Italian Journal of Medicine 2018-09-24T17:16:32+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 Scopus and Embase since September 2009.</p> Optimal duration of anticoagulant therapy in patients with venous thromboembolism 2018-09-17T15:44:26+02:00 Gualtiero Palareti <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> 2018-09-14T17:43:39+02:00 ##submission.copyrightStatement## Images in clinical medicine: gouty arthritis with osteomyelitis 2018-09-24T17:16:31+02:00 Rosa Scipioni Luciano Frate Valentino Di Tomasso Michele Saltarelli Francesco Carubbi Marco Petrarca <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> 2018-09-13T11:20:23+02:00 ##submission.copyrightStatement## A decalogue for end-of-life care in Internal Medicine 2018-09-24T17:16:32+02:00 Luigi Lusiani Giorgio Ballardini Roberto Nardi Luigi Magnani Claudio Santini Giovanna Pentella Andrea Fontanella <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> 2018-09-10T17:24:06+02:00 ##submission.copyrightStatement##