July 2020

44 Articles

Commentary

No double-edged sword and no doubt about the relation between smoking and COVID-19 severity

13 June 2020
Author(s): Silvano Gallus, Alessandra Lugo, Giuseppe Gorini

At the beginning of March 2020, with the publication of the first Chinese epidemiological studies on the determinants of a severe form of COVID-19, tobacco smoking consistently appeared as one of the... more

Cluster analysis for clinical sarcoidosis’ phenotyping

29 May 2020
Author(s): Miriana d'Alessandro, Elena Bargagli

In the current issue of the European Journal of Internal Medicine, we read with interest a new cluster-analysis to distinguish clinical phenotypes of sarcoidosis [1]. Six phenotype clusters emerged... more

Assessing complexity through simplicity

24 May 2020
Author(s): Raffaele Antonelli Incalzi, Claudio Pedone

Older patients admitted to medical wards have a disproportionately high risk of dying. Although mortality rate estimates vary according to the case mix of patients and the hospital characteristics,... more

From meta-analysis to the individual patient with atrial fibrillation and coronary artery disease: the complexity of antithrombotic treatment in real-world clinical practice and the need for a tailored approach

22 May 2020
Author(s): Giuseppe Boriani, Jacopo Francesco Imberti, Marco Vitolo

The management of antithrombotic therapy in atrial fibrillation (AF) patients presenting with acute coronary syndromes (ACS) and/or undergoing percutaneous coronary interventions (PCI) is highly... more

The 2019 ESC guidelines on pulmonary embolism: some further insights

20 May 2020
Author(s): Helia Robert-Ebadi, Marc Righini

This manuscript represents original work, and it is not under consideration for publication elsewhere. It has never been neither submitted nor published in another scientific journal. All authors... more

First episode of acute heart failure: Can we already predict the risk of short-term mortality?

15 May 2020
Author(s): Pedro Moliner, Josep Comin-Colet

This commentary refers to “Short-term mortality risk score for de novo acute heart failure (ESSIC-FEHF)” by S. García-Gutiérrez et al., published in this issue.

Internal Medicine Flashcard

A 44-year-old man with cough, arthralgia, and fever

14 May 2020
Author(s): Priyanka Bhugra, Abhishek Maiti

A 44-year- old man presented with dry cough, diffuse joint pain, fevers, and night sweats for one month and poor appetite and weight loss for three months. Physical examination showed... more

Sudden onset headache, dizziness, unilateral facial numbness, and speech disturbance

14 May 2020
Author(s): Keizo Tanitame

A 48-year-old woman presented to the emergency department with acute onset of headache, dizziness, right facial numbness, and difficulty of swallowing and speech. She was not a smoker and consumed... more

Letter to the Editor

Need for innovative and timely synthesis of evidence during Covid-19 outbreak

7 June 2020
Author(s): Giulio Francesco Romiti, Bernadette Corica, Roberto Cangemi, Stefania Basili, Valeria Raparelli

Amid the Covid-19 pandemic, one major challenge for health-care providers is to navigate the outstanding number of new studies released every day, looking for evidence to improve clinical practice.... more

Protective role of chronic treatment with direct oral anticoagulants in elderly patients affected by interstitial pneumonia in COVID-19 era

6 June 2020
Author(s): Rosario Rossi, Francesca Coppi, Marisa Talarico, Giuseppe Boriani

Since December 2019, coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing global health emergency [1]. Elderly patients... more

COVID-19, a viral endocrinological disease?

5 June 2020
Author(s): Tiziana Grassi, Elena Varotto, Francesco M. Galassi

Ever since Chinese health officials informed the WHO of the presence of 44 patients suffering from an anomalous pneumonia apparently linked with the Huanan Seafood Wholesale Market (Wuhan City) on... more

COVID-19: The Waterloo of governments, healthcare systems, and large health organizations

1 June 2020
Author(s): Michael Doumas, Konstantinos P. Imprialos, Dimitrios Patoulias, Alexandra Katsimardou, Konstantinos Stavropoulos

To the editor

Covid-19 in Italy: Lesson from the Veneto Region

27 May 2020
Author(s): Giacomo Mugnai, Claudio Bilato

The day after the first case of Italian COVID-19 patient in Codogno (Lombardy, Italy) on February 20, 2020, a second outbreak was detected at the “Riuniti Hospitals Padova Sud” of Monselice (Veneto,... more

Does active smoking worsen Covid-19?

27 May 2020
Author(s): Alberto Carmona-Bayonas, Paula Jimenez-Fonseca, Álvaro Sánchez Arraez, Felipe Álvarez Manceñido, Eduardo Castañón

Probably it does.

Balancing the need for rapid and rigorous scientific data during early phase of the COVID-19 pandemic: A further role for the scientific community

27 May 2020
Author(s): Mario Rotondi, Manuel Nieto-Diaz, Flavia Magri, Antonio Oliviero

The primary focus of biomedical sciences is to apply scientific methodology to the biology of human disease with the aim of producing recommendations to be adopted in healthcare. The scientific... more

Active smoking and severity of coronavirus disease 2019 (COVID-19): Differences in measurement of variables could cause errors in the results

27 May 2020
Author(s): Sánchez JJ, Acevedo N, Guzmán E

In this letter to the editor, we would like to address some main points presented in the manuscript by Lippi G, and Henry BM. [1] regarding smoking as a risk factor for SARS-CoV-2. Even though the... more

The eighth alternative to evidence based medicine in the early era of the COVID-19 pandemic: Too much emergency and emotion, too little evidence

27 May 2020
Author(s): Filippo Pieralli, Vieri Vannucchi, Iacopo Olivotto

“Clinical decisions should, as far as possible, be evidence based. So runs the current clinical dogma. We are urged to lump all the relevant randomised controlled trials into one giant meta-analysis... more

Why should we use convalescent plasma for COVID-19?

16 May 2020
Author(s): Massimo Franchini

Coronavirus, an enveloped virus belonging to the family of Coronaviridae which initially caused enzootic infections, has shown in the last decades to be capable of crossing the species barrier... more

Good times, bad times: A diary of a physician in the COVID-19 era

15 May 2020
Author(s): Tommaso Lupia, Giacomo Stroffolini, Roberto Angilletta, Stefano Bonora, Giovanni Di Perri

7:30 a.m.

Active smoking and severity of coronavirus disease 2019 (COVID-19): The use of significance testing leads to an erroneous conclusion

7 May 2020
Author(s): Ernest Lo, Benoit Lasnier

In their letter to the Editor, “Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19)”, Lippi et al. [1] present a timely and important meta-analysis to evaluate if... more

Bleeding in COVID-19 severe pneumonia: The other side of abnormal coagulation pattern?

6 May 2020
Author(s): Clara Benedetta Conti, Sonia Henchi, Giovanni Paolo Coppeta, Sophie Testa, Roberto Grassia

A novel coronavirus (SARS CoV-2) spread in China in December 2019, becoming soon a relevant problem of international public health concern [1]. In Italy the SARS-CoV-2 officially spread around the... more

Do we know when to end isolation of persons affected with COVID-19?

3 May 2020
Author(s): Dror Dicker, Tatiana Kournos, Dana Marcoviciu, Rachel Golan

The pathogen responsible for coronavirus disease 2019 (COVID-19) is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This novel coronavirus was first detected in Wuhan, China in late... more

Active smoking and COVID-19: a double-edged sword

1 May 2020
Author(s): Giuseppe Lippi, Fabian Sanchis-Gomar, Brandon Michael Henry

We are thankful to Garufi et al [1] for the comments on our recent article published in this journal [2], and we wish to add some further pieces to the intricate puzzle linking active cigarette... more

Covid-19 cases in a no-Covid-19 geriatric acute care setting. A sporadic occurrence?

29 April 2020
Author(s): Stefano Fumagalli, Bernardo Salani, Luciano Gabbani, Enrico Mossello, Andrea Ungar

The pandemic outbreaks of coronarovirus disease 2019 (Covid-19) is associated to a higher risk of complications and mortality in older patients because of their greater complexity and the frequent... more

The quality of the reported sample size calculation in clinical trials on COVID-19 patients indexed in PubMed

29 April 2020
Author(s): Paul H. Lee

Given the utmost priority of COVID-19 research, many medical journals, especially the leading ones, expedited the review process of these papers. It was expected that the amount of submitted papers... more

Reorganizing Italian Internal Medicine wards for COVID 19

29 April 2020
Author(s): Antonino Mazzone, Nicola Mumoli

most of the Internal Medicine wards in the Lombardy hospitals, have beens almost completely reorganized to accommodate the management of patients with COVID-19. Analysis of the data coming from... more

Non-SARS CoV2 positive critical patients: Sons of a lesser God?

28 April 2020
Author(s): Giovanni Gulli

As the number of confirmed cases of coronavirus in Italy continues to rise, the reorganization of the hospitals outlined by Grasselli et Al. [1] across the country made wards slowly emptied, elective... more

Smoking habit and hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related pneumonia: The unsolved paradox behind the evidence.

22 April 2020
Author(s): Giovanna Garufi, Luisa Carbognin, Armando Orlandi, Giampaolo Tortora, Emilio Bria

Since the beginning of the SARS-CoV-2 pandemic earthquake (more than 1.8 million infected subjects worldwide as of mid-April), differences across countries with regard to hospitalization and death... more

Acute hemolysis by hydroxycloroquine was observed in G6PD-deficient patient with severe COVD-19 related lung injury

20 April 2020
Author(s): Lucia De Franceschi, Enrico Costa, Francesco Dima, Matteo Morandi, Oliviero Olivieri

The coronavirus disease COVID19 is a global health pandemic emergency. The disease, named coronavirus disease 2019 (COVID-19) by the WHO, presents symptoms that range from mild to severe and fatal... more

COVID-19: Timing is Important

13 April 2020
Author(s): Giovanni de Simone, Costantino Mancusi

On March 23, 2020, the Bergamo hospital team, one of the most challenged teams fighting against COVID-19 web-broadcasted a 1-hour conference on the state of their experience, seeking for discussion... more

Original Article

Clinical practice guidelines adaptation for internists - An EFIM methodology

29 May 2020
Author(s): Wiktoria Leśniak, Laura Morbidoni, Dror Dicker, Ignacio Marín-León, EFIM

With the easy access to internet, the increasing number of clinical studies and the better quality of these studies, the main challenge for the clinicians nowadays is to quickly find a relevant... more

Clinical phenotypes and prediction of chronicity in sarcoidosis using cluster analysis in a prospective cohort of 694 patients

21 April 2020
Author(s): Manuel Rubio-Rivas, Xavier Corbella

Sarcoidosis is a multisystem granulomatous disease with high variability and sometimes unpredictable behavior. This great variability necessitates the search for clinical patterns of observed... more

Coffee Consumption is Associated with a Decreased Risk of Incident Chronic Kidney Disease: A Systematic Review and Meta-analysis of Cohort Studies

18 April 2020
Author(s): Thatsaphan Srithongkul, Patompong Ungprasert

Coffee is a popular beverage that is consumed in every corner of the world. It has been estimated that at least 50 percent of adults in the United States drink coffee on a regular basis [1]. With its... more

Clinical utility of fecal calprotectin in monitoring disease activity and predicting relapse in pregnant patients with inflammatory bowel diseases

20 March 2020
Author(s): Amihai Rottenstreich, Tali Mishael, Sorina Grisaru Granovsky, Benjamin Koslowsky, Hagai Schweistein, Guila Abitbol, Eran Goldin, Ariella Bar-Gil Shitrit

Inflammatory bowel disease (IBD) is frequently diagnosed among reproductive-aged women, with 25% of women conceiving after diagnosis [1]. Associations of IBD with pregnancy outcomes have been... more

Impact of treatment strategies on long-term outcome of CTO patients

14 March 2020
Author(s): Christian Roth, Georg Goliasch, Stefan Aschauer, Clemens Gangl, Mohamed Ayoub, Klaus Distelmaier, Bernhard Frey, Irene M. Lang, Rudolf Berger, Kambis Mashayekhi, Miroslaw Ferenc, Christian Hengstenberg, Aurel Toma

Chronic total occlusions (CTO) are a common entity in patients with stable coronary artery disease undergoing coronary angiography with a point-prevalence between 15 and 30% [1–3]. CTO... more

Anticoagulation in thrombocytopenic patients with hematological malignancy: A multinational clinical vignette-based experiment

13 March 2020
Author(s): Avi Leader, Vincent ten Cate, Arina J ten Cate-Hoek, Erik A.M. Beckers, Galia Spectre, Cinzia Giaccherini, Anna Gurevich-Shapiro, Eilon Krashin, Pia Raanani, Harry C. Schouten, Anna Falanga, Hugo ten Cate

Thrombocytopenia in cancer patients with an indication for anticoagulation is not uncommon [1], and poses a unique clinical challenge. Clinical trials evaluating anticoagulants for treatment of... more

Abnormal ankle-brachial index (ABI) predicts primary and secondary cardiovascular risk and cancer mortality

6 March 2020
Author(s): A. Visonà, A. De Paoli, U. Fedeli, D. Tonello, B. Zalunardo, N. Zanatta, R. Martini, R. Pesavento, S. Cuppini, M. Prior, S. Benazzi, C. Cimminiello, F. Avossa

An abnormal ankle-brachial pressure index (ABI) is a marker of the risk for increased total and cardiovascular (CV) mortality. However, it is not clear whether it is associated with an even worse... more

Short-term mortality risk score for de novo acute heart failure (ESSIC-FEHF)

4 March 2020
Author(s): Susana García-Gutiérrez, Ane Antón-Ladislao, Raul Quiros, Antonio Lara, Irene Rilo, Miren Morillas, Nekane Murga, Maria Soledad Gallardo, Iratxe Lafuente, Urko Aguirre, Jose Maria Quintana, ESSIC –REDISSEC Group

Acute heart failure (AHF) is one of the most common reasons for emergency department (ED) attendance in Spain, 24% of patients being discharged home from the ED). AHF may present de novo, that is, as... more

Predictors of infection after “de novo” cardiac electronic device implantation

29 February 2020
Author(s): C. Balla, A. Brieda, A. Righetto, F. Vitali, M. Malagù, R. Cultrera, M. Bertini

Over the past few decades, a rapid and stable increase in cardiovascular implantable electronic devices (CIEDs) rates has been observed. Continuous aging of the population and a wider spectrum of... more

Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure

29 February 2020
Author(s): Juan Sanchez-Serna, Alvaro Hernandez-Vicente, Iris P. Garrido-Bravo, Francisco Pastor-Perez, Jose A. Noguera-Velasco, Teresa Casas-Pina, Ana I. Rodriguez-Serrano, Julio Núñez, Domingo Pascual-Figal

Heart failure (HF), a chronic heterogeneous syndrome with increasing prevalence and incidence, is associated with high mortality and morbidity [1,2]. In ambulatory patients, the occurrence of an... more

A new simplified model for predicting 30-day mortality in older medical emergency department patients: The rise up score

26 February 2020
Author(s): Noortje Zelis, Jacqueline Buijs, Peter W. de Leeuw, Sander M.J. van Kuijk, Patricia M. Stassen

Early identification of high risk patients who visit an emergency department (ED) is important to optimise the diagnostic approach, care and outcome. In particular, older patients are at high risk of... more

Antithrombotic treatment in patients with atrial fibrillation undergoing coronary angioplasty: rational convincement and supporting evidence

13 February 2020
Author(s): Elisabetta Ricottini, Antonio Nenna, Rosetta Melfi, Sara Giannone, Mario Lusini, Germano Di Sciascio, Massimo Chello, Gian Paolo Ussia, Francesco Grigioni

The choice of optimal antithrombotic therapy for patients undergoing percutaneous coronary interventions (PCI) with an indication for long-term oral anticoagulation (OAT) is challenging. Atrial... more

Review Article

Hepatic consequences of COVID-19 infection. Lapping or biting?

1 June 2020
Author(s): Piero Portincasa, Marcin Krawczyk, Antonia Machill, Frank Lammert, Agostino Di Ciaula

The outbreak of coronavirus disease 2019 (COVID-19) starting last December in China placed emphasis on liver involvement during infection. This review discusses the underlying mechanisms linking... more

Therapeutic strategies for virus-negative myocarditis: a comprehensive review

10 May 2020
Author(s): Giacomo De Luca, Corrado Campochiaro, Silvia Sartorelli, Giovanni Peretto, Lorenzo Dagna

Myocarditis is defined by World Health Organization as an inflammatory disease affecting the myocardium, diagnosed by endomyocardial biopsy (EMB) using established histological, immunological, and... 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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The principal objectives of EFIM is to promote internal medicine on a scientific educational, ethical and professional level and to support internists in providing better care for patients throughout Europe.

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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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