Marco Cei

Medical divisions are at high risk of Clostridioides difficile infection (CDI) due to patients’ frailty and complexity. This sub-analysis of the FADOI-PRACTICE study included patients presenting with diarrhea either at admission or during hospitalization. CDI diagnosis was confirmed when both enzyme immunoassay and A and B toxin detection were foun...

Some patients affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) experience acute hypoxemic respiratory failure progressing toward atypical acute respiratory distress syndrome (ARDS). The aim of the study is to evaluate whether a correlation between ratio of peripheral saturation of oxygen (SpO2) and fraction of inspired oxyge...

Background Venous thromboembolism is a frequent complication of COVID-19 infection. Less than 50% of pulmonary embolism (PE) is associated with the evidence of deep venous thrombosis (DVT) of the lower extremities. DVT may also occur in the venous system of the upper limbs especially if provoking conditions are present such as continuous positive a...

Background Superior Vena Cava (SVC) syndrome, is a quite rare but serious complication after pacemaker lead implantation; most patients are asymptomatic due to the development of adequate venous collateral circulation. Case presentation We report a case of a 75-year-old woman who developed SVC syndrome after transvenous pacemaker implantation with...

Objective To address the lack of information about clinical sequelae of coronavirus disease 2019 (COVID-19). Patients and Methods Previously hospitalized COVID-19 patients who were attending the outpatient clinic for post-COVID-19 patients (ASST Ovest Milanese, Magenta, Italy) were included in this retrospective study. They underwent blood draw fo...

Although myocarditis can be a severe cardiac complication of COVID-19 patients, few data are available in the literature about the incidence and clinical significance in patients affected by SARS-CoV-2. This study aims to describe the prevalence and the clinical features of suspected myocarditis in 3 cohorts of patients hospitalized for COVID-19. W...

Background chest X-Ray (CXR) is universally accepted as the method of choice to confirm correct positioning of nasogastric tube (NGT). Considering also that radiation exposure could increase with multiple insertion in a single patient, bedside abdominal ultrasound (BAU) may be a potentially useful alternative to CXR in the management of NGT. Resea...

Background: in the current pandemic emergency, increased attention has given to treating symptoms that cause suffering in patients with COVID-19. This study aims to describe the role of palliative care in the management of these patients. Methods: palliative consultation was requested by the staff as per protocol. In brief, the criteria for refe...

Background Enterobacterales are among the most common causes of bacterial infections in the community and among hospitalized patients, and multidrug-resistant (MDR) strains have emerged as a major threat to human health. Resistance to third-generation cephalosporins is typical of MDRs, being mainly due to the production of extended spectrum β-lacta...

Background Ultrasound Elastography (UE) imaging is a novel sonographic technique commonly employed for relative quantification of tissue elasticity. Its applicability to venous thromboembolic events has not yet been fully established; in particular, it is unclear if this technique may be useful in determining the age of deep vein thrombosis (DVT)....

Background: Patients with suspected deep vein thrombosis (DVT) of the lower limb represent a diagnostic dilemma for general practitioners. Compression ultrasonography (US) is universally recognized as the best test of choice. We assessed the diagnostic accuracy of compression US performed by general practitioners given short training in the manage...

The decision concerning the introduction of primary and secondary prophylaxis of venous thromboembolism (VTE) in patients with solid brain neoplasms and brain metastases is often challenging due to the concomitant increased risk of intracranial hemorrhage and to limited evidence from available literature. A standardized questionnaire composed of ni...

: Atrial fibrillation is the most common arrhythmia in over-midlife patients. In addition to systolic heart failure, cerebral thromboembolism represents the most dramatic complication of this rhythm disorder, contributing to morbidity and mortality. Traditionally, anticoagulation has been considered the main strategy in preventing stroke and system...

Dyspnea affects approximately 50% of patients admitted to hospitals. Prompt identification of its correct cause may optimize the management and improve outcomes. Lung ultrasound (LUS) is emerging as a bedside tool that could discriminate different causes of dyspnea even by non-physicians.

In clinical practice lung ultrasound (LUS) is becoming an easy and reliable noninvasive tool for the evaluation of dyspnea. The aim of this study was to assess the accuracy of nurse-performed LUS, in particular, in the diagnosis of acute cardiogenic pulmonary congestion. We prospectively evaluated all the consecutive patients admitted for dyspnea i...

A 77-year-old woman was complaining of pain in the scapular cingulum since 3 months and pain and swelling in both the wrists, with elevated CRP. She began therapy with deflazacort, bisphosphonates and vitamin D. After a month the patient complained of frontal and bitemporal headache. Shortly after, the patient had intense onset pain in the tongue a...

Lesson Given the rare nature of Madelung's disease many clinicians will not have seen a patient with it and will not be able to recognise them: subsequently a diagnosis is unlikely to be made.

Elderly patients admitted to the hospital are at increased risk for both in-hospital and post-discharge mortality. Risk assessment models (RAMs) for in-hospital mortality are based mainly on physiological variables and a few laboratory data, whereas RAMs for late mortality usually include other domains such as disability and comorbidities. We aim t...

Pulmonary embolism (PE) is a common disease with a considerable short- and long-term risk of death. An adequate evaluation of the prognosis in patients with PE may guide decision making in terms of the intensity of the initial treatment during the acute phase, duration of treatment, and intensity of follow-up control visits in the long term. Patien...

Background and aim: Prognostic stratification of acute pulmonary embolism (PE) represents the cornerstone of modern management of this potentially life-threatening disease. In the latest years, a lot of clinical prognostic models have been validated. However, these are yet underused in clinical practice, especially in real world populations. The ai...

Background: Prognostic stratification is of utmost importance for management of acute Pulmonary Embolism (PE) in clinical practice. Many prognostic models have been proposed, but which is the best prognosticator in real life remains unclear. The aim of our study was to compare and combine the predictive values of the hemodynamics/biomarkers based p...

Atrial fibrillation (AF) is the most prevalent sustained heart arrhythmia. It is the most important clinical risk factor for systemic embolism (SE) and is regarded to be the cause of stroke in up to one fourth of cases [1]. However, since stroke is much more prevalent than SE in patients with AF, the latter is not considered to be a main single out...

Compression ultrasonography (CUS) has been recognized as the diagnostic procedure of choice for the investigation of patients with suspected deep vein thrombosis (DVT); the aim of this study was to assess the diagnostic accuracy of nurse-performed CUS for symptomatic proximal DVT of the lower limb. We prospectively evaluated all the consecutive out...

Compression ultrasonography (CUS) has been recognized as the diagnostic procedure of choice for the investigation of patients with suspected deep vein thrombosis (DVT); the aim of this study was to assess the diagnostic accuracy of nurse‐performed CUS for symptomatic proximal DVT of the lower limb. In summary, our results suggest, for the first tim...

In this retrospective analysis, we analyzed all clinical record data in our Medical Division between January 2005 and December 2006 to evaluate an association between clomipramine treatment and glucose intolerance. Of 1997 patients, 154 (7.7 %) had diabetes and 525 (26.3 %) had depression. Diabetes prevalence was significantly higher in patients tr...

Highlights • Isolated left ventricular non-compaction (LVNC) has recently emerged due to widespread use of noninvasive cardiac imaging. • The prevalence of LVNC is high in patients hospitalized in Departments of Medicine. • In such patients, LVNC is strongly associated with depressed left ventricular systolic function. • LVNC is frequently misdiagn...

BACKGROUND Early warning scores based on simple physiological variables were originally derived to recognize the impending patients’ clinical deterioration and to prevent in-hospital deaths. However, they can also be used to allocate patients on admission. The hypothesis of a previously validated model, the Modified Early Warning Score (MEWS) was t...

Hypoplasia of the inferior vena cava (IVC) has been described mainly as an incidental finding associated with a number of congenital malformations; it should be taken into account when otherwise unexplained deep vein thrombosis (DVT) develops in young people; tips for diagnosis are the presence of extensive and bilateral iliac thrombosis and an enl...

Outpatient treatment of deep vein thrombosis became a standard practice all over the world since the introduction into clinical practice of low-molecular-weight heparins. Certain groups of patients were not represented in clinical trials of home treatment, however, and still need to be admitted. In deciding which patient to admit, physicians should...

The treatment for infections in hospitalized patients can be summarized in the timely start of empirical therapy, followed by adjustment on the basis of isolates and microbial susceptibilities. Initial therapy may be based on international guidelines. However, to know local frequencies of bacterial and fungal strains together with patterns of drug...

A 76-year-old, female, non-smoker developed all the spectrum of dermatological reactions 2 months after receiving erlotinib (150 mg daily) for advanced non-small cell lung cancer and known epidermal growth-factor receptor (EGFR) mutation. Her face had a papulopustular rash with erythematous and dry skin; trichomegaly (elongation and curling of the...

The early stage of pancreatic and renal cancer are usually clinically silent and evidence-based medicine cannot help us at this stage; although most presentations are incidental with the widespread use of abdominal imaging, in some cases only fate can help us to make an early diagnosis. We present a new case involving a patient with incidental dete...

In the last decade, parenteral anticoagulants have proven to be effective in the prevention of venous thromboembolism (VTE) in patients admitted to hospitals. Despite this, some registry studies have shown that pharmacological prophylaxis is still widely underused. We performed a literature search to identify important knowledge gaps in the use of...

Croscarmellose sodium is a very commonly used pharmaceutical additive approved by the US Food and Drug Administration. It is used in injectable preparations as a suspending agent to promote solubilization of compounds with poor water solubility; it is also present in tablets as binder, glidant and antiadherent, in bulk laxatives as active principle...

Since its first discovery in 1955, coagulation factor XII (FXII) deficiency was, quite surprisingly, linked with thrombosis instead of haemorrhage; indeed, John Hageman ultimately died from pulmonary embolism.1 After this, several reports have highlighted the association between both arterial and venous thrombosis and FXII deficiency; however, a ca...

A 80-year-old woman with relapsing, idiopathic thrombocytopenic purpura was admitted because of diffuse cutaneous and mucosal petechiae and ecchimoses; no sign of visceral bleeding was noted. A marrow aspirate confirmed the absence of morphologic abnormalities in the blood cell precursor lineages. Blood counts revealed Hb 14.5 mg/dl and platelets 1...

Type II heparin-induced thrombocytopenia (HIT) is a potentially severe adverse effect of heparin treatment triggered by an immune response. Although most cases occur in patients receiving unfractioned heparin, HIT can also arise after low-molecular-weight heparin (LMWH). We report a case of HIT in a postoperative orthopedic 75-year-old woman in tre...

The American Journal of Gastroenterology is published by Nature Publishing Group (NPG) on behalf of the American College of Gastroenterology (ACG). Ranked the #1 clinical journal covering gastroenterology and hepatology*, The American Journal of Gastroenterology (AJG) provides practical and professional support for clinicians dealing with the gastr...

Paragangliomas of the head and neck are rare neoplasms presented as cervical mass, generally bilateral, that arise from chemoreceptors located at the carotid bifurcation (carotid body tumors), along the vagus nerve (vagal paragangliomas), and in the jugular fossa and tympanic cavity (jugulotympanic paragangliomas). They are typically asymptomatic a...

Abnormal ST T-wave changes can be found at presentation in various noncoronary disorders; misinterpretation of these patterns as ischemic heart disease can lead to erroneous diagnosis and treatment. Here we present a case of myasthenia gravis (MG) with thymoma, in which the resting electrocardiogram (ECG) led to a misleading diagnosis of myocardial...

A previously healthy 34-year-old man was admitted because of motor vehicle accident. In the Emergency Room, the patient was alert and oriented [Glasgow Coma Score (GCS) was 15] and physical examination showed a fracture of the right femoral shaft. The results of laboratory investigations, computed tomographic (CT) scan of the head and chest radiogr...

A 63-year-old man with a history of type 2 diabetes mellitus underwent a screening duplex and ultrasound scan of the leg arteries. Although he had no symptoms, the short-axis views of the inguinal region showed a mouse-shaped image formed by the normal femoral artery at bifurcation and by an enlarged and incompressible femoral vein (fig 1). This hy...

Neurofibromatosis type 1 is a common autosomal dominant condition that affects about 1 in 5000 people. We describe a 75-year-old man who, in addition to many classic developmental changes of the disease in his skin, eyes and nervous system, had blindness in his right eye as a complication.

Although early warning scores were originally derived as bedside tools for alerting the medical staff, they may serve as decision rules for the admission of medical patients. We conducted this study to investigate the ability of the Modified Early Warning Score (MEWS) to identify a subset of patients at risk of deterioration, who might benefit from...