July 2026
193 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
Multiparametric and multi-organ ultrasound assessment of adiposity for cardiovascular risk stratification
For decades, clinical practice relied on deceptively simple anthropometric measures—most notably body mass index (BMI), waist circumference, waist-to-hip ratio, and waist-to-height ratio (WHtR)—to... more
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
Disease clearance in immune-mediated gastrointestinal disorders: A new standard or a semantic trap?
Immune-mediated gastrointestinal disorders, including eosinophilic oesophagitis, coeliac disease, and inflammatory bowel disease, are increasingly managed with therapeutic goals that extend beyond... more
Would a single centralized ethical review in Europe be feasible for multinational trials in public health emergencies?
In the development of clinical research guidelines and regulations over the past 60 years, those relating to research ethics have deserved special attention. Among these, all those referring to the... more
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
Chronic hyperkeratotic and pustular cutaneous lesions of the hand
A 49-year-old Algerian woman, was referred for evaluation of cutaneous lesions evolving for four years suggestive of chronic infection. His medical history was relevant for diabetes mellitus... more
Opportunistic infections in a patient with T-cell lymphocytopenia of unclear cause
A 57-year-old Moroccan woman with no relevant personal and family history presented with a 2 month history of progressive loss of vision of the left eye. Vital signs were normal. Ophthalmologic... more
The “flame sign” in a young painter with acute neurologic deterioration
A 24-year-old man, a painter with two years of occupational exposure to paints and thinners under poorly ventilated conditions (8–10 h daily), presented with a three-month history of headache,... more
Facial swelling with unexpected pelvic hypermetabolism
A 59-year-old man with a history of smoking and adult-onset asthma with recurrent eosinophilia presented with fatigue and weight loss, along with a progressive left facial swelling involving the... more
Papulonodular rash and destructive palatal lesion with systemic symptoms
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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
Artificial intelligence in diagnostics and medical decision making
Artificial intelligence (AI) applications bear a great promise for healthcare. If successfully implemented, AI could reduce the workload for healthcare professionals and enhance the quality of work... more
A clinically oriented review of cystatin c in hospitalized adults: when creatinine misleads—A practical guide for internists and its role in heart failure risk stratification
Accurate assessment of kidney function is essential in hospitalized patients. However, serum creatinine does not always reflect true kidney function because it can be influenced by factors such as... more
Physical activity in older patients: Push your performance capacity to prevent and limit frailty!
Optimal aging is characterized by older adults maintaining good functional reserves, complete independence, and physiological resilience to stress. Conversely, some elderly individuals exhibit... more
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
Have mediators and at-risk time shaped the Lipoprotein(a)-dementia null? Author’s reply
Dear Editor,
Using latent class analysis for identifying clinical phenotypes associated with prognosis in patients with atrial high-rate episodes
Atrial high-rate episodes (AHRE) detected by cardiac implantable electronic devices are frequently encountered in clinical practice [1,2] and are associated with an increased risk of atrial... more
Severe hyperkalaemia during liposomal amphotericin B treatment, independent of nephrotoxicity
Dear Editor,
Artificial intelligence and clinical responsibility in the multimorbid patient
Artificial intelligence (AI) is not simply transforming clinical practice; it is reshaping how clinical responsibility is organised. Much of the current debate has focused on whether AI will replace... more
Risk reclassification and implementation challenges in the 2026 AHA/ACC pulmonary embolism guideline
The recently published 2026 AHA/ACC guideline for the evaluation and management of acute pulmonary embolism (PE) introduces several conceptual innovations that may influence clinical practice beyond... more
Recurrent Pericarditis, Hydroxychloroquine, and the Unrecognized Risk of Myasthenia Gravis
We read with great interest the article by Trotta et al. evaluating the role of hydroxychloroquine (HCQ) in recurrent pericarditis (RP), as well as the accompanying commentary by Tan et al. [1,2].... more
Obstructive sleep apnea syndrome as the missing piece in the puzzle of cardiovascular–kidney–liver–metabolic syndrome
Dear Editor, the staging framework of cardiovascular–kidney–metabolic (CKM) syndrome initially proposed by the American Heart Association in November 2023 represents an impressive conceptual advance... more
“Non-reproducible mortality data in a hyponatremia–TBI meta-analysis”. Author's Reply
We would like to thank Huang et al [1] for their careful review of our systematic review and meta-analysis [2] and for raising concerns regarding the presentation and reproducibility of the mortality... more
Considerations regarding the diagnosis of short telomere syndrome in a patient with opportunistic infections
The recent manuscript by Belhabib et al., presents an interesting and educational case of opportunistic infections associated with severe CD4+ lymphocytopenia, yet the central conclusion, that the... more
Interpreting echocardiographic improvement in EGPA: pulmonary vascular reversal, cardiac involvement, or disease activity?
We read with interest the study by Carlucci et al., “Eosinophil-linked pulmonary circulation in EGPA Improves under anti-IL-5/R therapy: A longitudinal study” [1]. The authors should be commended for... more
Twelve-year trends in sex and age of patients with COPD and chronic respiratory failure undergoing pulmonary rehabilitation
Dear 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
Does T90 reflect OSA-specific hypoxic burden or underlying pulmonary disease?
To the Editor,
The missing piece in severe acquired brain injury care: Integrating neurophysiological screening for critical illness polyneuropathy and myopathy
We read with great interest the recent article by Grifoni and Bucciardini, regarding the implementation of an interdisciplinary co-management model between the Neuro-Intensive Care Unit (Neuro-ICU)... more
Readmission risk after protected discharge: are multidimensional tools superior to functional scales?
Early hospital readmissions remain one of the major challenges for healthcare systems and are widely recognized as an indicator of healthcare quality, effective discharge planning, and continuity of... more
Non-reproducible mortality data in a hyponatremia–TBI meta-analysis
Dear Editor,
Logistic regression ignores time-to-event in competing risks analysis
We read with interest the study by Brunetti et al. on oral anticoagulant (OAC) nonprescription in older atrial fibrillation patients with reduced expected survival [1]. The authors should be... more
Optical coherence tomography angiography in systemic sclerosis: from a microvascular signal to clinical utility
Comment on.
Baseline or dynamic prediction after venous thromboembolism? Clarifying the clinical use of the CAVE score for occult cancer
Jara-Palomares and colleagues should be congratulated for developing and externally validating an international score to estimate the risk of cancer within one year after venous thromboembolism (VTE... more
The time has come for comprehensive geriatric assessment in internal medicine
Complexity has become a defining feature of modern internal medicine. Older adults with multimorbidity, polypharmacy, biological and functional vulnerability, and multidimensional frailty now... more
Have mediators and at-risk time shaped the Lipoprotein(a)-dementia null?
Rossi and colleagues report no association between elevated lipoprotein(a) [Lp(a)] and incident dementia in a large propensity-score-matched TriNetX cohort [1]. The study is valuable because Lp(a) is... more
Lower incidence of venous thromboembolism in hospital-at-home patients: Do unequal detection opportunities and between-group non-equivalence affect the interpretation of the findings?
We read with great interest the prospective cohort study by Dos Santos et al. published in the European Journal of Internal Medicine [1]. This study focused on VTE risk assessment in patients with... 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].
Hydroxychloroquine for recurrent pericarditis
We thank Zhang and Xu [1,2] for their interest in our work [3]. Regarding the observations of Zhang [1], we agree that observational studies can suggest that a treatment may be beneficial but cannot... more
GLP-1 receptor agonists for the management of obesity in individuals treated with antipsychotics
Individuals with psychotic disorders treated with antipsychotic drug classes are at high risk for developing overweight/obesity and related cardiometabolic complications, resulting in excess... more
Evidence of increased awareness in cardiac amyloidosis, but still room for improvement.
Dear Editor,
Dismantling the routine use of prophylactic volume expansion in contrast-associated acute kidney injury
We read with profound clinical interest the recent prospective analysis by Ragnarsdottir et al., [1] in the European Journal of Internal Medicine regarding the evolving risk factors for hospital- and... more
Reporting clinical escalation in Hospital-at-Home: from a single rate to a structured framework
Hospital-at-Home (HaH) programmes are expanding rapidly across European health systems as substitutive acute care models [1,2]. As they consolidate, unplanned transfer back to hospital — termed... more
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].
Microplastics in drinking water: A silent threat amplifying health inequities in low-resource settings
Microplastics have become ubiquitous contaminants in global drinking water supplies. Detected in tap water, bottled water, and untreated sources across both high- and low-income countries, these... more
Male hypogonadism and incretin therapy response
Dear Editor,
Coronary microvascular dysfunction as a plausible convergent mechanism in cancer therapy-related MINOCA: evidence synthesis and a call for diagnostic standardization
Myocardial infarction with non-obstructive coronary arteries (MINOCA) accounts for 6–10 % of all acute myocardial infarctions (MI), carries a non-trivial long-term risk of major adverse... more
Evaluating the use of hydroxychloroquine in recurrent pericarditis: Methodological concerns and public health implications
We were highly interested in the article by Trotta et al. regarding the use of hydroxychloroquine (HCQ) for treating recurrent pericarditis (RP) [1]. The authors reported that HCQ significantly... more
Reconsidering the interpretation of prescribing shifts and treatment response in the AMBI-RA study
We read with great interest the AMBI-RA study by Bertola et al. [1], which examined changes in b/tsDMARD prescribing and short-term treatment outcomes after regulatory restrictions on Janus kinase... more
Initial misdiagnoses in Sjögren’s disease patients
Sjögren’s disease (SjD) is a chronic systemic autoimmune disease affecting exocrine glands, causing sicca symptoms, arthralgias and fatigue. It is highly heterogenous and may have variable clinical... more
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,
Hydroxychloroquine for recurrent pericarditis: A necessary balance between therapeutic benefit and potential adverse risk
Dear Editor,
Paroxysmal atrial fibrillation and bleeding: Pattern, prescription, or both? A call for aspirin-informed analyses in COMBINE-AF
Ntaios and colleagues report an exceptional individual patient-level analysis from COMBINE-AF (n = 71,466), providing unusually precise estimates of outcome gradients between paroxysmal atrial... more
Cumulative nocturnal hypoxemia, but not apnea-hypopnea index, is independently associated with vertebral fracture burden in obstructive sleep apnea
Obstructive sleep apnea (OSA) is a highly prevalent disorder characterized by recurrent upper airway collapse, intermittent hypoxemia, and sleep fragmentation [1]. Beyond its established... more
Timing of brain biopsy in cryptogenic neurological diseases: beyond diagnostic yield
We read with great interest the study by Aboubakr et al [1] investigating the impact of brain biopsy timing on diagnostic yield and clinical outcomes in patients with neurological diseases of unknown... more
Cardiac amyloidosis trends: Methodological limitations in estimating incidence and mortality from inpatient data alone
Dear Editor,
Rethinking renal protection in patients with heart failure and reduced ejection fraction
We read with great interest the review titled “Renal protection in heart failure with reduced ejection fraction: not all that glitters is gold” by Elisa Russo and colleagues, published in your... more
Dialysis, but not severe renal dysfunction, is associated with excess bleeding in venous thromboembolism: Insights from a nationwide registry
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal complication in patients with chronic kidney disease (CKD), including... more
Clinical applicability considerations for depot-specific miRNA profiling in gastrointestinal cancer
Dear Editor,
Serological and clinical features in patients with anti‐centromere antibody positivity
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
Refining cerebrovascular risk in left atrial enlargement: integrating CKM framework and atrial cardiomyopathy phenotyping
We read with great interest the article “Left atrial enlargement and 1-year cerebrovascular events in subjects without atrial fibrillation: A prospective cohort study” by Clerici et al. [1]. The... more
Uric Acid, Homocysteine, and comorbidities in sarcoidosis
Sarcoidosis (SA) is a multisystem granulomatous disease with a highly variable clinical course. To-date, there are no validated circulating biomarkers capable of reliably predicting long-term outcome... more
SGLT2 inhibitors for acute heart failure: Efficacy established, but for whom and when?
Dear editor,
Beyond survival: nuances in the robustness of SGLT2 inhibitor evidence for HFpEF
We read with great interest the article by Zuin et al., which provides a rigorous evaluation of the robustness of randomized controlled trial (RCT) evidence for sodium-glucose co-transporter 2... 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
Universities and healthcare as privileged war targets. An urgent call for an international academic and institutional response to the attack on the Lebanese University and the health system
Attacks on universities during armed conflicts represent a profound threat to individual lives but also to the institutions that sustain knowledge, scientific progress, and social stability [1]. In... 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
Pathophysiological and prognostic implications of psychological distress in non-obstructive coronary syndromes: When the mind breaks the heart
Cardiovascular disease remains the leading cause of death worldwide [1], yet the field’s diagnostic and treatment strategies continue to target obstructive epicardial coronary artery disease... more
Methodological considerations for translating the STAMP score in intermediate-high-risk pulmonary embolism
We read with interest the study by Zuin and colleagues reporting the STAMP score for predicting 48-hour clinical deterioration in hemodynamically stable patients with intermediate-high-risk acute... more
Interpreting observational comparisons of DOACs and VKAs in kidney transplant recipients
Dear Editor,
From structure to function: A commentary on left atrial enlargement and cerebrovascular events and the potential value of left atrial strain
I read with great interest the article by Clerici and colleagues titled "Left atrial enlargement and 1-year cerebrovascular events in subjects without atrial fibrillation: A prospective cohort study... more
Tachycardia-induced electrocardiogram false positive diagnosis of left ventricular hypertrophy
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
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
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
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
Diagnosis, treatment and outcomes of euvolemic hyponatremia among geriatric hospitalised patients
Hyponatremia is the most common electrolytic disturbance among inpatients. It is associated with poor outcomes in frail older patients, even for mild disturbances. Prevalence increases with age, and... more
Sex-based differences and clinical outcomes in older adults with Candida bloodstream infection: a post-hoc secondary analysis of a multicentre study
Candida bloodstream infections (BSI) are a major cause of disease in hospitalized patients, with particularly high morbidity and mortality among older adults. However, the impact of biological sex on... more
Low-renin hypertension in incidental adrenal adenomas and response to aldosterone-targeted therapy: a prospective study
Incidental adrenal adenomas are common, yet renin status is infrequently assessed in hypertensive patients. Emerging evidence supports a spectrum of renin-independent aldosterone excess associated... more
Pharmacokinetic robustness of direct oral anticoagulants vs. phenprocoumon in the emergency setting: impact of renal and hepatic impairment
Direct oral anticoagulants (DOACs) are increasingly used, but their pharmacokinetic stability compared to vitamin K antagonists during acute illness remains poorly characterized. We aimed to evaluate... more
SARS-CoV-2 infection, viral burden, and variant-specific outcomes in hospitalized patients with heart failure
Patients with heart failure (HF) are particularly vulnerable to systemic infection; however, the combined impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral... more
Neutrophil-to-lymphocyte ratio: A disease severity biomarker in stable chronic obstructive pulmonary disease?
The neutrophil-to-lymphocyte ratio (NLR) is a biomarker of systemic inflammation that has been investigated in different chronic diseases. However, its role as biomarker of severity in patients with... more
Unlocking the benefits of allopurinol: the role of timely initiation and adherence in cardiovascular and renal outcomes in hyperuricemia
Hyperuricemia (HU) is a prevalent chronic metabolic condition characterized by elevated serum uric acid (SUA) levels [1]. The accumulation of monosodium urate crystals in joint and extra-articular... more
Vitamin D at hospital admission as an independent predictor of outcome of sepsis patients: Results of a secondary analysis from a “Need-Speed” trial prospective cohort
Sepsis is currently defined as a life-threatening organ dysfunction caused by a dysregulated host response to an infection, according to the Sepsis-3 consensus [1].
Diagnostic and therapeutic inertia for LDL cholesterol management of consecutively verified patients with acute myocardial infarction
The effective management of low-density lipoprotein cholesterol (LDL-C) after acute myocardial infarction (AMI) is a cornerstone of secondary prevention in contemporary cardiovascular care [1–5].... more
Eosinophil-linked pulmonary circulation in EGPA Improves under anti-IL-5/R therapy: A longitudinal study
Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare, multisystemic vasculitis that primarily affects small to medium-sized blood vessels. It is characterized by a well-defined triad of... more
Depressive symptoms in older patients undergoing electrical cardioversion of persistent atrial fibrillation. A possible association with clinical complexity, physical performance and inflammation
Atrial fibrillation is the most frequently sustained arrhythmia diagnosed in older individuals. In 15 years, the prevalence of AF greatly increased in subjects ≥85 years approaching 40% [1]. The... more
Asymptomatic atrial fibrillation in patients treated with BTK inhibitors in hematologic malignancies: a systematic review and metanalysis
Atrial fibrillation (AF) is a frequent complication of Bruton’s tyrosine kinase inhibitor (BTKi) therapy, yet the proportion of asymptomatic AF events in this setting remains poorly defined.
Fibroblast growth factor 23 and mortality, heart failure and cardiovascular events across the chronic kidney disease spectrum - A systematic review and meta-analysis
Chronic kidney disease (CKD) is a highly prevalent condition worldwide and is associated with a substantial cardiovascular burden and premature mortality [1,2]. The risk of cardiovascular events and... more
How many blood eosinophil measurements are needed to identify COPD patients eligible for biologic therapy? A multi-source decision analysis simulation
Biologic therapies for eosinophilic COPD require a blood eosinophil count (BEC) ≥300 cells/µL for eligibility. Landmark trials used a single screening measurement, yet BEC exhibits substantial within... more
Window of opportunity with abatacept in Rheumatoid arthritis-associated interstitial lung disease
ABA stabilised lung function, improved RA control, and reduced glucocorticoid use.Earlier initiation was associated with better DLCO preservation in adjusted analyses, suggesting a possible pulmonary... more
Cardiological hypertensive emergencies: Real word data compared to guidelines indications
Hypertensive Emergencies (HE) are defined as a severe elevation in Blood Pressure (BP), i.e. higher than 180/120 mmHg, associated with the evidence of a new or worsening Hypertension Mediated Organ... more
Polycythemia, SGLT2 inhibitors, and associated outcomes across the cardio-kidney-metabolic spectrum: a pooled analysis of randomized trials
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) increase hemoglobin and hematocrit, effects that have emerged as key statistical mediators of the cardiorenal benefits observed with SGLT2i... more
Recurrent t(9;12) translocation disrupting ACVRL1 intron 9 causes hereditary haemorrhagic telangiectasia missed by standard exome sequencing in four unrelated families
Hereditary haemorrhagic telangiectasia (HHT) (MIM #187300, ORPHA:774), also known as Rendu-Osler-Weber disease, is a rare autosomal dominant vascular disorder and the second most common inherited... more
Phase III maintenance telerehabilitation in elderly patients with chronic heart failure and type 2 diabetes (TELEMECHRON study)
Heart failure (HF) and type 2 diabetes (T2DM) are significant public health concerns. This study evaluated a 6-month home-based telemedicine program for older patients with combined HF and T2DM. The... more
Sex and 30-day mortality in elderly critically Ill adults: A frailty-adjusted multinational analysis with frequentist and bayesian estimates
Evidence on sex-related mortality differences in critically ill older adults is inconsistent, and frailty is rarely incorporated despite its major prognostic relevance in geriatric intensive care.
Prevalence and impact of psychiatric and neurocognitive comorbidities on pulmonary rehabilitation outcomes
Chronic respiratory diseases are associated with psychiatric/neurocognitive comorbidities; prevalence, clinical impact and responsiveness to in-patient pulmonary rehabilitation (PR) remain poorly... more
Pre-admission and in-hospital embolisms have a different prognostic significance in infective endocarditis
To describe the clinical profile of a large cohort of patients with left-sided IE (LSIE) and embolic events (EE); to explore differences between those who present with an embolism at admission (EEa)... more
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.
Innovative co-management between Neuro-ICU and Neurorehabilitation Unit in patients with severe acquired brain injury: enhancing clinical care pathways
Severe acquired brain injury (sABI) is a major challenge in post-acute care, affecting disability, quality of life, and healthcare resources. Traditional sequential care from acute units to... more
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
Anti-Ro/SSA and rheumatoid factor antibodies are associated with more severe lung involvement in patients with systemic sclerosis: a study from the EUSTAR database
In the large EUSTAR cohort, anti-Ro/SSA antibodies are detected in 15% of SSc patients and represent an independent risk factor for the presence and severity of ILD, particularly for cases with anti-... more
Development and external validation of an international score to predict cancer 1 year after venous thromboembolism
Routine cancer screening is not recommended after venous thromboembolism (VTE), but improved risk stratification may support tailored strategies.
Epicardial fat enhances prediction of exercise-induced hypertension and ventricular arrhythmias in asymptomatic normotensive individuals
Exercise stress testing is commonly used to evaluate the cardiovascular response to exercise and to identify coronary artery abnormalities and arrhythmias. The normal physiological response to... more
Exercise pulmonary hypertension in asymptomatic patients with HIV infection Insights from the RIGHT-NET registry
Asymptomatic patients with Human Immunodeficiency Virus (HIV) infection may remain at increased risk for pulmonary vascular disease. We therefore explored the pulmonary circulation in these patients... more
Pulmonary artery dilation in pulmonary arterial hypertension: haemodynamic determinants and association with sudden death
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by increased pulmonary vascular resistance and pressure, leading to right ventricular failure and reduced survival.... more
Sex-related disparities in sepsis in western Europe: A systematic review and meta-analysis
Sepsis is a potentially fatal systemic disease characterized by dysregulated immune response to infection [1]. Despite significant improvements in early detection and management, sepsis continues to... more
Discharge medical treatment implementation and predictors of a successful decongestion in patients with acute heart failure: first data from the BRING-UP 3 Heart Failure Study
Current discharge management of acute heart failure patients and clinical predictors of successful decongestion in a large Italian network of cardiology sites.AF, atrial fibrillation; BMI, body mass... more
Infectious complications of ANCA-associated vasculitis: Description and associated outcome
ANCA-associated vasculitis (AAV) are a systemic autoimmune disease that primarily affect small vessels, according to the Chapel Hill classification [1] and cause necrotizing vasculitis and result... more
Hypertension and blood pressure profiles in patients with acute intermittent porphyria: a prospective case-control study
Acute intermittent porphyria (AIP), a rare disorder of heme biosynthesis, may manifest with neurovisceral crises affecting autonomic regulation. This study aimed to assess blood pressure (BP) pattern... more
Early vasopressin administration in septic shock: A systematic review, meta-analysis, and multicenter retrospective observational study
To determine the optimal timing for initiating vasopressin in septic shock.
Relationship between T90 and systemic hypertension in patients with obstructive sleep apnea: Data from the European sleep apnea database
Obstructive sleep apnoea (OSA) is a sleep disorder characterized by a partial or complete cessation of upper airway during sleep. It is estimated that approximately one billion individuals between... more
Specialist or generalist management of emergency medical admissions - immediate and long-term outcomes
To study whether the admission of unselected emergency medical patients, under either a Consultant with General Medicine (GIM) or Specialist accreditation, influenced either short or longer-term all-... more
Hospital-to-community care pathways for patients with heart failure, an inter-society consensus document
Heart failure (HF), defined as the inability of the heart to meet the metabolic requirements of peripheral tissues, or to do so only at the expense of elevated ventricular filling pressures,... more
Effects of urine uromodulin levels on the association between sodium intake and ambulatory blood pressure in individuals with chronic kidney disease
In CKD, hypertension is often accompanied by sodium sensitivity. Uromodulin promotes sodium sensitivity by activating tubular sodium transporters (NKCC2, NCC). In the general population, individuals... 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
Prognostic impact of percutaneous coronary intervention in acute coronary syndrome vs. elective settings in heart transplant recipients
Cardiac allograft vasculopathy (CAV) affects >50% of patients following heart transplantation (HTX) within ten years and is one of the main reasons for late graft failure. The study aimed to... more
Fatty acid binding protein 4, resistin, diastolic dysfunction, and cardiovascular risk in patients with rheumatoid arthritis
Rheumatoid arthritis is a chronic autoimmune disease associated with CV system involvement [1]. Cardiovascular mortality and incidence of major adverse cardiovascular events (MACE) are increased by... 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
Prevalence of asymptomatic bacteriuria in high-risk hematological patients and its association with bacteremia: A prospective observational study on the need for antibiotic treatment
Antibiotic treatment for asymptomatic bacteriuria (AB) is not recommended in the general population, and its significance in oncohematological patients remains unclear.
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
Cardiovascular complications of antineoplastic treatment in prostate cancer patients and compensatory strategies for clinical management
Prostate cancer (PCa) represents one of the most prevalent malignancies affecting men worldwide and constitutes a major public health challenge. According to the most recent GLOBOCAN estimates,... more
Testosterone therapy in chronic kidney disease patients: an underutilized resource
Testosterone deficiency is highly prevalent in men with chronic kidney disease (CKD), affecting 30–70% of patients depending on disease stage and diagnostic criteria. Despite its frequency and... more
Understanding the Barriers to Translating Artificial Intelligence into the Clinical Laboratory
Artificial intelligence (AI) is having a transformational impact on society, yet its adoption in laboratory medicine has proceeded notably slower than in many other industries and even different... more
From technology adoption to noise reduction: Behavioral and psychological dimensions of clinical artificial intelligence deployment
For more than five decades, patients with the same condition have received markedly different care depending on which clinician they happen to see. This unwarranted clinical variation has been... more
Retinal microcirculation as a window to coronary artery disease
Coronary artery disease includes obstructive epicardial stenosis and ischemia with non-obstructive coronary arteries driven by microvascular dysfunction. Population screening is limited by the... more
Healthcare sustainability and the planetary crisis: A solution orientation
The climate crisis is an escalating public health emergency that demands urgent, systemic action from the healthcare sector. This article presents a solution-oriented framework for integrating... more
Linking the exposome to frailty: pathways, mechanisms, clinical implications, and prevention
Frailty is a state of heightened vulnerability arising from multisystem decline, in which minor stressors can precipitate disproportionate deterioration in function and health. It predicts falls,... more
Artificial intelligence in cardiovascular care for internal medicine: from promising algorithms to useful clinical services
Cardiovascular disease is a core part of internal medicine, where clinicians manage patients with multimorbidity, polypharmacy, repeated transitions of care, and a high burden of fragmented... more
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
Device-based therapies for cardiorenal syndrome: A comprehensive, mechanism-driven framework for next-generation decongestion
Cardiorenal dysfunction is a major contributor to morbidity, rehospitalization, and mortality in advanced heart failure (HF) and cardiogenic shock. Traditional decongestive approaches—loop diuretics... 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
Organization and delivery of home-based care for chronic obstructive pulmonary disease patients receiving long-term home non-invasive ventilation: a systematic review
The delivery of LTHNIV remains heterogeneous, even within countries. This variability in care organization and reporting mandates establishing harmonized, patient-centred pathways that integrate... 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