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The advent of portable equipment in the last years has brought ultrasound (US) technology available at patient bedside, giving the opportunity to non-cardiologists to extend cardiac assessment based on physical examination. Bedside echocardiography is a question-driven examination, where simple and often dichotomous answers are searched. It is performed using phased-array probes and bi-dimensional images are visually evaluated to obtain information regarding cardiac size and function, presence of pericardial effusion, gross valvular diseases. Although this approach cannot in any case substitute a standard 2D color-Doppler echocardiography, bedside echocardiography has been demonstrated to maintain a good diagnostic accuracy when limited to basic questions, even in the hands of short-trained non cardiologist physicians. At present the bedside US approach is widely used in different settings and focused echocardiography takes part together with US explorations of lung, abdomen and deep veins in an integrated perspective that perfectly fits with the holistic approach of the internist. In this context we address two typical scenarios encountered in the internal medicine divisions - the patient presenting with dyspnea or nonpost-traumatic hypotension - showing the main questions we can ask to bedside echocardiography for a rapid identification of the determinants of symptoms and consequently for a therapeutic choice based on more objective evidence. [ABSTRACT FROM AUTHOR]

Clostridium difficile-associated disease (CDAD) is a growing health care problem. Elderly patients with multiple comorbidities and repeated hospitalization are at high risk for developing the disease. Few data are available on epidemiology of CDAD in Italy and no studies have focused on CDAD burden in internal medicine wards. We retrospectively analysed all CDAD cases in four internal medicine wards of a city hospital in northern Italy and reviewed the medical records of patients who developed CDAD during hospitalization. We identified 146 newly acquired cases, yielding a cumulative incidence of 2.56 per 100 hospitalizations and an incidence rate of 23.3 per 10,000 patient-days. Main risk factors were advanced age and length of hospitalization. A high proportion of CDAD patients had several comorbidities and had been treated with more than one antibiotic. The incidence is among the highest previously reported, this may be due to the characteristics of patients admitted to internal medicine wards and to the wards per se. We conclude that efforts are needed to reduce CDAD’s burden in this setting, paying attention to logistics, patients care and antibiotic use. [ABSTRACT FROM AUTHOR]

Women candidates for heart transplantation are definitely less than men, just 20% of all patients transplanted; even in the INTERMACS registry they represent only 21% of all ventricular assist devices (VAD) implanted. The reasons for this big difference are discussed in this article. Why women are less frequently assessed for unconventional therapies? Are they sicker or just less regarded? Our experience and the literature show us clear epidemiological, clinical and treatment differences that could lead to a lower prevalence of end-stage disease in women of an age suitable for unconventional therapies. Once on the transplant list, women wait less than men for a heart transplant, because they present with more severe disease, have a lower body mass index and undergo less VAD implants. After transplantation women's survival is comparable to men's, although they usually complain of a lower quality of life. Females receive less often a VAD than men. The main reasons for this include presentation with advanced heart failure at an older age than men, worse outcomes related to small body surface area, and lower survival rates on VAD when implanted as bridge to heart transplantation.