June 2025

34 Articles

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Hydroxychloroquine use in patients with primary immune thrombocytopenia and antiphospholipid antibodies

13 January 2025
Author(s): Fernando Porto, Artur Saldanha, Erica Okazaki, Paula Villaça, Fernanda A. Orsi

The prevalence of antiphospholipid antibodies (aPL) among patients with immune thrombocytopenia (ITP) is high, at 20 % or higher according to previous studies [1,2].

Clinical Insights

Clinical trajectories in liver cirrhosis: An evidence-based reappraisal for the internist

2 May 2025
Author(s): Rosa Zampino, Fabian Patauner, Emanuele Durante-Mangoni

Over the last few years, the approach to clinical recognition and risk stratification of advanced liver disease has changed substantially, and liver cirrhosis has been increasingly conceptualized as... more

Commentary

Wheels within wheels: Diagnostic and risk modifiers for familial hypercholesterolemia in the community

21 March 2025
Author(s): Seyed Saeed Tamehri Zadeh, Jing Pang, Gerald F Watts

Familial hypercholesterolaemia (FH) is an autosomal dominant condition, marked by elevated plasma concentrations of low-density lipoprotein (LDL)-cholesterol from birth. It confers a substantial risk... more

Ideas and Opinions

Pharmaceutical policy in europe: Time for a common priceless solution?

21 April 2025
Author(s): Livio Garattini, Bruno Finazzi, Antonino Mazzone

Over the last decade, the prices of new medicines have increased dramatically, raising a major challenge for health systems and stressing the divergent values which underlie business and medicine [1... more

Internal Medicine Flashcard

An umbilical nodule

1 April 2025
Author(s): Gema Castillo-Ruiz, Enrique Rojo-Villardón, Víctor Domínguez-Prieto

A 94-year-old male patient, with previous history of atrioventricular block carrying a pacemaker and right inguinal hernioplasty, and recent history of a painless umbilical nodule suspicious of... more

A man with brown macules on the limbs

28 March 2025
Author(s): Xie He, Shunhong Chen, Ruiting Huang

A 35-year-old man presented with multiple brown macules on the limbs without associated pruritus or pain for 2 years. He observed these changes with no identifiable triggers, and noted a gradual... more

A febrile woman with gas collection in the right upper abdomen

25 March 2025
Author(s): Shinji Yoshida, Junpei Komagamine

A 69-year-old woman with uncontrolled diabetes mellitus presented to the emergency department with a 5-day history of loss of appetite and fever. She reported no sore throat, cough, or abdominal pain... more

Letter to the Editor

Benefits of intensive blood pressure control on cardiovascular mortality: ESPRIT and BPROAD change the scene

28 April 2025
Author(s): Paolo Verdecchia, Fabio Angeli, Gianpaolo Reboldi

Two recent randomized clinical trials (RCTs) [1,2] are likely to influence upcoming Hypertension Guidelines regarding the blood pressure (BP) targets. The important findings of these two studies... more

Evidence that adequate vitamin D intake reduces cardiovascular disease risk. Author's reply

15 April 2025
Author(s): Claudio Cimminiello

I thank the colleagues Grant and Boucher for their interest in my clinical insight article [1]. And I also thank them for giving me the opportunity to better clarify a concept already present in my... more

Evidence that adequate provision of vitamin D reduces cardiovascular disease risks

3 March 2025
Author(s): William B. Grant, Barbara J. Boucher

We read with interest the clinical insight by Cimminiello regarding the role of vitamin D and cardiovascular risk [1]. He dismissed the epidemiological evidence that vitamin D deficiency is... more

Effect of newer glucose-lowering medications on chronic obstructive pulmonary disease exacerbations among individuals with type 2 diabetes

22 February 2025
Author(s): Paschalis Karakasis, Dimitrios Patoulias, Nikolaos Fragakis, Ricardo Gómez-Huelgas

Type 2 diabetes mellitus (T2D) and chronic obstructive pulmonary disease (COPD) are prevalent chronic conditions that frequently coexist, contributing to significant morbidity and healthcare burden... more

Gut dysbiosis and leaky gut syndrome in moderately impaired amyotrophic lateral sclerosis patients

20 February 2025
Author(s): Laura Comini, Davide Antonio Di Pietro, Adriana Olivares, Enrica Bertella, Michele Vitacca

Dear Editor,

Rising ischemic stroke-related mortality among young adults in the United States: Insights from CDC WONDER

8 February 2025
Author(s): Usama Qamar, Farhan Naeem, Maaz Asif, Waleed Qamar, Eisha Mazhar

Ischemic Stroke-related mortality among young adults aged 25–64 years in the United States from 1999 to 2020.

Bedside CEUS: A feasible option to consider

6 February 2025
Author(s): Andrea Boccatonda, Alice Brighenti, Valeria Tiraferri, Rossella Loiacono, Carla Serra

Contrast-enhanced ultrasound (CEUS) is widely used for assessing the perfusion of specific organs or lesions. While CEUS has been extensively studied in outpatient settings, its use as a bedside... more

Tecovirimat and mpox: A regulatory balancing act between hope, hurdles, and high-risk populations

3 February 2025
Author(s): John G. Rizk, Giuseppe Lippi, Brandon M. Henry, Kin Israel Notarte, Youssef Rizk

Tecovirimat (marketed as TPOXX in the United States and other regions) is an antiviral drug that targets orthopoxviruses, including smallpox, monkeypox (now mpox), and cowpox. Tecovirimat inhibits... more

Disability and caregivers in Italy: Results from an online survey

3 February 2025
Author(s): Sergio Harari, Antonella Caminati, Luigi Ripamonti, Paolo Marveggio, Pier Mannuccio Mannucci

Disability is a condition with a significant impact on the quality of life of patients, on families who are often acting as their caregivers and on the society at large, with important economic... more

Mortality in the first 24 hours after admission in the intensive care unit

30 January 2025
Author(s): Rita Pinto Medeiros, Rita Pereira, Carla Teixeira

Dear Editor,

Obesity in Europe: Less impact on chronic diseases thanks to internists?

20 January 2025
Author(s): Livio Garattini, Antonino Mazzone

Defined by the WHO as the ‘new epidemic of the 21st century’, nowadays obesity has become an international public health issue [1], since it can cause a wide range of diseases and a growth in both... more

Telerehabilitation in patients with long COVID-19 syndrome

20 January 2025
Author(s): Shige Li, Wenbo Dong, Bing Dai, Wei Wang, Wei Tan

Post-acute sequelae of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19), known as long COVID syndrome, is defined as new symptoms that occur beyond 3 months after... more

Trends in industry-sponsored research payments to internist principal investigators

17 January 2025
Author(s): Aurora J. Grutman, Zeyad Hammadeh, Joseph G. Cheaib, Evans K.H. Brown, Misop Han

In the United States, the Physician Payments Sunshine Act, passed by Congress as part of the 2010 Affordable Care Act, has brought greater transparency to financial relationships between industry and... more

Refining insights into rheumatoid arthritis-associated liver dysfunction: Opportunities for methodological advancements and clinical implications

13 January 2025
Author(s): Zhongxing Liu, Peng Guo, Guohong Xiang, Lincheng Duan

We read with great interest the article by Arias-de la Rosa et al., published in the European Journal of Internal Medicine [1]. This study provides valuable evidence that patients with rheumatoid... more

Original Article

Chronic kidney disease classification according to different formulas and impact on adverse outcomes in patients with atrial fibrillation: A report from a prospective observational European registry

5 May 2025
Author(s): Giuseppe Boriani, Davide Antonio Mei, Niccolò Bonini, Marco Vitolo, Jacopo Francesco Imberti, Giulio Francesco Romiti, Bernadette Corica, Igor Diemberger, Gheorghe Andrei Dan, Tatjana Potpara, Marco Proietti, Gregory Y.H. Lip

Atrial fibrillation (AF) has an increasing incidence and prevalence with an aging population, and is associated with adverse cardiovascular events, stroke in particular, that can result in... more

Impact of L-arginine and liposomal vitamin C supplementation on quality of life and daily life activities in patients with COPD: a randomized, multicenter, single blind, placebo-controlled trial (ILDA study)

1 May 2025
Author(s): Dejan Radovanovic, Juan Camilo Signorello, Giuseppe Fuccia, Giada Lazzaroni, Fiammetta Danzo, Gualtiero Maria Guandalini, Federica Massaro, Francesco Tursi, Pierachille Santus

Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that involves lung parenchyma and the airways characterized by progressive airflow obstruction, reduced lung elastic recoil,... more

Cerebral small vessel disease and cognitive dysfunction in relation to central systolic blood pressure

30 April 2025
Author(s): Zhongping Yu, Zihao Chen, Chang Chen, Jiale Huang, Xin He, Jingjing Zhao, Wenqing Li, Cuiping Zhao, Jiangui He, Yugang Dong, Chen Liu, Fang-Fei Wei

Cerebral small vessel disease (CSVD) represents cerebral microvascular disorders [1,2] and visualizes on magnetic resonance imaging (MRI) as white matter hyperintensities (WMH), microinfarcts,... more

Aortic valve calcium as a novel risk marker for kidney function deterioration: The MESA study

21 April 2025
Author(s): Ashkan Abdollahi, Maryam Mojarrad Sani, Mahsima Shabani, Bruna S. Matuck, Michael J. Blaha, Colin O. Wu, Bharath Ambale-Venkatesh, Matthew J. Budoff, Jordan B. Strom, Jerome I. Rotter, Wendy S. Post, Roger S. Blumenthal, David A. Bluemke, Nasrollah Ghahramani, João A.C. Lima, Seamus P. Whelton

Chronic kidney disease (CKD) is a major cause of morbidity and mortality globally [1,2] and shares many risk factors with atherosclerotic cardiovascular disease (ASCVD) [3,4]. Increasing evidence has... more

The impact of sensitization patterns on COPD severity and exacerbations: Insights from a case-control and longitudinal study

12 April 2025
Author(s): Meropi Karakioulaki, Caroline Maria Berkemeier, Leticia Grize, Ingmar Heijnen, Stergios A. Polyzos, Antonis Goulas, Michael Tamm, Daiana Stolz

Common to several allergic diseases is the generation of immunoglobulin E (IgE) by plasma cells, when exposed to an innocuous antigen [1]. Upon initial exposure to allergen, antigen presenting cells... more

Performance and costs of rule-out protocols for acute aortic syndromes: analysis of pooled prospective cohorts

11 April 2025
Author(s): Paolo Bima, Peiman Nazerian, Christian Mueller, Matteo Castelli, Elisa Capretti, Alexandre de Matos Soeiro, Alessandro Cipriano, Giorgio Costantino, Simone Vanni, Bernd A. Leidel, Beat A. Kaufmann, Adi Osman, Marcello Candelli, Nicolò Capsoni, Wilhelm Behringer, Giovanni Ascione, Tatiana de Carvalho Andreucci Torres Leal, Lorenzo Ghiadoni, Emanuele Pivetta, Enrico Lupia, Fulvio Morello, PROFUNDUS and ADvISED Study Investigators

Acute aortic syndromes (AASs) are life-threatening cardiovascular emergencies affecting 5–15 individuals per 100,000 person-years [1]. They are characterized by dissection, hematoma, ulceration or... more

Diagnostic accuracy of emergency department ECGs in hyperkalemia detection: A cross-sectional study

9 April 2025
Author(s): Luca Ünlü, Frank-Peter Stephan, Florian N. Riede, Annette Christine Mettler, Gilles Dutilh, Gioele Capoferri, Tito Bosia, Christian Sticherling, Roland Bingisser, Christian H. Nickel

Hyperkalemia is a common condition in Emergency Departments (EDs) and can be fatal [1–3]. Hyperkalemia reduces conduction velocity and renders myocytes refractory to excitation. Dysrhythmias are... more

Serum interleukin-18 levels are specifically elevated in auto-inflammatory diseases involving the pyrin inflammasome: A study on 516 patients

8 April 2025
Author(s): Inès Elhani, Laure Calas, Farah Bejar, Bruno Fautrel, Laurence Pieroni, Véronique Hentgen, Philippe Mertz, Stéphane Mitrovic, Marion Delplanque, Léa Savey, Sophie Georgin-Lavialle

Auto-inflammatory diseases (AIDs) are defined as dysfunction of innate immunity [1]. They can involve different pathways. Familial Mediterranean fever (FMF), Still's disease, Mevalonate Kinase... more

Isolated joint involvement in Whipple's disease: a cohort study

8 April 2025
Author(s): Victor Eiferman, Alice Chanteloup, Jean Christophe Lagier, Xavier Puéchal

Whipple's disease was first described in 1907 by George Hoyt Whipple. Significant microbiological advances have since revolutionised our understanding of the disease, first with molecular biology and... more

Clinical familial hypercholesterolemia - factors influencing diagnosis and cardiovascular risk in the general population

13 February 2025
Author(s): Frida Toft-Nielsen, Frida Emanuelsson, Børge G Nordestgaard, Marianne Benn

Heterozygous familial hypercholesterolemia (FH) is an autosomal, dominant disorder of lipoprotein metabolism. The disease is estimated to affect 1:250 of individuals in Western populations [1–3].... more

Review Article

Avian flu: a swooping threat or just a volatile menace? What clinicians need to know

30 April 2025
Author(s): Fabian Patauner, Emanuele Durante-Mangoni, Lorenzo Bertolino

Avian flu is a cause of emerging fears among citizens and health care providers. In this review article, we provide the practicing Internal Medicine physician with a concise update regarding... more

Cancer genetic profile and risk of thrombosis

11 April 2025
Author(s): Francisco J. Pelegrín-Mateo, Carmen Beato Zambrano, Elena Brozos Vázquez, Ignacio García Escobar, Andrés Muñoz Martín

The occurrence of a venous thromboembolic event (VTE) among cancer patients has been rising steadily by up to threefold in some series with respect to the general population [1–3]. This risk is... more

Ultra-processed foods and cardio-kidney-metabolic syndrome: A review of recent evidence

22 March 2025
Author(s): Mehmet Kanbay, Lasin Ozbek, Mustafa Guldan, Sama Mahmoud Abdel-Rahman, Arif E. Narin, Alberto Ortiz

The rapid rise in ultra-processed foods (UPFs) has become a significant public health concern worldwide [1]. UPFs are typically high in unhealthy fats, refined sugars, refined carbohydrates, sodium,... more

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