Italian Journal of Medicine 2019-04-20T18:53:18+02:00 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> <p>This journal does not apply the article processing charge&nbsp;to Authors as it is supported by institutional funds.</p> Acute myocardial infarction as the first manifestation of paraganglioma 2019-04-20T18:53:16+02:00 Sara Pinto Raquel Ferreira Anabela Gonzaga José Mesquita Bastos <p>Paragangliomas (PGLs) are extra-adrenal neuroendocrine tumors, classified as sympathetic or parasympathetic according to their origin in the paraganglia of the autonomic nervous system. Sympathetic PGLs are mostly functional, presenting in a variable and non-specific way. We report a case of PGL, which was diagnosed following investigation of acute myocardial infarction in a postpartum woman, highlighting that the absence of typical symptoms may delay the diagnosis.</p> 2019-04-16T17:19:59+02:00 ##submission.copyrightStatement## Intensity of medical care in internal medicine: impact on outcomes from a trend analysis over six years 2019-04-20T18:53:17+02:00 Walter Spagnolli Dimitri Peterlana Stefania Dorigoni Marta Rigoni Emanuele Torri Giandomenico Nollo <p>In large acute medical wards treating heterogenous and complex patients intensity of patient care should be graduated according to clinical severity. We conducted a retrospective observational study on all unselected admissions (8838) to the internal medicine ward of the Santa Chiara Hospital of Trento from 2012 to 2017. During 2012 and 2013, a standard organizational model (SMC) was in place, while an organizational model for intensity of medical care (IMC) was introduced in 2014. In SMC, patient admission was performed according to bed availability only. In IMC, patients were allocated to three different ward settings (high, medium and post-acute care) based on the stratification of clinical instability. The National Early Warning Score (NEWS) was used for the stratification, together with the clinical judgment. The implementation of the IMC model led to a decrease of mortality and urgent transfers for clinical deterioration to Intensive Care Unit and to an increase of admissions from Intensive Care Unit and from regional spoke hospitals. Redesigning delivery processes based on IMC can play a pivotal role in improving patient outcomes and bed management.</p> 2019-04-16T17:08:45+02:00 ##submission.copyrightStatement## Interatrial block as electrocardiographic predictive sign for atrial fibrillation in Internal Medicine Departments hospitalized patients 2019-04-20T18:53:18+02:00 Gianpaolo Bragagni Chiu Hua Chen Federico Lari Gaetano Magenta <p>This study evaluated the correlation between interatrial block (IAB) and atrial fibrillation (AF) among patients admitted to our Internal Medicine Unit: 110 (group 1) were identified with electrocardiograms both in sinus rhythm and AF, and 123 (group 2) constantly in sinus rhythm. In both we analyzed: the presence of partial (P≥120 msec) or advanced (P&gt;120 msec and biphasic in D2, D3, aVF) IAB, and the main electrocardiographic and clinical features. Age and gender between the two groups were similar. IAB was present in 89/110 (80.91%,) in group 1 and 26/123 (21.13%) in group 2 (P=&lt;0.01); partial in 50/110 (45.45%) and 19/123 (15.7%) in group 1 and 2 respectively (P&lt;0.01), advanced in 39/110 (35.45%) and 7/123 (5.69%) (P&lt;0.019). The correlation between IAB and AF was significant (P&lt;0.001); out of 55 patients with atrial echo dilatation 36 (65.4%) had IAB and 14 (25.4%) had deep terminal negativity of P-wave in V1 (DTNPV1) &gt;0.1 mV (P&lt;0.01). IAB represents a reliable predictor of AF; moreover, the sensitivity of the IAB in detecting atrial dilatation is higher than the DTNPV1 &gt;0.1 mV.</p> 2019-04-16T00:00:00+02:00 ##submission.copyrightStatement##