Abstract Background Heart failure (HF) is a major health and social problem. Internal Medicine (IM) wards admit a high proportion of patients with HF, frequently with advanced age and comorbidities. ...Few recent data are available in this setting, especially on predictors of in-hospital outcome. Methods In this observational study, we recruited patients admitted with diagnosis of HF and present in five index days, in 91 units of IM in Italy. Characteristics and management of HF, comorbidities, functional and cognitive status, and quality of life, were analyzed. Results We observed 1411 patients, with a mean age of 78.7 ± 9.6 years. At admission, 81.7% of the patients were in NYHA classes III–IV. Ninety percent of the patients had at least one comorbidity. Dementia or severely impaired functional status were registered in 21.5% and 22.8% of the patients. In 89 patients (6,3%) a negative outcome (death or clinical worsening) occurred during hospitalization. A number of variables were significantly related to negative outcome by means of univariate analysis (systolic blood pressure < 100 mmHg, pulse pressure ≥ 55 mmHg, anaemia, brain deficit, permanent bed rest, Barthel Index ≤ 30). At multivariable analysis, significant correlation was retained by anaemia and Barthel Index ≤ 30, the latter being the strongest predictor. Conclusions Real-world patients with HF and hospitalized in IM are frequently very old, frail and with multiple comorbidities. Functional and cognitive status significantly influence patients' outcome, and this could lead to a rethinking of the overall (in-hospital but also home-based) management of HF.
Early diagnosis and appropriate staging of pancreatic adenocarcinoma is of vital importance to possibly detect this otherwise lethal disease at a curable phase and to stratify patients who would ...benefit the most from surgical resection. The availability of endoscopic ultrasound (EUS) with its unique capability of obtaining refine images of the pancreas has represented a major breakthrough in the management of these difficult tasks. Furthermore, the ability to perform fine needle aspiration (FNA) under real time EUS guidance has offered the possibility to reach a definite diagnosis which has a major impact on the decision making process in the care of patients with both resectable and unresecectable pancreatic cancer. In parallel to the widespread importance of diagnostic EUS, the therapeutic applications of EUS are increasing and may further expand the role of this procedure in the management of pancreatic cancer. This article focuses on the current role of EUS and EUS-FNA in the diagnosis and staging of solid pancreatic lesions in different clinical scenarios, including those individuals at a high risk of developing pancreatic cancer and who may be candidates for a EUS-based screening and surveillance program. Data on the emerging therapeutic role of EUS for pancreatic cancer treatment will also be reviewed.
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