Internal and Emergency Medicine

Journal Information
ISSN / EISSN : 18280447 / 19709366
Current Publisher: Springer Science and Business Media LLC (10.1007)
Total articles ≅ 2,384
Google Scholar h5-index: 32
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Cesare Perotti, Claudia Del Fante, Fausto Baldanti, Massimo Franchini, Elena Percivalle, Edoardo Vecchio Nepita, Elena Seminari, Annalisa De Silvestri, Raffele Bruno, Catherine Klersy
Internal and Emergency Medicine pp 1-6; doi:10.1007/s11739-020-02384-2

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Markus Depfenhart, Danielle De Villiers, Gottfried Lemperle, Markus Meyer, Salvatore Di Somma
Internal and Emergency Medicine pp 1-12; doi:10.1007/s11739-020-02383-3

Of huge importance now is to provide a fast, cost-effective, safe, and immediately available pharmaceutical solution to curb the rapid global spread of SARS-CoV-2. Recent publications on SARS-CoV-2 have brought attention to the possible benefit of chloroquine in the treatment of patients infected by SARS-CoV-2. Whether chloroquine can treat SARS-CoV-2 alone and also work as a prophylactic is doubtful. An effective prophylactic medication to prevent viral entry has to contain, at least, either a protease inhibitor or a competitive virus ACE2-binding inhibitor. Using bromhexine at a dosage that selectively inhibits TMPRSS2 and, in so doing, inhibits TMPRSS2-specific viral entry is likely to be effective against SARS-CoV-2. We propose the use of bromhexine as a prophylactic and treatment. We encourage the scientific community to assess bromhexine clinically as a prophylactic and curative treatment. If proven to be effective, this would allow a rapid, accessible, and cost-effective application worldwide.
Stavros Konstantinides, Guy Meyer
Internal and Emergency Medicine pp 1-10; doi:10.1007/s11739-020-02340-0

Pulmonary embolism (PE) is the third most frequent acute cardiovascular syndrome. Annual PE incidence and PE-related mortality rates rise exponentially with age, and consequently, the disease burden imposed by PE on the society continues to rise as the population ages worldwide. Recently published landmark trials provided the basis for new or changed recommendations included in the 2019 update of the European Society of Cardiology Guidelines (developed in cooperation with the European Respiratory Society). Refinements in diagnostic algorithms were proposed and validated, increasing the specificity of pre-test clinical probability and d-dimer testing, and thus helping to avoid unnecessary pulmonary angiograms. Improved diagnostic strategies were also successfully tested in pregnant women with suspected PE. Non-vitamin K antagonist oral anticoagulants (NOACs) are now the preferred agents for treating the majority of patients with PE, both in the acute phase (with or without a brief lead-in period of parenteral heparin or fondaparinux) and over the long term. Primary reperfusion is reserved for haemodynamically unstable patients. Besides, the 2019 Guidelines endorse multidisciplinary teams for coordinating the acute-phase management of high-risk and (in selected cases) intermediate-risk PE. For normotensive patients, physicians are advised to include the assessment of the right ventricle on top of clinical severity scores in further risk stratification, especially if early discharge of the patient is envisaged. Further important updates include guidance (1) on extended anticoagulation after PE, taking into account the improved safety profile of NOACs; and (2) on the overall care and follow-up of patients who have suffered PE, with the aim to prevent, detect and treat late sequelae of venous thromboembolism.
Elisabetta Cocconcelli, Roberto Tonelli, Gianluca Abbati, Alessandro Marchioni, Ivana Castaniere, Filippo Pelizzaro, Francesco Paolo Russo, Alberto Vegetti, Elisabetta Balestro, Antonello Pietrangelo, et al.
Internal and Emergency Medicine pp 1-9; doi:10.1007/s11739-020-02376-2

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Zhenhua Huang, Keke Wang, Daya Yang, Qianlin Gu, Qiuxia Wei, Zhen Yang, Hong Zhan
Internal and Emergency Medicine pp 1-8; doi:10.1007/s11739-020-02378-0

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Gualtiero Palareti, Cristina Legnani, Emilia Antonucci, Serena Zorzi, Angelo A. Bignamini, Corrado Lodigiani, Alberto Tosetto, Lorenza Bertù, Vittorio Pengo, Sophie Testa, et al.
Internal and Emergency Medicine pp 1-10; doi:10.1007/s11739-020-02381-5

How to prevent recurrences after a first venous thromboembolic (VTE) event in elderly patients is still an open issue, especially because of the high bleeding risk of anticoagulation in these patients. The placebo-controlled “Jason” study aims at assessing the efficacy and safety for secondary VTE prevention in elderly patients of oral Sulodexide (Vessel®) administration, a mixture of glycosaminoglycans (Alfasigma, Bologna, Italy) which proved effective against recurrences in a general population (SURVET study) without major bleeding (MB) complications. 1450 patients, aged ≥ 75 years, after at least 3 months of anticoagulation treatment for a first VTE episode, are double-blind randomized to receive for 12 months either sulodexide 500 lipasemic units (LSUs) twice daily, or sulodexide 250 LSU twice daily + indistinguishable placebo, or indistinguishable placebo. Primary outcomes for efficacy are the composite of death for VTE and recurrent VTE, and occurrence of MB for safety. Secondary outcomes include stroke, cardiovascular death and other thromboembolic events, and MB + clinically relevant non-MB. The first patient is scheduled to be randomized in May 2020. The study protocol has been approved by AIFA (Agenzia Italiana del Farmaco) and the Ethics Committee of the coordinating center. Written informed consent will be obtained from all patients prior to study participation. Jason study is an investigator-initiated trial, promoted by “Arianna Anticoagulazione” Foundation, Bologna, Italy, and supported by Alfasigma, Bologna, Italy. Study findings will be disseminated to participant centers, at research conferences and in peer-reviewed journals. Trial registration numbers NCT 04257487; EudraCT (2019–000570-33).
Jacopo Ciaffi, Riccardo Meliconi, Maria Paola Landini, Francesco Ursini
Internal and Emergency Medicine pp 1-5; doi:10.1007/s11739-020-02371-7

Verma M, Kishore K, Kumar M, Sondh AR, Aggarwal G, Kathirvel S (2018) Google search trends predicting disease outbreaks: an analysis from India. Healthc Inform Res 24(4):300–308. 30443418 Husnayain A, Fuad A, Lazuardi L (2019) Correlation between Google Trends on dengue fever and national surveillance report in Indonesia. Glob Health Action 12(1):1552652. 31154985 Li C, Chen LJ, Chen X, Zhang M, Pang CP, Chen H (2020) Retrospective analysis of the possibility of predicting the COVID-19 outbreak from Internet searches and social media data, China, 2020. Euro Surveill 25(10):2000199. Ayyoubzadeh SM, Ayyoubzadeh SM, Zahedi H, Ahmadi M, Niakan R, Kalhori S (2019) Predicting COVID-19 incidence through analysis of google trends data in iran: data mining and deep learning pilot study. JMIR Public Health Surveill. 6(2):e18828. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y (2020) The epidemiology, diagnosis and treatment of COVID-19 [published online ahead of print, 2020 Mar 28]. Int J Antimicrob Agents. 32234468) Leung K, Wu JT, Liu D, Leung GM (2020) First-wave COVID-19 transmissibility and severity in China outside Hubei after control measures, and second-wave scenario planning: a modelling impact assessment published online ahead of print, 2020 Apr 8]. Lancet. 32277878) Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB (2019) Pharmacologic treatments for coronavirus disease 2019 (COVID-19): a review [published online ahead of print, 2020 Apr 13]. JAMA. Testa S, Paoletti O, Giorgi-Pierfranceschi M, Pan A (2019) Switch from oral anticoagulants to parenteral heparin in SARS-CoV-2 hospitalized patients [published online ahead of print, 2020 Apr 15]. Intern Emerg Med. Eysenbach G (2011) Infodemiology and infoveillance tracking online health information and cyberbehavior for public health. Am J Prev Med 40(5 Suppl 2):S154–S158. Download references None. Correspondence to Jacopo Ciaffi. The authors declare they have no conflict of interest. No human participant or animal was involved in the present research. The authors used open-access data and information available on official websites of the Italian government. Only aggregate, anonymous data were used for the purpose of the present research. Therefore, informed consent was not required. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions Ciaffi, J., Meliconi, R., Landini, M.P. et al. Google trends and COVID-19 in Italy: could we brace for impact?. Intern Emerg Med (2020). Download citation Received: 22 April 2020 Accepted: 06 May 2020 Published: 25 May 2020 DOI:
Lorenzo Bertolino, Martina Vitrone, Emanuele Durante-Mangoni
Internal and Emergency Medicine pp 1-10; doi:10.1007/s11739-020-02377-1

Coronavirus disease 2019 (COVID-19) is currently causing a pandemic and will likely persist in endemic form in the foreseeable future. Physicians need to correctly approach this new disease, often representing a challenge in terms of differential diagnosis. Although COVID-19 lacks specific signs and symptoms, we believe internists should develop specific skills to recognize the disease, learning its ‘semeiotic’. In this review article, we summarize the key clinical features that may guide in differentiating a COVID-19 case, requiring specific testing, from upper respiratory and/or influenza-like illnesses of other aetiology. We consider two different clinical settings, where availability of the different diagnostic strategies differs widely: outpatient and inpatient. Our reasoning highlights how challenging a balanced approach to a patient with fever and flu-like symptoms can be. At present, clinical workup of COVID-19 remains a hard task to accomplish. However, knowledge of the natural history of the disease may aid the internist in putting common and unspecific symptoms into the correct clinical context.
Stefano Gitto, Roberto Giulio Romanelli, Anna Paola Cellai, Donatella Lami, Francesco Vizzutti, Rosanna Abbate, Francesca Margheri, Gabriella Fibbi, Mario Del Rosso, Giacomo Laffi
Internal and Emergency Medicine pp 1-9; doi:10.1007/s11739-020-02375-3

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Elisa Gesu, Pietro Bellone, Katia Khouri Chalouhi, Federico Longhitano, Andrea Risso, Andrea Di Rita, Luca Mellace
Internal and Emergency Medicine pp 1-4; doi:10.1007/s11739-020-02349-5

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