June 2025
34 ArticlesNo Section
Hydroxychloroquine use in patients with primary immune thrombocytopenia and antiphospholipid antibodies
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
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
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?
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
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
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
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
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
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
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
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
Dear Editor,
Rising ischemic stroke-related mortality among young adults in the United States: Insights from CDC WONDER
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
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
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
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
Dear Editor,
Obesity in Europe: Less impact on chronic diseases thanks to internists?
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
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
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
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
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)
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
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
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
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
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
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
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
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
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
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
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
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