April 2026
41 ArticlesNo Section
Re-examining fluid volume variability: Why the critique misreads our data and methods
We thank Tang et al [1] for their inerest in our report on long-term fluid volume fluctuations and mortality in patients with kidney failure (KF) on hemodialysis (HD) [2]. Some of their concerns,... more
Detection of left ventricular hypertrophy through ECG: diagnostic performance and comparison of ten ECG scores in different hypertrophic conditions
Different electrocardiographic (ECG) criteria were proposed to improve ECG-based detection of left ventricular hypertrophy (LVH), but external validation data are limited and their diagnostic... more
Multiperspective ultrasonography in COPD exacerbations: Insights into inspiratory muscle recruitment and clinical outcomes
We have read with considerable interest the recent investigation by Tabbì and colleagues elucidating inspiratory muscle activity through ultrasonographic assessment in patients with chronic... more
Oral anticoagulant nonprescription at discharge in geriatric patients with atrial fibrillation and reduced expected survival
Oral anticoagulant therapy (OAC), with direct oral anticoagulants (DOACs) recommended over vitamin K antagonists (VKAs), is considered the standard of care for patients with atrial fibrillation (AF)... more
Commentary
From attribution to precision-care action: risk stratification in patients with patent foramen ovale and embolic stroke of undetermined source
Embolic strokes of undetermined source (ESUS) account for approximately 25% of all ischemic strokes, representing a substantial challenge in clinical practice [1]. The presence of patent foramen... more
Predicting left ventricular hypertrophy from ECG: the never-ending search for the optimal diagnostic criteria
Left ventricular hypertrophy (LVH) is a condition characterized by the increase in left ventricular mass due to an increase in wall thickness [1]. LVH is not per se a disease, since it may represent... more
Should we really target a higher blood pressure in the presence of left ventricular hypertrophy?
In the current issue of the European Journal of Internal Medicine, Kjeldsen et al. present a descriptive review that concludes that caution is needed in reducing systolic blood pressure (BP) below... more
Oral anticoagulation nonprescription in elderly patients with atrial fibrillation and associated complex comorbidity and severe frailty – Harmful or overall futile?
Atrial fibrillation (AF) and atrial flutter (AFL) are increasingly prevalent cardiac arrhythmias that contribute to high mortality and morbidity, especially in the elderly population. Oral... more
Editorial
Delimiting medicine
Medicine has expanded vastly. More people are diagnosed and treated for more diseases than ever, and there are more professionals working in the health services. More resources are allocated for the... more
Internal Medicine Flashcard
De Winter‐like electrocardiogram changes in the inferior leads
A 48-year-old man with an unremarkable medical history presented with two hours of persistent chest tightness and heartburn. His electrocardiogram (ECG) on arrival showed 1‑ to 3‑mm upsloping ST‑... more
Double halo sign, abdominal pain and purpura
A 66-year-old man was admitted to the internal medicine department with subacute abdominal pain and diarrhoea, resulting in a weight loss of 10 kg over three weeks. Shortly thereafter, he developed... more
Letter to the Editor
Multiperspective ultrasonography in COPD exacerbations: insights into inspiratory muscle recruitment and clinical outcomes. Author’s reply
We sincerely thank Long and Shen [1] for their insightful letter and for the thoughtful interpretation of our work [2].
Infections as a dynamic trigger for venous thromboembolism: toward clinically actionable risk stratification. Author's reply
Dear Editor,
Environmental PM10 exposure and MASLD: Challenges in translating gene–environment interactions into routine clinical care. Author's reply
We sincerely thank Zhuang M et al [1]. for appreciating our work [2] and for giving us the possibility to better discuss relevant points about possible interactions between genotyping, environmental... more
Fractional exhaled nitric oxide in acute exacerbations of chronic obstructive pulmonary disease: From pooled means to prediction-informed clinical interpretation
We thank Mou and Pan for their interesting and constructive correspondence [1] regarding our meta-analysis on fractional exhaled nitric oxide (FeNO) in acute exacerbations of chronic obstructive... more
Recombinant hf-SCIg in inflammatory myositis: refining patient selection and outcome assessment. Author’s reply
We thank Tan [1] for his constructive comments on our multicentre real-world study evaluating recombinant human hyaluronidase-facilitated subcutaneous immunoglobulin (hf-SCIg) in idiopathic... more
Timing and absolute benefit in updated colchicine meta-analysis for coronary artery disease. Author's reply
Dear Editor
Fractional exhaled nitric oxide in acute exacerbations of chronic obstructive pulmonary disease: Beyond pooled means to individual precision
We read with great interest the meta-analysis by Ambrosino and colleagues evaluating fractional exhaled nitric oxide (FeNO) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) [1... more
Environmental PM10 exposure and MASLD: Challenges in translating gene–environment interactions into routine clinical care
We read with great interest the article by Di Ciaula et al. exploring the association between long-term PM10 exposure and metabolic dysfunction-associated steatotic liver disease (MASLD) in... more
Timing and absolute benefit in updated colchicine meta-analysis for coronary artery disease
We read with interest the updated systematic review and meta-analysis by Boracchi and colleagues evaluating long-term secondary prevention with low-dose colchicine in patients with coronary artery... more
Infections as a dynamic trigger for venous thromboembolism: toward clinically actionable risk stratification
Dear Editor,
Reconsidering the prognostic significance of fluid volume fluctuations in kidney failure
We read with great interest the recent study by Zoccali and colleagues regarding the association between long term fluid volume fluctuations and mortality in patients with kidney failure [1]. The... more
Recombinant hf-SCIg in inflammatory myositis: refining patient selection and outcome assessment
We read with great interest the article by Palermo et al. reporting a multicentre real-world experience with recombinant human hyaluronidase-facilitated subcutaneous immunoglobulin (hf-SCIg) for... more
Stratifying AF ablation recurrence risk: Limitations of BMI and optimized assessment strategies
We read with great interest the article by Liao et al. titled “Both underweight and obese patients are prone to relapse after ablation of paroxysmal atrial fibrillation” published in the European... more
Enhancing the clinical relevance of BMI in atrial fibrillation ablation: A call for integrating body-composition and peri-left-atrial adipose tissue measures
Liao et al. report a multicentre analysis showing a U-shaped association between pre-ablation BMI and post-ablation atrial tachyarrhythmia recurrence in paroxysmal AF [1]. The work is timely and... more
Clinical implications of the U-shaped association between body mass index and atrial tachyarrhythmia recurrence after paroxysmal atrial fibrillation ablation
We read with great interest the article by Liao et al., which reported that both underweight and obese patients are at increased risk of atrial tachyarrhythmia (ATa) recurrence after catheter... more
Body weight extremes and recurrence risk after ablation of paroxysmal atrial fibrillation
We read with great interest the recent article by Liao et al., entitled “Both underweight and obese patients are prone to relapse after ablation of paroxysmal atrial fibrillation” [1]. The authors... more
Considerations on socioeconomic and hormonal factors in sex- and gender-specific risk of metabolic syndrome
We read with great interest the article by Alipour et al. entitled “Role of sex and gender-related variables in development of metabolic syndrome” published in the European Journal of Internal... more
Anifrolumab for refractory dermatomyositis: Experience from a Spanish cohort
Dermatomyositis (DM) frequently remains active despite glucocorticoids and conventional immunosuppressants. A type I interferon (IFN-I) gene-expression signature across skin, muscle, and blood... more
Original Article
Impact of chronic kidney disease on treatment implementation and prognosis of patients with heart failure: A large retrospective observational analysis from the Italian Network-Heart Failure (IN-HF) registry
In contemporary cohorts of stable heart failure (HF) outpatients, the prevalence of renal dysfunction varies upon definition, but may approach 70% [1]. Hemodynamic and metabolic alterations resulting... more
Optimizing patient selection for patent foramen ovale closure after stroke: The CRISP-PFO score
Although patent foramen ovale (PFO) transcatheter closure lowers recurrent cryptogenic stroke (CS), identifying patients who benefit most remains challenging. We developed, validated and assessed the... more
Adrenal insufficiency following systemic glucocorticoid therapy: a systematic review and meta-analysis
Adrenal insufficiency (AI) is a common complication following glucocorticoid (GC) therapy. However, reliable predictors of AI and GC regimens that mitigate this risk remain unclear. Previous... more
Pre- and in-hospital lactate ratio as a predictor of mortality in severe diabetic ketoacidosis: a multicenter prospective cohort study
Lactate kinetics between prehospital and in-hospital measurements have been associated with prognosis in acute conditions. This study aimed to evaluate the prognostic value of the prehospital-to-... more
Inflammatory spectrum of frailty: Association between the systemic immune-inflammation index and frailty in liver transplant candidates
Frailty is common among patients with advanced chronic liver disease (AdvCLD), progressively impairing physical fitness as the disease worsens [1]. It is characterized by reduced physiological and... more
Growth differentiation factor-15 in patients presenting with acute chest pain: Diagnostic and prognostic utility
Each year, over 15 million patients present to the emergency department (ED) in North America and Europe with suspected acute myocardial infarction (AMI) [1,2]. Clinical practice guidelines highlight... more
Residual respiratory events and daytime sleepiness despite management of obstructive sleep apnoea with and without additional central apnoeas. A three-month follow-up study
Despite treatment, individuals with obstructive sleep apnoea (OSA) may still exhibit high apnoea and hypopnoea indices (AHI) and excessive daytime sleepiness (EDS). We recorded residual respiratory... more
Practice Guidelines
Expert consensus for the diagnosis and treatment of patients with hyperuricemia and high cardiovascular risk: 2025 update
Hyperuricemia has traditionally been viewed primarily as a cause of gout; however, accumulating evidence indicates that elevated serum uric acid (sUA) is also associated with increased cardiovascular... more
Review Article
Target systolic blood pressure in patients with left ventricular hypertrophy
Left ventricular hypertrophy (LVH) is the most common hypertension-related cardiac disorder. Indeed, it is present in about 50% of patients with hypertension when examined by echocardiography and up... more
Renal protection in heart failure with reduced ejection fraction: not all that glitters is gold
Chronic kidney disease (CKD) is prevalent among patients with chronic heart failure (CHF), largely due to shared risk factors such as hypertension, diabetes, and dyslipidemia. In patients with heart... more
Medical cannabis and the hype cycle: Clinical evidence and future directions
Medical cannabis has moved from a taboo subject to a mainstream clinical discussion over the past three decades. This review synthesizes the evidence and frames its progression using a Hype Cycle... more
The neuro-cardiac axis in epilepsy
Epilepsy is one of the major noncommunicable neurological disorders (the other comprising migraine, Alzheimer disease/other dementias, Parkinson’s disease, motor neuron diseases, multiple sclerosis,... more