June 2024

Clinical Insights

Metabolic dysfunction-associated steatotic liver disease: Evolution of the final terminology

22 April 2024
Author(s): Piero Portincasa, Gyorgy Baffy

The liver is affected by metabolic dysfunction, featuring variable degrees of steatosis, inflammation, liver cell injury, and fibrosis. Since alcohol can cause similar changes in the liver, this... more

Clopidogrel induced reduction in neutrophil count: An overlooked beneficial effect?

6 April 2024
Author(s): Stefano De Servi, Antonio Landi, Stefano Savonitto

Atherosclerosis is an inflammatory disease of the arteries with endothelial dysfunction favouring leukocytes recruitment into the arterial wall and ensuing lesion growth. The role of neutrophils has... more


The optimal management of arterial blood pressure in acute stroke: A never-ending conundrum

10 May 2024
Author(s): Dimitra Papadimitriou, Eleni Korompoki, George Ntaios

Our understanding of the influence of blood pressure (BP) on the development of acute ischemic stroke and its significance in preventing further occurrences has prompted numerous researchers to... more

Obesity phenotyping at the “heart” of risk stratification

13 April 2024
Author(s): Paolo Sbraccia

The recognition of obesity as a chronic disease is increasingly gaining consensus within the scientific community, supported by mounting evidence of its significant impact on overall morbidity and... more

Pulmonary embolism: Put the sPESI into practice

9 April 2024
Author(s): David Jiménez

Since acute pulmonary embolism (PE) remains one of the leading causes of cardiovascular morbidity and mortality, the increased attention to risk prediction is well deserved [1]. Timely and accurate... more

Ideas and Opinions

What is disease modification and is this concept even helpful?

29 March 2024
Author(s): Maximilian Boesch, Florent Baty, Frank Rassouli, Martin H. Brutsche

An interesting session during a major scientific conference attended by the authors in fall 2023 discussed the concept of disease modification (DM). It became evident that DM is something that... more

Internal Medicine Flashcard

Gram staining of shoulder joint fluid

2 March 2024
Author(s): Yayoi Miyamatsu, Ryutaro Tanizaki

An 88-year-old Japanese man with Alzheimer's disease presented with fever that lasted for 1 day and arthralgia in the left shoulder. The patient had no history of trauma. On physical examination, his... more

A man with neurologic symptoms during liver abscess treatment

27 February 2024
Author(s): Yasuhiro Kano

An 84-year-old man was admitted for a pyogenic liver abscess and was treated with intravenous ceftriaxone and oral metronidazole 500 mg three times per day. The treatment proved effective; however,... more

Letter to the Editor

Early intervention is important when administering glucarpidase for methotrexate intoxication. Author's reply

29 April 2024
Author(s): G. Miceli, M. Daidone, F. Corpora, F. Di Gaudio, A. Tuttolomondo, METHOTRETOXY GROUP

Bettini and Rizzari recently responded with precision [1] to a letter our group sent to the European Journal of Internal Medicine regarding the possible benefits of administering the antidote... more

Patient-reported outcomes and apixaban therapy in older patients

11 March 2024
Author(s): Stefano Fumagalli, Giuseppe Di Pasquale, Simone Pupo, Giancarlo Agnelli, Niccolò Marchionni, APULEIO Study Investigators

Dear Editor

Admission in Internal Medicine: The Italian issue

9 March 2024
Author(s): Antonino Mazzone, Nicola Montano

We appreciated the editorial by Garattini et al. [1], about the redesign of the Emergency and Urgency system in Europe. In relation to this argument, we would like to underline some critical aspects... more

Minimally invasive puncture and drainage guided by 3D printed guide plate for the treatment of primary brain stem hemorrhage

8 March 2024
Author(s): Jun Shen, Quan Chen, Qiang Tong, Xiangyang Tian, Qiu Han

Primary brainstem hemorrhage manifests rapidly and is linked to poor prognosis, boasting a high fatality rate. It is an acute and lethal neurological disorder. With a hemorrhage volume exceeding 5 mL... more

Effect of sodium-glucose cotransporter-2 inhibitors on pulmonary arterial wedge pressure

8 March 2024
Author(s): Paschalis Karakasis, Dimitrios Patoulias, George Giannakoulas, Stephan Rosenkranz, Nikolaos Fragakis

Several recent landmark trials have demonstrated that treatment with sodium–glucose cotransporter 2 inhibitors (SGLT2i) confers significant benefits to patients with heart failure (HF) and/or type 2... more

Impact of the timing of initial antibiotic administration on community-onset pneumonia hospital mortality

7 March 2024
Author(s): J. Vasco Barreto, Cláudia Camila Dias, Teresa Cardoso

Timely administration of appropriate antibiotics (ATB) is critical for treatment success in severe infections [1]. In clinical practice, early ATB administration in pneumonia is a common-sense... more

HbA1c% level patterns as a marker for malignancy in diabetic patients

6 March 2024
Author(s): Adi Rotkopf, Ela Giladi, Avishay Elis

Tumor-induced hypoglycemia is an uncommon phenomenon, usually resulting from insulin-secreting tumors [1]. However, it can also develop in other tumors, exclusively due to increased glucose... more

Effect of non-vitamin K oral anticoagulants for thrombosis prophylaxis in pediatric heart diseases

4 March 2024
Author(s): Hong Hong, Wengen Zhu, Zhongli Xie

Non-vitamin K oral anticoagulants (NOACs, namely dabigatran, rivaroxaban, apixaban, and edoxaban) have been widely recommended in preventing thromboembolic events among adult patients with atrial... more

Role of emergency department physician in the management of osteoporotic fragility fractures in the elderly trauma patient

20 February 2024
Author(s): Tarik Wasfie, Holland Korbitz, Sara N. Nesheiwat, Jennifer Hille, Avery Jackson

Worldwide, half of females above the age of fifty years and 25 % of males over 65 years will sustain a fracture secondary to osteoporosis during their lifetime, with a refracture rate of 50 % in... more

Outcomes of initial intravenous diuretic dose in acute heart failure

20 February 2024
Author(s): Houssam Bendoudouch, Badre El Boussaadani, Loubna Hara, Amine Ech-chenbouli, Zainab Raissouni

We would like to share with you the outcomes of our study revolving around the routine use of diuretics in acute heart failure (AHF). The topic is of great interest, and although many studies and... more

Original Article

Risk prediction of major cardiac adverse events and all-cause death following covid-19 hospitalization at one year follow-up: The HOPE-2 score

11 March 2024
Author(s): Francesco Santoro, Ivan J. Núñez-Gil, María C. Viana-Llamas, Emilio Alfonso-Rodríguez, Aitor Uribarri, Victor Manuel Becerra-Muñoz, Gisela Feltes Guzman, Nicola Di Nunno, Javier Lopez-Pais, Enrico Cerrato, Gianfranco Sinagra, Massimo Mapelli, Riccardo M. Inciardi, Claudia Specchia, Chiara Oriecuia, Natale Daniele Brunetti

COVID-19 is an infectious disease that has become pandemic from 2020. Data on acute outcome, showed that among hospitalized patients mortality rates were 15.8 % in USA[1] and 22 % in Europe [2,3].... more

Cardiometabolic risk stratification using a novel obesity phenotyping system based on body adiposity and waist circumference

6 March 2024
Author(s): Javier Gómez-Ambrosi, Victoria Catalán, Beatriz Ramírez, Laura Salmón-Gómez, Rocío Marugán-Pinos, Amaia Rodríguez, Sara Becerril, Maite Aguas-Ayesa, Patricia Yárnoz-Esquíroz, Laura Olazarán, Carolina M. Perdomo, Camilo Silva, Javier Escalada, Gema Frühbeck

Over the past decades, obesity has been increasingly prevalent throughout the world. Between 1975 and 2014, the prevalence of obesity in adults, defined as a body mass index (BMI) ≥30 kg/m²,... more

Personalized decision support system for tailoring IgA nephropathy treatment strategies

4 March 2024
Author(s): Jiaxing Tan, Rongxin Yang, Liyin Xiao, Yuanlin Xia, Wei Qin

Immunoglobulin A nephropathy (IgAN), considered the most prevalent form of primary glomerular disease worldwide, is characterized by the deposition of IgA in the mesangial area of the glomeruli and... more

Comparison of diagnostic spectrum between inflammation of unknown origin and fever of unknown origin: A systematic review and meta-analysis

1 March 2024
Author(s): Albrecht Betrains, Lien Moreel, Catharina M. Mulders-Manders, Paul G. Auwaerter, Joaquim Torné-Cachot, Friedrich Weitzer, Teruhiko Terasawa, Kim H. Ly, Verena Schönau, Daniel Blockmans, William F. Wright, Chantal Rovers, Steven Vanderschueren

Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are two clinical syndromes that are separated by an arbitrary temperature threshold. They share a common spectrum of underlying... more

TSLP is localized in and released from human lung macrophages activated by T2-high and T2-low stimuli: relevance in asthma and COPD

24 February 2024
Author(s): Luisa Canè, Remo Poto, Francesco Palestra, Marinella Pirozzi, Seetharaman Parashuraman, Ilaria Iacobucci, Anne Lise Ferrara, Antonello La Rocca, Edoardo Mercadante, Piero Pucci, Gianni Marone, Maria Monti, Stefania Loffredo, Gilda Varricchi

The human lung is a remarkable organ that filters up to 10,000 liters of air daily, interfacing with the exposome [1]. Several environmental factors, including airborne pollutants, particulate matter... more

Primary Sjögren's syndrome in Italy: Real-world evidence of a rare disease through administrative healthcare data

17 February 2024
Author(s): Giacomo Cafaro, Carlo Perricone, Giulia Ronconi, Silvia Calabria, Letizia Dondi, Leonardo Dondi, Antonella Pedrini, Immacolata Esposito, Roberto Gerli, Elena Bartoloni, Nello Martini

Primary Sjögren's syndrome (pSS) is a chronic systemic autoimmune disease with a protean clinical phenotype ranging from very mild manifestations of dry eye and dry mouth to life-threatening major... more

Performance of the Simplified Pulmonary Embolism Severity Index in predicting 30-day mortality after acute pulmonary embolism: Validation from a large-scale cohort

12 February 2024
Author(s): Yu Zhang, Yinong Chen, Hong Chen, Chunling Dong, Xiaoyun Hu, Xiaomao Xu, Ling Zhu, Zhe Cheng, Dingyi Wang, Zhu Zhang, Wanmu Xie, Jun Wan, Peiran Yang, Shengfeng Wang, Chen Wang, Zhenguo Zhai, CURES investigators

Acute pulmonary embolism (PE) can be life-threatening in certain situations. Recent epidemiological data suggest that PE can affect approximately 300,000 patients and may result in 60,000 to 100,000... more

Impact of early initiation of ezetimibe in patients with acute coronary syndrome: A systematic review and meta-analysis

9 February 2024
Author(s): Kunal Mahajan, Lakshmi Nagendra, Anil Dhall, Deep Dutta

Patients with acute coronary syndrome (ACS) are at maximal risk of recurrent events in the initial few weeks following the index coronary event, with some studies suggesting that the risk may be as... more

The yield of total body CT in the workup of fever of unknown origin in hospitalized medical patients

1 February 2024
Author(s): Jacob David Miller, Naomy Moskovich, Lior Nesher, Victor Novack

A fever of an Unknown Origin (FUO) is defined as a rectal temperature above 38.3 on at least two occasions with an illness duration of over three weeks and no apparent cause after one week of... more

The usefulness of 18F-FDG-PET/CT in detecting musculoskeletal and vascular involvement in patients with polymyalgia rheumatica receiving glucocorticoids

31 January 2024
Author(s): Ana Serrano-Combarro, Diana Prieto-Peña, Isabel Martínez-Rodríguez, Néstor Martínez-Amador, Javier Loricera, Ricardo Blanco

Polymyalgia rheumatica (PMR) is a relatively common disease among European patients older than 50 years [1]. It is an inflammatory disorder characterized by severe pain and stiffness affecting mainly... more

Neurological hypertensive emergencies: Correlation of blood pressure values with in-hospital outcomes in ischemic stroke

30 January 2024
Author(s): Valentina Giani, Tommaso Valobra, Nicolò Capsoni, Michele Galasso, Lorenzo De Censi, Cecilia Ferretti, Andrea Sultana, Annalisa Giacalone, Ilaria Garofani, Michele Bombelli, Chiara Ceresa, Silvia Gheda, Elio Clemente Agostoni, Filippo Galbiati, Cristina Giannattasio, Alessandro Maloberti

Few certainties exist regarding optimal management of Blood Pressure (BP) in the very first hours after an ischemic stroke and many questions remain still unanswered. Our work aimed to evaluate the... more

Review Article

The complement system in the pathogenesis and progression of kidney diseases: What doesn't kill you makes you older

8 March 2024
Author(s): Emma Diletta Stea, Giuseppina D'Ettorre, Adele Mitrotti, Loreto Gesualdo

The Complement System is an evolutionarily conserved component of immunity that plays a key role in host defense against infections and tissue homeostasis. However, the dysfunction of the Complement... more

Challenges of antimicrobial stewardship among older adults

14 February 2024
Author(s): Joana Alves, Virginie Prendki, Marie Chedid, Dafna Yahav, Davide Bosetti, Jordi Rello, ESCMID Study group of infections in the elderly (ESGIE)

Antimicrobial resistance is a global public health concern that threatens our ability to treat bacterial infections successfully [1]. Whereas antimicrobial optimization in the hospital was reported... more

Treatment in primary biliary cholangitis: Beyond ursodeoxycholic acid

2 February 2024
Author(s): M.C. van Hooff, E. Werner, A.J. van der Meer

Primary biliary cholangitis (PBC), which was formerly called primary biliary cirrhosis, is a rare chronic immune-mediated liver disease [1,2]. A recent meta-analysis indicated that the pooled global... more


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