European journal of internal medicine
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Eur. J. Intern. Med. · Aug 2021
Minimal portosystemic encephalopathy: A new nosological entity in patients with hereditary haemorrhagic telangiectasia.
Portosystemic shunts in Hereditary Haemorrhagic Telangiectasia (HHT) are often overlooked by conventional imaging although they could reduce hepatic clearance of gut-derived toxins. ⋯ HHT patients represent a human model of mPSE secondary to portosystemic shunts escaping radiological detection. mPSE evaluation should be incorporated in HHT surveillance protocols since it can affect both health-related/social aspects and pharmacokinetics of orally administered drugs with a narrow therapeutic index and high hepatic first-pass uptake.
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Sarcopenia is a disease related to accelerated loss of skeletal muscle and subsequent decline in functional capacity. It affects approximately 13% of the world's population aged over 60 years. Sarcopenia is primarily managed and prevented through a combination of exercise prescription combined with appropriate nutritional strategies. ⋯ Criteria used by diagnostic tools (muscle mass, muscle strength and physical functioning/performance) are also detailed. Case-finding tools include the SARC-F questionnaire, Ishii's formula and Goodman's screening grid. Additionally, this review discusses the strengths and weaknesses of each diagnostic and case-finding tool, and examines their ability to reliably predict adverse clinical outcomes and patient responses to potential therapies.
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Eur. J. Intern. Med. · Aug 2021
ReviewCombining New Classes of Drugs for HFrEF: from Trials to Clinical Practice.
Pharmacological approach to heart failure with reduced ejection fraction (HFrEF) is evolving, as recently published large randomized clinical trials have implemented the disposal of HFrEF treatments with four new classes of drugs, namely angiotensin receptor/neprilysin inhibitor , sodium-glucose co-transporters 2 inhibitors , soluble guanylate cyclase modulators and myosin activators, which have proved to further improve patients' quality of life and long-term outcomes. As these novel drugs target additional pathways not already intercepted by the guideline-directed medical therapy, integration of them in the management of HFrEF is desirable. This review paper aims to provide an overview of the current evolving concepts of HFrEF therapy joining the most recent evidences and to furnish practical suggestions for the use of these new classes of drugs in clinical practice.
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Eur. J. Intern. Med. · Aug 2021
Multicenter Study Observational StudyPrevalence, determinants and practical implications of inappropriate hospitalizations in older subjects: A prospective observational study.
In a context of high demand for hospital services among older people, we aimed to assess the rate and determinants of inappropriate hospitalizations of older patients, and to what extent they were associated with inappropriate hospital stay. This prospective observational multicentre study evaluated a random sample of consecutive patients aged ≥ 70 years accessing the Emergency Department (ED) of two Italian tertiary hospitals. A standardized comprehensive geriatric assessment was carried out in each patient, including the Blaylock Risk Assessment Screen Scale (BRASS) for identification of patients at risk of difficult discharge. ⋯ Compared with patients appropriately admitted, inappropriate hospitalizations had shorter length of hospital stay but accounted for 1059/9154 days of stay (11.6%). Inappropriate hospitalizations occurred in less than 15% of cases, mainly accounted for by patients no longer manageable at home, but contributed to the greatest proportion of inappropriate hospital stay. These findings highlight the need of implementing appropriate home-care services and ensuring rapid access to suitable care-facilities for community-dwelling frail older patients.