June 2026
41 ArticlesNo Section
eGFR imbalance may confound DOAC-VKA comparisons in kidney transplant recipients
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From algorithms to care: ten principles for responsible deployment of artificial intelligence in healthcare
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Clinical Insights
Bedside contrast-enhanced ultrasound: Clinical applications for internal medicine
Point-of-care ultrasound (POCUS) is widely used in Internal Medicine for rapid bedside assessment, but conventional modalities such as B-mode and Doppler provide limited information on tissue... more
Commentary
Sustained innovation in ATTR-CM - Twenty years of innovation in transthyretin amyloidosis
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive disease caused by relentless accumulation of ATTR amyloid in the heart [1]. The past 20 years has seen ATTR-CM evolve from a seemingly... more
Rethinking atrial fibrillation classification: Static labels in a dynamic disease
Atrial fibrillation (AF) remains the most common arrhythmia worldwide and a major contributor to mortality and morbidity from stroke and heart failure (HF). Despite growing recognition that AF... more
Integrating multi-omics and artificial intelligence in internal medicine: Opportunities for precision care
Modern Internal Medicine stands at a critical inflection point. The traditional disease-centred paradigm, built on clinical phenotypes, organ-based classifications, and population-level evidence, is... more
Expanding the stroke risk paradigm: Left atrial size as a trigger for preventive action
Stroke is a vascular disease that impacts the brain and is one of the leading causes of disability and death worldwide; notably, heart diseases contribute significantly to its development and risk.... more
Editorial
When more money does not mean more health- disparities in healthcare efficiency in OECD
How to improve the efficiency of the healthcare system is vividly debated, as states facing increased competition for resources struggle to contain healthcare costs. The question is: how do we ensure... more
Internal Medicine Flashcard
A deceptive lung mass in a smoker man
A 50-year-old man presented with cough, streaky haemoptysis and left-sided chest pain for two weeks. He was a heavy smoker with 30 pack-years of smoking history. Clinical examination showed decreased... more
A woman with fever, feet hypostesia and disseminated papules
A previously healthy 75-year-old woman presented with a 3-day history of fever (39.3°C), distal paresthesias and hypoesthesia of both feet, and abrupt onset of disseminated erythematous papules with... more
Letter to the Editor
Bedside-oriented new risk stratification in acute pulmonary embolism: Implications and clinical utility of the 2026 ACC/AHA guidelines compared with the 2019 ESC guidelines
Recently, the American College of Cardiology (ACC) and American Heart Association (AHA) with scientific joint committees published the new clinical practice guidelines of acute pulmonary embolism (PE... more
Is there a clinical benefit of mechanical CPR in obesity? Author’s reply
We thank Steffen et.al for their thoughtful and constructive comments regarding our study evaluating the use of mechanical versus manual CPR in obese patients with in-hospital cardiac arrest [1,2].... more
Time and transitions in cardiogenic shock: making the Cath lab–CICU–cardiac step-down pathway reliable
While the ImCU models described by Canetta et al. and Turcato et al. arise from Internal Medicine, their broader relevance to cardiology lies not in patient case-mix, but in the principle that... more
eGFR imbalance and DOAC-VKA comparisons in kidney transplant recipients. Author’s reply
We thank Jin et al [1] for the comment on methodological considerations regarding our study [2]. The observation of a higher mean eGFR in the DOAC group after propensity score matching (PSM) deserves... more
Rethinking readmission prediction in multiple chronic conditions: Clinical utility over accuracy
Hospital readmissions among patients with multiple chronic conditions (MCC) represent a persistent challenge in European healthcare systems, with rates approaching 20 % in Spain and similar figures... more
Cardiorenal anemia syndrome: Are we ready for paradigm shifts?
To the Editor
Is there a clinical benefit of mechanical CPR in obesity?
We read with interest the article by Sujanyal et al. investigating the outcomes of LUCAS®-assisted versus manual cardiopulmonary resuscitation (CPR) in obese patients with in-hospital cardiac arrest... more
Unmeasured confounders in residual OSA: The roles of polypharmacy, loop gain, and weight trajectory
We read with interest the article by Vitacca et al. [1] In this retrospective cohort spanning ten years of cardiorespiratory monitoring (CRM), the authors assessed residual respiratory events (rAHI≥... more
Cerebral small vessel disease: a potential risk modifier for future guidelines on management of dyslipidaemias
Cerebral small vessel disease (cSVD) is a highly prevalent and prognostically relevant condition in older adults, yet it is not specifically addressed in current dyslipidaemia management guidelines.... more
Use of continuous morphine infusions in end-of-life care in an internal medicine ward
The use of continuous opioid infusions at the end of life remains a clinically and ethically sensitive area in acute hospital practice[1,2]. International recommendations emphasize that opioids are... more
Comparison of primary prevention strategy guided by SCORE2 versus coronary artery calcium scoring in a non-diabetic population
Cardiovascular disease (CVD) remains the leading cause of death and disability worldwide [1]. The role of preventive medicine in reducing the burden of CVD tends to grow because prevention is better... more
Clinical incidents attended by the internal medicine on-call team at a tertiary care hospital
On-call duty is a cornerstone of hospital-based Internal Medicine, yet it remains one of the least quantified and most debated components of medical practice. Originally conceived to address... more
Survival outcomes with LUCAS-AssiSTED VS MANUal CPR in in-hospital cardiac arrest obese patients
Obesity has emerged as a global health challenge, contributing not only to chronic disease but also to poorer outcomes in acute, high-acuity situations such as cardiac arrest. In the in-hospital... more
Methodological and generalizability considerations in the study of bleeding risk with rivaroxaban vs apixaban in older VTE patients
We read with great interest the nationwide register-based cohort study by Roupe et al., recently published in the European Journal of Internal Medicine [1]. The authors should be commended for... more
Antiplatelet therapy in patients with stable coronary artery disease who require long-term oral anticoagulation
Coronary artery disease (CAD) and atrial fibrillation (AF) and frequently coexist, with overlapping cardiovascular risk factors [1]. Oral anticoagulants (OACs) are indicated for AF-related stroke... more
Refining cardio-kidney-metabolic phenotyping to strengthen interpretation and clinical translation in atrial fibrillation
We read with great interest the article by Mei and colleagues, who investigated cardiovascular-kidney-metabolic (CKM) domains in a large European cohort of patients with atrial fibrillation (AF) and... more
Quality-of-life outcomes after sleeve gastrectomy versus Roux-en-Y gastric bypass: looking beyond mean differences
We read with great interest the article by ’t Hart et al. reporting long-term quality of life (QoL) outcomes after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in the SleeveBypass... more
Beyond systemic biomarkers: Future directions in understanding the inflammatory nexus of obstructive sleep apnea and atrial fibrillation
We read with great interest the article by Hunt et al. entitled “Systemic markers of inflammation and immune activation in patients with obstructive sleep apnea and paroxysmal atrial fibrillation,”... more
Original Article
Morning urinary calcium/creatinine ratio as a sex-specific screening tool for detecting hypercalciuria in hypoparathyroidism
Hypercalciuria is a relevant complication in patients with treated hypoparathyroidism. While hypercalciuria is usually estimated by 24-hour urinary calcium excretion (24hUCa), the calcium/creatinine... more
Peripheral ulcerative keratitis (PUK) in autoimmune diseases: a severe ocular manifestation not always associated with systemic disease activity
Peripheral ulcerative keratitis (PUK) is a rare and severe ocular manifestation frequently associated with systemic autoimmune diseases. This retrospective two-center observational study including... more
Assessing the proportion of patients with type 2 diabetes in tertiary care eligible for combination therapy with GLP-1 receptor agonist and SGLT2 inhibitors
That almost half of the patients with type 2 diabetes in tertiary care were eligible for combination therapy with GLP-1 RA and SGLT2i highlight the potential negative impact of restricting access to... more
Left atrial enlargement and 1-year cerebrovascular events in subjects without atrial fibrillation: A prospective cohort study
Left atrial enlargement (LAE) is a cardiac structural abnormality linked to adverse cardiovascular events, including stroke. However, its independent prognostic role in patients without atrial... more
Major adverse cardiovascular and bleeding outcomes in paroxysmal vs. non-paroxysmal atrial fibrillation: an individual patient-level data analysis of a large cohort of patients from the COMBINE-AF
Background: We performed an individual patient data analysis of COMBINE AF to assess differences in 14 clinically relevant outcomes between patients with paroxysmal (PAF) vs. non-PAF.Methods: Cox-... more
MBL2 deficiency and IgA Nephropathy in transplant patients: Is complement inhibition always beneficial?
Immunoglobulin A nephropathy (IgAN) represents the most prevalent form of primary glomerulonephritis globally and constitutes a major contributor to the burden of end-stage renal disease (ESRD) [1].... more
The changing prognosis of infective endocarditis. A 15-year analysis
Infective endocarditis (IE) mortality remains high. Population aging makes the aim of improving IE prognosis particularly difficult, as age is associated with comorbidity and mortality. Our objective... more
Genetic, and clinical features in Italian and lebanese subjects with familial mediterranean fever (FMF)
Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease with variable manifestations across Mediterranean regions. This study compares FMF cohorts from Italy (Apulia) and Lebanon... more
Review Article
How to monitor disease progression in ATTR amyloid cardiomyopathy: Implications for clinical practice and trial design
Transthyretin amyloid cardiomyopathy (ATTR-CM) has been traditionally considered a rare and inexorably fatal condition. However, the development of therapies able to slow or halt ATTR-CM progression... more
Redefining optimal medical therapy for heart failure in amyloid transthyretin cardiomyopathy
Amyloid transthyretin cardiomyopathy (ATTR-CM) is an infiltrative cardiomyopathy and an underdiagnosed cause of heart failure (HF) across the left ventricular ejection fraction spectrum. As disease-... more
Omics medicine: what the clinicians should know
Omics technologies analyze comprehensive molecular datasets, enabling the detailed characterization of pathological processes. Genomic, transcriptomic, proteomic, and metabolomic approaches, as well... more
Precision medicine with pioneering RNAi therapeutics in ATTR amyloidosis: from bench to bedside
Transthyretin (ATTR) amyloidosis is a multisystem disease caused by misfolding and aggregation of the plasma protein transthyretin (TTR) into insoluble amyloid fibrils in various organs [1]. This... more
The evolving landscape of screening, management and treatment strategies of aortic stenosis in ATTR amyloidosis
Transthyretin amyloid cardiomyopathy (ATTR-CM) and aortic stenosis (AS) frequently coexist in elderly patients, particularly men, creating a complex clinical scenario with overlapping symptoms and... more