Prevalence and prognostic impact of anemia and iron deficiency in patients hospitalized in an internal medicine ward: The PRO-IRON study.

OBJECTIVES: To assess prevalence, predictive factors, and prognostic impact on in-hospital mortality of anemia, iron deficiency anemia (IDA), iron deficiency with or without anemia (ID), and iron deficiency without anemia (IDWA) in patients admitted to an internal medicine ward. METHODS: This 1-year prospective study collected data on demographics, medical history, and blood tests in 771 consecutive patients on admission. RESULTS: Most patients were ≥65 years old (80%) and had hypertension (63%), moderate chronic kidney disease (CKD) (43%), and heart failure (41%). Prevalence of anemia, IDA, ID, and IDWA was 67%, 41%, 58%, and 18%, respectively. Anemia was independently associated with age ≥65 years (OR 1.76, 95% CI 1.15-2.70), active cancer (OR 2.44, 95% CI 1.42-4.39), and moderate CKD (OR 1.65, 95% CI 1.12-2.43). ID was independently associated with female gender (OR 2.29, 95% CI 1.64-3.22), heart failure (OR 1.65, 95% CI 1.16-2.37), and moderate CKD (OR 2.95, 95% CI 2.04-4.30). Incidence of in-hospital mortality was 21% and independently associated with anemia (RR 1.82, 95% CI 1.21-2.74). CONCLUSIONS: Anemia and iron deficiency were highly prevalent in internal medicine patients. As anemia negatively impacts on in-hospital mortality, awareness should be raised for effective diagnosis and management of these comorbidities in hospitalized patients.

Left Atrial Appendage Occlusion: A Therapeutic Option in a Patient With Atrial Fibrillation and Hereditary Hemorrhagic Telangiectasia.

Hereditary hemorrhagic telangiectasia (HHT) is a predominantly inherited disorder of blood vessel structure, characterized by mucocutaneous telangiectasias, multiple arteriovenous malformations, and frequent epistaxis. A 67-year-old female with atrial fibrillation and high thromboembolic risk (CHADs2Vasc2: 4) with renal arterial thrombosis started oral anticoagulation (OAC). The patient had multiple episodes of heavy nasal and gastrointestinal bleeding (requiring multiple blood transfusions) such that OAC had to be interrupted, and a complementary investigation led to the diagnosis of HHT. Due to concomitant high thromboembolic and hemorrhagic risks, the patient was proposed left atrial appendage occlusion as an alternative to OAC intolerance. After the procedure, there were no new episodes of bleeding or thrombotic events.

Pain in an Internal Medicine Ward: An Undervalued Reality?

Introduction Pain is prevalent in most pathologic situations that require healthcare and is very common in hospitalised patients. However, there is limited evidence about the prevalence and the actual management of pain in medical wards. The aim of this work was to evaluate and characterise pain management in an internal medicine ward. Methods Retrospective analysis of clinical data of patients consecutively discharged from the internal medicine ward of a central tertiary hospital over a period of five months in 2018. Results 199 patients evaluated, the median age was 78 years and 63% were female. Of these, 14% had a previous diagnosis of chronic pain, 24% were on chronic pain medication, and in 29% medication was interrupted. Pain was noted in medical records of 118 patients, with moderate to severe intensity in 67%. Among those, 71% had pain occurrence registered in the medical notes but not characterised in duration in 61%. The most common attributed etiologies of pain were musculoskeletal (16%), visceral (9%), and headache (8%); no identifiable cause was specified in 57%. In the group of patients reporting pain, 63% received analgesics. Opioids were used in 35% and 47% of patients with moderate and severe pain, respectively. At discharge, 12 patients were still referred pain, 16 had pain listed as a diagnosis, 45 were medicated for pain, and eight were referred for pain consultation. Conclusions Despite being highly prevalent in the internal medicine ward, pain is still under-recognised, undervalued, and under-treated. Education of healthcare staff and adoption of treatment protocols is essential to improve care for these patients.

Immune Thrombocytopenic Purpura - Different Presentations in Two COVID-19 Patients.

Immune thrombocytopenic purpura (ITP) is a rare acquired autoimmune disease, resulting from platelet destruction and impaired platelet production. It has been described as associated with either genetic or environmental risk factors, such as viral infections, and in a few cases has been reported to be associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although steroid treatment is the most widely used first-line treatment of ITP, in the early days of coronavirus disease 2019 (COVID-19) it was controversial, but it has since become approved in treatment for COVID-19. The authors report two different cases of COVID-19-associated ITP, with special emphasis on the timing of presentation, severity, and treatment decisions. Remarkably, one of the patients who suffered severe thrombocytopenia was safely treated with corticosteroids in the late phase of COVID-19 infection.

A Patient with Severe Malaria and COVID-19: How Do You Tell the Difference between These Infections?

Coronavirus infection, known as COVID-19, is characterized by clinical, epidemiological and biological features similar to those of malaria. In each case, fever, myalgia, fatigue, headaches and gastrointestinal symptoms may be present. Both diseases can also induce a cytokine storm and pro-coagulant states. An appropriate epidemiological approach and differential diagnosis are very important so that the right clinical intervention can be selected. Malaria remains a serious global public health issue, especially in endemic countries. Elimination campaigns are helping to control the disease, but in many countries these programs are now at risk of failure due to logistic and economic problems caused by COVID-19. The authors describe the case of a patient with co-infection with malaria and COVID-19, reminding us that during this coronavirus pandemic it is critical to consider other diagnoses, particularly in people traveling between countries. LEARNING POINTS: As far as we know, this is one of the first case reports of co-infection with COVID-19 and Plasmodium falciparum malaria.It is important to be aware of the clinical challenges of diagnosing the cause of fever in returned travellers.

Acondroplasia: diagnóstico clínico precoce / Achondroplasia: early clinical diagnosis

A acondroplasia é uma síndrome genética que afetaa ossificação endocondral, sendo uma das causas denanismo. Acomete um recém-nascido em cada oitoa dez mil nascimentos. Embora o defeito genéticotenha caráter autossômico dominante, cerca de 85%dos casos resultam de novas mutações. Os portadoresda acondroplasia apresentam características clínicastípicas como macrocefalia, baixa estatura, membroscurtos com predomínio do segmento proximal e limitaçãoda extensão dos cotovelos. Entretanto, essascaracterísticas clínicas no período neonatal podempassar despercebidas dos pais e pediatras, uma vezque os recém-nascidos normais apresentam os membroscurtos em relação ao tronco, o que dificulta aobservação dessa desproporção. No presente estudode caso, registra-se um caso típico de acondroplasiadiagnosticado imediatamente após o nascimento.

Achondroplasia is a genetic syndrome that affects the endochondralossification, being one of the causes of dwarfism.It affects one newborn in every 8 to 10 thousandbirths. Although the genetic defect is of autosomal dominantorigin, about 85% of cases result from new mutations.The typical clinical features of achondroplasia are macrocephaly,short stature, short limbs with predominanceof the proximal segment and limitation of elbow extension.However, these clinical features may go unnoticedin the neonatal period, since newborns? limbs are shorterin relation to the trunk, making it difficult for parents andpediatricians to notice this disproportion. This case reportdescribes a typical case of achondroplasia diagnosed immediatelyafter birth.