Italian Journal of Medicine <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> PAGEPress Scientific Publications, Pavia, Italy en-US Italian Journal of Medicine 1877-9344 <p><strong>PAGEPress</strong> has chosen to apply the&nbsp;<a href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution NonCommercial 4.0 International License</strong></a>&nbsp;(CC BY-NC 4.0) to all manuscripts to be published.<br><br> An Open Access Publication is one that meets the following two conditions:</p> <ol> <li>the author(s) and copyright holder(s) grant(s) to all users a free, irrevocable, worldwide, perpetual right of access to, and a license to copy, use, distribute, transmit and display the work publicly and to make and distribute derivative works, in any digital medium for any responsible purpose, subject to proper attribution of authorship, as well as the right to make small numbers of printed copies for their personal use.</li> <li>a complete version of the work and all supplemental materials, including a copy of the permission as stated above, in a suitable standard electronic format is deposited immediately upon initial publication in at least one online repository that is supported by an academic institution, scholarly society, government agency, or other well-established organization that seeks to enable open access, unrestricted distribution, interoperability, and long-term archiving.</li> </ol> <p>Authors who publish with this journal agree to the following terms:</p> <ol> <li>Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> <li>Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> <li>Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.</li> </ol> Optimal duration of anticoagulant therapy in patients with venous thromboembolism <p>Venous thromboembolism (VTE), a frequent and severe disease, has clinically important early and late complications and a strong tendency to recur. Anticoagulant therapy is the mainstay of treatment, performed by immediate administration of: a) parenteral anticoagulants followed by vitamin K antagonists (VKAs), either dabigatran or edoxaban, two direct oral anticoagulants (DOACs); or b) direct rivaroxaban or apixaban, two DOACs that can be used as single-drug approach. Treatment should last no less than 3 months in all patients though how long it should last thereafter is a more complex issue. The risk of recurrence results from several event- or patient-associated factors. Some patients have low risk and may be treated for 3 to 6 months only. Others (the majority), have a high risk of recurrence (approximately 50% in 10 years). Unfortunately, the protective effect of anticoagulation against recurrence is present only during treatment and is lost when therapy is stopped. For this reason, international guidelines recommend there be no pre-definite period of anticoagulation (e.g. 1 or 2 years, and so on) in patients at high risk and suggest instead indefinite (extended) anticoagulation, provided there is no high risk of bleeding. When the decision is difficult, adjunctive criteria may be adopted, such as male sex and abnormal Ddimer assessed after anticoagulation is stopped, to identify patients at high risk who need indefinite therapy. The use of DOACs, especially at lower doses with a lower risk of bleeding, may make indefinite anticoagulation for patients easier.</p> Gualtiero Palareti ##submission.copyrightStatement## 2018-09-14 2018-09-14 12 3 10.4081/itjm.2018.1077 Images in clinical medicine: gouty arthritis with osteomyelitis <p>Gout is one of the most common inflammatory arthropathies, characterized by the deposition of monosodium urate crystals in the synovial membrane, articular cartilage and periarticular tissues and leading to inflammation. The natural history of articular gout is typically composed of four periods: asymptomatic hyperuricemia, episodes of acute attacks of gout (acute gouty arthritis) with asymptomatic intervals (intercritical gout), and chronic tophaceous gout. Tophi develop in 12-35% of gout patients without adequate control of uricaemia. Initially, they do not cause significant complaints or function limitation of the nearby joints. However, if they become larger, joint instability and movement range limitation, joint function impairment and bone erosions and infection at the sites of their penetration can develop. We report a case of a poorly controlled polyarticular tophaceous gout complicated by osteomyelitis.</p> Rosa Scipioni Luciano Frate Valentino Di Tomasso Michele Saltarelli Francesco Carubbi Marco Petrarca ##submission.copyrightStatement## 2018-09-13 2018-09-13 12 3 10.4081/itjm.2018.1047 A decalogue for end-of-life care in Internal Medicine <p>Since a large number of patients with chronical medical diseases die in hospital, often in an internal medicine ward, internists are urged to improve their expertise in end-of-life (EOL) care, which is a neglected part of their academic education. Recently, FADOI (the Italian Federation of the Associations Hospital Doctors on Internal Medicine) has addressed EOL-medicine in many ways, promoting many scientific meetings on this and allied topics, providing educational material made available in its website on a free basis and establishing an <em>ad hoc</em> Committee charged with the task of organizing dedicated events annually. The Committee has also elaborated a series of recommendations on EOL-care in internal medicine (a <em>decalogue</em>), reflecting largely shared visions. It has been endorsed also by ANIMO (the Association of the Italian Nurses working in an Internal Medicine Department). The <em>decalogue</em> for EOL care in internal medicine is issued here, and calls for its diffusion and implementation. The driving concept is that doctors and nurses must feel responsible for disregarding appropriate EOL-care for the dying patients, because delaying it means to add suffering and discomfort to them in the final phase of their existence.</p> Luigi Lusiani Giorgio Ballardini Roberto Nardi Luigi Magnani Claudio Santini Giovanna Pentella Andrea Fontanella ##submission.copyrightStatement## 2018-09-10 2018-09-10 12 3 230 234 10.4081/itjm.2018.1060