Emergency Care Journal

A practice teaching from GIMSI (Italian Multidisciplinary Syncope Group) 2025: yoga as a treatment for recurrent vasovagal syncope

2025-03-10T16:17:29+00:00

The XII Italian National Congress of GIMSI (Italian Multidisciplinary Syncope Group) has taken place in Milan on February 6-7, 2025. This report summarizes a practice teaching from the congress regarding the role of yoga and physical exercise in managing Vasovagal Syncope (VVS).

VVS is a very common clinical condition with an estimated lifetime prevalence of 35%¹ and a frequent reason for emergency department visits.² Although VVS is not associated with an increased rate of mortality, there is a significant deterioration in the Quality Of Life (QoL) in conjunction with the severity and frequency of recurrences.³

Pharmacological and non-pharmacological therapies, such as elastic compression stocking, dietary modification with oral rehydration salts and increased salt intake, tilt training (also known as standing training), and physical counter-pressure manoeuvres, have demonstrated only limited and modest efficacy, which can be frustrating for both patients and clinicians.^4,5 There is no single uniformly accepted protocol to prevent VVS recurrences and some patients with recurrent syncope end up being submitted to procedures, such as pacemaker implantation or cardioneuroablation. The latter is showing promising results, but it is an invasive manoeuvre, and its long-term effects are unknown.⁶[...]

Emergency department visits in Italy: 2017-2023 trends, decline and recovery

2025-04-16T14:46:53+00:00

This study analyzes the trend of Emergency Department (ED) visits in Italy between 2017-2023 using data of Italian National Institute for Statistics (ISTAT). We found a fluctuating trend, with ED visits peaking in 2019, followed by a sharp decline in 2020 and 2021, and partial recovery in 2022 and 2023. In 2023, the ED visit rate reached 58.5 per 1,000 population, marking a 25.6% reduction compared to 2019, but with a 4.7% increase from 2022. The decline during the pandemic affected all age groups, with the 0–5 years category exhibiting an anomalous surge in 2023, recording the second-highest ED visit rate after that of older people. ED visits generally increased with age, but older adults (>75 years) continued to access EDs at lower rates post-pandemic. Sex-stratified trends mirrored overall patterns, though the decline from 2019 to 2023 was more pronounced in females than in males. The trends observed across the macro-regions closely mirror national data, with the most significant decline occurring in South and Islands regions. These findings indicate that the pandemic has resulted in enduring changes in both economic and healthcare-seeking behaviors, supported by a range of potential contributing factors, the impact of which remains challenging.

SEPSIS TRIESTE 2024 - 2nd Edition | Generali Convention Center Trieste, 20 e 21 settembre 2024

2025-02-13T15:24:11+00:00

SEPSIS TRIESTE 2024 - 2^nd Edition, Generali Convention Center Trieste, 20-21 September 2024

From a sore throat to Lemierre syndrome. A case report and literature review

2025-04-02T14:59:20+00:00

A 17-year-old male patient presented to our emergency department for fever, persistent sore throat and right-sided neck pain despite antibiotics, and dehydration. He was found to have thrombosis of the right facial vein and diffuse septic emboli. Blood culture tested positive for Fusobacterium necrophorum, leading to a diagnosis of Lemierre Syndrome (LS). LS is a life-threatening condition characterized by thrombosis of the internal jugular vein, anaerobic bacteraemia, and diffuse septic emboli. It should be suspected in healthy young patients who present with persistent sore throat or atypical lateral cervical pain, followed by sepsis and bronchopneumonia. Diagnosis is confirmed through the identification of jugular venous thrombosis and is supported by the growth of anaerobic bacteria in blood cultures. Treatment is based on prolonged targeted antibiotic therapy and hydration. The indication for anticoagulant therapy remains a topic of debate. Our patient was treated with antibiotics and anticoagulant therapy, resulting in a good clinical response and subsequent complete recovery.

Palpitations in a Fontan patient: what now?

2025-03-07T09:10:17+00:00

A 32-year-old male presented to our emergency department with palpitations. His blood pressure was 95/65 mmHg, heart rate 150 beats per minute, oxygen saturation 87% on room air, and body temperature 36°C. The electrocardiogram (EKG) showed paroxysmal supraventricular tachycardia (PSVT). He reported a history of heart surgery – Fontan procedure – during childhood for a complex congenital heart disease (CHD) characterized by a single atrium, a single ventricle, and a single atrioventricular valve. A focused cardiac ultrasound confirmed a single atrium, a single ventricle, no pericardial effusion, and an estimated ejection fraction of 50% (Videos 1 and 2). His current medication regimen included sotalol 80 mg, losartan 12.5 mg, dapagliflozin 10 mg, furosemide 25 mg, and warfarin.

Hikikomori: a world within a room

2025-03-07T08:03:17+00:00

Dear Editor,

Hikikomori is a condition characterized by prolonged and extreme social withdrawal lasting at least six months, resulting in substantial functional impairment or distress associated with this isolation.¹

While the cultural roots of social withdrawal can be observed in Japanese mythology (e.g., the sun goddess Amaterasu, a paramount deity in Shinto, exemplifies voluntary seclusion), the contemporary phenomenon of hikikomori emerged from what was often termed “truancy” or “school refusal” (futoko) during the 1970s and 1980s. The term “hikikomori” itself was first introduced by the psychologist Fujiya Tomita in 1985.² This term comes from the verb hiki, which means “to pull back”, and komoru, which means “to seclude oneself”.³

However, hikikomori did not gain widespread recognition within Japanese society until the publication of “Shakaiteki Hikikomori-Owaranai Shishunki” (Social Withdrawal: A Never-Ending Adolescence) by the psychiatrist Tamaki Saito in 1998.²[...]