Internists are experts in diagnosing, treating and caring for adult patients. They often serve as medical consultants to physicians in other specialties. In some countries internists may specialize in general primary care of adults (for instance in Switzerland); they can also take additional training and “subspecialize” in such areas as endocrinology, hematology/oncology, immunology. Cardiology, pulmonology, gastroenterology and reumatology ususally are independent subspecialties. What is internal medicine? (European definition): The specialty of internal medicine covers a wide range of conditions affecting the internal organs of the body. Although some diseases specifically affect individual organs, the majority of common diseases may affect many internal organs of the body. The internist must then be trained to recognise and manage a broad range of diseases and, with the aging population, many patients with chronic and multiple disorders.
Although everyone knows that cycling is good for overall health, this has now scientifically been proven for persons with diabetes. In a longitudinal European study in 10 countries, the benefits of cycling in a large cohort of persons with diabetes (110,944 person years; 7459 persons) have been reported. Cycling for between 1 to 5 hours per week was associated with at least 24 % lower all-cause and CVD (cardiovascular disease) mortality when compared with non-cyclists, independent of other physical activities and possible confounders. Usually 4 – 5 hours of exercise per week is the recommended time to improve health. Taking up cycling for a 5-year period was associated with at least 35 % lower risk of all-cause and CVD mortality. These relations are stronger than the earlier reported beneficial effects of walking, probably because cycling is more intensive than walking. Cycling should be encouraged as an activity for persons with diabetes to reduce the risk of premature death.
What do you need to know about covid-19 and pregnancy? Authors: Nerea Maiz1,2, Berta Serrano1, Anna Suy1, Elena Carreras1,2 1 Hospital Universitari Vall d’hebron. Barcelona. Catalonia. Spain. 2 Universitat de Vic-Universitat central de Catalunya. Catalonia. Spain. The infection caused by the SARS-CoV-2 virus, which causes the COVID-19 disease, was first described in the city of Wuhan, China, in December 2019 and rapidly spread to the rest of the planet. The World Health Organization declared the coronavirus infection a pandemic in March 2020. A progressive accumulation of scientific evidence since the beginning of the pandemic has tried to determine the effect of this new disease on pregnancy and the influence of pregnancy in the course of the disease. How do normal changes in gestation influence in SARS-CoV-2 infection? Pregnant women have higher risk of disease and mortality due to certain respiratory infections. Normal changes of pregnancy make these patients especially susceptible to respiratory infections. Respiratory changes during pregnancy include increasing oedema and congestion in the upper airway tract and elevation of the diaphragm. These changes cause increased susceptibility to respiratory pathogens, added to others such as immunotolerance, metabolic changes, etc., make pregnancy a situation of special susceptibility. How is the virus […]
A prospective cohort study from the US was performed in 2110 young adults of 38 to 50 years, wearing an accelerometer. Patients were followed during a mean of 10,8 years. Daily steps were classified as low (< 7000 steps/d), moderate (7000 – 9999 steps/d) and high ( > 10000 steps/d) and stepping intensity as peak 30-minute-stepping rate and time spent at 100 steps/min or more. Outcome prameter was all-cause mortality. During the follow-up period 72 patients (3.4 %) died. There was significantly lower risk of mortality in the moderate and high step groups. This lower risk was about equal in Black and White participants and also in women. There was, however, no association of step intensity with mortality.
A pooled cohort study was done in 20.065 English (9.254) and Chinese (10.811) aged people with a mean age of 64.6 years (UK) and 57.8 years (China) and a median follow-up of respectively 8 and 4 years. The proportion of females and males was approximately equal. During 100.000 person-years of follow-up global cognitive sccores in individuals with 4 hours or less and 10 hours or more of sleep per night declined faster than in the reference group (7 hours per night). The sleep duration per night was self-reported according to face-to-face interviews. An inverted U-shaped association between sleep duration and global cognitive decline was also observed. It is concluded that cognitive function should be monitored in individuals with insufficient (≤ 4 hours per night) or excessive ( ≥ 10 hours per night) sleep duration. Future studies should examine the mechanism of the association between sleep duration and cognitive decline.
Long-term outcome after acute Covid-19 infection Author: Stefan Lindgren, Sweden The Covid-19 pandemic still persists, although the consequences for patients and societies have diminished dramatically after successful vaccination of the populations. The burden of disease on individuals and societies is still high in countries where the proportion of vaccinated individuals is low. However, new variants of the virus are likely to appear and the duration of the vaccine protection is uncertain. So, we will probably have to live with the threat from the Covid-19 virus and need for revaccination for a long time. Data is accumulating regarding long-term consequences after Covid-19 infection. Although the majority recovers completely, quite a few experience persistent symptoms for many months or even longer. The clinical outcome is more clearly described and understood if we consider two categories of patients; those with severe Covid-19 in need of hospitalization or even intensive care and those with clinically milder disease, managed outside the hospital. Also, the virus variants must be considered, which is particularly obvious now with the apparent milder course of disease with the omicron variant. The vast majority of patients with mild acute disease recover rapidly and completely, particularly those who are fully vaccinated. However, […]
Unwanted loss of appetite after major abdominal surgery is a common problem and has significance for the prognosis of the patient. The cause lies in a reduced gastric reservoir, combined with a decrease in the formation of ghrelin ( an appetite promoting hormone ) in the stomach and decreased secretion of satiety hormones in the small bowel. German investigators conducted a systemic review into this problem. They concluded that research into the problem is limited and heterogeneous. The studies analyzed include 20.506 patients. The only treatment with a high burden of proof was chewing chewing gum, measured on the basis of the time until the first feeling of hunger. Next to that diet guidance, watching cooking shows and “rikkunshito” (a traditional Japanese herbal remedy) could stimulate appetite. Administration of sophisticated drugs such as ghrelin intravenously and 5-HT-agonists respectively showed various results or were investigated only once. Appetite stimulants such as cannabinoids and corticosteroids have not been investigated in surgical patients. Unfortunately, it was not mentioned by the authors whether peppermint or a more sweet flavour of the gum had a better effect.