June 2024
33 ArticlesClinical Insights
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
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
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
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
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
Letter to the Editor
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
Patient-reported outcomes and apixaban therapy in older patients
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,
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
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
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
Review Article
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