June 2024
140 ArticlesClinical Insights
Sepsis scoring systems: Mindful use in clinical practice
Sepsis is a challenging condition: the high prevalence and the complexity of its clinical presentation lead to high morbidity and mortality. The most updated definition of sepsis and septic shock,... more
Towards precision medicine in COPD: Targeting type 2 cytokines and alarmins
Chronic obstructive pulmonary disease (COPD) is a main global epidemic increasing as population age and affecting approximately 10% of subjects over 45 years. COPD is a heterogeneous inflammatory... more
Metabolic dysfunction-associated steatotic liver disease: Evolution of the final terminology
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?
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
Commentary
Statins to prevent anthracycline-related myocardial toxicity: The jury is still out
Anthracyclines are cytostatic antibiotics [1] that have been used since the 1970s. These anticancer agents still represent the backbone of many chemotherapy-based strategies with a curative intent in... more
Use simple tools to improve complex conditions
"Medicine is both an art and a science; the art of listening, the art of understanding, and the art of predicting." (Hippocrates)
Low-dose colchicine for chronic stable atherosclerosis: Under-appreciated and under-prescribed
In June of 2023, the United States Food and Drug Administration (FDA) approved the use of low dose colchicine as the first anti-inflammatory drug to treat atherosclerotic disease. Specifically, “... more
The optimal management of arterial blood pressure in acute stroke: A never-ending conundrum
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
Artificial intelligence supported ultrasonography: Can it be the solution for early and accurate diagnosis of steatotic liver disease?
Last December, a multi-society Delphi consensus reported on the new nomenclature and definitions of fatty liver disease [1]. Accordingly, the previous terms of non-alcoholic fatty liver disease (... more
Obesity phenotyping at the “heart” of risk stratification
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
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
Corrigendum
Corrigendum to “Systemic diseases associated with a diagnosis of achalasia: A case-control study with the All of Us research program” [European Journal of Internal Medicine 104C (2022) 125–127]
The authors regret that one of the tables in the above published article. The correct version of the table is below:
Ideas and Opinions
What is disease modification and is this concept even helpful?
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
Acrocyanosis and edema in a male with thrombocytosis, polyneuropathy and monoclonal gammopathy
A 77-year-old male consulted for edema, skin changes, asthenia, anorexia, weight loss and leg corkiness of more than one year of evolution. About two years earlier, primary hypothyroidism was... more
Black fingernails
A 60-year-old man presented with a 2-weeks history of darkening and tenderness of fingernails. He was diagnosed with local advanced squamous cell lung cancer and initiated neoadjuvant chemotherapy (... more
Patchy reversible renal vasoconstriction
A 24-year-old male patient presented to the emergency department with left-sided back pain and bilateral lower limb myalgia. The previous day, he was involved in a head-on motor-vehicle collision at... more
A man with fever, headache, and ulcers
A 25-year-old male attended our department because of a 2-week history of malaise, severe headache, myalgia, and low-grade to spiking fevers. He had no medical history, was not taking any medications... more
Surfers' myelopathy
A 29-year-old Japanese man presented with bilateral weakness in the legs and low back pain. On the day of admission, the patient had gone surfing for the first time in his life and developed sudden... more
Gram staining of shoulder joint fluid
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
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
Internal Medicine Flashcards
An unexpected detour: Acute throat pain and trismus in a fast-food deliveryman
A 40-year-old man fast-food deliveryman presented to the emergency department with a severe sore throat and trismus. His-symptoms rapidly escalated over 24 h, impairing his ability to speak, eat, and... more
Invited Review Article
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
Pitfalls in the detection of anti-Nucleolar Organizer Region 90 (NOR90) antibodies
Dear Editor,
Risk of psoriatic arthritis development with interleukin-17 inhibitors compared to tumour necrosis factor inhibitors
Psoriatic arthritis (PsA) is one of the most important comorbidities in patients with psoriasis (PsO), with approximately one third of PsO patients developing arthritis over their whole lifetime [1... more
Direct oral anticoagulants or vitamin K antagonists in adult patients with congenital heart disease?
Dear Editor,
Divergent views on prescription adherence: A qualitative comparison of perspectives from the patient, pharmacist, and physician triad
Up to 70 % of patients fail to follow prescribed regimens [1], resulting in detrimental health and economic consequences. While existing adherence research often focuses on either the traditional... more
Myocardial infarction in foreign-born individuals in the total population of Sweden
Cardiovascular diseases (CVD) are still frequent globally with a high mortality rate, even if the incidence has decreased since the 1980s in Europe, especially in Northern Europe [1], including a... more
Beneficial effects of early low-dose methylprednisolone with long-term treatment in ARDS
Since the concept of acute respiratory distress syndrome (ARDS) was first proposed by Ashbaugh in 1967 [1], it has been refined several times for better reflect the phenotype in recent decades. The... more
Pioneering the future: CRISPR-Cas9 gene therapy for hereditary hemorrhagic telangiectasia
We read with great interest the article titled “New genetic drivers in hemorrhagic hereditary telangiectasia’, recently published in the European Journal of Internal Medicine. Cerdà and colleagues... more
The role of age in recognizing cognitive impairment in the emergency department
I read with interest the study by Espejo et al. published in the European Journal of Internal Medicine. In this study, patients presenting to the emergency department with vague symptoms who met the... more
Cardiovascular outcome with SGLT2i and GLP1RA
Dear editor,
Clostridioides difficile infection as a potential trigger for Familial Mediterranean Fever attacks and fecal transplantation as a rescue
Sir,
Evaluating cognitive impairment in emergency department: Challenges with screening tools
We read the article by Tanguy Espejo et al. with great interest [1]. The authors have performed admirably in achieving the purpose of the research. The article concludes that Clock Drawing Test (CDT... more
Definition of an algorithm to identify patients with sickle-cell disease in the French National Health Database
Sickle cell disease (SCD) is the most frequent inherited disease with monogenic transmission (300,000 newborns per year in the world) [1]. SCD is due to a mutation on both alleles of the gene coding... more
Navigating the challenges: Would onboarding bootcamps enhance comfort and wellbeing of residents in medicine?
Medical interns (first-year residents) and residents (second-to fourth-year residents) in France are junior medical staff in charge of overseeing up to 200 medicine beds during night shifts, with no... more
Dual tobacco smoking, electronic cigarette use and COVID-19 outcomes
We congratulate Scala and colleagues on the publication of their paper on electronic cigarette (e-cigarette) use and Coronavirus Disease 2019 (COVID-19) outcomes [1]. Scala et al. focused on e-... more
Survival analysis of diabetes cardiovascular outcome trials using reconstructed Kaplan-Meier curves
The management of type 2 diabetes mellitus (T2DM) has witnessed a treatment paradigm in the light of recent cardiovascular outcomes trials (CVOTs) which have placed more emphasis on cardiovascular... more
Multi-organ abnormalities assessed by a single MRI scan in individuals with blood cancer
During the COVID-19 pandemic individuals with all blood cancers were classified as clinically vulnerable and at high risk of complications and death. Our study sought to determine if individuals with... more
The association between long-acting muscarinic antagonist-based therapy and the risk of urinary tract infection in patients with chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a common respiratory disease featuring persistent respiratory symptoms and progressive airflow limitation. Long-acting muscarinic antagonists (LAMAs)... more
Comparison of factor X inhibitors versus vitamin K antagonists in atrial fibrillation patients on dialysis
Atrial fibrillation (AF) is a common heart rhythm disorder that occurs in patients with end-stage kidney disease (ESKD). Recent studies have shown that the incidence of AF increases in patients... more
Stenting improves cardiovascular clinical outcomes in patients with middle aortic syndrome caused by aortoarteritis: Long-term results
Takayasu arteritis (TA), also known as aortoarteritis, often involves the middle aorta and manifests as middle aortic syndrome (MAS) [1]. Owing to persistent and severe hypertension attributed to... more
Self-publishing in the history of medicine: The paradoxical case of Edward Jenner's science-changing monograph (1798)
According to the Cambridge Dictionary, self-publishing is regarded as the act of arranging or paying for one's ‘own book to be published, rather than having it done by a publisher’ [1]. Whether it be... more
Nitrous oxide toxicity in adult patients with sickle cell disease
Sickle cell disease (SCD) is an inherited autosomal recessive disorder that confers atypical haemoglobin called haemoglobin S, which can distort red blood cells in sickle-shaped cells and modifies... more
Kidney function and sarcopenia: A risk assessment. Author's reply
To the Editor
Environmental costs of noninvasive cardiac testing for acute chest pain after ED discharge
Acute chest pain (ACP) accounts for more than 7 million Emergency Department (ED) visits each year in the US [1]. Patient management initially relies on the estimated risk of short term... more
Monkeypox: A risk factor for inflammatory diseases?
I read with interest the article by Patauner and colleagues [1]. Even though most cases have a full recovery without significant sequelae, little is known about the mid- and long-term outcome of... more
The new nomenclature SLD and categories provided better classification for elderly Chinese with liver steatosis
We were inspired by the recent article by van Erpecum and Dalekos [1], which proposed new horizons in the diagnosis and management of patients with metabolic dysfunction-associated steatotic liver... more
Prevalence and outcome of occult giant cell arteritis
Giant cell arteritis (GCA) is a large vessel vasculitis that preferentially affects the cranial arteries and the aorta and its proximal branches [1]. Presenting features of GCA may include symptoms... more
Early intervention is important when administering glucarpidase for methotrexate intoxication. Author's reply
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
Use of direct oral anticoagulants in patients with left ventricular thrombus
Left ventricular thrombus (LVT), one of the most feared and common complications of acute myocardial infarction (AMI), still causes morbidity and mortality in a proportion of patients despite the... more
Short-term trends in gastric cancer incidence after insurance coverage expansion for Helicobacter pylori eradication in Japan
Helicobacter pylori (H. pylori) infection is a risk factor for gastric cancer (GC). The International Agency for Research on Cancer has recommended population-based screening and eradication of H.... more
Synergistic effect of spironolactone/ARB on cardiovascular endpoints in heart failure patients with preserved ejection
Currently, treatment options for HFpEF are limited. Several randomized controlled trials of RAAS inhibitors for HFpEF, including perindopril, candesartan, irbesartan, and spironolactone, have yielded... more
Effect of direct oral anticoagulants in patients with cerebral venous thrombosis
Cerebral venous thrombosis (CVT) is a rare clotting disorder that mainly affects younger females. In order to achieve recanalization of cerebral veins and reduce the risk of venous thromboembolism (... more
‘Impact of Haemophilus spp. as a sexually transmitted disease’
Despite the increasing prevalence of Haemophilus spp. isolates in urethral exudates in our health area, a city with more than 160,000 inhabitants in the south of Madrid, there are still uncertainties... more
The clinical spectrum of thymoma-associated immunodeficiency: Good syndrome and beyond
Good syndrome (GS) is an acquired adult-onset combined immunodeficiency typically characterized by thymoma and hypogammaglobulinemia. Other clinical manifestations include recurrent infections,... more
Interaction between age and efficacy of dual antiplatelet therapy in non-cardioembolic minor acute ischemic stroke or high-risk transient ischemic attack
Short-term (21–90 days) dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel is recommended for patients with minor non-cardioembolic ischemic stroke [National Institutes of Health Stroke... more
Infective endocarditis complicated with heart failure
Infective Endocarditis (IE) is a clinical entity with high morbidity and mortality despite advances in diagnosis and medical and surgical treatment alternatives. Globally, the prevalence is estimated... more
Resuming antiplatelet therapy in patients with intracranial hemorrhage
More than a third of adults who experience primary intracranial hemorrhage (ICH) in high-income countries are prescribed antiplatelet medications due to similar risk factors shared with vascular... more
Polyvalent immunoglobulin use: Issues between good use, economic constraints and shortages over 25 years
Human normal polyvalent immunoglobulins (HNIg) have been widely used for the treatment of primary and secondary immune deficiencies. They also possess immunomodulatory properties and are employed in... more
A prediction model for differentiating recurrent Kawasaki disease from other febrile illnesses
Kawasaki disease (KD) can result in coronary artery aneurysms (CAA), elevating the risk of coronary artery thrombosis in the later stage [1]. Intravenous immunoglobulin within the first 10 days after... more
Long-term compliance of lipoprotein apheresis patients. What is health-related quality of life?
Clinical research and scientific evidence confirm the role of low-density lipoprotein cholesterol (LDL-C) and lipoprotein (a) [Lp(a)] as a risk factor for atherosclerosis and cardiovascular events.... more
Diagnosis traps for patients with acquired NLRP3 mutation
Cryopyrinopathies (cryopyrin-associated periodic syndrome, CAPS), also referred to as NLRP3 mutation-associated autoinflammatory diseases (NLRP3-AID), have historically been described as three... more
Antibiotic shortages in Europe: Another question of prices?
Pharmaceutical shortages are currently a worldwide issue despite advancement in manufacturing and transport technologies [1]. Surprisingly, shortages still happen in many high-income countries too... more
Changes in the Dynamic Trajectory of Remnant Cholesterol Affect the Occurrence of Nonalcoholic Fatty Liver Disease
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide, affecting approximately 20–25 % of the global adult population [1]. Epidemiological evidence showed that,... more
Patient-reported outcomes and apixaban therapy in older patients
Dear Editor
Chronic limb-threatening ischemia with no revascularization option: Result from a multidisciplinary care model
Lower extremity chronic limb-threatening ischemia (CLTI) is the most advanced form of peripheral arterial disease (PAD). Historically, development of CLTI was associated with 1-year amputation rates... more
Development and validation of a clinical risk score for all-cause mortality in patients with acquired long QT syndrome
Dear editor,
Admission in Internal Medicine: The Italian issue
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
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
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
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
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
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
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
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
Safety of apixaban and rivaroxaban in patients with atrial fibrillation on hemodialysis
Dear Editor,
Kidney function and sarcopenia: A risk assessment
I read with great interest the paper by Moreno-González et al. [1], who investigated the association between sarcopenia and kidney function in older adults, aged ≥75 years. Estimated glomerular... more
Original Article
Effectiveness Of Tocilizumab In Aortitis And Aneurysms Associated With Giant Cell Arteritis
Giant Cell Arteritis (GCA) is a vasculitis involving the large and medium vessels, especially the extracranial branches of the carotid arteries, and particularly, the temporal artery. Arterial wall... more
Red flags for clinical suspicion of eosinophilic granulomatosis with polyangiitis (EGPA)
Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome [1], is a systemic vasculitis classified as an anti-neutrophil cytoplasm antibody (ANCA)-associated... more
Low-dose ondansetron: A candidate prospective precision medicine to treat alcohol use disorder endophenotypes
Alcohol is an addictive substance that contributes to millions of deaths and disabilities worldwide [1]. Excessive alcohol use accounts for 5.1 % of the global disease burden and is the primary risk... more
Beta-cell function and glucose metabolism in patients with chronic pancreatitis
Diabetes of the exocrine pancreas (DEP), - also defined as pancreatic, pancreatogenic, or type 3c diabetes - arises from the structural or functional loss of insulin secretion secondary to exocrine... more
Efficacy and safety of rituximab induction therapy and effect of rituximab maintenance for IgG4-related disease: a systematic review and meta-analysis
IgG4-related disease (IgG4-RD) is a rare systemic fibro-inflammatory condition characterized by widespread lesions that exhibit specific histological characteristics [1]. This disease is typically... more
Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study
Acute aortic syndromes (AASs), including aortic dissection (AD), intramural aortic haematoma (IMH) and penetrating aortic ulcer (PAU), affect 5–7/100,000 individuals/year [1]. They are time-dependent... more
A group-based intervention for diabetes-related emotional distress among emerging adults with type 1 diabetes: A pilot study
Emerging adulthood is a critical period with increased risk of acute and chronic health complications, psychological problems, and psychosocial issues for emerging adults with type 1 diabetes (T1D) [... more
Relationship between degree of risk factor control and all-cause mortality in individuals with type 2 diabetes: A prospective cohort study
Risk of death is approximately twice higher in people with diabetes than in those without, mainly though not exclusively due to an increased risk of cardiovascular disease (CVD) [1]. However, death... more
Association between socioeconomic and psychosocial factors with use of interventional and surgical treatments and outcomes in patients with myocardial infarction – Inpatient data of the largest European health care system
Myocardial infarction (MI) remains a leading contributor for morbidity and mortality worldwide [1,2]. While the medical progress regarding diagnostic and therapeutic approaches has improved outcomes... more
Targets for deprescribing in patients with hypertension and reflex syncope
In hypertensive patients with reflex syncope, detection of transient hypotension as possible trigger mechanism of syncope may prompt deprescribing of hypotensive medications to counteract the risk of... more
Early palliative care program in idiopathic pulmonary fibrosis patients favors at-home and hospice deaths, reduces unplanned medical visits, and prolongs survival: A pilot study
Idiopathic Pulmonary Fibrosis (IPF) is a relentlessly progressive fibrotic interstitial lung disease (ILD) with an unfavourable prognosis1. The median survival is 3 to 5 years form the time of... more
Comparison of different frailty instruments for prediction of functional decline in older hypertensive outpatients (HYPER-FRAIL pilot study 2)
Frailty is a geriatric syndrome characterized by a cumulative decline in multiple body systems, which results in the reduction of individuals’ physiological functional reserve with increased... more
Combining loop with thiazide diuretics in patients discharged home after a heart failure decompensation: Association with 30-day outcomes
Heart failure (HF) is a highly prevalent cardiovascular condition in people over 65 years old [1]. Mortality associated with HF decompensations (acute HF; AHF) is high, with 30-day and 1-year all-... more
Acute kidney injury predicts mortality in very elderly critically-ill patients
The age of patients admitted to intensive care units (ICUs) has witnessed a significant increase in the last decades. Recent statistics reveal that ten to fifteen percent of ICU-admitted patients are... more
Effects of a medical admission unit on in-hospital patient flow and clinical outcomes
In the last decades the epidemiological transition has brought to several acute complex (elderly, frail and poli-pathological) patients that access to Emergency Departments (ED) and require... more
Cardiovascular events after exacerbations of chronic obstructive pulmonary disease: Results from the EXAcerbations of COPD and their OutcomeS in CardioVascular diseases study in Italy
Chronic obstructive pulmonary disease (COPD) is a chronic progressive disorder of the lungs with high global morbidity and mortality [1]. The burden and prevalence of COPD are increasing likely due... more
Development and validation of a novel sleep health score in the sleep heart health study
Sleep is closely related to health [1]. Middle-aged and elderly people, especially the elderly, often suffer from sleep disorders, such as sleep apnea and insomnia [2]. These sleep disorders likely... more
C-reactive protein is more suitable than Serum Amyloid A to monitor crises and attack-free periods in Systemic Auto-Inflammatory Diseases.
Systemic Auto-Inflammatory Diseases (SAID) are diseases with a deregulation of the innate inflammatory response characterized by recurrent fever episodes with systemic inflammation without infectious... more
Hepatic T1-time, cardiac structure and function and cardiovascular outcomes in patients with dilated cardiomyopathy
Liver damage frequently occurs in patients with cardiovascular (CV) disease and predicts worse clinical outcomes [1,2]. In this context, liver damage may be mainly caused by elevated hepatic venous... more
Incidence and predisposing factors of extra-articular manifestations in contemporary rheumatoid arthritis
Rheumatoid arthritis (RA) is the most prevalent of the chronic inflammatory joint diseases, with gradual destruction of joints and an increased risk of co-morbidity, predominantly cardiovascular... more
Consecutive or selectively included high bleeding risk patients in the MASTER DAPT screening log and trial
Screening logs have the potential to appraise the actual prevalence and distribution of predefined patient subsets, avoiding selection biases, which are inevitably and potentially present in... more
Iron deficiency and all-cause mortality after myocardial infarction
Iron is an essential element required for normal mitochondrial function [1,2] oxygen transport, synthesis of proteins and nucleic acids, and normal immune system function. Although iron is... more
Direct oral anticoagulant-associated bleeding complications in patients with gastrointestinal cancer and venous thromboembolism
Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), constitutes the second leading cause of morbidity and mortality in patients with cancer besides the... more
Serum IL-6 level trajectory for predicting the effectiveness and safety of tocilizumab in the treatment of refractory Takayasu arteritis
Takayasu arteritis (TAK) is a chronic systemic granulomatous vasculitis that mainly affects aorta and its major branches in young women [1]. The inflammatory damage of arteries can develop... more
Cardio-protective effects of statins in patients undergoing anthracycline-based chemotherapy: An updated meta-analysis of randomized controlled trials
Cancer and cardiovascular disease are two leading causes of mortality worldwide, and cancer survivors have an increased cardiovascular risk due to shared risk factors with cardiovascular disease and... more
Prognostic value of 18 FDG-PET at diagnosis and follow-up in giant cell arteritis: An observational restrospective study
To evaluate the ability of 18FDG PET/CT, at diagnosis of giant cell arteritis (GCA) and during follow-up, to predict occurrence of relapse in large-vessel GCA (LV-GCA).
Identifying COPD patients with poor health status and low exercise tolerance through the five-repetition sit-to-stand test and modified Medical Research Council Dyspnea Score
Chronic obstructive pulmonary disease (COPD) is a heterogeneous and systemic condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production) due to abnormalities of the... more
Prognostic impact of hypertension grading
Notwithstanding the continuous relation between blood pressure (BP) and the risk of cardiovascular disease [1,2], Guidelines generally grade hypertension in untreated subjects by arbitrary categories... more
Prognostic value of cognitive impairment, assessed by the Clock Drawing Test, in emergency department patients presenting with non-specific complaints
Cognitive impairment (CI) is common among older patients presenting to the emergency department (ED) [1–6]. Up to 40% of older ED patients have some degree of CI at presentation, particularly due to... more
Clinical significance of the anti-Nucleolar Organizer Region 90 antibodies (NOR90) in systemic sclerosis: Analysis of the European Scleroderma Trials and Research (EUSTAR) cohort and a systematic literature review
The anti-Nucleolar Organizer Region 90 antibodies (NOR90) are rare antinuclear antibodies (ANA) reported in systemic sclerosis (SSc). Especially due to low prevalence, the clinical relevance of NOR90... more
Evolution and outcomes of aortic dilations in giant cell arteritis
Giant cell arteritis (GCA) is a systemic vasculitis that typically affects large and medium vessels in patients over 50 years of age [1–3]. In addition to the cephalic presentation mainly explained... more
Relation of plasma neuropeptide-Y with myocardial function and infarct severity in acute ST-elevation myocardial infarction
Acute myocardial infarction is associated with high levels of cardiac sympathetic stimulation [1], which is strongly related to poor outcome [2]. Prolongation of this sympathetic drive leads to the... more
The interplay between subclinical hypothyroidism and poor sleep quality: A systematic review
Sleep and the hypothalamic-pituitary-thyroid (HPT) axis show a mutual interdependence in normal physiological functioning [1]. While the interconnection between overt hypo- and hyperthyroidism and... more
Serum potassium abnormalities, renin-angiotensin-aldosterone system inhibitor discontinuation, and clinical outcomes in patients with chronic cardiovascular, metabolic, and renal conditions: A population-based analysis
The inhibition of the renin-angiotensin-aldosterone system (RAAS) is a essential aspect of the medical treatment of several chronic cardiovascular, metabolic, and renal conditions. It plays a vital... more
Sex-based differences in the comprehensive geriatric assessment in elderly hospitalized patients with non-valvular atrial fibrillation
Atrial fibrillation (AF) represents the most common supraventricular arrhythmia in elderly [1]. It was estimated that 1 % to 3 % of the world population suffers from AF, with higher prevalence in the... more
The correlation of atherogenic index of plasma with non-obstructive CAD and unfavorable prognosis among patients diagnosed with MINOCA
Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a complex and intriguing phenomenon with diverse underlying pathophysiological mechanisms that challenge conventional... more
Recurrence of hypertriglyceridemia-associated acute pancreatitis: A multicenter, prospective cohort study
Hypertriglyceridemia (HTG) is a well-established etiology of acute pancreatitis (AP), accounting for approximately 4.7–14.3 % of all cases globally [1,2]. Recurrent acute pancreatitis (RAP) is one of... more
Safety and compliance of long-term low-dose ondansetron in alcohol use disorder treatment.
There are geographical differences regarding alcohol-associated morbidity and mortality, the WHO European Region being the most affected area [1]. Europe leads globally in per capita alcohol... more
Visit-to-visit blood pressure variability is associated with intrinsic capacity decline: Results from the MAPT Study
Blood Pressure (BP) values fluctuate over time around average values, as a consequence of the interaction between multiple intrinsic and environmental factors affecting the cardiovascular system [1... more
Early and accurate diagnosis of steatotic liver by artificial intelligence (AI)-supported ultrasonography
Nonalcoholic fatty liver disease (NAFLD) refers to liver steatosis, i.e., over-storage of fat, mainly triglycerides, in the hepatocytes, without other causes for secondary hepatic fat accumulation [1... more
Risk prediction of major cardiac adverse events and all-cause death following covid-19 hospitalization at one year follow-up: The HOPE-2 score
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
Prognosis of COVID-19 severity using DERGA, a novel machine learning algorithm
The Coronavirus Disease 2019 (COVID-19) pandemic, caused by the novel coronavirus Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV-2), has had a profound impact on healthcare systems... more
Cardiometabolic risk stratification using a novel obesity phenotyping system based on body adiposity and waist circumference
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
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
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
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
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
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
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
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
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
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
A systematic literature review of randomised controlled trials evaluating colchicine for cardiovascular prevention: There is an elephant in the room
Gout is a chronic inflammatory disease burdened by a higher CV risk compared to the general population [1] and this excess risk cannot be explained only by the prevalence of traditional risk factors... more
Practice Guidelines
2024 European Society of Hypertension clinical practice guidelines for the management of arterial hypertension
The European Society of Hypertension (ESH) reported in 2023 its current Guidelines for the management of arterial hypertension [1]. Following their aim to summarize the best available evidence for... more
Review Article
What should I eat today? Evidence, guidelines, dietary patterns and consumer's behavior
The modern science of nutrition, starting from its origins more than one century and a half ago, initially has been strictly confined to the concepts of dietary requirements. These included energy... more
Single-pill combination for treatment of hypertension: Just a matter of practicality or is there a real clinical benefit?
Cardiovascular disease (CVD) represents the leading cause of morbidity and mortality worldwide resulting in approximately one third of all deaths globally [1,2]. Despite significant advances in... more
Type 1 diabetes-related distress: Current implications in care
Type 1 diabetes (T1D) is a complex and demanding chronic disease characterized by a severe lack of insulin synthesis which needs to be supplied exogenously [1,2]. In this context, people living with... 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
Gender-specific insights into the irritable bowel syndrome pathophysiology. Focus on gut dysbiosis and permeability
Irritable bowel syndrome (IBS), a chronic functional gastrointestinal disorder, manifests through recurrent episodes of abdominal pain or discomfort, coupled with variations in bowel habits... more
The complement system in the pathogenesis and progression of kidney diseases: What doesn't kill you makes you older
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
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
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
The impact of colchicine on patients with acute and chronic coronary artery disease
Inflammation is a major contributor in the development and progression of coronary artery disease (CAD). Preclinical studies have demonstrated that inflammatory processes, by means of specific... more