European journal of internal medicine
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Eur. J. Intern. Med. · Jan 2025
ReviewTranslating evidence into practice: Managing electrolyte imbalances and iron deficiency in heart failure.
Mineral abnormalities are a common complication of heart failure (HF). In particular, dyskalaemia, hyponatraemia, and hypomagnesaemia are prevalent, with hypo- and hyperkalaemia observed in over 40 % of HF patients, hyponatraemia in 18-27 %, hypomagnesaemia in 7-52 %, and phosphate imbalance in 13 %. These abnormalities serve as indicators of the severity of HF and are strongly associated with an increased risk of morbidity and mortality. ⋯ Various pathways contribute to the development of ID in HF, including reduced iron intake due to anorexia, increased hepcidin levels associated with chronic inflammation and hepatic congestion, and occult gastrointestinal bleeding due to the concomitant use of antithrombotic agents. The efficacy of iron replacement therapy has been demonstrated in clinical trials, particularly in heart failure with reduced ejection fraction (HFrEF), whilst more recently, it has also been shown to improve exercise capacity in patients with heart failure with preserved ejection fraction (HFpEF). This review focuses on potassium and phosphate abnormalities, hyponatraemia, hypomagnesaemia, and ID in HF, providing a comprehensive overview of the mechanisms, clinical significance, and intervention strategies with the latest findings.
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Eur. J. Intern. Med. · Jan 2025
Adherence to the 2019 ESC/EAS guidelines for dyslipidaemia management in a large rheumatoid arthritis cohort: Data from the CORDIS Study Group of the Italian Society of Rheumatology.
Lipid-lowering therapy prescription is low in rheumatoid arthritis (RA) patients, often not achieving lipid threshold target despite treatment. However, evidence derives from small, monocentric cohorts. We assessed adherence to lipid-lowering treatment for primary cardiovascular (CV) prevention in a RA cohort according to international guidelines. ⋯ In a wide Italian RA cohort, more than 50% of patients had high or very high CV risk. In these, lipid-lowering treatment prescription is suboptimal leading to not achievement of LDL-c target. Physicians should improve lipid screening and primary prevention therapy to reduce CV risk and improve CV comorbidity in RA patients.
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Eur. J. Intern. Med. · Jan 2025
Prospective study of risk factors for community-acquired acute kidney injury.
Causes and risk factors for community-acquired acute kidney injury (CA-AKI) have not been thoroughly studied. The aim of this study was to examine the risk factors for CA-AKI. ⋯ Events in the setting of acute illness and medication use, including OTC NSAIDs, may play a greater role in the development of CA-AKI than comorbid conditions. Frequent use of OTC NSAIDs is a concern and should be addressed in view of serious adverse effects.
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Eur. J. Intern. Med. · Jan 2025
A large language model-based clinical decision support system for syncope recognition in the emergency department: A framework for clinical workflow integration.
Differentiation of syncope from transient loss of consciousness can be challenging in the emergency department (ED). Natural Language Processing (NLP) enables the analysis of free text in the electronic medical records (EMR). The present paper aimed to develop a large language models (LLM) for syncope recognition in the ED and proposed a framework for model integration within the clinical workflow. ⋯ The anamnesis model had an AUC of 0·98 for the Italian BERT and 0·97 for Multi BERT. The LLM identified syncope when not explicitly mentioned in the EMR and also recognized common prodromal symptoms preceding syncope. Both models identified syncope patients in the ED with a high discriminative capability from nurses and doctors' notes, thus potentially acting as a tool helping physicians to differentiate syncope from others transient loss of consciousness.