June 2025
140 ArticlesNo Section
Refining the predictive value of nasal pressure swing in acute hypoxemic respiratory failure management. Author's reply
Dear Editor,
Diagnostic contribution of minor salivary glands biopsy in clinical practice
Dear Editor,
The role of achieving blood pressure targets in renal protection: Insights from the VALUE trial
We have read with great interest the article by Olsen et al. on the VALUE trial [1], which investigated the comparative effectiveness of valsartan versus amlodipine in reducing the incidence of end-... more
Demographic features in patients with acute mountain sickness
Dear editor,
The Declaration of Helsinki protects clinical trial participants
Dear Editor,
Some comments on Tecovirimat and mpox
The paper by Rizk et al., "Tecovirimat and mpox: A regulatory balancing act between hope, hurdles, and high-risk populations," presents a detailed discussion on the antiviral Tecovirimat (TPOXX) and... more
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
Challenges in the diagnosis of coeliac disease in primary care: Serology, biopsy, and administrative data
Coeliac disease (CD) is a common, lifelong, immune-mediated condition characterised by villous atrophy resulting from the ingestion of dietary gluten [1], which leads to malabsorption and various... more
Intermediate care units in internal medicine – From concept to consolidation
The traditional organization of hospital care along rigid specialty lines is increasingly challenged by the complex clinical profiles of today’s inpatients. Multimorbidity, polypharmacy and... more
Predicting the unpredictable: Personalizing VTE risk in cancer with the Caravaggio Score
Patients with cancer account for >20 % of all patients newly diagnosed with venous thromboembolism (VTE), which remains a leading cause of morbidity and mortality in this patient population [1].... more
The oldest old and critical care: a potentially successful binomial
Very old people are frequently denied advanced care on the assumption that they will not benefit from such interventions, even in absence of coexisting conditions that may impact their prognosis [1... more
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
Editorial
Phenomena and noumena in nephrology: Beyond the illusion of precision in kidney function assessment
In his Critique of Pure Reason, Immanuel Kant famously distinguished between phenomena, the world as it appears to us, and noumena, the thing-in-itself, which eludes direct human comprehension.... more
Ideas and Opinions
Fast versus slow fibrosers: Risk factors for fibrosis progression in eosinophilic oesophagitis
Oesophageal fibrosis is a progressive and severe complication of long-standing, T-helper type 2-driven, allergen-mediated inflammation in untreated patients with eosinophilic oesophagitis (EoE) [1].... more
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
Progressive skin thickening in a young adult
A 22-year-old man was referred to the dermatology service for the appearance of thickening of the skin, predominantly on the hands, feet and face, accentuation of the folds of the forehead and... more
Inverted V sign
A 79-year-old woman visited with a 3-week history of tingling sensation of the tongue. Physical examination showed smooth back ground of tongue with scattered reddish lesions (Fig. 1A). Results of... more
Atypical and fatal presentation of acute liver failure
A 44-year-old female presented to the emergency department with fever (38 °C) and general malaise three days after an elective hysterectomy for bleeding uterine fibroids. The procedure was... more
Electrocardiographic changes associated with hypothermia
A 69-year-old Japanese man, who lived alone and was undergoing treatment for diabetes at another hospital was found unconscious in an unheated room at his residence in February 2025. He was... more
Black discoloration of the esophageal mucosa
A 66-year-old man with type 2 diabetes mellitus and chronic alcohol consumption presented to an acute care hospital with generalized fatigue, anorexia, and melena. On arrival, he was in hypovolemic... more
A protrusion of the left abdominal wall
A 73-year-old male presented to the dermatology department following a 5-day history of vesicular rash accompanied with serious pain in the left waist and abdomen. Constipation-associated symptom... more
A man with chronic progressive mucositis and extensive skin detachment
A 62-year-old man was referred to our department with a 6-week history of a progressively worsening rash. Three weeks earlier, he had been admitted for gastric perforation, which was ultimately... more
Omalizumab-associated purpura fulminans
A 27-year-old male with chronic urticaria began omalizumab treatment. Before treatment, blood count, coagulation profile, and liver function were normal. After one dose, he developed chest, back, and... more
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
Efficacy and safety of beta-blockers in patients with comorbid chronic obstructive pulmonary disease and cardiovascular disease
To the editor: Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular disease (CVD) often co-occur, presenting complex management challenges due to concerns over the effects of beta-blockers... more
Substantial variety in point of care ultrasound training across EFIM
Dear Editor,
Addressing unmet needs in the use of SGLT2 inhibitors in critical and acute care setting
Despite mounting evidence of benefit in acute heart failure (AHF), acute myocardial infarction (AMI), arrhythmias, and even intensive care settings, there remains a significant lack of clear guidance... more
Role of 12-lead electrocardiogram for identifying very low mortality risk patients with non-hypotensive acute pulmonary embolism
Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality and a significant global health issue [1]. The simplified Pulmonary Embolism Severity Index (sPESI) is a practical tool... more
Real-world glucose-lowering strategies for managing glucocorticoid-induced diabetes in non-intensive hospital settings
A prolonged administration of glucocorticoids (GCs) can lead to side effects such as glucocorticoid-induced diabetes (GC-DM), a form of secondary diabetes, namely drug- or chemical-induced diabetes [... more
Gastroenteritis caused by Shiga-toxigenic Escherichia coli. Are antibiotics always prohibited in this disease?
Dear Editor-in-Chief and editorial team,
Validation of different acute kidney injury scores in patients undergoing transcatheter aortic valve implantation
Contrast-associated acute kidney injury (CA-AKI) remains one of the most relevant procedural complications in patients undergoing transcatheter aortic valve implantation (TAVI). Beyond contrast dye... more
Drug-induced hyponatremia in clinical care
In their excellent literature review, Mannheimer B et al. do not include several drugs that may induce hyponatremia [1]. Various dopaminergic agents are associated with hyponatremia.
Unmasking atrial cardiomyopathy in middle-aged patients with AF: A call for early detection
Atrial cardiomyopathy (AtCM) has emerged as a critical clinical entity in recent years, encompassing structural, architectural, electrical, and functional abnormalities in the atria [1]. Atrial... more
Nonarteritic anterior ischemic optic neuropathy and glucagon-like peptide-1 receptor agonists: Evaluating a potential association
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for type 2 diabetes mellitus (T2DM) and obesity due to their efficacy in glycemic control, weight reduction, and... more
The role of the hospitalist in Europe: results by EFIM multimorbidity working group survey
The increasing prevalence of chronic diseases has led to a population with a higher level of care complexity. Multimorbidity (MM) has emerged as the most prevalent patient profile in both outpatient... more
Insights from the VALUE Trial: Achieving blood pressure targets for renal protection
We thank Wang, Jiang and Zhou [1] for their interest in our paper [2]. We agree in their conclusions that the VALUE Trial [2,3] provides critical evidence to guide antihypertensive therapy in high-... more
Hyponatremia and mortality: Marker of disease or modifiable risk? Rethinking causality in large-scale observational research. Authors’ reply
We would like to thank Xia et al. for their thorough evaluation of our recent work based on the Stockholm Sodium Cohort (SSC) [1,2], in which they raise several concerns, some of which are inherent... more
Genotype-phenotype correlations and resistance to colchicine in a familial Mediterranean fever cohort in southwestern Spain
Familial Mediterranean Fever (FMF) is the most frequent autoinflammatory disease, characterized by recurrent episodes of fever, abdominal pain, arthritis, and rash. It primarily affects people in the... more
Abrupt fluoroquinolone-associated suicides: a SONAR report from North America, Europe, Australia, and Asia
One billion doses of fluoroquinolone (FQ) antibiotics have been administered since 1987. In 1998, the German Pharmaceutical Regulatory Agency received “a few” suicide reports that occurred shortly... more
Disabling hearing loss in ischemic stroke: Prevalence, predictors, and prognostic implications
Growing evidence suggests that hearing loss may be an overlooked risk factor and consequence of ischemic stroke [1]. Several large-scale cohort analyses indicate that individuals with hearing loss... more
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
Serum IL-18 in autoinflammatory diseases diagnosis: unresolved challenges
We read with great the article by Elhani et al. recently published in the European Journal of Internal Medicine [1]. This study attempts to establish the relationship between interleukin-18 (IL-18)... more
Hyponatremia and mortality: Marker of disease or modifiable risk? Rethinking causality in large-scale observational research
We read with great interest the article by Mannheimer et al. investigating mortality and causes of death in patients hospitalized with hyponatremia using a large propensity-matched cohort from the... more
Prognostic impact of bone scintigraphy in elderly patients with hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is a heterogeneous condition that may result from sarcomeric mutations or infiltrative disorders such as transthyretin amyloid cardiomyopathy (ATTR-CM) [1].... more
Prevalence, awareness, and control of cardiovascular risk factors among specialists in cardiovascular field: A survey
Dear Editor,
Short term variability of peripheral blood eosinophil count in individuals with stable COPD
Chronic obstructive pulmonary disease (COPD) is typically considered a neutrophil-driven inflammatory disease [1], but some individuals, particularly those with frequent exacerbations, show... 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
Trends in cardiovascular disease-related mortality among adults with sleep apnea in the United States from 1999-2020
Cardiovascular disease-related mortality in adults with comorbid sleep apnea in the United States from 1999 to 2020.
Cardiovascular safety and efficacy of intensive blood pressure control: how low should we go?
Dear Editor,
Excess risk or misestimated baseline? Reconsidering relative survival in the oldest ICU patients
We commend Weller et al. for their important and timely contribution, which provides a rigorous and impressively sized analysis of 1076 ICU patients aged 90 years and older, using relative survival... more
Clinical epidemiological characteristics of BRASH syndrome
BRASH syndrome—characterized by bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia—has recently been recognized as a distinct clinical entity. This syndrome is... more
Protected discharge and combined interventions: A viable path to reduce hospital readmissions
Hospital readmissions within 30 days continue to be a challenge for healthcare systems, particularly in the case of frail, elderly patients and those with chronic diseases. From international studies... more
Clinical trial landscape for pulmonary arterial hypertension targeted therapy: Beyond vasodilators
Pulmonary arterial hypertension (PAH) is a multifaceted and lethal disorder characterized by elevated pulmonary pressures and right ventricular failure, ultimately leading to premature death. With an... more
Thromboembolic and bleeding risks in patients on anticoagulation after noncardiac surgery for malignancy
Atrial fibrillation (AF) and pulmonary embolism/deep vein thrombosis (DVT), all of which have an indication for anticoagulation, are observed commonly in patients with malignancy, regardless of... more
Refining the predictive value of nasal pressure swing in acute hypoxemic respiratory failure management
With great interest, we read about the study by Tonelli et al. on the predictive value of nasal pressure swing (Pnose) in assessing respiratory support dependency among patients with acute hypoxemic... more
Efficacy and safety of crinecerfont for the treatment of congenital adrenal hyperplasia
Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic disease that leads to an enzyme deficiency, the main consequence of which is the reduction in the production of cortisol and... more
Clinical factors associated with limited therapeutic implementation in patients with heart failure and reduced ejection fraction hospitalized in internal medicine wards
Heart failure (HF) affects over 56 million people globally and accounts for 1–2 % of all hospitalizations in the Western world [1]. Prevalence of HF rises with age, as patients over 70 years of age... more
Accuracy of glomerular filtration rate estimating equations in systemic sclerosis
Kidney involvement in Systemic Sclerosis (SSc) is primarily due to vasospasm induced by renal Raynaud's phenomenon, leading to hypoxia, impaired angiogenesis and microvascular dysfunction. Renal... more
Serum angiopoietin-like protein 4 levels correlate with hypertriglyceridemia and renal function decline in pediatric patients with lupus nephritis
Lupus nephritis (LN) is the most common complication of systemic lupus erythematosus (SLE), with up to 70 % of pediatric SLE patients experiencing kidney involvement, and LN also aggravates the... more
Atrial fibrillation ablation versus medical therapy in heart failure with preserved ejection fraction
Heart failure with preserved ejection fraction (HFpEF) is a multifaceted and increasingly prevalent clinical syndrome that presents significant challenges in both diagnosis and management. Its... more
Why did it take forty years to uncover long-term fluoroquinolone associated toxicities?
Since fluoroquinolones (FQs) were introduced in 1986, 1 billion courses have been administered [1]. Safety announcements have been disseminated since 2016 in the United States (US), European Union (... more
Diastolic blood pressure variability predicts adverse outcomes in stabilized acute heart failure patients
Blood pressure variability; heart failure; Cardiovascular outcome; Diastolic blood pressure
Utilizing D-dimer levels for predicting survival probability in unplanned hospital admissions: Insights from a 5-year nationwide population-based register study
Although the most common clinical use of D-dimer measurements is to rule out thromboembolic disease [1], it is also elevated in several other serious illnesses and raised levels are associated with a... 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
Why doesn't sepsis rhyme with Internal Medicine?
I am writing to share some reflections on the challenges that internists face in the management of sepsis, a complex and multifactorial condition requiring a multidisciplinary approach. Despite the... more
Glucagon-like peptide–1 receptor agonist for patients with heart failure with preserved ejection fraction and obesity
Dear Editor,
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,
Hemoglobin levels for the diagnosis of polycythemia vera: How high is high enough?
The World Health Organization (WHO) diagnostic criteria for Polycythemia Vera (PV), initially published in 2001 and 2008, were last revised in 2016. According to these criteria, evaluation for PV is... more
Evolution of care pathways in clinical practice guidelines for heart failure
In the context of the increasing complexity of patients with heart failure (HF) and the rapid expansion of available therapies, clinical practice guidelines (CPGs) have become indispensable for... more
Direct oral anticoagulants guided by CHA2DS2-VASc stratification for stroke prevention in patients with device-detected atrial fibrillation
Atrial fibrillation (AF) significantly increases stroke risk, with affected individuals having a fivefold higher likelihood compared to the general population. Oral anticoagulation (OAC),... more
Sodium-glucose cotransporter2 inhibitor-associated ketoacidosis in nondiabetic patients
Sodium-Glucose Cotransporter2-inhibitors (SGLT2i) were developed for treating diabetic patients. Empagliflozin and dapagliflozin, frequently prescribed SGLT2i, are now also recommended for... more
Factor XI/XIa inhibitors versus direct oral anticoagulants in atrial fibrillation
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
Blood pressure values in healthy normal weight children and adolescents in eight European countries: auscultatory and oscillometric measurements
The importance of high blood pressure (BP) as a modifiable risk factor for early disability and death is well established [1]. Although the majority of adverse outcomes occur in adulthood, high BP is... more
Long-term quality of life after sleeve gastrectomy vs Roux-en-Y Gastric Bypass in patients with severe obesity: Results from the SleeveBypass multicentre randomised controlled trial
Obesity is a chronic condition and a worldwide problem that poses health risks, reduces quality of life (QoL), contributes to psychosocial issues and increases public healthcare costs [1]. While,... more
Determinants of time to first palliative care consultation in hospitalized patients with advanced or terminal illness – A retrospective analysis
The Yentl Syndrome, a term coined by Dr. Bernadine Healy in 1991, refers to the phenomenon that women are less likely to receive accurate diagnosis and treatment because their symptoms do not align... more
Efficacy and safety of once-daily oral semaglutide in patients with heart failure with preserved ejection fraction, type 2 diabetes and obesity: a real-world study
Heart failure with preserved ejection fraction (HFpEF) is a complex and multifactorial heart disease. It has become the most common type of heart failure (HF), which can be explained in part by its... more
Identification of risk factors for permanent visual loss in patients with giant cell arteritis
Giant cell arteritis (GCA) is the most common systemic vasculitis affecting older people in Western countries, being more prevalent in females [1–4]. Vascular inflammation predominantly affects the... more
Current epidemiology, risk factors and influence on prognosis of multidrug resistance in Klebsiella spp. bloodstream infection. Insights from a prospective cohort
Klebsiella spp. are the third most common cause of bloodstream infections, only after Escherichia coli and Staphylococcus aureus, both in the community and nosocomial infections [1]. Usually arising... more
Systemic markers of inflammation and immune activation in patients with obstructive sleep apnea and paroxysmal atrial fibrillation
Sleep apnea and AF are both associated with adverse cardiovascular outcomes [1,2]. Obstructive sleep apnea (OSA) is more prevalent in patients with atrial fibrillation (AF) than in patients with... more
Gamma-glutamyltransferase independently predicts mortality and heart failure hospitalization in cardiac transthyretin amyloidosis
Transthyretin cardiac amyloidosis (ATTR-CA) is an infiltrative cardiomyopathy caused by extracellular deposition of misfolded transthyretin (TTR) fibrils within the myocardium, leading to progressive... more
The approach to triglyceride levels in patients with coronary heart disease
Hypercholesterolemia is one of the major modifiable cardiovascular risk factors, while current guidelines mark the low-density lipoprotein cholesterol (LDL-C) levels as the primary target of... more
Hypochloremia in chronic and acute heart failure scenarios: Prevalence and risk factors
Traditionally, sodium and potassium disorders have been considered the most relevant ionic disturbances in heart failure (HF)., [1] However, in recent years, hypochloremia has emerged as a critical... more
Long-term secondary prevention with colchicine in patients with CAD: an updated systematic review and meta-analysis
Randomized clinical trials (RCTs) for the prevention of vascular events in patients with coronary artery disease (CAD) over the past decade have clearly demonstrated that colchicine is able to reduce... more
Different loop diuretic dosing and administration in acute heart failure (DIUR-AHF): a multicenter prospective observational open-label study
Acute heart failure (AHF) is a clinical syndrome characterized by progressive or sudden and rapid onset of signs and symptoms of HF, related to hemodynamic and neurohormonal derangement [1,2]. AHF... more
Prevalence of malnutrition and its impact on clinical outcomes in internal medicine wards: The SIMI-NUTRO study
Screening for malnutrition is recommended for all hospitalized patients and can be performed using tools such NRS-2002, MUST, and MNA-SF. Patients at risk should undergo further evaluation for the... more
Recombinant human hyaluronidase-facilitated subcutaneous immunoglobulin (hf-SCIg) for inflammatory myositis: a multicenter retrospective real-world observational study
The spectrum of idiopathic inflammatory myositis (IIM) includes a heterogeneous group of diseases that share chronic inflammation of skeletal muscle, mainly characterized by proximal muscle weakness... more
Latent class analysis identifies novel coeliac disease subgroups with distinctive clinical features: a multicentric study
Coeliac disease (CD) is a chronic, lifelong, immune-mediated disorder causing villous atrophy in genetically susceptible individuals upon the ingestion of gluten in the diet [1,2]. It has been... more
Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome: A comprehensive review of cases across different ethnicities
Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome is a recently described somatic autoinflammatory disease [1]. A genetic mutation in the UBA1 gene results in a deficiency of... more
Natural history of the severe subtype of MYH9-related disease (Epstein syndrome)
Congenital thrombocytopenia, giant platelets, and Döhle-like bodies in granulocytes characterize MYH9-related disease (MYH9-RD). Clinical manifestations include deafness, nephritis, and cataracts [1,... more
Metabolic dysfunction-associated steatotic liver disease (MASLD). Assessing metabolic dysfunction, cardiovascular risk factors, and lifestyle habits
Steatotic liver disease (SLD), a hallmark of metabolic dysfunction, is closely associated with atherosclerotic cardiovascular disease (ASCVD). This study investigated gender differences, metabolic... more
Effectiveness and safety of telemonitoring compared with standard of care in people with type 2 diabetes treated with insulin: a national multicenter randomized controlled trial
The trial demonstrated that telemonitoring is superior to standard of care in T2D for improving glycemic control.
PEPPER – Prehospital prediction in pulmonary embolism: The association of the national early warning score with mortality, thrombolysis, and clinical outcomes
Pulmonary embolism (PE) requires careful risk assessment for informed care decisions. We evaluated the value of the National Early Warning Score (NEWS) in patients with PE when used by emergency... more
New onset left atrial dilatation in the general population: A quarter-century follow-up
Left atrial (LA) anatomical remodeling, detected by measuring the diameter or, more comprehensively, the volume with echocardiography is regarded as a marker of left ventricular (LV) diastolic... more
The effects of sleep improving interventions in medical hospital wards: the WEsleep study - A randomized clinical trial
Multiple studies indicate that sleep in hospitals is suboptimal.1,2 Disturbed and inadequate sleep occurs in 48 to 77 % of hospitalized patients.3,4 Sleep-disturbing factors in hospitals include... more
Difficult-to-treat rheumatoid arthritis among elderly patients from the KOBIO registry
Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by systemic inflammation the primarily affects the joints, resulting in pain, swelling, stiffness, and functional impairment [... more
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
Cost-effectiveness of daily home haemodialysis versus in-centre haemodialysis: A propensity score matching analysis based on real-world data from the French healthcare system
Home haemodialysis (HD) offers several advantages over conventional in-centre 3-times-weekly HD which have been summarised in recent reviews [1,2]. Among them are better preservation of health-... 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
NT-proBNP to guide risk stratification after cardiac rehabilitation in patients with ST-segment elevation myocardial infarction
The use of N-terminal pro-brain natriuretic peptide (NT-proBNP) after ST-segment elevation acute myocardial infarction (STEMI) is unclear. We evaluated its prognostic significance after post-STEMI... 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
Burden and risk factors for 30-day readmission and mortality after CAP hospitalization: A population-based cohort study
Community-acquired pneumonia (CAP) is considered the world’s most fatal infectious disease and is associated with a fundamental burden in healthcare and society [1]. 30-day mortality ranges from <... more
ICD-10-CM coding uncovers the gap between serological and clinically identified coeliac disease prevalence: A population-based study
Coeliac disease (CD) is one of the most common lifelong disorders and affects people of all ages worldwide [1]. A systematic review and meta-analysis reported that the global CD seroprevalence was 14... 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
Derivation and validation of the Caravaggio score for the risk stratification for recurrence in patients with cancer-associated venous thromboembolism
Cancer associated venous thromboembolism (CAT) has a high risk of recurrence and treatment-emergent bleeding [1–4]. The identification of risk factors for venous thromboembolic (VTE) recurrence and... more
Mortality and causes of death in patients hospitalized with hyponatremia – a propensity matched cohort study
Hyponatremia is the commonest electrolyte imbalance, affecting more than one in 10 patients admitted to hospital [1]. Women, elderly, and individuals with comorbid burdens are generally at greater... 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
Intermediate Care Units in Internal Medicine
A cornerstone of the reorganization challenge of hospital systems has been provided by the Progressive Patient Care (PPC) model [1], lying on the concept of pooling patients around the acuity of... more
The role of an intermediate care unit in reducing intensive care unit admissions and improving patient outcomes in internal medicine: A quasi-experimental study
The optimal management of non-intensive critical patients remains a debated topic. This debate is further complicated by the fact that Intensive Care Units (ICUs) bed availability is regulated by... more
Excess mortality of critically ill patients aged ≥90 years in intensive care units: A retrospective cohort study
We live in an aging society, which is foremost caused by increasing life expectancy, next other factors. In concordance, at least the sheer number of older patients increases, too. When those older... more
R202Q homozygosity of Mediterranean fever gene is associated with atypical clinical phenotype of familial Mediterranean fever
Autoinflammatory disorders represent a heterogenous group of genetic or acquired systemic diseases characterized by febrile episodes and chronic inflammation, due to dysregulation of innate immunity... 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
When inflammatory bowel disease meets pregnancy
Inflammatory bowel disease (IBD) is a group of chronic and relapsing inflammatory conditions of the gastrointestinal tract with two major forms: Crohn’s disease (CD) (affecting any segment of the... more
Point of care ultrasound: focus on evidence for a critical appraisal
The term point of care ultrasound (POCUS) refers to a sonographic examination directly performed at the patient’s bedside, ideally by the treating physician, to interpret and integrate images into... more
A holistic view of SGLT2 inhibitors: From cardio-renal management to cognitive and andrological aspects
Type 2 diabetes mellitus (T2DM) is a multifactorial disease associated with complications that significantly affect both survival and quality of life, including cardiovascular, renal, cognitive,... more
Artificial intelligence and the electrocardiogram: A modern renaissance
The electrocardiogram (ECG) is a fundamental, non-invasive diagnostic tool in cardiology, widely accessible and crucial for assessing the heart's electrical and structural conditions [1].... more
Cogan's syndrome. A comprehensive review
Cogan Syndrome (CS) is a rare systemic vasculitis affecting the inner ear and the eye with systemic manifestations described first in 1945 by David G. Cogan as a “syndrome of non-syphilitic... more
The medical ward round: evidence, pitfalls, and tips
Ward rounds are pivotal for patient-centered care and bedside teaching. In today’s hospitals, care is provided by multidisciplinary and multiprofessional teams. To conduct an effective and efficient... more
Drug-induced hyponatremia in clinical care
Over the last decades, advances in understanding of previously described associations have important implications for diagnosis and workup of hyponatremia. In addition, new drug groups potentially... more
Tailoring non-invasive respiratory supports in acute hypoxemic respiratory failure: A practical approach for clinicians
The use of non-invasive respiratory support (NIRS) for acute respiratory failure (ARF), particularly hypoxemic respiratory failure, has advanced in recent years, especially during the COVID-19... more
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
A physico-chemical explanation for the litho-protective effects of obeticholic acid in low phospholipid-associated cholelithiasis
Prevalence of gallstones in the adult European population is ̴20 % (mostly cholesterol stones in the gallbladder). Obesity, metabolic syndrome, type 2 diabetes, female sex, pregnancy, multiparity and... 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