January 2022
53 ArticlesNo Section
Diagnosis is a probabilistic estimate of disease. A dynamic approach to diminish resource overuse
Clinical reasoning (mostly diagnostic reasoning) is made of two sequential steps: firstly, problem-solving - estimating disease probabilities through information from the physical exam and sequential... more
Associations of Post-Acute COVID syndrome with physiological and clinical measures 10 months after hospitalization in patients of the first wave
Since the beginning of the COVID-19 pandemic in 2020, in Germany almost 3.8 million inhabitants have been positively tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1], and... more
Infective endocarditis, is there a goal beyond antibiotics and surgery?
In the vast majority of infectious diseases, the primary endpoint to evaluate an intervention relies on short terms variables and, when relevant, in-hospital mortality, or 28 days mortality. In most... more
Optimal duration of anticoagulation therapy for venous thromboembolism in autoimmune diseases
Venous thromboembolism (VTE) is a common issue in patients with autoimmune diseases. One of the clinically relevant issues for VTE in autoimmune disorders is the optimal duration of anticoagulation... more
Hydroxichloroquine for COVID-19 infection: Do we have a final word after one year?
The results presently available from randomised clinical trials and their meta-analysis indicate that Hydroxychloroquine is not associated in COVID-19 patients with either decreased mortality or... more
Serum IgG4 elevation in hyper-inflamed COVID-19 patients. Author's reply
Dear Editor, we thank Dulak and Trzciński for their insightful and pertinent comments on our observation about serum IgG4 levels predicting mortality in hospitalized patients affected by Coronavirus... more
Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation
To analyze the frequency with which patients with heart failure with preserved ejection fraction (HFpEF) discharged after an acute heart failure (AHF) episode are treated with antineurohormonal drugs... more
A metabolomic index based on lipoprotein subfractions and branched chain amino acids is associated with incident hypertension
Hypertension is the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide, with a sustained increment in mortality over the last 40 years [1]. Over the... more
Clinical Insights
Management of COVID patients with convalescent plasma: Do we have the final word?
Immunotherapy with convalescent plasma (CP) has been used in the past in several infectious diseases (influenza, SARS, MERS) with the aim to shorten or stop the phase of viral replication and to... more
Predicting adverse outcomes in patients with COVID-19: just an epidemiological debate or a valuable clinical approach?
On February 16, 2020 the executive committee of the European Federation of Internal Medicine (EFIM) met in Malaga, Spain, to prepare for the EFIM annual congress to be held in March 2021. As usual,... more
Commentary
Tocilizumab in severe COVID-19: A promise fulfilled
A proportion of patients who are infected with SARS-CoV-2 develop severe disease. Apart from a serious bilateral pneumonia organs other than the lungs may become involved as well. The clinical... more
Anticoagulation for stroke prevention after embolic stroke of undetermined source of presumably cardiac source: The sail to Ithaca
During the last decade, the term embolic stroke of undetermined source (ESUS) was introduced in a pursue to standardized diagnostic workup in a more targeted sub-population of cryptogenic stroke... more
Editorial
One year later: The case of tocilizumab in COVID-19
In severe coronavirus disease 2019 (COVID-19) patients, SARS-CoV-2 infection induces a systemic immune activation characterized by an afinalistic release of inflammatory cytokines [1,2]. This... more
Ideas and Opinions
Should the European Union have an office of research integrity?
Scientific misconduct is detrimental to both society and researchers, potentially resulting in a mistrust in science. When the results of a scientific publication are based on erroneous content or... more
Internal Medicine Flashcard
Multiple tumors on the pleura with pleural effusion mimicking malignant mesothelioma
A 68-year-old male presented with left chest pain and was referred to our hospital due to left-sided pleural effusion on a chest X-ray (Fig. 1 A). Initial laboratory data included a white blood cell... more
Multiple organ nodules or polyps
A 48-year old female presented with intermittent epigastric pain for 2 months accompanied with belching, nausea, vomiting and occasionally melena. She had endometrial polypectomy and thyroidectomy in... more
New onset rectal bleeding
A 36-year-old male with no significant past medical history presented to the emergency department for new onset hematochezia. Prior to arrival, the patient reported having five episodes of passing... more
Stuck in my head as an old song
A 61-year-old piano man was admitted to the emergency department for loss of consciousness, aphasia and Glasgow coma scale of 13 points. His past medical history included hypertension, non-insulin-... more
“Comb and Target signs” in abdominal CT in patients with purpura
A 56-year-old woman complained of nausea, abdominal pain, and bloody diarrhea 10 days prior to the day of consult in our institution. Her abdominal pain worsened and was accompanied by joint pain for... more
COVID-19 vaccination and a severe pain in the neck
A 40-year-old woman developed malaise and severe anterior neck pain 12 hours after the second dose of COVID-19 mRNA vaccine (Pfizer/BioNTech). The pain peaked and plateaued at the fourth post-... more
Letter to the Editor
The prognostic value of malnutrition on duration of admission, financial cost and mortality in elderly, hospitalized patients
Dear Editor,
Ankle-brachial index and the risk of hemorrhagic stroke
Dear editor,
Long COVID: A patient perspective
Even though in this [1,2] and other journals [3–5] a number of articles described the long-term consequences of COVID-19 in patients who recovered from the acute illness, most reports mainly dealt... more
Disguised aspects of IgG4
Dear Editor,
Humoral SARS-COV-2 IgG decay within 6 months in COVID-19 healthy vaccinees: The need for a booster vaccine dose?
The most effective approach to fight COVID-19 infection is prevention by targeted vaccines that prime the immune system prior to a first encounter with the virus. The BNT162b2 messenger RNA (mRNA)... more
Venous thromboembolism treatment duration in autoimmune diseases. Research trends
Dear editor,
Standardized PaO2/FiO2 ratio in COVID-19: Added value or risky assumption. Author's reply
Dear Editor,
Cardiopulmonary exercise test with stress echocardiography in COVID-19 survivors at 6 months follow-up
Although many studies suggest different degrees of myocardial and pulmonary injury during the acute infection and early follow-up [1–3],there is disagreement about cardio-pulmonary injury and... more
Smartphone-based ECG devices: Beyond atrial fibrillation screening
Dear Professor Agnelli,
Is serum hyperosmolality related with myocardial dysfunction in septic shock patients?
Etiopathogenesis of cardiac dysfunction in septic shock is multifactorial, arising from autonomic dysregulation, increased capillary permeability, metabolic and mitochondrial dysfunction, oxidative... more
Association of new-onset atrial fibrillation in patients taking high-dose fish oil
Atrial fibrillation (AF) is the most common cardiac arrythmia, with an estimate of 37.6 million cases (0.51% of the world population) in 2017. Its prevalence has increased by 33% in the last 20 years... more
A simple method to validate medical bed number calculations
Doctors are often called upon to make input into planning for hospital bed numbers. Unknown to doctors the models behind forecasting bed numbers can be deliberately manipulated. It is often the case... more
Do we really know what drives relapse in obesity management?
I have read with much interest the narrative review by Busetto and colleagues entitled “Mechanisms of weight regain”, recently published in your journal [1]. There is no doubt that relapse in obesity... more
Original Article
The high-risk bleeding category of different scores in patients with venous thromboembolism: Systematic review and meta-analysis
Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially life-threatening condition associated with a high case-fatality rate [1], and... more
Extended venous thromboprophylaxis in patients hospitalized for acute ischemic stroke: A systematic review and meta-analysis
Acute ischemic stroke is a major health burden worldwide due to high rates of ensuing hospitalizations, complications, disability, dependency, and death [1]. Venous thromboembolism (VTE), which... more
Clinical outcomes associated with the emergency treatment of hyperkalaemia with intravenous insulin-dextrose
Hyperkalaemia is a common, life-threatening electrolyte abnormality present in up to 10% of acute hospital admissions [1]. In patients receiving treatment with renin-angiotensin-aldosterone system (... more
Response to mepolizumab according to disease manifestations in patients with eosinophilic granulomatosis with polyangiitis
Eosinophilic granulomatosis with polyangiitis
Sex differences in clinical presentation and risk stratification in the Emergency Department: An observational multicenter cohort study
Sex differences affect patient outcomes in many diseases, such as Coronavirus Disease 2019 (COVID-19), acute myocardial infarction, acute ischemic stroke and infectious diseases, while outcome... more
Prognostic value of NT-proBNP and CA125 across glomerular filtration rate categories in acute heart failure
Heart and kidney function are heavily intertwined, and once both organs are affected, the patient's prognosis worsens dramatically [1–3]. Natriuretic peptides (NP) (brain natriuretic peptide [BNP]... more
Predictors of long-term mortality in left-sided infective endocarditis: an historical cohort study in 414 patients
Infective endocarditis (IE) is a life-threatening disease associated, in 2010, with 1.58 millions of disability-adjusted life years lost due to death, concurrent illnesses and functional impairment [... more
Clinical presentation of secondary infectious complications in COVID-19 patients in intensive care unit treated with tocilizumab or standard of care
Tocilizumab is a recombinant humanized monoclonal antibody developed against soluble and membrane-bound isoforms of the interleukin-6 [IL-6] receptor. It prevents the binding of IL-6 to its receptor... more
Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987–2016
Irritable bowel syndrome (IBS) affects 11.2% of the global population [1], with significant impacts on patients’ quality of life despite no increased risk of mortality [2]. Among this sizeable... more
Oral anticoagulants vs antiplatelets in cryptogenic stroke with potential cardiac emboli: Meta-analysis
Cryptogenic strokes are cerebral infarcts for which no probable underlying pathophysiologic cause is identified after adequate diagnostic evaluation [1]. However, it's been shown that some strokes... more
Dediagnosing – a novel framework for making people less ill
The vast progress in science and technology has greatly increased the number of diseases. Today, the International Classification of Diseases (ICD-11) consists of approximately 55,000 unique codes... more
Examination of the relationship between emergency department presentations and population mortality: a multicenter analysis of emergency department presentations during the COVID-19 pandemic
The first deaths outside of China due to COVID-19 (coronavirus disease 2019), caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), occurred in February 2020 [1]. Subsequently,... more
The role of minor salivary glands’ biopsy in the diagnosis of Sjögren's syndrome and other systemic diseases
Minor salivary gland biopsy (MSGB) is a minimally invasive, safe and low-cost diagnostic procedure. It is mainly used for the diagnosis of Sjögren's syndrome (SS), by identifying the presence of... more
Multidisciplinary team led by internists improves diabetic foot ulceration outcomes a before-after retrospective study
Diabetic foot ulceration (DFU), one of the most serious complications of diabetes mellitus (DM), affects 25% of all patients with diabetes and is associated with high morbidity and mortality [1-5].... more
Review Article
One year after the ESC/EAS guidelines on cholesterol control. What's the new evidence? What's missing?
The recent ESC/EAS 2019 Guidelines for the management of dyslipidaemias are centred on the causal role of low density lipoprotein (LDL), or more generally apolipoprotein B (apoB)-containing... more
Electrocardiographic features of patients with COVID-19: One year of unexpected manifestations
Coronavirus Disease 2019 (COVID-19) is the clinical manifestation of infection with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) [1 -3]. COVID-19 is frequently characterized by... more
Should we continue surveillance for hepatocellular carcinoma and gastroesophageal varices in patients with cirrhosis and cured HCV infection?
alpha-fetoprotein
Recent advances in pericarditis
Pericardial diseases are a heterogeneous group of entities, ranging from acute pericarditis (AP) to asymptomatic pericardial effusions. Diagnosis of AP can be made when two of the following criteria... more
Translational medicine in hereditary hemorrhagic telangiectasia
Hereditary hemorrhagic telangiectasia (HHT) or Rendu–Osler–Weber syndrome (ORPHA:774) is a rare autosomal dominant vascular disease characterized by systemic telangiectases and larger vascular... more
Popular procedures without evidence of benefit: A case study of percutaneous coronary intervention for stable coronary artery disease
Coronary artery disease is common, affecting more than an estimated 125 million people worlwide [1,2]. More than half of all patients with coronary artery disease (CAD) have anginal symptoms [3].... more