January 2021
58 ArticlesNo Section
Anticoagulation dosing in atherosclerotic cardiovascular disease: Is less more?
Pivotal randomized clinical trials (RCTs) conducted in the 1970s and 1980s comparing aspirin with placebo in patients with prior myocardial infarction established antithrombotic agents as mainstays... more
Lower dose direct oral anticoagulants and improved survival: A combined analysis in patients with established atherosclerosis
Anti-thrombotic and anti-coagulation effects of direct oral anticoagulants (DOACs) are dose-dependent [1–5]. Conversely, the benefit from higher dose DOACs is counterbalanced by a dose-dependent risk... more
Disease- and gender-related characteristics of coeliac disease influence diagnostic delay
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
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
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
Commentary
Sodium: sign, signifier, or signified, of sepsis?
85% of the known universe is made up of something we cannot directly observe as it does not absorb, emit, or reflect light. We can only infer the existence of dark matter through its effects on... more
Increasing the impact of Post Authorisation Safety Studies: transparency is key
In ETNA VTA Europe: A contemporary snapshot of patients treated with edoxaban in clinical practice across eight European countries, Cohen et al. report the results of a non-interventional drug... more
Hydroxychloroquine for COVID-19: Balancing contrasting claims
The place of hydroxychloroquine in the prevention and treatment of COVID-19 has been controversial, with contrasting claims and high-emotions. It was initially proposed as treatment or prophylaxis... more
Large-scale use of hydroxychloroquine for COVID-19 confirms safety, if not effectiveness
In this issue of the Journal, Di Castelnuovo and colleagues report the findings of the observational multicentre Italian CORIST Study on the use of hydroxychloroquine (HCQ) in hospitalised COVID-19... more
Venous thromboembolism and COVID-19: Mind the gap between clinical epidemiology and patient management
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
Hypertension guidelines: Managing the differences or the patients?
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
Does hydroxychloroquine reduce mortality for COVID-19?
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
Utilize the full potential of real world evidence
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
European Journal of Internal Medicine: IM Flashcards
Atypical chest pain with precordial T wave inversions
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
Bilateral foot drop and cherry skin lesion
A 34-year-old woman with no previous medical history presented with bilateral lower limbs weakness and numbness for three months. It was progressively worsening that she required wheelchair for... more
Spontaneous discoloration of the finger in a 67-year-old woman
A 67-year-old woman presented to our clinic because she had developed spontaneous pain and purple discoloration of the fourth finger of her right hand that had started the previous day. She had... more
Chronic urticaria with inflammation
A 67-year-old man presented with a 15-year history of chronic urticaria. It was distributed symmetrically on the limb trunk (Fig. 1A and B) without pruritus. No fever or joint pain or headache is... more
Bright liver: a surprise discovery
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
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
Internal Medicine Flashcards
A middle-aged woman with numbness and weakness of the extremities
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
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 the Editor
The COVID-19 burden for health care professionals: Results of a global survey
At the end of December 2019, a novel coronavirus (SARS-CoV-2) started to spread in the city of Wuhan, Hubei province in China, first described as novel coronavirus [1,2]. Meanwhile, the current COVID... more
End-Stage renal disease and 30-day mortality for adults with and without COVID-19
Emerging evidence suggests that people with chronic kidney disease have a higher risk of severe infection with coronavirus disease 2019 (COVID-19) [1]. Furthermore, acute kidney injury is common... more
Time to speed up–the rate at which we correct hypernatremia
Hypernatremia is a common electrolyte disorder. It is defined as a serum sodium concentration > 145 mmol/L and is a hyperosmolar state in which there is a deficit in total body volume relative to... more
Temporal changes in co-morbidities and mortality in patients hospitalized for COVID-19 in Italy
In response to the growing pandemic of Coronavirus Disease 2019 (COVID-19) in Italy, the Italian government imposed a strict nationwide quarantine which began on March 9, 2020. The restrictive... more
Disease course in patients with systemic autoimmune diseases: insights on the safety of immunosuppression during the SARS-CoV-2 outbreak in Italy
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.
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
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
Is the 2020 Sampson equation the best formula for LDL-C estimation?
Dear Editor,
Trans-catheter valve implantation and patient outcomes: Focus on the kidney
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
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
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
Renal failure after trans-catheter aortic valve implantation
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
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
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
Original Article
Non-classical clinical presentation at diagnosis by male celiac disease patients of older age
Celiac disease (CeD) is a complex immune-mediated disease that occurs in ̴1–2% of the Caucasian population [1]. In patients with CeD, ingestion of gluten peptides that are present in barley, wheat... more
Hypernatremia and moderate-to-severe hyponatremia are independent predictors of mortality in septic patients at emergency department presentation: A sub-group analysis of the need-speed trial
Early risk stratification of septic patients admitted to the Emergency Department (ED) is challenging [1,2] since signs and symptoms may be similar for patients who will have either a favorable or an... more
Interleukin-6 receptor blockade with subcutaneous tocilizumab improves coagulation activity in patients with COVID-19
A considerable proportion of patients with Coronavirus Disease 2019 (COVID-19) presents with a hypercoagulable state which may increase the risk of thromboembolic complications [1]. The most typical... more
Mobile health technology-supported atrial fibrillation screening and integrated care: A report from the mAFA-II trial Long-term Extension Cohort
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
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
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
Consumer-led screening for atrial fibrillation using consumer-facing wearables, devices and apps: A survey of health care professionals by AF-SCREEN international collaboration
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
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
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
Impact of non-selective ß-blockers on hepatic encephalopathy in patients with liver cirrhosis
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
Hydroxychloroquine (HCQ) was proposed as potential treatment for COVID-19.
Definition of tachycardia for risk stratification of pulmonary embolism
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
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
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
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?
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
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
Pharmacist-driven medication recognition/ reconciliation in older medical patients
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
Impact of admission serum acid uric levels on in-hospital outcomes in patients with acute coronary syndrome
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?
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
Review
Multiparametric assessment of “fluid status” in heart failure
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
How does SARS-CoV-2 targets the elderly patients? A review on potential mechanisms increasing disease severity
On November 18th 2020, there have been over 55 million confirmed cases of SARS-CoV-2 infection causing COVID-19, with up to 1.3 million deaths worldwide. In the Netherlands alone, there are up to 8,... more
Transthyretin amyloid cardiomyopathy: An uncharted territory awaiting discovery
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
Incidence of acute pulmonary embolism in COVID-19 patients: Systematic review and meta-analysis.
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