January 2025
35 ArticlesBeyond the Guidelines
Elevated blood pressure and hypertension in older persons: A comment on the recent ESC guidelines
The recently published European Society of Cardiology (ESC) Guidelines (GLs) for the management of elevated blood pressure (BP) and hypertension [1] introduced substantial changes in recommendations... more
Clinical Insights
The assessment, interpretation and implementation of lung ultrasound examinations in Heart Failure: Current evidence and gaps in knowledge
Pulmonary congestion is a common finding of volume overload or volume shift in heart failure (HF) and its detection is essential to facilitate timely therapy initiation or adjustment prior to frank... more
The screening of cognitive impairment in the emergency department: A valuable clinical and epidemiological goal
The screening of cognitive impairment is a critical and underestimated problem in the Emergency Department (ED). Overall, dementia remains unrecognized in more than a half of the Italian population,... more
Commentary
“Obesity management in the older age, new understanding for old challenges”
Obesity, a silent pandemic, is rapidly spreading across all age groups and populations worldwide. >1 billion individuals are expected to be living with obesity by 2030 [1]. Parallel to the obesity... more
Linking functional capacity and heart failure outcomes: Easy assessment, major implications
Heart failure (HF) is a global pandemic that affects nearly 60 million people worldwide. Despite continuous and significant advances in treatment, HF continues to be associated with poor prognosis... more
Realizing the scope of venous and arterial thrombosis in cyclin-dependent kinase 4/6 inhibitors in hormone positive breast cancer
In hormone positive, human epidermal growth factor receptor 2 (HER2)-negative advanced and metastatic breast cancer, the cyclin-dependent kinase (CDK) 4/6 inhibitors palbociclib, ribociclib and... more
Treatment of systemic lupus erythematosus in real life
The study by Du et al., published in this issue of the European Journal of Internal Medicine [1] adds significant information regarding the treatment patterns in systemic lupus erythematosus (SLE),... more
Editorial
Two recent European guidelines on hypertension
During the past year, two influential Hypertension Guidelines from Europe have been released. The first, published in year 2023, was issued by the European Society of Hypertension [1]. The second,... more
Internal Medicine Flashcard
A tiny green lesion mimicking a big problem
A 75-year-old smoker patient presented to our hospital with shortness of breath and mild hemoptysis. A chest radiograph demonstrated a suspicious left parahilar opacity (Fig. 1A). A thoracic computed... more
Reversible polyneuropathy with multiple hypochromic lesions, digital ulcers and onychodystrophy
A 40-year-old Brazilian woman with a medical history of a subclinical hypothyroidism came to our clinic because of progressive distal numbness, weakness and polyarthralgia. She denied fever nor... more
Invited Review Article
Behaviour therapy for obesity in older adults
Obesity is a major public health concern, with global data highlighting that 650 million adults are living with obesity and 1.9 billion adults are living with overweight [1]. Current epidemiological... more
Pharmacotherapy for older people with obesity
The prevalence of obesity continues to rise in Europe, particularly in adults aged between 60 and 74 years [1]. Despite this rising prevalence of obesity in older adults, use of medication for weight... more
Letter to the Editor
Compassion in medicine: Are we failing our future doctors?
Dear editor,
Empagliflozin controls cirrhotic refractory ascites along with improvement of natriuresis and circulatory, cardiac, and renal function: A pilot study
Ascites is the most common decompensating event in cirrhosis [1]. Its pathophysiology involves splanchnic arterial vasodilation and reduced effective arterial blood volume, which activate potent... more
Combining L-arginine and vitamin C improves physical frailty in hypertensive elders
Hypertension is one of the most common comorbidities which has been suggested to play a pivotal role in the transition to pre-frailty and physical frailty (hereafter called frailty), especially in... more
Atrial fibrillation-related mortality trends among adults with comorbid chronic obstructive pulmonary disease in the United States from 1999 to 2020
Atrial fibrillation-related mortality in adults with comorbid chronic obstructive pulmonary disease in the United States from 1999 to 2020.
Effect of tirzepatide on leptin and adiponectin levels
In the field of innovative treatments for type 2 diabetes, tirzepatide emerges as a novel dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) receptor and the glucagon-like peptide... more
Clinical trial landscape for immune thrombocytopenia: Progress and the long road ahead
Immune thrombocytopenia (ITP) has seen the development and evaluation of several breakthroughs in recent clinical trials [1-4]. The clinical trial landscape for ITP provides valuable insights into... more
Integrated care and lean management in internal medicine: An ideal mix for a functioning health system?
Many European health systems are still under pressure in the post pandemic period, mainly because of the long-term trend of ageing people requiring more and more health care. Therefore, a rational... more
Sudden death in congenitally corrected transposition of the great vessels
Transposition of the great arteries (TGA) comprises dextro-TGA and levo-TGA (L-TGA). In dextro-TGA, the aorta, arising from the right ventricle (RV), is positioned to the right of the pulmonary... more
Impact of an active case-finding strategy in autoimmune gastritis
Dear Editor,
Sodium–Glucose Co-transporter 2 Inhibitors treatment improve pancreatic β-cells function and insulin resistance in patients with Type 2 diabetes
Diabetes is a leading cause of death and disability [1]. Approximately, more than 1.31 billion people will have diabetes by 2050 [1,2]. Insulin resistance in target tissues and insufficient insulin... more
Glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors combination therapy versus monotherapy and major adverse cardiovascular events: Do the benefits add up?
Dear Editor,
Original Article
Carotid plaque offsets sex-related differences in cardiovascular risk of young hypertensive patients
Risk for cardiovascular disease (CVD), in particular risk for coronary artery disease and acute coronary syndrome, is lifelong higher in men than in women [1], although this difference is attenuated... more
Impaired insulin sensitivity measured by estimated glucose disposal rate is associated with decreased myocardial mechano-energetic efficiency in non-diabetic individuals
Atherosclerotic cardiovascular diseases encompassing coronary artery disease, and stroke, remain major causes of death worldwide regardless the substantial advances in the prevention and treatment of... more
Thrombosis in breast cancer patients on cyclin-dependent kinase inhibitors: Survival impact and predictive factors - A study by the cancer and thrombosis group of the spanish society of medical oncology (SEOM)
TESEO registry data indicate that breast cancer ranks third in cases of cancer-associated thrombosis [1]. This cannot be solely attributed to the prevalence of malignant breast pathology, as a study... more
Towards a comprehensive approach to the management and prognosis of systemic sclerosis's patients: The role of comorbidities in the SPRING-SIR registry
In systemic sclerosis (SSc), widespread skin and visceral fibrosis are associated with poor outcome and increased mortality [1]. For this reason, SSc management remains a challenge due to clinical... more
Treatment of systemic lupus erythematosus: Analysis of treatment patterns in adult and paediatric patients across four European countries
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder of connective tissue with a highly variable clinical presentation, disease course and prognosis [1]. SLE is characterised by... more
Prevalence and clinical determinants of rapid eGFR decline among patients with newly diagnosed type 2 diabetes
Diabetic kidney disease (DKD) is the most common cause of end-stage kidney disease (ESKD) in the western world, accounting for more than 40 % of patients that require kidney replacement therapy [1].... more
Prevalence and clinical predictors of vasodepressor syncope during head up tilt test
Head-up tilt test (HUTT) is a useful diagnostic tool for patients with suspected reflex syncope after initial clinical assessment [1]. When using the Italian protocol, HUTT allows to confirm the... more
Prognostic role of gait speed in worsening heart failure
Heart failure (HF) is a progressive disease, affecting more than 60 million people worldwide [1]. Despite advances in treatment options, HF is associated with a high risk of mortality and morbidity.... more
Functional limitation predicts mortality in heart failure with preserved ejection fraction
Globally, more than 64 million people are affected by HF [1]. The estimated prevalence of HF is 1 % to 3 % in Europe and 2.1 % in the USA [2,3]. The estimated incidence is 1 to 4 cases per 1000... more
Distribution and prognostic impact of different heart failure etiologies in patients with heart failure with mildly reduced ejection fraction
As a result of ongoing demographic changes and an ageing population, the overall number of patients with heart failure (HF) has significantly increased. It is estimated that more than 60 million... more
Review Article
Diet and physical exercise in elderly people with obesity: The state of the art
“Obesity and ageing: two side of the same coin” in 2020 Tam et al. have summarised the complex pathophysiological interaction and mutual relationship between obesity and ageing in a comprehensive... more
Metabolic Bariatric surgery in People with Obesity aged ≥65 Years
The World Health Organization (WHO) estimated that 1.4 billion people in the world will be aged 60 years and older in 2030 and 2.1 billion by 2050, comprising 12–22 % of the global population [1].... more