April 2022
34 ArticlesBeyond the Guidelines
Critical appraisal of international adult bronchiectasis guidelines using the AGREE II tool
Bronchiectasis is a chronic respiratory disease, characterized clinically by a persistent cough, excessive sputum production, bronchial infection, and abnormal and permanent dilatation of the bronchi... more
Clinical Insights
Psoriasis and risk of myocardial infarction: Uncertain link, costly implications
Psoriasis is a chronic, immune-mediated inflammatory disease of the skin affecting about two percent of the population with relatively similar burden among men and women throughout all age groups [1... more
Commentary
High sensitivity troponins: From the acute setting to the general population
Troponins are proteins essential for the contraction of the myocardium and currently cardiac troponin I and cardiac troponin T are used as blood biomarkers to assess myocardial injury1,2.
A non-invasive score for nonalcoholic fatty liver disease (NAFLD) cirrhosis
Currently the global prevalence of non-alcoholic fatty liver disease (NAFLD) is estimated to be around 25% for the general adult population [1], with estimates over 50% in populations with type 2... more
Internists or specialists-that is the question!
Over the past few decades the rising burden of chronic disorders and multimorbidity has heavily challenged health systems worldwide. In general terms, the architecture of a healthcare service should... more
Prediction tools in clinical practice: Carefully read instructions before use
Decisions in clinical practice, especially in the acute setting where identification of potentially unstable patients is critical, are hard to be made. They rely, or should rely, on the clinical... more
Surprising outcomes of general internal medicine care versus specialty care in acutely admitted medical patients
Biomedical knowledge, resulting in better treatment for patients, is accumulating at a breathtaking pace. As these developments occur, in some situations medicine gets increasingly complex, requiring... more
Corrigendum
Corrigendum to ‘Adiponectin involved in portal flow hepatic extraction of 13C-methacetin in obesity and non-alcoholic fatty liver.’ [European Journal of Internal Medicine 89C (2021) 56–64]
The authors regret that a mistake was made in the spelling of one of the co-author's name. The third author's name is: Harshitha Shanmugam
Editorial
Medicine before and after David Cox
Herein we recount the legacy of Sir David Roxbee Cox (15 July 1924 – 18 January 2022) from the perspective of practicing clinicians. His-pioneering work in developing the logistic and Cox... more
Internal Medicine Flashcard
A pretibial skin lesion in a patient with type 1 diabetes mellitus
A 17-years-old woman with type 1 diabetes mellitus known since the age of 9 was admitted in the high-dependency unit for diabetic ketoacidosis. She had a history of poor glycemic control and many... more
Palpitations in a middle-aged male… Searching a needle in a haystack
A gentleman in his 50s presented with episodes of intermittent palpitations which were self-limiting. His symptoms were not related to exertion and had short duration with sudden onset and offset. He... more
A diagnosis at hand
A 45-year-old man was found unconscious on the sidewalk and brought to the Emergency Department. He could not provide anamnestic information, but the hospital electronic archive revealed he was... more
Letter to the Editor
Intravenous insulin-dextrose repetition for hyperkalemia: How can we avoid subsequent hypoglycemia?
According to Humphrey and colleagues, one-third of patients with intravenous insulin-dextrose (IDex) for hyperkalemia needed repeated treatments with IDex [1]. Besides, approximately 20% of patients... more
Primary Raynaud's phenomenon, very early and early scleroderma tips for a timely diagnosis
Dear Editor,
Usefulness of non-invasive methods for the monitoring of oxygenation parameters in patients with COVID-19 associated acute respiratory distress syndrome (ARDS)
We have read with great interest the article recently published by Zaccagnini et al. [1], entitled "Correlation of non-invasive oxygenation parameters with PaO2/FiO2 ratio in patients with COVID-19... more
Atrial high rate episodes as a marker of atrial cardiomyopathy: In the quest of the Holy Grail. Author's reply
We appreciate Doundoulakis and colleagues for the interest in our article [1,2]. We take advantage of the opportunity to reply focusing on some aspects that we believe are clinically important. In... more
“Which one should I choose, a glucagon-like peptide-1 receptor agonist or a sodium−glucose cotransporter 2 inhibitor? Or maybe both?”
In a recently published narrative review article authored by Gomez-Huelgas and colleagues, authors propose an interesting treatment algorithm, based on the cardiovascular and renal protection offered... more
Admissions in a medical ward and factors independently associated with mortality
Admission to a medical ward is commonly used for the management of conditions that are not amenable to outpatient management, either due to the need for specialized care or for practical reasons,... more
Glucocorticoid sparing in sarcoidosis using the Janus kinase (JAK) inhibitor tofacitinib
There is an unmet medical need to provide novel treatments with high efficiency and low side effects in patients with sarcoidosis resistant to glucocorticoids or second-line therapies (methotrexate,... more
Prediction of ischemic stroke in different populations: a comparison of absolute stroke risk and CHA2DS2-VASc in real-world and clinical trial patients
The CHA2DS2-VASc score is one of the most validated risk tools in atrial fibrillation (AF) [1], and remains a simple and practical clinical score to aid decision-making. However, it has limitations... more
Willingness to participate in a lung cancer screening program: Patients’ attitudes towards United States Preventive Services Taskforce (USPSTF) recommendations
Like many other cancers, the prognosis of lung cancer largely depends on the stage of cancer at the time of diagnosis and early detection could significantly improve cancer-related morbidity and... more
The impact of nutrition on cancer prevention in Europe: From the bench to the Parliament
Dear Editor,
Clinical significance of Staphylococcus aureus bacteriuria
Dear editor
Original Article
Reduced COVID-19 mortality linked with early antibodies against SARS-CoV-2, irrespective of age
COVID-19 pandemic has generated, to date, over 4.6 million deaths worldwide [1]. The high infection rate, however, is counterbalanced by variable clinical outcomes at the individual level. SARS-CoV-2... more
Truly unexplained falls after evaluation for syncope: A new diagnostic entity with severe prognosis
Syncope and falls are a common concern in older adults with dementia [1,2]. In Literature, great importance has been established in the recognition of causes of falling in older patients, in... more
Mortality and its risk factors in critically ill patients with connective tissue diseases: A meta-analysis
Connective tissue diseases (CTD) encompass entities such as systemic lupus erythematosus (SLE), primary Sjögren's syndrome (pSS), systemic sclerosis (SSc), idiopathic inflammatory myopathies (IIM),... more
Pulmonary embolism severity and in-hospital mortality: An international comparative study between COVID-19 and non-COVID patients
Infection by SARS-Cov-2 is mainly characterized by fever and respiratory symptoms, with dyspnea and lung infiltrates in more severe cases[1,2]. Many patients also present a procoagulant state, which... more
Obesity survival paradox in patients hospitalized with community-acquired pneumonia. Assessing sex-differences in a population-based cohort study
Community acquired pneumonia (CAP) is one of the most common infectious diseases and contributes significantly to morbidity, mortality and costs [1]. In fact, it has been ranked as the third leading... more
Derivation and validation of the nonalcoholic fatty liver disease cirrhosis score (NCS) to distinguish bridging fibrosis from cirrhosis
Non-alcoholic fatty liver disease (NAFLD) has become a major health burden [1]. Among the large group of patients that are affected, the subgroup progressing to end-stage disease exhibits the highest... more
High-sensitivity troponins for outcome prediction in the general population: a systematic review and meta-analysis
High-sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs-cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably... more
Generalist vs specialist acute medical admissions - What is the impact of moving towards acute medical subspecialty admissions on efficacy of care provision?
In an era of increasing hospital admissions and a growing older population with multiple co-morbidities [1], the discussion surrounding generalist versus specialist medical acute admissions continues... more
Review Article
The identity of the internist: A U.S. perspective
The etymology of Internal Medicine dates to an important development in the approach to patient care arising in 19th Century Germany and reflected by the term, Innere Medezin. This marked the... more
A systematic review of the discrimination and absolute mortality predicted by the National Early Warning Scores according to different cut-off values and prediction windows
Early warning scores (EWS) were originally proposed by Morgan et al. to help identify patients who need immediate life-saving interventions, but not to predict their outcomes [1]. Ironically outcome... more
Sepsis-driven atrial fibrillation and ischaemic stroke. Is there enough evidence to recommend anticoagulation?
Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice and is associated with significant morbidity and mortality [1]. Currently, it is estimated that between 2 and... more