern. Med. · Mar 2013
Multicenter Study Comparative StudyEducation, household wealth and blood pressure in Albania, Armenia, Azerbaijan and Ukraine: findings from the Demographic Health Surveys, 2005-2009.
While socioeconomic gradients in cardiovascular disease have been well established in high-income countries, this relationship is not well understood in middle-income countries. ⋯ There is compelling evidence that wealth and education gradients affect the probability of HTN for women in Albania, Armenia, and Azerbaijan, and for men in Albania.
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Eur. J. Intern. Med. · Mar 2013
Multicenter Study Comparative StudyDiagnostic role of copeptin in patients presenting with chest pain in the emergency room.
Chest pain is a frequent symptom leading patients to the Emergency Room. Copeptin, the C-terminal fragment of arginin-vasopressin, is a marker of stressful situations. Recent studies showed that normal levels of copeptin combined with normal troponin accurately rule out the diagnosis of acute coronary syndrome (ACS). In this observational, prospective, multicenter study we evaluated if negative levels of copeptin combined with negative troponin (Tn-T) can correctly rule out the diagnosis of ACS and also of other life-threatening causes of chest pain. ⋯ The combined use of troponin and copeptin significantly improved the diagnostic accuracy of troponin alone both in ACS (STEMI and NSTEMI) and in other life-threatening diseases. Measurement of this marker might be therefore considered not only for a rule-out strategy but also as a warning sign of a life-threatening disease.
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Eur. J. Intern. Med. · Mar 2013
ReviewOf pills, plants, and paraquat: the relevance of poison centers in emergency medicine.
The organization and work of a poisons center are demonstrated on the basis of GIZ-Nord Poisons Center Annual Report for 2011. In a short summary the basic principles of clinical toxicology are elucidated: the indications for gastric lavage and the application of activated charcoal. Moreover the means of enhanced elimination are presented: hemodialysis, hemoperfusion, multi-dose activated charcoal and molecular absorbent recirculating system (MARS). ⋯ In intoxications with CNS penetrating substances gastric lavage should be performed only after endotracheal intubation due to the risk of aspiration. The basic management of the intoxicated patient by emergency medicine personnel out of hospital and on the way into the hospital is presented. The "Bremen List", a compilation of five antidotes (atropine, 4-DMAP, tolonium chloride, naloxone, activated charcoal) for the out of hospital treatment by emergency doctors is introduced.
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Eur. J. Intern. Med. · Mar 2013
Multicenter Study Comparative StudyLong-term survival following acute heart failure: the Acute Heart Failure Database Main registry (AHEAD Main).
The in-hospital mortality of patients with acute heart failure (AHF) is reported to be 12.7% and mortality on day 30 after admission 17.2%. Less information is known about the long-term prognosis of those patients discharged after hospitalization. As such, the aim of this study was to investigate long-term survival in a cohort of patients who had been hospitalized for AHF and then discharged. ⋯ The AHEAD Main registry provides up-to-date information on the long-term prognosis of patients hospitalized with AHF. The 3-year survival of patients following day 30 of admission was 64.5%. Higher age, LV dysfunction, comorbidities and high levels of natriuretic peptides were the most powerful predictors of worse prognosis in long-term survival.