October 2020

103 Articles

No Section

Venous thromboembolism and COVID-19: mind the gap between clinical epidemiology and patient management

22 October 2020
Author(s): Michela Giustozzi, Maria Cristina Vedovati, Giancarlo Agnelli

Since the beginning of the coronavirus disease-2019 (COVID-19) pandemic, a compelling evidence of the association between this infection and an increased risk of venous thromboembolism has drawn the... more

Does Hydroxychloroquine Reduce Mortality for COVID-19?

16 October 2020
Author(s): Silvano GALLUS, Antonio CLAVENNA, Alessandra LUGO

A paper published in this issue of the European Journal of Internal Medicine shows results from the COVID-19 RISK and Treatments (CORIST) Collaboration Study [1]. The authors analysed data from a... more

Disease- and gender-related characteristics of coeliac disease influence diagnostic delay

28 September 2020
Author(s): Marco Vincenzo Lenti, Antonio Di Sabatino

Coeliac disease is a high-prevalent, immune-mediated, chronic enteropathy caused by the ingestion of gluten in genetically susceptible individuals [1,2]. From the clinical viewpoint, coeliac disease... more

The 2020 International Society of Hypertension global hypertension practice guidelines - key messages and clinical considerations

22 September 2020
Author(s): Paolo Verdecchia, Gianpaolo Reboldi, Fabio Angeli

The International Society of Hypertension (ISH) has recently developed practice guidelines for the management of hypertension in adults aged ≥18 years. Conceptually, the 2020 ISH Guidelines are... more

Predicting spontaneous conversion to sinus rhythm in symptomatic atrial fibrillation: The ReSinus score

17 September 2020
Author(s): Jan Niederdöckl, Alexander Simon, Filippo Cacioppo, Nina Buchtele, Anne Merrelaar, Nikola Schütz, Sebastian Schnaubelt, Alexander O Spiel, Dominik Roth, Christian Schörgenhofer, Harald Herkner, Hans Domanovits, Michael Schwameis

In patients with symptomatic atrial fibrillation rates of spontaneous conversion are high.1-3 In real-world emergency cohorts optimal management is unclear; however, treatment with early... more

Hyperuricaemia and gout in cardiovascular, metabolic and kidney disease

29 July 2020
Author(s): Claudio Borghi, Enrico Agabiti-Rosei, Richard J. Johnson, Jan T. Kielstein, Empar Lurbe, Giuseppe Mancia, Josep Redon, Austin G. Stack, Konstantinos P. Tsioufis

Hyperuricaemia refers to an abnormally high concentration of uric acid in serum [1], typically defined as >7 mg/dL (416 μmol/L) in men and >6 mg/dL in women [2]. Mean serum uric acid has... more

Erectile dysfunction and adherence to antihypertensive therapy: Focus on β-blockers

18 July 2020
Author(s): Athanasios Manolis, Michael Doumas, Claudio Ferri, Giuseppe Mancia

Arterial hypertension is a major public health issue because it affects more than 1.1 billion patients worldwide [1], and represents a very important risk factor for the development of cardiac,... more

Influence of BMI and geographical region on prescription of oral anticoagulants in newly diagnosed atrial fibrillation: The GLORIA-AF Registry Program

14 May 2020
Author(s): Giuseppe Boriani, Menno V. Huisman, Christine Teutsch, Sabrina Marler, Lionel Riou França, Shihai Lu, Gregory Y.H. Lip, GLORIA-AF Investigators

Body mass index (BMI) is widely used for estimating adiposity and has been extensively studied across different populations for evaluating the relationships between BMI values and the risks of... more


Hypertension guidelines: Managing the differences or the patients?

19 October 2020
Author(s): AJ Manolis, LE Poulimenos, MS Kallistratos

Clinical guidelines summarize and evaluate all evidence available on a topic, with the aim of assisting physicians in selecting the best diagnostic and therapeutic strategies for an individual... more

Utilize the full potential of real world evidence

7 October 2020
Author(s): Rupert Bauersachs

After the pivotal phase 3 trials on venous thromboembolism (VTE) treatment with non-vitamin K antagonist oral anticoagulants (NOACs) had been performed some 10 years ago, these drugs have now become... more

Erectile dysfunction and arterial hypertension: Still looking for a scapegoat

16 September 2020
Author(s): Giovanni de Simone, Costantino Mancusi

Hypertension awareness, treatment and control have improved substantially in the past 40 years. However, control rates have plateaued in the past decade in many countries, and a substantial... more

Gender differences in long-term prognosis after NSTEACS: Now you see me, now you don't!

1 September 2020
Author(s): Gaia Cattadori, Isabella Tritto, Giuseppe Ambrosio

It is known that women are often underrepresented, or even excluded, in randomized clinical trials, the results of which consequently may not be entirely reproduced in the general population. At the... more

Performance of creatinine- and cystatin C-based formulas to estimate glomerular filtration rate

13 August 2020
Author(s): Giorgio Gentile, Fabio Angeli, Gianpaolo Reboldi

Chronic kidney disease (CKD) affects 8-16% of the population worldwide and is a huge global health issue, given its strong association with higher cardiovascular morbidity and mortality, progression... more

Increased risk of cardiac arrhythmias with cannabis use – More studies are needed

6 August 2020
Author(s): Ran Abuhasira, Victor Novack

The regulations of medical and recreational cannabis are constantly changing in recent years, both in United States and in many other countries around the world [1]. As a consequence of the changing... more


Early diagnosis of idiopathic pulmonary fibrosis: Closer to the goal?

23 August 2020
Author(s): Alessia Comes, Giacomo Sgalla, Luca Richeldi

Early diagnosis of idiopathic pulmonary fibrosis (IPF) is definitely a challenge. Several studies have been investigating how to achieve this goal. IPF is the most common type of idiopathic... more

European Journal of Internal Medicine: IM Flashcards

Atypical chest pain with precordial T wave inversions

10 October 2020
Author(s): Leah Weston, Hani Alkhatib, Susrutha Kotwal

A 74-year-old woman with a prior history of coronary artery disease presented to the emergency department with intermittent, burning epigastric pain. Five months prior, she had a stress... more

Internal Medicine Flashcard

Bright liver: a surprise discovery

29 September 2020
Author(s): Daisuke Murakami, Hideaki Harada, Yuji Amano

A 69-year-old woman with hypothyroidism, alcoholic liver disease, coronary artery disease, ventricular arrhythmia requiring placement of an implantable cardioverter defibrillator, and end-stage renal... more

A middle-aged woman with acute onset of fever, altered mental status, and movement disorder

25 September 2020
Author(s): Yusaku Kajihara

A 60-year-old woman was admitted in the emergency room with acute onset of fever, altered mental status, and movement disorder. The patient had well-controlled type 2 diabetes mellitus with... more

What ‘s the link between otological signs and oral contraception?

25 September 2020
Author(s): Laurence Salle, Henri Salle

A 48-year-old woman presented chronic headache and serous otitis with feeling of fullness of the right ear. She had no medical or surgery history. ENT and clinical neurological examination revealed... more

Paroxysmal Atrial Fibrillation on Flecainide Therapy

24 September 2020
Author(s): Jordan L Gavin, Graham S Peigh, Susan S Kim

Flecainide pill-in-the-pocket therapy is a pharmacologic treatment option for patients with infrequent episodes of symptomatic atrial fibrillation. We report a case of wide complex tachycardia due to... more

Chest pain in a middle-aged smoker with heart failure and missing lung

23 September 2020
Author(s): Sarah Hossain, Afif Hossain, Aldo Barajas-Ochoa

A 45-year-old man presented with sharp, left-sided chest pain of one-hour duration that radiated to the right chest and back, and started two hours after snorting cocaine. He was an active smoker and... more

Bilateral hilar opacities

23 September 2020
Author(s): João A. Cunha Neves, Maria Margarida Rosado, Marcelo Gordinho

A 20-year-old male was admitted to the emergency department with a 1-week history of fever, right pleuritic chest pain and aggravating sporadic hemoptoic cough.

Anterior neck mass that appeared after a common cold

1 September 2020
Author(s): Hiroaki Nakagawa, Yasushi Miyata

A 62-year-old man experienced a common cold for 7 days. He presented to the clinic with a 2-day history of anterior neck pain and swelling. His body temperature was 37.4°C, and a soft, well-defined... more

Internal Medicine Flashcards

A middle-aged woman with numbness and weakness of the extremities

23 September 2020
Author(s): Keizo Tanitame

A 45-year-old woman presented to the neurology department with numbness and weakness of extremities, which had progressed during 3 months. The patient had tingling sensation in the left neck.... more

Disturbance of consciousness after postpartum hemorrhage

23 September 2020
Author(s): Keizo Tanitame, Chinatsu Akagi, Nobuyuki Kamaki

A 37-year-old woman with postpartum hemorrhage was transferred by ambulance to our hospital for emergency treatment. On arrival massive hemorrhage continued, and she developed tachycardia (130 beats/... more

Letter to Editor

Linking hydroxychloroquine to hemolysis in a ‘suspected’ glucose-6-phosphate dehydrogenase deficient patient with COVID-19 infection – a critical appraisal

8 July 2020
Author(s): T.P. Afra, Ram Vasudevan Nampoothiri, Muhammed Razmi T, N. A. Bishurul Hafi

We read the recent letter by De Franceschi et al. [1] attributing acute intravascular hemolysis in a patient with COVID-19 infection to intake of hydroxychloroquine (HCQ). We would like to highlight... more

Letter to the Editor

Autoimmune disorders and venous thromboembolism: An update from the COMMAND VTE registry

24 October 2020
Author(s): Yugo Yamashita, Takeshi Morimoto, Kazushige Kadota, Koh Ono, Takeshi Kimura

There are various well-known predisposing risk factors for development of venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), and several studies reported... more

Determinants of circulating angiotensin-converting enzyme 2 protein levels in the general population

19 October 2020
Author(s): Tatiana Kuznetsova, Nicholas Cauwenberghs

Similar to SARS-CoV, the novel coronavirus (SARS-CoV-2) uses the angiotensin-converting enzyme 2 (ACE2) receptor to infiltrate target cells [1]. Previous experimental study provided the genetic proof... more

Risk of thrombosis, pregnancy morbidity or death in antiphospholipid antibodies positive patients with or without thrombocytopenia

17 October 2020
Author(s): Thomas Moulinet, Virginie Dufrost, Isabelle Clerc-Urmès, Denis Wahl, Stéphane Zuily

Antiphospholipid syndrome (APS) is an immune-mediated acquired disorder characterized by venous, arterial or small vessels thromboses and/or obstetrical morbidity, and the persistent presence of... more

Disease course in patients with systemic autoimmune diseases: insights on the safety of immunosuppression during the SARS-CoV-2 outbreak in Italy

15 October 2020
Author(s): Devis Benfaremo, Lucia Perini, Valentina Marconi, Michele Maria Luchetti, Armando Gabrielli

From December 2019 the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), responsible for the Coronavirus Disease 2019 (COVID-19), has caused a pandemic, with over 28 million cases and... more

COMPASS vs PEGASUS approach in a comparative budget impact analysis.

10 October 2020
Author(s): Natale Daniele Brunetti, Luisa De Gennaro, Michele Correale, Riccardo Ieva, Francesco Santoro

The treatment of coronary artery disease (CAD), peripheral artery disease (PAD) and ischemic heart disease (IHD), has been radically modified in the recent past by the implementation of the results... more

Significant increase in the incidence of high-risk pulmonary embolism during the COVID-19 shutdown: The pandemic response causes serious collateral consequences

6 October 2020
Author(s): Paul Gressenberger, Thomas Gary, Reinhard B. Raggam, Andrea Borenich, Marianne Brodmann

When the novel coronavirus disease (COVID-19) started to spread globally in December 2019 and COVID-19 related deaths continued to increase rapidly [1], the World Health Organization (WHO) declared a... more

Change over time of COVID-19 hospital presentation in Northern Italy

25 September 2020
Author(s): Giuseppe Patti, Marco Mennuni, Francesco Della Corte, Enrico Spinoni, Pier Paolo Sainaghi, for the COVID-UPO Clinical Team

After the first autochthonous case described on February 19, also in Italy the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) infection rapidly circulated, mainly in the Northern... more

COVID-19 randomized controlled trials in medRxiv and PubMed

22 September 2020
Author(s): Yuki Kataoka, Shiho Oide, Takashi Ariie, Yasushi Tsujimoto, Toshi A. Furukawa

Fast-track preprints have garnered increased attention since the COVID-19 pandemic. However, little is known about the quality of clinical research published as preprints. The objective of this study... more

Is the 2020 Sampson equation the best formula for LDL-C estimation?

22 September 2020
Author(s): Federica Piani, Arrigo F.G. Cicero, Claudio Borghi, Sergio D’Addato, on behalf of the BLIP Study group

Dear Editor,

Trans-catheter valve implantation and patient outcomes: Focus on the kidney

24 August 2020
Author(s): Giuseppe Boriani, Salvo Arrotti, Davide Gabbieri, Paolo Magnavacchi, Fabio Alfredo Sgura

In 2012 the Kidney Disease Improving Global Outcomes organization published a guideline focused on the definition and management of acute kidney injury (AKI) [1] which became an important reference... more

Healthy and non healthy obese patients. The truth lies in the adipose tissue

19 August 2020
Author(s): E. Sanidas, Μ. Velliou, D. Papadopoulos, D. Iliopoulos, J. Barbetseas

Obesity is commonly correlated with metabolic complications such as insulin resistance, type 2 diabetes mellitus, dyslipidemia, arterial hypertension and metabolic syndrome that are significant risk... more

Cause of death and risk factors for mortality in AA amyloidosis: A French retrospective study

14 August 2020
Author(s): Alexandre Terré, Samuel Deshayes, Léa Savey, Gilles Grateau, Sophie Georgin-Lavialle

AA amyloidosis (AAA) is a major complication of chronic inflammation. It is the consequence of the deposition of fibrils of serum amyloid A protein (SAA) in tissues [1]. Lachman et al. prospectively... more

Glucose-6-phosphate dehydrogenase deficiency associated hemolysis in COVID-19 patients treated with hydroxychloroquine/chloroquine: New case reports coming out

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

Afra TP et al comment our recent report entitled: “acute hemolysis by hydroxychloroquine (HCQ) was observed in G6PD-deficient patient with severe COVID-19 related lung injury” [1,2]. Afra et al.... more

Renal failure after trans-catheter aortic valve implantation

7 August 2020
Author(s): Marianna Adamo, Salvatore Curello, Marco Metra

Trans-catheter aortic valve implantation (TAVI) is by now considered the treatment of choice in patients with severe and symptomatic aortic stenosis deemed at prohibitive or high surgical risk.... more

Patterns of anticoagulation for atrial fibrillation in cancer patients referred to cardio-oncological evaluation

5 August 2020
Author(s): Matteo Toma, Edlira Rrapaj, Paolo Spallarossa, Federico Guerra, Pietro Ameri

Prophylaxis of atrial fibrillation (AF)-related cardioembolism in oncology is often challenging [1]. The CHA2DS2-VASc score performs differently according to the presence or absence of cancer, with... more

Bowel resection reduces aortic pulse wave velocity in patients with ulcerative colitis. A longitudinal study

5 August 2020
Author(s): Luca Zanoli, Antonino Tuttolomondo, Giulio Geraci, Pietro Castellino

Ulcerative colitis (UC) is characterized by an involvement of the large bowel which leads to chronic systemic inflammation, increased aortic stiffness and reflected waves [1–4] and an excess of... more

Serum albumin and cardiovascular disease: Does low serum albumin contribute to the emergence and worsening of some cardiovascular diseases?

27 July 2020
Author(s): Stephane Arques

Cardiovascular disease is the leading cause of death worldwide, and the identification of modifiable risk factors potentially implicated in the onset and progression of cardiovascular disease... more

Do biomarkers add anything to clinical prediction of mortality in older medical emergency department patients?

25 July 2020
Author(s): Noortje Zelis, Jacqueline Buijs, Peter W. de Leeuw, Patricia M. Stassen, RISE UP investigator group

Recently, we described in this Journal a simplified, yet accurate clinical decision model (the RISE UP score) to predict 30-day mortality in older patients who visit an emergency department [1].... more

Italian Vò municipality cohort and COVID-19 epidemiology: The “Framingham” study of the 21st century

21 July 2020
Author(s): Marco Zuin, Claudio Bilato, Giovanni Zuliani, Loris Roncon

The small Italian municipality of Vò, located in the Veneto region, northeast of Italy, with a population of nearly 3200 inhabitants, suffered the first COVID-19-related death of the country on... more

The rise of rules: Will the new EU regulation of medical devices make us safer?

20 July 2020
Author(s): R. Tarricone, O. Ciani, S. D'Acunto, S. Scalzo

Whenever markets fail and minimum level of quality must be guaranteed to consumers, users and the system as a whole, regulations are needed. This is undoubtedly the case for healthcare technologies,... more

Hourly variation in urine (Na+K) in chronic hyponatremia related to SIADH: Clinical implication

16 July 2020
Author(s): G. Decaux, Wim Musch, Fabrice Gankam Kengne, Frédéric Vandergheynst, Bruno Couturier

Dilute urine may be considered to have an isotonic portion and an electrolyte-free water portion. The proportions of electrolytes-free water and isotonic can be measured by the ratio of effective... more

Waste in COVID-19 clinical trials conducted in western Europe

9 July 2020
Author(s): Rafael Dal-Ré, Ignacio Mahillo-Fernández

Amid huge efforts to address the therapeutic uncertainties clinicians are facing with COVID-19 patients’ management, many clinical trials are badly designed [1]. Trials with no control group and with... more

Romeo and Juliet: Revisited (at the time of COVID-19)

8 July 2020
Author(s): Giorgio Costantino, Flora Peyvandi, Nicola Montano, Carlo Agostoni

Once upon a time, EM, a 27-years old female resident in Internal Medicine, fell in love with JP, a 27-yrs male, a resident as well. It happens, in the pre-COVID-19 Milan, Lombardy, Italy.

The additive diagnostic value of heart-type fatty acid binding protein in patients presenting early with chest pain

6 July 2020
Author(s): Gassan Moady, Daisy Shtern, Shaul Atar

Acute myocardial infarction (AMI) is one of the most serious conditions encountered in the emergency room (ER), with outcomes that are highly affected by the time elapsed since symptoms onset. The... more

Safety and efficacy of levosimendan in patients with cardiac amyloidosis

3 July 2020
Author(s): Alberto Aimo, Claudio Rapezzi, Chiara Arzilli, Giuseppe Vergaro, Michele Emdin

Amyloidosis is a systemic disease characterized by extracellular deposition of insoluble fibrils [1]. Cardiac amyloidosis (CA) is common in both immunoglobulin light-chain (AL) and transthyretin... more

First comes the A, then the B: what we learned from the COVID-19 outbreak

28 June 2020
Author(s): Roberto Copetti, Giulia Amore, Carmine Cristiano Di Gioia, Daniele Orso

The SARS-CoV-2 epidemic, which has spread to many countries around the world, has hit Europe particularly hard. From our point of view, in a rural emergency department (with an annual patient census... more

Very low reporting rate of connective tissue diseases among coronavirus disease 2019 (Covid-19) patients and the renin-angiotensin system – An overlooked association?

12 June 2020
Author(s): Alessandro Giollo, Giovanni Cioffi, Maurizio Rossini, Ombretta Viapiana, Giovanni De Simone

Severe cases of Covid-19 are strongly associated with pre-existing comorbidities, specifically cardiovascular disease (CVD), diabetes, obesity and hypertension [1]. These conditions are commonly... more

Original Article

Serum uric acid and mortality thresholds among men and women in the Irish health system: A cohort study

19 October 2020
Author(s): Leonard D. Browne, Fatima-Zahra Jaouimaa, Cathal Walsh, Fernando Perez-Ruiz, Paschal Richette, Kevin Burke, Austin G. Stack

It is widely considered that serum uric acid (SUA), the final breakdown product of purine metabolism in humans, may represent a major cardiovascular risk factor and contribute to adverse health... more

Mobile health technology-supported atrial fibrillation screening and integrated care: A report from the mAFA-II trial Long-term Extension Cohort

13 October 2020
Author(s): Yutao Guo, Jun Guo, Xiangmin Shi, Yuan Yao, Yihong Sun, Yunlong Xia, Bo Yu, Tong Liu, Yundai Chen, Gregory Y H Lip, mAF-App II Trial investigators

The priorities of atrial fibrillation management include stroke prevention, decisions on rate or rhythm control and proactive management of comorbidities, as well as lifestyle changes. Given that... more

Sex-specific outcomes and management in critically ill septic patients

12 October 2020
Author(s): Bernhard Wernly, Raphael Romano Bruno, Behrooz Mamandipoor, Christian Jung, Venet Osmani

Sepsis is a life-threatening condition triggered by an “out-of-proportion” immune response to an infection [1]. Septic patients have low survival rates, and research to refine and individualize... more

Enterococcal infective endocarditis is a marker of current occult or future incident colorectal neoplasia

9 October 2020
Author(s): Maria Paola Ursi, Lorenzo Bertolino, Roberto Andini, Fabiana D'Amico, Domenico Iossa, Arta Karruli, Eugenio D'Avenia, Sabrina Manduca, Mariano Bernardo, Rosa Zampino, Emanuele Durante-Mangoni

Streptococcus gallolyticus and Enterococcus species are members of the gut microbiota and a major cause of infective endocarditis (IE), mainly affecting elderly subjects with digestive or urinary... more

Trends and outcomes of device-related 30-day readmissions after left ventricular assist device implantation

7 October 2020
Author(s): Alexandros Briasoulis, Hiroki Ueyama, Toshiki Kuno, Rabea Asleh, Paulino Alvarez, Aaqib H Malik

Newer generation, continuous-flow left ventricular assist devices (LVAD) have been introduced for use in end-stage heart failure as a bridge to transplant therapy or destination therapy, leading to... more

Consumer-led screening for atrial fibrillation using consumer-facing wearables, devices and apps: A survey of health care professionals by AF-SCREEN international collaboration

12 September 2020
Author(s): Giuseppe Boriani, Renate B Schnabel, Jeff S Healey, Renato D Lopes, Nicole Verbiest-van Gurp, Trudie Lobban, John A Camm, Ben Freedman

Atrial fibrillation (AF) is the most common sustained arrhythmia diagnosed in clinical practice, with an incidence that increases in the elderly [1,2] and a prevalence of diagnosed AF that is... more

Seventeen-year trend (2001–2017) in pacemaker and implantable cardioverter-defibrillator utilization based on hospital discharge database data: An analysis by age groups

12 September 2020
Author(s): Massimo Zecchin, Marina Torre, Eugenio Carrani, Letizia Sampaolo, Enrico Ciminello, Benedetta Ortis, Renato Ricci, Alessandro Proclemer, Gianfranco Sinagra, Giuseppe Boriani

National Registries are needed to monitor health care interventions, optimize the resources and utilize them appropriately [1], but are challenging to implement and manage due to the possible lack... more

Long-term effects of non-retrieved inferior vena cava filters on recurrences of venous thromboembolism in cancer and non-cancer patients: From the COMMAND VTE registry

10 September 2020
Author(s): Toru Takase, Yoshitaka Iwanaga, Yugo Yamashita, Takeshi Morimoto, Yusuke Yoshikawa, Hidewo Amano, Seiichi Hiramori, Kitae Kim, Maki Oi, Yohei Kobayashi, Yuji Nishimoto, Heitaro Watanabe, Kenji Yamaji, Ryobun Yasuoka, Masafumi Ueno, Kazuhiro Kobuke, Takeshi Kimura, Shunichi Miyazaki, COMMAND VTE Registry Investigators

There is a paucity of data comparing the long-term outcomes after inferior vena cava (IVC) filters placement for patients with acute venous thromboembolism (VTE) between those with and without active... more

Baseline and incident hypochloremia in chronic heart failure outpatients: Clinical correlates and prognostic role

5 September 2020
Author(s): Maria Consiglia Bellino, Francesco Massari, Miriam Albanese, Raffaella Ursi, Gianmarco Angelini, Francesco Lisi, Luca Amato, Pietro Scicchitano, Pietro Guida, Natale Daniele Brunetti, Francesca Di Serio, Marco Matteo Ciccone, Massimo Iacoviello

Abnormalities in serum electrolyte levels often complicate heart failure (HF) disease in acute (ADHF) and chronic (CHF) settings. Serum sodium has long been considered the most important electrolyte... more

Impact of non-selective ß-blockers on hepatic encephalopathy in patients with liver cirrhosis

29 August 2020
Author(s): Christian Labenz, Michael Nagel, Gerrit Toenges, Robert Kuchen, Jörn M. Schattenberg, Max Hilscher, Yvonne Huber, Jens U. Marquardt, Joachim Labenz, Peter R. Galle, Marcus-Alexander Wörns

Liver cirrhosis accounts for over one million deaths per year worldwide [1]. Hepatic encephalopathy (HE) - one of its most severe complications - is a brain dysfunction mainly caused by liver... more

Use of hydroxychloroquine in hospitalised COVID-19 patients is associated with reduced mortality: Findings from the observational multicentre Italian CORIST study

25 August 2020
Author(s): The COVID-19 RISK and Treatments (CORIST) Collaboration

Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19.

Definition of tachycardia for risk stratification of pulmonary embolism

23 August 2020
Author(s): Lukas Hobohm, Cecilia Becattini, Matthias Ebner, Markus H. Lerchbaumer, Franco Casazza, Gerd Hasenfuß, Stavros V. Konstantinides, Mareike Lankeit

Acute pulmonary embolism (PE) is the most serious manifestation of venous thromboembolism (VTE) and a major cause of mortality, morbidity and hospitalization in Western countries [1]. Acute right... more

Gastric regurgitation predicts neurological outcome in out-of-hospital cardiac arrest survivors

22 August 2020
Author(s): Anton Früh, Georg Goliasch, Raphael Wurm, Henrike Arfsten, Stefan Seidel, Lukas Galli, Lukas Kriechbaumer, Pia Hubner, Gottfried Heinz, Fritz Sterz, Christopher Adlbrecht, Klaus Distelmaier

Neurological prognostication after out-of-hospital cardiac arrest (OHCA) is challenging due to the lack of early and reliable predictors for clinically relevant brain damage [1]. The identification... more

Screening for nonalcoholic fatty liver disease in patients with type 2 diabetes mellitus using transient elastography - a prospective, cross sectional study

21 August 2020
Author(s): I Mikolasevic, V Domislovic, T Turk Wensveen, B Delija, M Klapan, T Juric, A Lukic, A Mijic, N Skenderevic, P Puz, A Ostojic, Z Krznaric, D Radic-Kristo, T Filipec Kanizaj, D Stimac

The number of people suffering from type 2 diabetes (T2DM) and obesity around the world has significantly increased during the past several decades due to changes in eating habits and sedentary... more

Prognostic impact of Vitamin D deficiency in patients with coronary artery disease undergoing percutaneous coronary intervention

20 August 2020
Author(s): Monica Verdoia, Matteo Nardin, Roberta Rolla, Federica Negro, Rocco Gioscia, Arraa Maddalena Saghir Afifeh, Filippo Viglione, Harry Suryapranata, Marco Marcolongo, Giuseppe De Luca, Novara Atherosclerosis Study Group (NAS)

Vitamin D (25(OH)D) is a fat-soluble vitamin, representing not only the principal modulator of calcium and bone homeostasis, but also a key-hormone, regulating the transcription of about 2000 to 8000... more

How many urinalysis and urine cultures are necessary?

20 August 2020
Author(s): Bart J. Laan, Tessa M.Z.X.K. van Horrik, Prabath W.B. Nanayakkara, Suzanne E. Geerlings

Low-value care is defined as a test or treatment that is unlikely to benefit the patient given the cost, available alternatives, and preferences of patients, [1] and can even cause harm to patients [... more

ETNA VTE Europe: A contemporary snapshot of patients treated with edoxaban in clinical practice across eight European countries

18 August 2020
Author(s): Alexander T. Cohen, Ulrich Hoffmann, Philippe Hainaut, Sean Gaine, Cihan Ay, Michiel Coppens, Marc Schindewolf, David Jimenez, Bernd Brüggenjürgen, Pierre Levy, Petra Laeis, Eva-Maria Fronk, Wolfgang Zierhut, Thomas Malzer, Marius Constantin Manu, Paul-Egbert Reimitz, Peter Bramlage, Giancarlo Agnelli, ETNA-VTE-Europe investigators

Venous thromboembolism (VTE) encompasses both deep vein thrombosis (DVT) and pulmonary embolism (PE). It has an incidence of approximately 1–2 per 1,000 person-years in Europe [1]. While both events... more

Limited prognostic accuracy of the CRB-65 and qSOFA in patients presenting with pneumonia and immunosuppression

7 August 2020
Author(s): Sophie Frantz, Bernhard Schulte-Hubbert, Michael Halank, Dirk Koschel, Martin Kolditz

Pneumonia remains an important health concern in the western world, with highly variable mortality rates [1]. Initial risk stratification to objectify prognosis is the first step in managing patients... more

Pharmacist-driven medication recognition/ reconciliation in older medical patients

7 August 2020
Author(s): Maria Teresa Chiarelli, Stefania Antoniazzi, Laura Cortesi, Luca Pasina, Alessio Novella, Francesca Venturini, Alessandro Nobili, Pier Mannuccio Mannucci, the ad hoc Deprescribing Study Group, Cinzia Hu, Francesca Minonzio, Anna Ludovica Fracanzani, Federica Iuculanno, Nicola Montano, Eleonora Tobaldini, Daniela Mari, Paolo Rossi, Valter Monzani, Francesca Tantardini, Flora Peyvandi, Raffaella Rossio

Older patients, the largest fraction of those acutely admitted to hospital medical wards, are often affected by multiple chronic diseases, that are in turn associated with the intake of multiple... more

Interdependence of VA-ECMO output, pulmonary congestion and outcome after cardiac surgery

28 July 2020
Author(s): Klaus Distelmaier, Dominik Wiedemann, Katharina Lampichler, Daniel Toth, Lukas Galli, Thomas Haberl, Barbara Steinlechner, Gottfried Heinz, Günther Laufer, Irene M. Lang, Georg Goliasch, Walter S. Speidl

Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is a life-saving method for patients with low-output failure after cardiac surgery. Although the use of VA-ECMO after cardiac surgery is... more

Sympathetic activation and outcomes in chronic heart failure: Does the neurohormonal hypothesis apply to mid-range and preserved ejection fraction patients?

25 July 2020
Author(s): Santiago Jimenez-Marrero, Pedro Moliner, Iris Rodríguez-Costoya, Cristina Enjuanes, Lidia Alcoberro, Sergi Yun, Jose Gonzalez-Costello, Alberto Garay, Marta Tajes, Esther Calero, Encarnación Hidalgo, Carmen Guerrero, Elena García-Romero, Carles Díez-López, Miguel Cainzos-Achirica, Josep Comin-Colet

body mass index

Low Creatinine Potentially Overestimates Glomerular Filtration Rate in Older Fracture Patients: A Plea for an Extensive Use of Cystatin C?

25 July 2020
Author(s): Iacopo Iacomelli, Antonella Giordano, Giulia Rivasi, Martina Rafanelli, Virginia Tortù, Alessandro Cartei, Carlo Rostagno, Mauro Di Bari, Niccolò Marchionni, Enrico Mossello, Andrea Ungar

The correct evaluation of renal function is crucial in clinical practice for diagnosis (e.g., imaging with contrast agents), treatment (e.g., drug dosing) and prognostic assessment (e.g., clinical... more

Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome

22 July 2020
Author(s): Marco Centola, Alessandro Maloberti, Diego Castini, Simone Persampieri, Ludovico Sabatelli, Giulia Ferrante, Stefano Lucreziotti, Nuccia Morici, Alice Sacco, Fabrizio Oliva, Paola Rebora, Cristina Giannattasio, Antonio Mafrici, Stefano Carugo

High levels of serum uric acid (SUA) have been showed to increase the risk of cardiac adverse events, independently of traditional cardiovascular risk factors [1,2]. Hyperuricemia has been also... more

The CHA2DS2-VASc score and Geriatric Multidimensional Assessment tools in elderly patients with persistent atrial fibrillation undergoing electrical cardioversion. A link with arrhythmia relapse?

22 July 2020
Author(s): Stefano Fumagalli, Giulia Pelagalli, Riccardo Franci Montorzi, Irene Marozzi, Marta Migliorini, Maria Flora D'Andria, Gregory Y.H. Lip, Niccolò Marchionni

The CHA2DS2-VASc is a clinical score used in everyday clinical practice to evaluate thrombo-embolic risk in patients with atrial fibrillation (AF) [1], and the guidelines for the management of AF... more

Safety and efficacy of anticoagulant monotherapy in atrial fibrillation and stable coronary artery disease: A systematic review and meta-analysis

22 July 2020
Author(s): Waqas Ullah, Yasar Sattar, Mishal Shaukat, David L. Fischman

Coronary artery disease (CAD) and atrial fibrillation (AF) have emerged as new cardiovascular epidemics in the modern era posing a high risk for acute coronary and cerebrovascular events,... more

Neurological diseases of unknown etiology: Brain-biopsy diagnostic yields and safety

10 July 2020
Author(s): Bertrand Mathon, Alexandre Le Joncour, Franck Bielle, Karima Mokhtari, Anne-Laure Boch, Matthieu Peyre, Zahir Amoura, Patrice Cacoub, Nadia Younan, Sophie Demeret, Eimad Shotar, Sonia Burrel, Arnaud Fekkar, Jérôme Robert, Aymeric Amelot, Marc Pineton de Chambrun, the PSL BRAIN-BIOPSY STUDY GROUP

The contribution of brain biopsy is well-established for patients with suspected neoplastic lesions, for which its diagnostic yield approaches 95% [1,2]. For nonneoplastic neurological diseases, no... more

Rifabutin-Based Triple Therapy Or Bismuth-Based Quadruple Regimen As Rescue Therapies For Helicobacter pylori Infection

6 July 2020
Author(s): Ilaria M. Saracino, Matteo Pavoni, Angelo Zullo, Giulia Fiorini, Laura Saccomanno, Tiziana Lazzarotto, Guido Antonelli, Rossana Cavallo, Claudio Borghi, Dino Vaira

H. pylori causes chronic gastritis and peptic ulceration, and concurs to gastric MALT lymphoma and carcinoma development [1]. Treatment of the infection remains a challenge for clinicians, as no... more

Systemic sclerosis is an independent risk factor for ischemic heart disease, especially in patients carrying certain antiphospholipid antibodies: A large cross-sectional study

30 June 2020
Author(s): Abdulla Watad, Dennis McGonagle, Nicola L. Bragazzi, Giovanni Damiani, Doron Comaneshter, Merav Lidar, Arnon D. Cohen, Howard Amital

Rheumatic diseases are characterized by chronic inflammation that affects the joints but also internal organs such as lungs, heart and other organs [1,2]. These disorders, if untreated, may lead to... more

Quality of care after AKI development in the hospital: Consensus from the 22nd Acute Disease Quality Initiative (ADQI) conference

30 June 2020
Author(s): Etienne Macedo, Azra Bihorac, Edward D. Siew, Paul M. Palevsky, John A. Kellum, Claudio Ronco, Ravindra L. Mehta, Mitchell H. Rosner, Michael Haase, Kianoush B. Kashani, Erin F. Barreto

The short- and long-term consequences of acute kidney injury (AKI) are well-recognized [1–3]. The number of AKI episodes, their severity, and duration are critical determinants of adverse outcomes,... more

Malignancy in patients with myocardial infarction and non-obstructive coronary arteries: A systematic review and meta-regression

24 June 2020
Author(s): Francesco Pelliccia, Vincenzo Pasceri, Gaetano Tanzilli, Giulio Speciale, Paolo G Camici, Carlo Gaudio

A growing number of investigations has recently called attention to patients with myocardial infarction (MI) and non-obstructive coronary arteries (MINOCA) [1], who constitute an intriguing subgroup... more

Sex-related differences in long-term mortality and heart failure in a contemporary cohort of patients with NSTEACS. The cardiochus-HSUJ registry

18 June 2020
Author(s): Belén Álvarez Álvarez, Charigan Abou Jokh Casas, Rosa Agra Bermejo, Alberto Cordero, Ana Belén Cid Álvarez, Moisés Rodriguez Mañero, Noelia Bouzas Cruz, José María García Acuña, Angel Salgado Barreiro, José R. González-Juanatey

Non-ST segment elevation acute coronary syndrome (NSTEACS) is the most frequent manifestation of acute coronary syndromes (ACS) [1, 2]. Acute heart failure (HF) remains a common complication of ACS,... more

Clinical profile and 1-year clinical outcomes of super elderly patients admitted with acute heart failure

15 June 2020
Author(s): Miguel Lorenzo, Rafael de la Espriella, Gema Miñana, Gonzalo Núñez, Enrique Santas, Eduardo Núñez, Raquel Heredia, Anna Mollar, Jose Civera, Amparo Villaescusa, Clara Sastre, Adriana Conesa, Clara Bonanad, Antoni Bayés-Genís, Julio Núñez

HFpEF, heart failure with preserved ejection fraction.

VAV3 rs7528153 and VAV3-AS1 rs1185222 polymorphisms are associated with an increased risk of developing hypertension

12 June 2020
Author(s): José Pablo Miramontes-González, Ricardo Usategui-Martín, Javier Martín-Vallejo, Michael Ziegler, Leopoldo López de Isla, Daniel O`Connor, Rogelio González-Sarmiento

Cardiovascular diseases are responsible for around 17 million deaths per year, accounting for nearly one-third of the total deaths in the world. The secondary effects of hypertension account for 9.4... more

Cluster analysis based clinical profiling of Idiopathic Pulmonary Fibrosis patients according to comorbidities evident prior to diagnosis: a single-center observational study

9 June 2020
Author(s): Keren Marks-Garber, Tali Bdolah-Abram, Samir Nusair

Idiopathic Pulmonary Fibrosis (IPF), a progressively destructive lung disease caused by unchecked fibroblast activity and uncontrolled formation of pulmonary scar tissue,[1] has a median survival... more

Comparison of bias and accuracy using cystatin C and creatinine in CKD-EPI equations for GFR estimation

8 June 2020
Author(s): Lu-Xi Zou, Ling Sun, Susanne B. Nicholas, Yan Lu, Satyesh Sinha K, Ruixue Hua

Glomerular filtrate rate (GFR) is the most useful index of kidney function. Reduction of GFR may indicate chronic kidney disease (CKD) or acute kidney injury (AKI) [1]. CKD is a growing global health... more

Anticoagulation resumption after intracranial hemorrhage in patients treated with VKA and DOACs

7 June 2020
Author(s): Daniela Poli, Emilia Antonucci, Elisa Vignini, Lucia Martinese, Sophie Testa, Paolo Simioni, Vittorio Pengo, Pasquale Pignatelli, Anna Falanga, Lucilla Masciocco, Doris Barcellona, Antonio Ciampa, Paolo Chiarugi, Carmelo Paparo, Walter Ageno, Gualtiero Palareti, START2 Registry investigators

Intracranial hemorrhage (ICH) is associated with high mortality and severe functional outcome [1]. ICH is frequently associated to antithrombotic treatment and carries a substantial risk of... more

Kidney dysfunction and short term all-cause mortality after transcatheter aortic valve implantation

30 May 2020
Author(s): Fabio Alfredo Sgura, Salvatore Arrotti, Paolo Magnavacchi, Daniel Monopoli, Davide Gabbieri, Federico Banchelli, Stefano Tondi, Andrea Denegri, Roberto D'Amico, Vincenzo Guiducci, Luigi Vignali, Giuseppe Boriani

Transcatheter aortic valve implantation (TAVI) has been proven to be the preferred procedure for patients with symptomatic aortic stenosis (AS) who do not qualify for surgery [1-2]. TAVI has been... more

The effect of Mid-Day Sleep on blood pressure levels in patients with arterial hypertension

29 May 2020
Author(s): Manolis S Kallistratos, Leonidas E Poulimenos, Pavlos Tsinivizov, Dimitris Varvarousis, Nikolaos Kouremenos, Andreas Pittaras, Andreas S Triantafyllis, Athanasios J Manolis

Life style changes represent the cornerstone of treatment in patients with arterial hypertension since not only they decrease blood pressure (BP) levels, but also reduce cardiovascular (CV) risk [1... more

Safety and Tolerability of Neurohormonal Antagonism in Cardiac Amyloidosis

28 May 2020
Author(s): Alberto Aimo, Giuseppe Vergaro, Vincenzo Castiglione, Claudio Rapezzi, Michele Emdin

Amyloidosis is a systemic disease characterized by extracellular deposition of insoluble fibrils, deriving from proteins encoded by mutated genes or normal, misfolded proteins [1,2]. Previously... more

Prevalence and risk factors for pulmonary embolism in patients with suspected acute exacerbation of COPD: a multi-center study.

28 May 2020
Author(s): Francesco Dentali, Fulvio Pomero, Pierpaolo Di Micco, Micaela La Regina, Federica Landini, Nicola Mumoli, Filippo Pieralli, Matteo Giorgi-Pierfranceschi, Roberta Re, Josè Vitale, Leonardo M Fabbri, Andrea Fontanella, Dimitriy Arioli, for the Young-FADOI Study Group

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide [1]. Acute exacerbation of COPD is a frequent cause of admission to an emergency department and of... more

Use of intravenous iron in patients with iron deficiency and chronic heart failure: Real-world evidence

19 May 2020
Author(s): José Gonzalez-Costello, Miguel Cainzos-Achirica, Josep Lupón, Nuria Farré, Pedro Moliner-Borja, Cristina Enjuanes, Marta de Antonio, Lara Fuentes, Carles Díez-López, Antoni Bayés-Genis, Nicolás Manito, Ramón Pujol, Josep Comin-Colet

Iron deficiency (ID) affects up to 50% of patients with chronic heart failure (HF). ID in patients with HF has been shown to be an independent adverse prognostic factor [1,2], it is associated with... more

Higher odds and rising trends in arrhythmia among young cannabis users with comorbid depression

14 May 2020
Author(s): Rupak Desai, Samarthkumar Thakkar, Harsh P Patel, Bryan E-Xin Tan, Nanush Damarlapally, Fariah Asha Haque, Nazia Farheen, Natalie DeWitt, Sejal Savani, Fahria Jessy Parisha, Rajkumar Doshi, Zeeshan Mansuri, Kishorbhai Gangani

The high prevalence of substance abuse especially cannabis among adolescents is one of the major health care challenges of the 21st century. The permissive nature of laws regarding cannabis use has... more


Multiparametric assessment of “fluid status” in heart failure

15 November 2017
Author(s): Giuseppe Romano, Diego Bellavia, Francesco Clemenza

The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.ejim.2017.09.016. The duplicate article has therefore... more

Review Article

Transthyretin amyloid cardiomyopathy: An uncharted territory awaiting discovery

5 October 2020
Author(s): Aldostefano Porcari, Marco Merlo, Claudio Rapezzi, Gianfranco Sinagra

Amyloidosis represents a largely unexplored field in medicine, with many grey areas remaining. The search for the mechanism triggering protein misfolding has been an important research topic for many... more

Management of chronic refractory cough in adults

19 September 2020
Author(s): Dina Visca, Bianca Beghè, Leonardo Michele Fabbri, Alberto Papi, Antonio Spanevello

Cough is a physiological response to mechanical and chemical stimuli due to irritation of cough receptors located mainly in the epithelium of the upper and lower respiratory tracts, pericardium,... more

Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.

17 September 2020
Author(s): Loris Roncon, Marco Zuin, Stefano Barco, Luca Valerio, Giovanni Zuliani, Pietro Zonzin, Stavros V Konstantinides

The outbreak of coronavirus disease 2019 (COVID-19) remains a severe public health emergency of international concern. Over the past months, several investigations have suggested an association... more

Point of care ultrasound for rapid assessment and treatment of palliative care patients in acute medical settings

14 August 2020
Author(s): Neal Breakey, Joseph Osterwalder, Gebhard Mathis, Beat Lehmann, Thomas C Sauter

The combination of an ageing population with improving survival in malignant and non-malignant disease processes results in a growing cohort of the population who live with advanced or end-stage... 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 EFIM?

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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