European journal of internal medicine
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Eur. J. Intern. Med. · Jul 2020
ReviewTherapeutic strategies for virus-negative myocarditis: a comprehensive review.
Virus-negative or autoimmune myocarditis(VNM) is an inflammatory disease affecting the myocardium that may occur as a distinct disease with exclusive cardiac involvement, or in the context of systemic autoimmune or inflammatory disorders. The pathogenesis of VNM involves both innate and acquired immunity and is not completely elucidated: an early immune-mediated pathogenic process lead to subacute and chronic stages and eventually results in tissue remodeling, fibrosis, contractile dysfunction, dilated cardiomyopathy and arrhythmic burden, accounting for a dismal prognosis. Treatment interventions effectively curbing the acute inflammatory process at an early stage can prevent late cardiac remodeling and improve patient's outcome. ⋯ Thus, second-line targeted therapeutic strategies to treat VNM are eagerly awaited. Recent data on the pathogenic mechanisms underlying myocardial inflammation are paving the way to novel, promising treatment strategies for myocarditis, which could reformulate future treatment strategies for VNM. In this review, we summarize the current therapeutic opportunities, beyond corticosteroids, to treat VNM, including conventional and biologic immunosuppressive drugs and cytokine blocking agents.
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Probably it does.
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Eur. J. Intern. Med. · Jul 2020
Predictors of infection after "de novo" cardiac electronic device implantation.
Cardiac implantable electronic device (CIED) infection is a major complication that increases morbidity and mortality after the procedure. Several infection risk scores have been suggested to identify patients at higher pre-procedural risk of infection OBJECTIVE: this study sought to evaluate rates of infection, potential risk factors and the role of a modified "Shariff" score as predictor of infection in high-risk patients undergoing de novo CIED implantation. ⋯ a "Shariff" score > 4 is suggested as a predictor of higher risk of infection in patients after de novo device implantation. The use of an infection risk score may help to improve tailored pre-operatory strategies to prevent infection.
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Eur. J. Intern. Med. · Jul 2020
Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure.
Acute kidney injury (AKI) is a serious complication in patients hospitalized for decompensated heart failure (HF). Currently, AKI definitions consider creatinine levels at admission as reference of baseline renal function (RF). However, renal impairment may already be present at admission. We aimed to study the impact on AKI detection of considering outpatient RF as reference. ⋯ Evaluation of AKI in patients admitted with HF should consider pre-hospital RF, since it improves early identification of AKI and has implications for risk assessment.
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Eur. J. Intern. Med. · Jul 2020
Clinical practice guidelines adaptation for internists - An EFIM methodology.
The rising number of clinical guidelines poses a new challenge to the internists. The main problems are: 1) available documents suffer from heterogeneous methodological quality, and 2) most of clinical guidelines target an 'ideal' patient affected by a single condition, while in real practice internists must face with comorbid patients typically undergoing a polypharmacy. ⋯ The project started with the creation of a research protocol containing details about all the steps needed to write the Clinical Practice Guideline Summary. In particular, this methodological document specifies the rules: 1) to select topics and clinical questions; 2) to build up a panel of experts, carefully managing eventual conflict of interests; 3) to critically appraise clinical guidelines (using a validated tool as AGREE II), selecting the most valid and applicable to the common clinical practice (using ADAPTE; 4) to address and solve potential disagreements among the selected documents.