January 2020

46 Articles

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Defensive medicine: Everything and its opposite

28 January 2020
Author(s): Livio Garattini, Anna Padula, Pier Mannuccio Mannucci

Defensive medicine (DM) refers to all medical care provided by physicians mainly for preventing the risk of litigation. Redundant DM practices induced by the threat of medical liability are expected... more

Cardiac arrest: The need for integrated multi-disciplinary actions for a continuum of care both in acute and at long-term

28 January 2020
Author(s): Giuseppe Boriani

Out-of-hospital cardiac arrest (OHCA) is a devastating and dramatic event, with a mortality of around 90% prior to hospitalization and a severe in-hospital outcome, since less than 6 percent of... more

Impact of HCV eradication with direct-acting antiviral agents on serum gamma globulin levels in HCV and HCV/HIV coinfected patients

21 January 2020
Author(s): Milazzo Laura, van den Bogaart Lorena, Sollima Salvatore, Oreni Letizia, Lai Alessia, Morena Valentina, Bonazzetti Cecilia, Ridolfo Anna Lisa, Antinori Spinello

Both HIV and HCV infection exert B-cell dysregulation possibly leading to polyclonal hypergammaglobulinemia, polyclonal B-cell hyperactivity, mixed cryoglobulinemia and non-Hodgkin lymphoma, as a... more

Hyperuricemia and mortality in heart failure: Is it time to change the route?

21 January 2020
Author(s): Claudio Borghi, Eugenio Cosentino, Alessio Bragagni

The prevalence of heart failure (HF) is increasing worldwide and in particular in the industrialized countries [1,2]. This is associated with a parallel increase in the rate of hyperuricemia and gout... more

Development of heart failure in asymptomatic patients with Bendopnea

21 January 2020
Author(s): Ramón Baeza-Trinidad, Jose Daniel Mosquera-Lozano, Angel Brea-Hernando

A new symptom of heart failure (HF) has been described in recent years, that is being called bendopnea [1]. This type of dyspnea is experienced while bending forward when putting on shoes or tying... more

Mortality in patients with intracerebral hemorrhage associated with antiplatelet agents, oral anticoagulants or no antithrombotic therapy

16 January 2020
Author(s): Laura Franco, Maurizio Paciaroni, Maria Lotti Enrico, Umberto Scoditti, Francesca Guideri, Alberto Chiti, Alessandro De Vito, Valeria Terruso, Domenico Consoli, Simone Vanni, Alessia Giossi, Giorgia Manina, Cinzia Nitti, Roberta Re, Simona Sacco, Roberto Cappelli, Jan Beyer-Westendorf, Fulvio Pomero, Giancarlo Agnelli, Cecilia Becattini

Intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes and results in significant morbidity and mortality [1]. Short-term mortality in patients with ICH is about 30% [2-4]. In these... more

Management of hyperuricemia in asymptomatic patients: A critical appraisal

15 January 2020
Author(s): Antonio Brucato, Francesco Cianci, Carla Carnovale

There is consensus on starting urate-lowering therapy (ULT) in cases of symptomatic hyperuricemia, but the frequent condition of asymptomatic hyperuricemia (AH), remains a challenge, given the... more

Left atrial diameter thresholds and new incident atrial fibrillation in embolic stroke of undetermined source

15 January 2020
Author(s): Kalliopi Perlepe, Gaia Sirimarco, Davide Strambo, Ashraf Eskandari, Efstathia Karagkiozi, Anastasia Vemmou, Eleni Koroboki, Efstathios Manios, Konstantinos Makaritsis, Konstantinos Vemmos, Patrik Michel, George Ntaios

Embolic Stroke of Undetermined Source (ESUS) is used to describe patients with cryptogenic stroke despite adequate diagnostic work-up, i.e. non-lacunar strokes without proximal arterial stenosis or a... more

One-year clinical events and management of patients with atrial fibrillation hospitalized in cardiology centers: Data from the BLITZ-AF study

14 January 2020
Author(s): Roberto Cemin, Furio Colivicchi, Aldo P. Maggioni, Giuseppe Boriani, Leonardo De Luca, Andrea Di Lenarda, Giuseppe Di Pasquale, Gianna Fabbri, Donata Lucci, Michele Massimo Gulizia, On the behalf of BLITZ-AF Investigators

Atrial fibrillation (AF) is associated with a significant risk of ischemic stroke, death and other cardiovascular events as well as with higher medical costs and reduced quality of life [1–3]. The... more

Gastrointestinal bleeding in a young male

13 January 2020
Author(s): Giulia Lupi, Fabrizio Elia, Aurelio Tello

A previously healthy 17-year-old male was admitted for pain in the right lower quadrant of the abdomen and emission of blood with stools. Abdominal angio-CT (computed tomography) was negative for... more

Usefulness of serum amyloid a protein dosage for monitoring patients receiving tocilizumab

13 January 2020
Author(s): Martin Michaud, Florian Catros, Francis Gaches

Tocilizumab (TCZ) is a humanized monoclonal antibody directed against the interleukin-6 (IL-6) receptor licensed for the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis and... more

A breathtaking spectacle

2 January 2020
Author(s): Cedric Van de Bruaene, Tim Flamant, Philippe Rogiers

A 36-year-old woman was referred to our department with a 4-day history of spiking fever up to 100.4 °F, nausea, vomiting and loss of appetite. She also complained of slight dyspnea and a mild cough... more

Limited skin lesions in a haemodialysis patient

31 December 2019
Author(s): David F.G.J. Wolthuis, Saskia de Mare, Jacobien C. Verhave

An 82-year old hemodialysis patient presented with a painful rash on his left arm. His-dialysis access was on this arm for more than ten years (synthetic PTFE graft). Within a week there was a non-... more

Dyspnea of a woman living in an old wooden house

28 December 2019
Author(s): Keizo Tanitame, Nobuko Tanitame

A 38-year-old woman presented to the emergency department with aggravated dyspnea at rest and productive cough for one week from late July. She was born and married in Brazil. Then she immigrated to... more

Case Report

Worth a careful look at the blood film

30 December 2019
Author(s): Konstantinos Liapis, Susan Delimpasis

A 46-year-old man with a history of alcohol abuse came to the emergency department with fever and a purpuric rash. He had been bitten by a dog on the left hand 3 days earlier. Minimal bleeding... more

Commentary

Clinical trial results – A closer look under the surface

28 January 2020
Author(s): Menno V. Huisman, Olaf M Dekkers

When reading the report of a clinical study in a medical journal, the typical question an overly busy clinician-reader asks is the following: do the results convince me and are they valid? In the era... more

Cardiac and vascular damage in systemic erythematosus lupus. Is disease activity the mediator?

27 January 2020
Author(s): Giacomo Pucci, Gaetano Vaudo

Cardiovascular (CV) risk associated with Systemic Erythematosus Lupus (SLE) yet remains an issue of great interest and current debate. Results from a large number of epidemiological studies clearly... more

Light anti-thrombotic regimen after interatrial shunt device closure: A strategy for all patients?

21 January 2020
Author(s): Riccardo Cappato

During the recent years, catheter-based closure of atrial septal defect (ASD) or patent foramen ovale (PFO) has become an effective and safe therapy for the curative treatment of patients with... more

Clinical trial publications: A sufficient basis for healthcare decisions?

13 January 2020
Author(s): Hans-Georg Eichler, Guido Rasi

Clinical studies remain the single most important information source of the scientific basis on which healthcare decisions are taken. This applies to population-level decisions taken by drug... more

Primum non nocere does not justify clinical inertia for stroke prevention in elderly patients with atrial fibrillation in the era of direct oral anticoagulants

27 December 2019
Author(s): Ilaria Cavallari, Giuseppe Patti

Stroke prevention with oral anticoagulation represents the cornerstone of atrial fibrillation (AF) management.

Internal Medicine Flashcard

A blue, painful limb in a cancer patient

13 January 2020
Author(s): Maria Alice Franzoi, Analu Vivian

A 40-year-old man with metastatic colorectal cancer (peritoneum and lymph-node metastases) under therapy with palliative chemotherapy, with a previous history of deep venous thrombosis in the lower... more

The unintended consequences of a bowl of soup

13 January 2020
Author(s): Daniel Angelov, Sarah Kelliher, Philip Murphy

A 33-year-old Romanian woman presented with a one day history of “cola-coloured” urine with associated fevers. She reported generalised malaise, arthralgia and reduced appetite for 24 h. The patient... more

An elderly man with diarrhea and weight loss

2 January 2020
Author(s): Yusaku Kajihara

A 77-year-old Japanese man presented to the author's department with diarrhea and weight loss (8 kg in the past 3 months). Vital signs were normal. Furthermore, abdominal examination was normal, and... more

A middle-aged woman with severe disorders of consciousness

30 December 2019
Author(s): Keizo Tanitame

A 47-year-old woman presented to the emergency department of the author's hospital with severe disorder of consciousness. She had been epileptic since early childhood and had many epileptic family... more

Elderly patient with prostate cancer and back pain

30 December 2019
Author(s): Marcus Villander Barros de Oliveira Sá, Flávio José Siqueira Pacheco, Francisco José Trindade Barretto

A 72-year-old man with hypertension came to our hospital with a history of severe posterior chest pain 3 months ago and worsened 1 week before admission. He denied a history of recent trauma but was... more

Letter to the Editor

Improving survival outcome among elderly lung transplant recipients

27 January 2020
Author(s): Shweta Kambali, Alejandro Max Antonio Mantero, Ali Ghodsizad, Matthias Loebe, Mehdi Mirsaeidi

To the Editor:

Characterisation of patients with acute myocardial infarction complicated by left ventricular thrombus

16 January 2020
Author(s): Aloysius Sheng-Ting Leow, Ching-Hui Sia, Benjamin Yong-Qiang Tan, Mark Yan-Yee Chan, Joshua Ping-Yun Loh

Left ventricular (LV) thrombus is a known complication of acute myocardial infarction (AMI), with a reported incidence ranging from 0.7 to 4.3% in the era of primary percutaneous coronary... more

Video-thoracoscopy for the evaluation of undiagnosed pleural effusion: Is it possible to optimize its indication?

13 January 2020
Author(s): Queralt Jordano, Tommaso Francesco Aiello, Ramon Rami, Angels Jaen, Alejandro de la Sierra

According to clinical guidelines, thoracoscopy is the investigation of choice in exudative pleural effusions when a diagnostic thoracocentesis is inclonclusive and malignancy is suspected [1].

The age-adjusted Charlson comorbidity index: A significant predictor of clinical outcome in patients with heart failure

13 January 2020
Author(s): Mony Shuvy, Donna R. Zwas, Andre Keren, Israel Gotsman

Heart failure (HF) has emerged as a major epidemic and a significant public health burden, associated with considerable morbidity and mortality [1]. Parameters specific for HF such as NYHA class and... more

Authors’ reply to ‘Reply to EC de Haas and HJ Luijendijk, Eur J Intern Med. 2019 Apr; 62: e8-e9’ by S Portsmouth et al.

2 January 2020
Author(s): Esther C. de Haas, Hendrika J. Luijendijk

In response to our comment, Dr Portsmouth and colleagues provide additional information about the results of the CAPSTONE-1 trial [1], which we appreciate. In our comment, we underlined that the... more

Letters to the Editor

Reply to EC de Haas EC and HJ Luijendijk, Eur J Intern Med. 2019 Apr;62: e8-e9

15 January 2020
Author(s): Simon Portsmouth, Keiko Kawaguchi, Takeki Uehara, Frederick G. Hayden

RE Baloxavir for influenza: Enrichment obscured lack of effect in North-American adults [1]

Original Article

Assessing the association between fluoroquinolones and emerging adverse drug reactions raised by regulatory agencies: An umbrella review

23 January 2020
Author(s): Milo Gatti, Matteo Bianchin, Emanuel Raschi, Fabrizio De Ponti

Systemic fluoroquinolones remain commonly prescribed broad-spectrum antibiotics, both in hospital and outpatient settings, despite rising resistance rates [1–7]. Since their approval,... more

Admission glucose level was associated with increased short-term mortality and length-of-stay irrespective of diagnosis, treating medical specialty or concomitant laboratory values

22 January 2020
Author(s): Magnus Björk, Eva O. Melin, Thomas Frisk, Maria Thunander

Diabetes is a global public health problem with serious and costly consequences for patients and for health care systems worldwide [1]. The global prevalence of diabetes in 2017 was estimated to 8.6... more

The association between education level and chronic liver disease of any etiology

22 January 2020
Author(s): Tommaso Stroffolini, Evangelista Sagnelli, Caterina Sagnelli, Filomena Morisco, Sergio Babudieri, Caterina Furlan, Mario Pirisi, Maurizio Russello, Antonina Smedile, Mariantonietta Pisaturo, Piero Luigi Almasio

Epidemiological surveys performed in several countries [1–7] have shown that a low socioeconomic status (SES) unfavorably influences liver-related mortality. In Denmark, a low SES has been shown to... more

Mild to moderate hyponatremia at discharge is associated with increased risk of recurrence in patients with community-acquired pneumonia

14 January 2020
Author(s): Laura Potasso, Clara Odilia Sailer, Claudine Angela Blum, Nicole Cesana-Nigro, Philipp Schuetz, Beat Mueller, Mirjam Christ-Crain

Hyponatremia, defined as a serum sodium 

Light anti-thrombotic regimen for prevention of device thrombosis and/or thrombotic complications after interatrial shunts device-based closure

2 January 2020
Author(s): Gianluca Rigatelli, Marco Zuin, Fabio Dell'Avvocata, Loris Roncon, Dobrin Vassilev, Nguyen Nghia

Transcatheter closure of both symptomatic atrial septal defect (ASD) and patent foramen ovale (PFO) has become a standard procedure in daily clinical practice, guaranteeing excellent technical... more

Long-term efficacy of maintenance therapy with Rituximab for IgG4-related disease

31 December 2019
Author(s): Corrado Campochiaro, Emanuel Della-Torre, Marco Lanzillotta, Enrica Bozzolo, Elena Baldissera, Raffaella Milani, Paolo Giorgio Arcidiacono, Stefano Crippa, Massimo Falconi, Lorenzo Dagna

IgG4-related disease (IgG4-RD) is a recently recognized fibro-inflammatory disorder involving virtually any organ system [1,2]. Clinical-pathological hallmarks of IgG4-RD include mass-forming lesions... more

Predictors of mortality of influenza virus infections in a Swiss Hospital during four influenza seasons: Role of quick sequential organ failure assessment

31 December 2019
Author(s): Matthaios Papadimitriou-Olivgeris, Nikitas Gkikopoulos, Melissa Wüst, Aurelie Ballif, Valentin Simonin, Marie Maulini, Charly Nusbaumer, Luce Bertaiola Monnerat, Jonathan Tschopp, Eleftheria-Evdokia Kampouri, Patrick Wilson, Hervé Duplain

Influenza virus infections have been associated with increased morbidity and they play an important role in the excess mortality reported every winter season in the northern hemisphere; this... more

Fibroblast growth factor 23 predicts carotid atherosclerosis in individuals without kidney disease. The CORDIOPREV study

30 December 2019
Author(s): Maria E. Rodríguez-Ortiz, Juan F. Alcalá-Díaz, Antonio Canalejo, José D. Torres-Peña, Francisco Gómez-Delgado, Juan R. Muñoz-Castañeda, Javier Delgado-Lista, Mariano Rodríguez, José López-Miranda, Yolanda Almadén

The fibroblast growth factor 23 (FGF23) is a hormone produced mainly by bone cells that plays a fundamental role in the regulation of mineral metabolism through acting on different key actors [1].... more

Review Article

ANCA associated vasculitis

29 January 2020
Author(s): Fernando Salvador

Vasculitis is a pathological process characterized by inflammation of the blood vessels [1]. This inflammation causes vascular destruction, translating histologically with fibrinoid necrosis, hence... more

Multimorbidity in COPD, does sleep matter?

21 January 2020
Author(s): Lowie EGW Vanfleteren, Bianca Beghe, Anders Andersson, Daniel Hansson, Leonardo M Fabbri, Ludger Grote

Sleep constitutes approximately one-third of the average lifetime, and good sleep quality is important for both physical and mental health, especially for patients with a chronic disease. A growing... more

Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life

16 January 2020
Author(s): John R. Hurst, Neil Skolnik, Gerald J. Hansen, Antonio Anzueto, Gavin C. Donaldson, Mark T. Dransfield, Precil Varghese

Chronic obstructive pulmonary disease (COPD) was the third leading cause of mortality in 2016 and was responsible for an estimated 3 million deaths worldwide that year, representing a vast global... more

The pleura and the endocrine system

13 January 2020
Author(s): Claudio Sorino, Stefano Negri, Antonio Spanevello, David Feller-Kopman

The endocrine system is a network of glands and organs which produces, stores, and secretes hormones. It has an essential role in the correct functioning of many vital organs and in the maintenance... more

Prevalence of gastrointestinal malignancy in iron deficiency without anaemia: A systematic review and meta-analysis

13 January 2020
Author(s): Leo Alexandre, Charelle Manning, Simon S M Chan

Gastrointestinal (GI) cancers are the most common malignancy worldwide, leading to over 1.6 million deaths per annum [1]. The significant burden from this disease and its association with iron... more

Speckle tracking echocardiography in patients with systemic lupus erythematosus: A meta-analysis

5 January 2020
Author(s): Matteo Nicola Dario Di Minno, Francesco Forte, Antonella Tufano, Agostino Buonauro, Francesca Wanda Rossi, Amato De Paulis, Maurizio Galderisi

Systemic lupus erythematosus (SLE), an autoimmune disease with unknown pathophysiological mechanisms, is characterized by systemic involvement. In particular, patients with SLE show an accelerated... more

The ESC 2019 CCS guidelines: Have we left our patients and scientific evidence behind?

24 December 2019
Author(s): A.J. Manolis, M.S. Kallistratos, L.Ε. Poulimenos, G. Ambrosio, R. Dechend, J. Lopez-Sendon, G. Rosano, P. Collins

The ESC CCS 2019 guidelines recognize that successful management of anginal symptoms relies on effective therapy tailored to individual patient characteristics but do not provide any specific advice... more

Relevant EFIM Publications

Clinical practice guidelines adaptation for internists - An EFIM methodology

Author(s): Wiktoria Leśniak, Laura Morbidoni, Dror Dicker, Ignacio Marín-León
Date:25 June 2020

The challenge of implementing Less is More medicine: A European perspective

Author(s): Omar Kherad, Nathan Peiffer-Smadja, Lina Karlafti, Margus Lember, Nathalie Van Aerde, Orvar Gunnarsson, Cristian Baicus, Miguel Bigotte Vieira, António Vaz-Carneiro, Antonio Brucato, Ivica Lazurova, Wiktoria Leśniak, Thomas Hanslik, Stephen Hewitt, Eleni Papanicolaou, Olga Boeva, Dror Dicker, Biljana Ivanovska, Pinar Yldiz, Patrick Lacor, Mark Cranston, Frauke Weidanz, Giorgio Costantino, Nicola Montano
Date:16 April 2020

Medical and surgical co-management – A strategy of improving the quality and outcomes of perioperative care

Author(s): Carmen Fierbinţeanu-Braticevicia, Matthias Raspeb, Alin Liviu Predac, Evija Livčāned, Leonid Lazebnike, Soňa Kiňováf, Evert- Jan de Kruijfg, Radovan Hojsh, Thomas Hansliki, Mine Durusu-Tanrioverj, Francesco Dentalik, Xavier Corbellal, Pietro Castellinom, Monica Bivoln, Stefano Bassettio, Vasco Barretop, Eduardo Montero Ruizq, Luis Camposr, The Working Group on Professional Issues and Quality of Care of the European Federation of Internal Medicine (EFIM)
Date:15 November 2018


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What is internal medicine?

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. 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.

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