Applications to augment patient care for Internal Medicine specialists: a position paper from the EFIM working group on telemedicine, innovative technologies & digital health.

Telemedicine applications present virtually limitless prospects for innovating and enhancing established and new models of patient care in the field of Internal Medicine. Although there is a wide range of innovative technological solutions in Europe, there are overarching elements associated with such technologies when applied to the practices of Internal Medicine specialists. The European Federation of Internal Medicine (EFIM) strongly advocates for active leadership and influence from the Internal Medicine societies and specialist physicians across Europe in the development and application of telemedicine and digital technologies in healthcare. This position paper's conclusions were drawn via Delphi method, which was developed collaboratively from July 2021 to December 2023. The panel, consisting of experts in clinical medicine, public health, health economics and statistics, assessed various aspects related to telemedicine. Participants assigned scores on a Likert scale reflecting perceived value and potential risks. The findings were consolidated in a comprehensive checklist aligning with relevant literature and a SWOT analysis. Specifically, key issues that need to be addressed include promoting the professional development of e-health competencies in the healthcare and medical workforce, using educational campaigns to promote digital literacy among patients and caregivers, designing and implementing telemedicine applications tailored to local conditions and needs and considering the ethical and legal contexts under which these applications are employed. Importantly, there is currently no consensus on care models or standardized protocols among European Internal Medicine specialists regarding the utilization of telemedicine. This position paper aims to outline the opportunities and challenges associated with the application of telemedicine in Internal Medical practice in Europe.

A new method of standartization of health-promoting pomegranate fruit (Punica granatum) extract.

This study analyzes the major phenolic constituents of pomegranate fruit juice and pericarp feedstock, and dry extracts thereof, using high-performance liquid chromatography. Pomegranate pericarp was extracted with water (WE) and alcohol (AE) as solvents, and liquid extracts were subsequently freeze-dried. The results indicate that ellagitannins punicalagin A and punicalagin B are the major constituents in the primary pomegranate feedstock and in both types of extracts. Ellagic acid, a common botanical constituent that is currently used to standardize pomegranate extracts, as well as ellagitannin punicalin, were found to be only minor constituents. Total punicalagins (the sum of punicalagins A+B and punicalin) and ellagic acid content in the pomegranate fruit pericarp feedstock WE were 7,6+/-0,3% and 0,2+/-0,1% by dry weight, respectively, and in the AE feedstock 7,0+/-0,2 and 0,4+/-0,1%, respectively. Total phenolic content (the sum of punicalagins and ellagic acid) in the pomegranate WE and AE were 45,8+/-1,2% and 42,3+/-1,1%, respectively. The concentrations of ellagic acid in the pomegranate WE and AE were 0,8+/-0,2% and 3,9+/-0,2%, respectively. Total phenolics in fresh single-strength pomegranate whole fruit juice contained 2,216+/-70 mg/L (95% punicalagins), whereas commercial pomegranate juice that was purchased from local stores was 317+/-13 mg/L (70% punicalagins). Our results strongly suggest that the commercially produced pomegranate extracts should be standardized to the content of total punicalagins as well as ellagic acid. The current standard uses only ellagic acid, which is unreliable, potentially misleading and vulnerable to commercial adulteration.

Technetium-99m-labeled n-(2,6-dimethylphenylcarbamoylmethyl) iminodiacetic acid (tc-99m HIDA): a new radiopharmaceutical for hepatobiliary imaging studies.

An easily formulated, stable kit preparation of technetium-99m HIDA, suitable for use in humans, was developed and tested in mice and dogs. The tracer was cleared rapidly from the blood and excreted predominantly by the liver in both species. In dogs, the hepatobiliary clearance of Tc-99m HIDA was significantly greater than that of C-14 HIDA and Sn-113 HIDA. The LD50 for HIDA in mice, 168 mg/kg, exceeded the average human dose by a factor of 1000 on a per-weight basis. Blood clearance curves for Tc-99m HIDA in 12 normal subjects were biexponential with half-times of 4.6 +/- 1.0 min and 31.5 +/- 7.0 min, and cumulative 90-min urine samples contained 14.2 +/- 1.8% of the injected dose. Images in normal subjects and nonjaundiced patients showed rapid concentration of tracer by the liver and activity was present within the biliary system in 10-20 min. In jaundiced patients, the tracer blood clearance was delayed and urinary excretion increased, but intestinal activity, indicating biliary patency, was imaged in those patients without complete focal obstruction of the common duct. Technetium-99m HIDA is a nontoxic radiopharmaceutical useful for clinical evaluation of hepatobiliary disorders in humans.

Hepatic clearance mechanism of Tc-99m-HIDA and its effect on quantitation of hepatobiliary function: Concise communication.

Parameters affecting the hepatobiliary clearance of Tc-99m N(2,6-dimethylphenyl carbamoylmethyl) iminodiacetic acid (Tc-HIDA) were evaluated in dogs. Competitive clearance studies, were performed with Tc-HIDA after infusion to plasma saturation levels of an anion, sodium sulfobromophthalein (BSP), and a cation, oxyphenonium. The results demonstrated that Tc-HIDA is transported through hepatocytes by a carrier-mediated organic-anion pathway. The data are consistent with an alteration of the elimination kinetics of Tc-HIDA induced by elevations in the serum bilirubin level, and it is predicted that serum bilirubin at some increased concentration will dominate the distribution and elimination kinetics of Tc-HIDA independently of hepatobiliary status. A quantitative description of liver function in terms of regional distribution and elimination rate constants will require either a pharmacokinetic model that expressly includes the effects of bilirubin, the development of new anionic hepatobiliary agents capable of displacing endogenous bilirubin from transport binding sites, or the development of new hepatobiliary agents that use a different clearance mechanism from that used by bilirubin.

The influence of furfural inhalation poisoning on calcium and phosphorus metabolism in rats.

The inhalation of furfural, 20 mg/m3 by adult rats during 3 months for 5 h daily, 6 times a week, did not change the calcium and phosphorus level in blood serum and in bones, but depressed the activity of alkaline phosphatase in blood serum. The exposure to furfural of immature rats (6-7 weeks old) during 4 weeks caused a depression of blood serum and intestine mucosa alkaline phosphatase activity, elevation of calcium and phosphorus levels in blood serum with concomitant fall in bones, and a decrease in calcium excretion with urine.

Epidemic of Q fever in Leszno district in Poland.

In 1988 an epidemic of Q fever was detected in Leszno district. During 1973-1985 all 28,066 cattle tested for C. burnetii antibodies were found to be negative. The first seroconversions were found in cows which produced stillborn young. In the following years the number of seropositive cattle increased from 8.4% in 1987 to 21.6% in 1989. In 1988 all animal workers in the district were tested for C. burnetii antibodies. Of 4,264 persons tested, 1,451 (34%) were seropositive. A detailed study of workers and animals on one farm were performed. A herd of animals was found to be seropositive (32.1%), 68% of workers in direct contact with infected animals were seropositive and 29% of persons drinking raw milk. C. burnetii strains have been isolated from ticks, wild animals and birds hunted in close proximity of the farm. The dynamics of C. burnetii infection among animals and humans in this district and the fact that there is no importation of animal herds suggests that the possible route of introduction of Q fever in this area may be with imported semen or breeding bulls. The presence of C. burnetii in ticks and wild animals indicates the transfer of Q fever to the natural environment and its maintenance in this territory.