Italian Journal of Medicine 2018-12-15T17:50:33+01:00 Paola Granata Open Journal Systems <p>The <strong>Italian Journal of Medicine (ITJM)</strong> is the official journal of FADOI, the Federation of Associations of Hospital Doctors on Internal Medicine and focus to describe the complex and variable situations confronted by Internists in daily practice. ITJM aims to promote excellence in the practice of internal medicine in hospitals and to disseminate the results of clinical research in internal medicine departments. The journal also contributes to the updating of hospital internists on general topics concerning public health, including ethical, legal, economical and health policy issues. The <strong>Italian Journal of Medicine (ITJM)</strong> is a quarterly peer-reviewed journal aiming to publish highest-quality material covering original basic and clinical research on all aspects of internal medicine. The Journal includes original clinical research papers, reviews, case reports and specific sections dedicated to clinical pharmacology, chronic diseases, health management. The Italian Journal of Medicine is currently indexed in <a title="Scopus" href="" target="_blank" rel="noopener">Scopus</a> and <a title="DOAJ" href="" target="_blank" rel="noopener">DOAJ</a> since September 2009.</p> The correct setting to improve the quality of health care process: a retrospective study in Internal Medicine Department 2018-12-15T17:50:29+01:00 Filomena Pietrantonio Paola Aperti Luca Tonoli Elaine Tyndall Orietta Meneghetti <p>The definition of the role of hospitals and communities in terms of the response to patients’ health care needs is essential in the Lombardy region health-care reform development (LR. 23/2015). The stratification of patients according to clinical severity and care complexity for adequate clinical health care, is achieved by delineating care settings, staff standards, required technical equipment and crucial aspects of clinical pathways. An observational and retrospective study at Manerbio Hospital Internal Medicine Unit (IMU) was carried out to define: i) characteristics of IMU patients; ii) role of IMU physician in management of poly-pathological patients; iii) alternative organizational models. After a Literature review, clinical severity was defined by modifying early warning score, complexity and co-morbidities by cumulative illness rating scale (CIRS) and by intensity of care through care intensity index (IIA). All medical records of patients admitted in the first quarter of 2016 were analyzed. A total of 393 medical records were examined: 199 M/194 F, median age 81 years. Critical patients (requiring continuous monitoring using advanced equipment): 27% of the sample (10% with intensive care transfer criteria). Co-morbidity: between 5 and 6 active diseases for most of the sample; 53% with CIRS between 7 and 12. Elevated care intensity (IIA) was found in 46% of the sample, remaining constant throughout hospital stay. Medium stay: 9.35 days. 27% of IMU patients needs subintensive care. About a quarter of patients has unresolved social problems contributing to acute presentations in the emergency room. Agreement on appropriate links between hospital and community care structures is advisable to reduce hospital stay, adequately responding to patients’ needs.</p> 2018-12-04T10:30:50+01:00 ##submission.copyrightStatement## Variant of plasmablastic microlymphoma in Castleman disease: a case report and review of the literature 2018-12-15T17:50:31+01:00 Nathan Artom Marcello Brignone Luca Paris Anna Lisa Garlaschelli Marina Cavaliere Gian Luca Michelis Claudia Venturino Silvia Ardoino Ezio Venturino Paola Gnerre Rodolfo Tassara <p>Castleman disease (CD) is a rare lymphoproliferative disorder also known as angiofollicular lymph node hyperplasia or giant lymph node hyperplasia. CD can be unicentric CD (UCD) or multicentric CD (MCD). MCD affects more than one group of lymph nodes and/or lymphoid tissues and it is frequently associated with HIV and human herpes virus 8 (HHV-8) infections and, in contrast with UCD, it often results in systemic symptoms, such as fever, fatigue, anemia, inflammatory syndrome. HHV- 8-associated MCD recognizes HHV-8 as an etiopathogenetic agent and occurs generally in HIV-positive subjects. Our report describes an HHV-8 positive Castleman disease with plasmablastic microlymphoma occurring in a 51-year-old HIV seronegative woman, with a previous history of HBV infection and Kaposi’s sarcoma, who presented elevated procalcitonin levels during the acute phase of CD.</p> 2018-12-04T10:07:29+01:00 ##submission.copyrightStatement## Implantable device-related endocarditis detected by point-of-care echocardiography in a patient with dyspnea and chest pain 2018-12-15T17:50:33+01:00 Alfonso Sforza Maria Viviana Carlino Mario Guarino Giuliano De Stefano Maria Immacolata Arnone Stefania Auciello Andrea D'Amato Costantino Mancusi <p>We describe a case of a 70-year-old man who presented to the emergency department with dyspnea and chest pain. He had history of atrial fibrillation, chronic obstructive pulmonary disease, prosthetic mitral valve and pacemaker implantation. He had a sepsis related to multiple bilateral septic emboli pointed out by chest computed tomography scan. Point of care echocardiography showed a pacemaker-related endocarditis with large vegetation on the right ventricular lead. The patient started empiric antibiotic therapy and he was addressed to complete hardware removal.</p> 2018-12-04T00:00:00+01:00 ##submission.copyrightStatement##