Discrepancies between nursing staff visual estimates and actual food intake among hospitalized patients in internal medicine departments

The aging of the Israeli population along with a shortage of ICU beds have led to hospitalization of invasive mechanical ventilation patients in internal medicine departments, where, as opposed to ICU, the treatment is less than optimal. The aims of the study were to evaluate the predictive factors for successful weaning from mechanical ventilation in ventilated patients admitted to internal medicine departments. A retrospective study that included non-COVID 19 ventilated patients in internal medicine departments in a university affiliated hospital in Israel between the years 2018–2019. We compared datapoints between patients who were weaned from ventilators versus those who remained ventilated during the hospitalization, and defined demographic and clinical predictive factors for successful weaning. Data were collected from electronic medical records and included demographic, clinical, laboratory and ventilator information. The study group included 348 patients. The rate of successful weaning was 19%; patients who were successfully weaned were primarily functionally independent prior to ventilation, ventilated with low PEEP values, had high hemoglobin and albumin levels alongside with low CRP and lactate levels. Those who remained ventilated either required vasopressor treatment, had positive blood cultures or had lower GFR levels. The overall in-hospital mortality rate was 60%, while the 30-day mortality rate was lower in the extubated group [214 (76%) vs. 6 (9%), P < 0.0001]. Our findings highlight the low rate of weaning from ventilation in the department of medicine, with higher mortality rate among the remained ventilated patients. Various favorable clinical parameters might predict successful weaning.

With the rapid growth of an aging global population and proportion, the prevalence of frailty is constantly increasing. Therefore, finding a frailty assessment tool suitable for clinical application by physicians has become the primary link in the comprehensive management of frailty in elderly patients. This study used the (fr)AGILE scale to investigate the frailty status of elderly patients from internal medicine wards and identified relevant factors that affect the severity of frailty. In this study, 408 elderly inpatients in internal medicine departments of Qilu Hospital of Shandong University from May 2021 to August 2022 were enrolled as research subjects, and a cross-sectional observational study was conducted. Researchers evaluated the frailty based on the (fr)AGILE scale score. The general condition, past medical history, physical examination, laboratory examination, nutrition control score, intervention and treatment measures and other elderly patient information was collected. Logistic regression analysis was used to analyze the relevant factors that affect the severity of frailty and hospitalization costs. According to the (fr)AGILE scale score, the elderly patients were divided into groups to determine whether they were frail and the severity of the frailty. Among them, 164 patients were in the prefrailty stage, which accounted for 40.2%. There were 188 cases of mild frailty that accounted for 46.1%, and 56 cases of moderate to severe frailty that accounted for 13.7%. Decreased grip strength, elevated white blood cell levels, and low sodium and potassium are independent risk factors affecting the severity of frailty. As the severity of frailty increases, the proportion of sodium, potassium, albumin supplementation as well as anti-infection gradually increases. Frailty is a common elderly syndrome with a high incidence among elderly patients in internal medicine departments. The main manifestations of frailty vary with different severity levels. Inflammation, anemia, and poor nutritional status can lead to an increase in the severity of frailty as well as blood hypercoagulability, myocardial damage, and additional supportive interventions. This ultimately leads to prolonged hospitalization and increased hospitalization costs.

BackgroundThe screening of high-risk populations using dried blood spots (DBS) has allowed the rapid identification of patients with Pompe disease, mostly in Neurology departments. The aim of the study was to determine the prevalence of late-onset Pompe disease (LOPD) among patients not previously diagnosed or tested for this entity despite presenting possible signs or symptoms of the disease in Internal Medicine departments in Spain.MethodsThis epidemiological, observational, cross-sectional, multicenter study included a single cohort of individuals with clinical suspicion of LOPD seen at Internal Medicine departments in Spain. The diagnosis of LOPD was initially established on the basis of the result of DBS. If decreased enzyme acid-alpha-1,4-glucosidase (GAA) activity was detected in DBS, additional confirmatory diagnostic measurements were conducted, including GAA activity in lymphocytes, fibroblasts, or muscle and/or genetic testing.ResultsThe diagnosis of LOPD was confirmed in 2 out of 322 patients (0.6%). Reasons for suspecting LOPD diagnosis were polymyositis or any type of myopathy of unknown etiology (in one patient), and asymptomatic or pauci-symptomatic hyperCKemia (in the other). The time between symptom onset and LOPD diagnosis was 2.0 and 0.0 years. Both patients were asymptomatic, with no muscle weakness. Additionally, 19.7% of the non-LOPD cases received an alternative diagnosis.ConclusionsOur study highlights the existence of a hidden population of LOPD patients in Internal Medicine departments who might benefit from early diagnosis and early initiation of potential treatments.

Causes of death in hospitalized patients in internal medicine departments with heart failure according to ejection fraction. RICA registry

Background: Peripheral arterial disease (PAD) is a common macrovascular complication in diabetic patients related to atherosclerosis. Early diagnosis of PAD by ankle brachial index (ABI) is highly critical as this disease results in significant morbidity and mortality. Objectives: Toscreen for PAD in asymptomatic diabetic patients by using ABI, determining its prevalence and associated risk factors. Patients and Methods: This is a cross-sectional study conducted on 309 diabetic asymptomatic patients in Internal Medicine Department, Menoufia University Hospitals in the period between December 2018 and December 2020. Full history and biochemical profiles were obtained and ABI indices were measured to evaluate for PAD. Results: The prevalence of PAD in this study was 36.2%. Advancing age, sedentary life, long duration of diabetes, smoking, poor glycemic control and dyslipidemia were identified as risk factors for PAD (p value <0.001)while, hypertension and body mass index were not significant among studied patients (p value 0.594 and 0.733 respectively). Conclusion: PAD has a high prevalence in asymptomatic diabetic individuals. It is associated with multiple risk factors such as smoking, dyslipidemia, advancing age, atherosclerosis and prolonged uncontrolled hyperglycemia. Diabetic patients should be routinely examined by ABI to improve the outcome.

Dietary and herbal supplements use among patients hospitalized in internal medicine departments

Objective To verify the efficacy of Caprini and Padua risk assessment models in screening of venous thromboembolism in patients in the department of internal medicine. Methods A single center retrospective study was performed in the inpatients at the Affiliated Hospital of Qingdao University from August 2017 to December. The Padua and Caprini risk scores were record retrospectively for each patient. Meanwhile, logistic bivariate regression analysis was performed to assess the predictive ability of combined Caprini and Padua risk assessment models for diagnosis of VTE. The operating characteristic curves (ROC) were plotted to calculate the area under the curve and pairwise comparisons were then performed. The cutoff point was chosen based on the Youden index. Results The area under the ROC curve of the combination model was significantly higher than that of Caprini or Padua model alone (0.927±0.009 vs 0.739±0.020, Z=10.659, P<0.001; 0.927±0.009 vs 0.817±0.017, Z=8.952, P<0.001).The sensitivity and specificity of the combination model were also higher than those of Caprini or Padua model alone (83.7% vs 79.1% vs 72.1%; 87.9% vs 66.7% vs 82.7%). Conclusion The combination of Caprini and Padua risk assessment models can improve the accuracy of screening for VTE in patients in the department of internal medicine. Key words: Caprini; Padua; Medical, inpatients; Venous thromboembolism

Pernicious anemia in black people, is little known. Through this study we assess its diagnostic and evolutive aspects, and compare vitamin therapy B12 intramuscular and oral. Sixty six Biermer disease patients followed (January 2000-June 2014) at Internal Medicine Department of Aristide Le Dantec University Teaching Hospital (Senegal) are included. They were 26 men and 46 women (gender ratio: 0.65), who had a mean age of 47.84 years ± 15.25 years. Patients consulted for anemia (65 cases), acquired melanodermia (36 cases), gastrointestinal symptoms (30 cases), peripheral neuropathy (27 cases), venous thrombosis (2 cases), acute depression (1 case). Macrocytosis was observed in 52 cases. The mean hemoglobin in the vitamin B12 intramuscular group (52 patients) or oral group (14 patients) was the inclusion: 6.55 g/dl ± 3.12 g/dl vs 6.52 g/dl ± 2.18 g/dl (p = 0.04); and at day 8 treatment: 8.69 g/dl ± 2.49 g/dl vs 8.85 g/dl ± 1.9 g/dl (p = 0.43). Neurological and vascular presentations are unusual in contrast to macrocytic anemia. Oral administration of vitamin B12, simple and effective should be recommended in country with limited resources.

Improved meal presentation increases food intake and decreases readmission rate in hospitalized patients

Myocardial injury and anemia are common among patients in internal medicine departments. Nevertheless, the level of anemia in which blood should be given to these patients is ill defined.We conducted a retrospective, cohort analysis.A total of 209 patients hospitalized to internal medicine, with myocardial injury (troponin I > 0.2 mcg/L, not diagnosed as ACS, acute coronary syndrome) and anemia (Hb < 10 g/dL, without overt bleeding) were included. The overall in-hospital mortality rate was 20.7%. A total of 37 patients (17.8%) had severe anemia (Hb < 8 g/dL). A total of 73 patients (34.9%) were transfused. Severe anemia was not associated with increased long-term mortality in the whole cohort while survival of patients with severe anemia that were not transfused was significantly reduced compared to transfused patients (44% vs 80%; P = 0.03). Mortality rates were similar for all patients with Hb ≥ 8 g/dL, regardless of transfusion (54% vs 49%; P = 0.60). Consistently, lack of blood transfusion in patients with severe anemia was independently associated with a 2.27 (1.08–4.81) greater adjusted risk of all-cause mortality (P-value for interaction = 0.04), whereas it did not significantly increase in patients with Hb ≥ 8 g/dL.Avoidance of blood transfusion is associated with unfavorable outcomes among patients with myocardial injury and severe anemia.

Attitudes towards and practice of venous thromboembolism prevention in general internal medicine wards: A multinational survey from member countries of the European Federation of Internal Medicine

Background. The main cause of non-alcoholic fatty liver disease (NAFLD) is insulin resistance and the one of the most common risk factors for insulin resistance is obesity. The abnormality of lipid metabolism can be seen in NAFLD such as: High level of free fatty acid (FFA) in plasma, formation of reactive oxygen species and high level of lipid peroxidation (malondialdehyde (MDA) and trans-4-hydroxy-2-nonenal).Objective. The aim of the study is to find the risk factors of NAFLD prevalence in obesity with or without diabetes mellitus.Methods. Case control study. The population was taken from general check up patients in Internal Medicine Department, Dr. Sardjito General Hospital Yogyakarta Indonesia, March 2007 until August 2008. The case group is obesity who suffered diabetes mellitus and the control group is obesity without diabetes mellitus. The Subjects who fulfilled inclusion and exclusion criteria are enrolled in this study. Diagnosis of NAFLD is defined by Liver Ultrasound (Bright Liver appearance). AST, ALT, GGT, cholesterol, triglyceride, fasting glucose, 2 hour post-prandial glucose, insulin, Apo-B, FFA, MDA and adiponectin were examined. Data analyzed by computer using t-test for different of mean, Anova and linear regression test for significant factors (CI 95% and p < 0.05), and odd ratio for risk factors. Results. The fourty six obese patients (case 23 pts, control 23 pts) are matched to age and sex. Significant difference are shown in triglyceride, FFA and adiponectin level (p: 0.013; p: <0.001; and p: 0,045). There are no significant difference in insulin resistance, cholesterol, MDA and Apo-B level. By linear regression test, triglyceride, FFA and adiponectin level are predicted as significant factor (p<0.05) with odd ratio 1.64, 12.4, and 0.9.Conclusion. Increasing of triglyceride, FFA and adiponectin level in obesity with diabetic have risk of NAFLD prevalence with odd ratio 1.64 time (triglyceride), 12.4 (FFA) and 0.9 (adiponectin).