August 2026
85 ArticlesBeyond the Guidelines
Imaging-guided dyslipidemia management: Bridging evidence and implementation
Arterial imaging has emerged as an increasingly important component of contemporary cardiovascular prevention strategies, enabling direct assessment of subclinical atherosclerosis and refining... more
Clinical Insights
Emerging evidence from combination therapy reinforces the role of β-blockers in resistant hypertension
Resistant hypertension (RHTN) represents a growing clinical challenge, affecting an estimated 10–15% of patients with treated hypertension [1–3]. Its prevalence might increase in the coming years,... more
Commentary
Aldosterone synthase inhibitors in uncontrolled and resistant hypertension: promise, pitfalls, and unanswered questions
Arterial hypertension remains the leading contributor to global morbidity and mortality, yet only a minority of patients achieve adequate blood pressure (BP) control [1]. This persistent gap is... more
Cocaine-induced ANCA-associated vasculitis: A diagnostic challenge at the interface of toxic exposure and autoimmunity
In the current issue of the European Journal of Internal Medicine, Garvín-Grande et al. present a cohort analysis combined with a structured literature review delineating the clinical and... more
Hydroxychloroquine for recurrent pericarditis: Old drug, new role
Recurrent pericarditis (RP) has posed a therapeutic challenge, with treatments consisting of nonsteroidal anti-inflammatory drugs, corticosteroids, drug-modifying antirheumatic drugs (DMARDs) and in... more
Beyond categorical exclusion: Reclaiming clinical judgment in the use of JAK inhibitors for rheumatoid arthritis
The therapeutic landscape for rheumatoid arthritis (RA) has undergone a profound transformation over the last decade, marked by the emergence of Janus kinase inhibitors (JAKi) as highly effective... more
Alcohol use: less is better. Shifting the clinical paradigm from 'safe thresholds' to risk reduction
When it comes to alcohol consumption, patients and healthcare providers want to know what amount is considered safe. But given that alcohol is recognized as a Group 1 carcinogen [1], this begs the... more
Pulmonary embolism and long-term survival: the role of comorbidities beyond the acute event
Pulmonary embolism (PE) is traditionally considered an acute cardiovascular emergency, with management strategies primarily aimed at reducing early mortality and secondarily at preventing recurrence... more
Social determinants of health in the era of precision medicine
“Man is by nature a social creature” Aristoteles used to say.
Corrigendum
Corrigendum to “Role of 12-lead Electrocardiogram for identifying very low mortality risk patients with non-hypotensive acute pulmonary embolism” [European Journal of Internal Medicine 140 (2025) 106373]
The authors regret that there is an error in the last row of Table 1, where the wrong information says:
Editorial
The meta-analysis deluge: When synthesis becomes pollution
Systematic reviews and meta-analyses have long been heralded as the apex of evidence-based medicine [1]. Positioned at the pinnacle of evidence hierarchies; these methodologies promise to synthesize... more
Ideas and Opinions
Should Ticagrelor in association with aspirin be still considered the standard dual antiplatelet treatment for acute coronary syndromes?
Ticagrelor, a potent inhibitor of P2Y12 platelet receptor, co-administered with aspirin in dual antiplatelet therapy (DAPT), received marketing authorization from the European Medicines Agency in... more
Internal Medicine Flashcard
Papulonodular rash and destructive palatal lesion with systemic symptoms
None.
Scurvy in a hemodialysis patient after prolonged hospitalization
A 64-year-old woman with a 38-year history of hemodialysis presented with general weakness. Until 3 days before presentation, she had been hospitalized for one month due to bullous pemphigoid... more
The central dot sign in liver
A 24-year-old man presented with a 2-year history of recurrent epistaxis and fatigue. Laboratory workup revealed persistent pancytopenia (white blood cell count 2.23 × 10⁹/L, platelet count 54 × 10⁹/... more
Multiple hepatic lesions and vascular lakes
An 86-year-old man with a history of polyarteritis nodosa on long-term corticosteroid therapy and prior splenic rupture requiring surgery presented with asthenia, low-grade fever, and jaundice. A CT... more
An unusual case of skin ulcer
A 29-year-old Italian woman presented at the emergency department with a 65-day history of cutaneous lesion on her left forearm, started while she was on a stay in Bolivia. Initially, the lesion was... more
Encephalitis with the temporal lobe signature
A 16-year-old boy presented with a fever and decreased responsiveness for one day. There was no history of focal neurological deficits or seizures. On examination, he was hemodynamically stable but... more
Painful leg nodules, fever, and ankle arthralgia in a middle-aged woman
A previously healthy 56-year-old woman presented with a 2-week history of painful erythematous-to-violaceous firm subcutaneous nodules involving the anterior and posterior aspects of both legs, with... more
Internal Medicine Flashcards
A hidden cause of sudden epigastric pain in a middle-aged man
A 45-year-old man with a history of smoking and dyslipidemia presented with a 3-day history of sudden-onset epigastric pain that occurred while walking. The pain had largely subsided by the time of... more
Invited Review Article
From unmet needs to new possibilities: PPAR-targeted therapies in the journey of people living with Primary Biliary Cholangitis
Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease characterized by progressive destruction of the small intrahepatic bile ducts. If is left untreated, the resulting... more
Erectile dysfunction and antihypertensive therapy: A critical reappraisal
Erectile dysfunction often coexists with arterial hypertension. They both share a common vascular pathophysiology, while antihypertensive treatment may also affect sexual function. Although some of... more
Letter to the Editor
Epicardial adipose tissue between biological complexity and clinical readiness
Epicardial adipose tissue (EAT) is gaining visibility as an imaging biomarker, yet its clinical maturity remains limited. The recent exchange between Angeli et al. and Momot et al. highlights... more
Baseline asymptomatic bacteriuria in high-risk hematological patients: Does low concordance adequately reflect its true invasive potential? Author's reply
We have carefully read the letter submitted by Zhikai Zhang [1].
Evidence of increased awareness in cardiac amyloidosis, but still room for improvement.
Dear Editor,
Refining checklist-based screening for transthyretin cardiac amyloidosis: methodological and pathophysiological considerations. Author's reply
We are grateful for the considerations made by Li Nie et al. [1] regarding the CHECKAMIC study [2] and would like to make the following clarifications.
Heart failure and COPD - guideline adherence, diagnostic characterisation and treatment quality
We thank Steffen et al. for their interest in our study on guideline-directed medical therapy (GDMT) in patients with heart failure (HF) during hospitalised exacerbations (ECOPD) [1,2] We acknowledge... more
Clinically isolated joint involvement is a distinct entity in Whipple’s disease
We thank Chen et al. for their insightful comments [1] on our cohort study [2]. Previous classifications of Whipple’s disease (WD) have largely been microbiology-driven [3]. Our objective was to... more
Interpreting observational comparisons of DOACs and VKAs in kidney transplant recipients. Author’s reply
We thank Liu et al. [1] for their thoughtful comments regarding the methodological aspects of our study [2].
Systemic inflammation and frailty in cirrhosis: Considerations regarding the role of the systemic immune-inflammation index. Author’s reply
We appreciate the thoughtful comments by Güven İE [1] regarding our study evaluating the association between the systemic immune-inflammation index (SII) and frailty in patients with advanced chronic... more
Clinical interpretation and limitations of the prehospital-to-inhospital lactate ratio in severe hyperglycemic emergencies
Dear Editor,
Cardiac amyloidosis trends: Methodological limitations in estimating incidence and mortality from inpatient data alone
Dear Editor,
Beyond the absolute value: A critical appraisal of the prognostic everest of lactate ratio in diabetic ketoacidosis
We read with great interest the recent study by Sebastian-Valles F et al. published in the European Journal of Internal Medicine, titled " Pre- and in-hospital lactate ratio as a predictor of... more
Heart failure and COPD – Disentangling undertreatment from the impact of severe comorbidities
We read with great interest the study by Vauterin et al. investigating the association between guideline-directed medical therapy (GDMT) and mortality in patients with heart failure (HF) hospitalized... more
Redefining “isolated” Whipple’s disease: bridging the gap between clinical phenotype and pathophysiological reality
We read with great interest the article by Eiferman et al., entitled “Isolated joint involvement in Whipple’s disease: a cohort study”, recently published in the European Journal of Internal Medicine... more
The paradox of increasing cardiac amyloidosis hospitalizations and persistent diagnostic delays
The recent population-based study by Ojeda-Fernández et al [1], provides a valuable and timely perspective on the evolving epidemiology of cardiac amyloidosis (CA). Leveraging two decades of... more
Advancing precision, accountability, and implementation in antithrombotic stewardship
We read with great interest the perspective by Ageno et al. addressing the urgent need for antithrombotic stewardship (ATS) within contemporary healthcare systems [1]. The synthesis of global data... more
Systemic inflammation and frailty in cirrhosis: Considerations regarding the role of the systemic immune-inflammation index
I read with great interest the study by Sogbe et al. entitled “Inflammatory spectrum of frailty: Association between the systemic immune-inflammation index and frailty in liver transplant candidates... more
Baseline asymptomatic bacteriuria in high-risk hematological patients: Does low concordance adequately reflect its true invasive potential?
We read with great interest the article by Tolosa-Ridao et al. published in the European Journal of Internal Medicine [1]. This study examined the prevalence of baseline asymptomatic bacteriuria... more
Interpreting observational comparisons of DOACs and VKAs in kidney transplant recipients
Dear Editor,
The Oral PCSK9 inhibitor enlicitide for hypercholesterolemia
Heterozygous familial hypercholesterolemia (HeFH) and other forms of severe hypercholesterolemia are characterized by lifelong elevation of low-density lipoprotein cholesterol (LDL-C), resulting in... more
Resting Heart Rate: a risk marker or factor for outcomes?
Resting heart rate (HR) remains one of the most routinely recorded yet paradoxically underappreciated cardiovascular parameters in clinical practice. Easily obtainable and highly reproducible, it... more
Training for prevention: exercise prescription as an Olympic discipline in the era of GLP-1 receptor agonists
Dear Editor,
Optimizing tezepelumab use in severe asthma: future research directions
Dear Editor,
Causal inference and the risk of osmotic demyelination: A methodological critique of population-based hyponatremia research
We read with great interest this population-based study derived from the Stockholm sodium cohort [1], which examined the association between early sodium correction rates in severe hyponatraemia and... more
Personalizing PFO closure decisions: The emerging role of the CRISP-PFO score
We read with great interest the recent article by Rigatelli et al. in the European Journal of Internal Medicine, describing the development and validation of the CRISP-PFO score for optimizing... more
Small airway dysfunction and glucocorticoid (OCS) reduction in severe asthma: Clinical insights from real-world tezepelumab use
Dear Editor
Prehospital-to-hospital lactate ratio in severe hyperglycemic emergencies: how far can one cutoff travel?
Sebastian-Valles et al. reported that a prehospital-to-hospital lactate ratio <1.23 identifies a subgroup of patients with severe hyperglycemic emergencies at markedly higher risk of in-hospital... more
Transparency regarding publication charges in leading medical journals
The code of conduct for research transparency guides authors to preregister protocols, adhere to reporting guidelines, and fully disclose funding sources and conflicts [1]. Although article... more
Reconsidering “normal” in medicine
“There are no norms. All people are exceptions to a rule that does not exist.”-Fernando Pessoa-
sTREM2 as an early MASH biomarker: a commentary on generalizability and mechanistic interpretation
We read with great interest the study by Mahmoudian et al. investigating soluble TREM2 (sTREM2) as a non-invasive biomarker for early metabolic dysfunction-associated steatohepatitis (MASH) [1]. The... more
Long-term doctor–patient communication: a patient‑reported perspective from a large Italian survey
Recent reports on long COVID and disability [1,2] have shown the value of large, patient‑reported web surveys in capturing dimensions of illness that are poorly described in traditional clinical... more
Rethinking scoring strategies for patient selection in PFO-related stroke
We read with great interest the article regarding the CRISP-PFO score for optimizing patient selection for patent foramen ovale closure [1]. While refining risk stratification in patients with a Risk... more
Sotatercept for pulmonary arterial hypertension
Pulmonary arterial hypertension (PAH) is a progressive, fatal disease driven by proliferative vascular remodeling. While current therapies targeting the endothelin, nitric oxide, and prostacyclin... more
Ostreopsis-related illness: An emerging and underrecognized clinical syndrome
Since the early 2000s, clusters of acute irritative and flu-like syndromes temporally associated with coastal exposure have been documented along Mediterranean shores, including Italy, France and... more
Reassessing SGLT2 Trials in HFpEF: When robustness and fragility coexist
Zuin and colleagues are to be commended for their rigorous reappraisal of sodium–glucose co-transporter 2 inhibitor (SGLT2i) trials in heart failure with preserved and mildly reduced ejection... more
Prevalence of aortic stenosis in patients with amyloidosis in northern Sweden
Amyloidosis and aortic stenosis seem to frequently occur together [1]. This has mainly been found in patients suffering from wild-type transthyretin amyloidosis (ATTRwt) [2]. It is still unclear... more
Access and Reimbursement Barriers to Guideline-Directed Cardiometabolic Therapy
Cardiometabolic medicine is entering an era in which the most effective therapies are also among the least accessible. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium–glucose... more
Refining checklist-based screening for transthyretin cardiac amyloidosis: Methodological and pathophysiological considerations
We read with great interest the study by Pérez-Nieva and colleagues regarding the implementation of a systematic checklist-based strategy for the screening of transthyretin cardiac amyloidosis (ATTR-... more
Original Article
Lipoprotein(a) and risk of dementia: A propensity score–matched real-world analysis from a global federated research network
The association between lipoprotein(a) [Lp(a)] and dementia remains controversial.
Association between hyponatremia and mortality in neurocritical patients with traumatic brain injury: A systematic review and meta-analysis
Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide, especially among young adults, and represents a considerable health, economic, and social burden [1,2]. In... more
Efficacy of Aldosterone synthase inhibitors in uncontrolled and resistant hypertension: A systematic review and updated meta-analysis with grade assessment
The current therapy for resistant hypertension is often limited by hyperkalemia, renal decline, and a failure to prevent compensatory increases in circulating aldosterone. The aldosterone synthase... more
Cocaine-induced ANCA-associated vasculitis: Cohort analysis from a referral center and literature review
Cocaine adulterated with levamisole has been implicated as a trigger of Cocaine-Levamisole-Associated Autoimmune Syndrome (CLAAS), frequently mimicking granulomatosis with polyangiitis (GPA).
Venous thromboembolism risk assessment in hospital-at-home setting: A prospective cohort study (the TROMBODOM study)
Venous thromboembolism (VTE) is a significant cause of preventable mortality in hospitalized patients. While risk assessment models such as Padua and IMPROVE-VTE scores have been validated in... more
Early brain biopsy in neurological diseases of unknown etiology improves functional outcome
Brain biopsy is established for diagnosing non-resectable neoplastic lesions, with yields approaching 95%, and for documenting brain infections [1,2]. However, the indications and timing of brain... more
Cause-specific mortality in patients with chronic pancreatitis: a nationwide population-based cohort study
Cause-specific mortality in chronic pancreatitis changes over time. Early deaths are driven by pancreatitis-related deaths and liver disease, whereas extra-pancreatic cancers, respiratory, and... more
Shaping rheumatoid arthritis treatment: Clinical and demographic drivers of tsDMARDs versus bDMARDs prescription post-EMA pronouncement on JAK inhibitors. Insights from the AMBI-RA study
Rheumatoid arthritis (RA) is a chronic autoimmune disease leading to progressive joint damage and functional disability [1,2]. The treatment landscape for RA has evolved substantially over the last... more
Distinct miRNA expression profiles in subcutaneous and visceral adipose tissue of gastrointestinal cancer patients and their modulation based on adiposity level assessed by CT-scan
Metabolic and nutritional derangements during cancer are often characterized by significant loss of body weight, primarily due to the wasting of skeletal muscle and adipose tissue [1,2].
Long-term mortality in patients with first-time pulmonary embolism according to the presence of comorbidities at baseline: a nationwide register study
Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep vein thrombosis (DVT), represents a significant global health burden due to high morbidity and mortality rates associated... more
Rituximab limits glucocorticoid use in IgG4-related disease: Real-world evidence from a large European cohort
While the rituximab-treated patients in this study had more severe IgG4-RD than the glucocorticoid-treated comparators, treatment with rituximab was associated with similar effectiveness endpoints,... more
Lifestyle characteristics and plasma biomarkers for risk of MASLD differ by sex in the general population
The rise in global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) has highlighted the importance of developing sex-specific risk profiles for MASLD based on readily... more
Hydroxychloroquine for recurrent pericarditis: A multicentre observational study
To assess the effect of hydroxychloroquine (HCQ) in recurrent pericarditis (RP).
Optical coherence tomography angiography: a window on systemic sclerosis microangiopathy
Systemic sclerosis (SSc) is a rare multisystem disease characterized by early microvascular damage that leads to fibrosis of skin and internal organs [1]. SSc-related ocular manifestations have been... more
Exercise testing in chronic thromboembolic pulmonary hypertension and chronic thromboembolic pulmonary disease without pulmonary hypertension: a comprehensive systematic review and meta-analysis
The role of exercise testing in the follow up of patients with persistent dyspnea after pulmonary embolism (PE) is currently limited, with cardiopulmonary exercise test (CPET) mainly recommended in... more
All-cause mortality and early cardiovascular complications in relation to lesion location and stroke subtype in haemorrhagic and ischaemic stroke: the Perugia stroke registry
Stroke is a major global cause of morbidity and mortality and is frequently complicated by early cardiovascular events, collectively referred to as stroke-heart syndrome (SHS)[1,2]. The SHS... more
Risk of infection shortly before and after a diagnosis of liver cirrhosis: a nationwide, population-based study in Sweden
Liver cirrhosis is a serious medical condition and an increasing cause of mortality and morbidity worldwide [1–3] Cirrhosis poses a major burden on health systems, with patients having high risk of... more
Trends in cardiac amyloidosis hospital admissions and associated mortality risk over 20 years: a population-based study using healthcare administrative databases
Cardiac amyloidosis (CA) remains substantially underdiagnosed despite greater awareness. This study evaluated hospital admissions for CA as a proxy of its incidence in Lombardy over the last two... more
When social issues become medical emergencies: Prevalence and patient characteristics of social emergency admissions in internal medicine
Hospitalisations constitute the largest share of healthcare expenditures, and recent evidence suggests that a growing number of admissions are driven primarily by non-acute or non-medical factors... more
Review Article
Human infection with Andes hantavirus: an update for the general physician
Orthohantaviruses are zoonotic RNA-viruses transmitted to humans through inhalation of aerosols contaminated by infected rodent excreta. Among hantavirus species, Andes virus (ANDV) owns unique... more
Assessment and management of cardiovascular–kidney–liver metabolic-syndrome in the primary care setting: A multidisciplinary consensus statement
The recently introduced cardiovascular–kidney–metabolic (CKM) syndrome captures the close interplay between metabolic risk factors, chronic kidney disease, and cardiovascular disease, but... more
Trigger-induced atrial fibrillation for the hospitalist: a review
Atrial fibrillation (AF) is a common arrhythmia that a hospitalist may encounter. It is known to occur transiently or in response to specific triggers (trigger-induced AF), which presents a challenge... more
“Unpatients” in haemostasis and thrombosis. A yardstick of current paths in healthy carriers of a genetic susceptibility
Thrombophilia is defined as either an inherited or acquired abnormality of haemostasis inclining affected subjects to thrombosis, mainly because of interaction of multiple inherited and/or acquired... more
Alcohol use: less is better. An umbrella systematic review of clinical interventions, policies, and dose–response health risks in adults
Alcohol is a major modifiable cause of morbidity, premature mortality and health inequalities, yet evidence informing “low-risk” thresholds and prevention strategies is fragmented.
Chronic therapeutic non-adherence: Toward a new nosological entity
In 2021, non-communicable diseases caused approximately 43.8 million deaths and 1.73 billion DALYs globally, posing a major challenge for healthcare systems [1]. Despite significant advances in... more
Special Article
Reassessing venous thromboembolism risk in the hospital-at-home era: Toward tailored, context-specific assessment
Venous thromboembolism (VTE) continues to represent a leading cause of preventable morbidity and mortality among acutely ill medical patients [1]. Effective thromboprophylaxis remains a cornerstone... more