March 2025
Clinical Insights
Aspirin-free strategies after percutaneous coronary intervention: Old habits, consolidated evidence and future perspectives
Antithrombotic therapy represents the mainstay of the pharmacological treatment in patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) [1]. Dual antiplatelet... more
Redefining giant cell arteritis: From current practices to future paradigms
The management of patients with giant cell arteritis (GCA), the most common vasculitis in adults, has undergone significant transformation over the past decade [1]. This shift has been primarily... more
Commentary
Sodium bicarbonate in metabolic acidosis: A never-ending story?
Is it useful to treat metabolic acidosis with bicarbonate or not? This question is still one of the hot topics that doctors deal with in their daily clinical practice, mainly due to the lack of clear... more
Pulmonary metastases and bleeding in the anticoagulated oncology patient with thrombosis: is the risk solely influenced by the location of distant disease?
The article by García-García V et al. [1], published in this issue of the European Journal of Internal Medicine,provides a valuable exploration of hemorrhagic complications in cancer-associated... more
Internal Medicine Flashcard
An uncommon and unexpected cause of chest pain: When stockings become trauma
An 80-year-old woman presented to the emergency department (ED) with acute sternal pain that began after removing her compression stockings. Three days earlier, she experienced a similar episode... more
Female patient with telangiectasia, epistaxis and pulmonary arteriovenous malformation
A 55-years-old female patient was admitted to our clinic with a long-standing complaint of epistaxis. She had no medical history and was not taking any medications. Both her children had nosebleeds.... more
Generalized bullous fixed drug eruption
A 73-year-old female presented with a diffuse rash accompanied by itching for 3 days. She had taken levofloxacin orally for a cough one day before the rash developed. She had a 16-year history of... more
Esophagitis in an immunocompetent patient: A diagnostic challenge
A 65-year-old man with Parkinson's disease was admitted to hospital for continuous subcutaneous infusion of levodopa/carbidopa. On day 6 of hospitalization, he developed pharyngalgia, sensation of... more
Man with red eyes
A 71-year-old male presented to our hospital with vertigo. The supine roll test induced vertigo, leading to a diagnosis of left horizontal semicircular canal benign paroxysmal positional vertigo (... more
Invited Review Article
Treat the patient, not the disease: The embolic stroke of undetermined source as an opportunity to optimize cardiovascular prevention in a holistic approach
“It is much more important to know what sort of patient has a disease than what sort of disease a patient has.”“The good physician treats the disease; the great physician treats the patient who has... more
Letter to the Editor
Disease activity and disability influence CV risk estimation and management of rheumatoid arthritis patients
We sincerely appreciate Shoulin Dou et al.'s interest in our article, and we are grateful for their constructive comments, which have certainly contributed to raising awareness of the significant... more
Extra-articular manifestations in rheumatoid arthritis: Incidence and predisposing factors. Author's reply
We appreciate that Wang, Wu and Li [1] have taken an interest in our publication on patients with early rheumatoid arthritis (RA) developing extra articular (ExRA) disease [2]. ExRA manifestations... more
Optimal BMI cutoff for lean MASLD/MetALD and adverse hepatic outcomes in East-Asian populations
Nonalcoholic fatty liver disease (NAFLD) is a primary contributor to hepatocellular carcinoma (HCC)/liver cirrhosis (LC), affecting ∼30 % of the global population. Its incidence is rising parallel to... more
Internists at the frontline of epidemic viral illnesses: From tiredness to preparedness
In the wake of the coronavirus disease 2019 (COVID-19) pandemic, who would reasonably declare that a time will ever come «to close the book on infectious diseases»? Indeed, new viral threats are... more
The evolving role of head up tilt test: New protocol and indications for optimizing the care of syncope patients
Dear Editor, we read with great interest the metanalysis by Guida et al. [1] about the diagnostic held of head up tilt test (HUTT) in patients with suspected vasovagal (VVS) syncope. The authors... more
Evaluating feature importance biases in logistic regression: Recommendations for Robust Statistical Methods. Author's reply
Dear Editor,
Associations of cardiovascular health and exercise capacity with moderate-to-vigorous physical activity prior to enrolment to cardiac rehabilitation in coronary artery disease patients
Exercise training is a core component of cardiac rehabilitation (CR) and is associated with improvement in (sub)maximal exercise capacity, quality of life, and a reduction in the risk of re-... more
The potential impact of educational attainment on NAFLD risk. Author's reply
We thank Ke-qian Chen et al. and the European Journal of Internal Medicine for the opportunity to engage in a constructive discussion about the relationship between educational attainment and non-... more
Revisiting the association between air pollution and peripheral artery disease: Evidence from mendelian randomization analysis
We read with great interest the article by Di Blasi et al., published in the European Journal of Internal Medicine [1]. This well-designed study provides significant evidence on the association... more
Enhancing hypertension prevention research: Insights and opportunities for social work interventions. Author's reply
Dear Editor,
Prognostic impact of different triggers in patients with Takotsubo syndrome and chronic obstructive pulmonary disease. Author's reply
We thank the authors for the interest in our study recently published in the journal [1]. In that, we focused specifically on patients with takotsubo syndrome (TTS) and chronic obstructive pulmonary... more
Measuring the risk of clinical adverse events (RISK ACE) by quantifying liver function: A patient-centric model
Identifying the patients with compensated advanced chronic liver disease (cACLD) who are at risk for clinical decompensation is a goal of clinical management [1]. Early detection of those at risk for... more
Clarifications and enhancements for cardiovascular risk study in metabolic dysfunction-associated steatotic liver disease
This study by Shibata et al. [1] investigated the risk of major adverse cardiac events (MACE) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) and employed a... more
Extra-articular manifestations in rheumatoid arthritis: Incidence and predisposing factors
The research by Lotta Ljung et al. [1] offers valuable insights into extra-articular manifestations (ExRA) in rheumatoid arthritis (RA) yet has room for improvement. The questionnaire-based approach... more
Evaluating feature importance biases in logistic regression: Recommendations for robust statistical methods
Dear Editor,
Prognostic impact of different triggers in patients with Takotsubo syndrome and chronic obstructive pulmonary disease
We read with great interest a recently published study by Luca Arcari, Giacomo Tini, Michela Zuccanti, et al. regarding clinical characteristics and outcomes of Takotsubo syndrome (TTS) in patients... more
Diagnostic yield of head-up tilt testing in suspected vasovagal syncope
Vasovagal syncope (VVS) is the most frequent form of syncopal spells characterized by a reflex causing hypotension and often bradycardia, usually elicited by prolonged standing or exposure to... more
Enhancing cardiovascular risk management in rheumatoid arthritis: From medication adherence to multidisciplinary interventions
We carefully read the article by Cacciapaglia et al. published in the European Journal of Internal Medicine [1]. This study reveals the suboptimal adherence to lipid-lowering therapy prescriptions in... more
Enhancing hypertension prevention research: Insights and opportunities for social work interventions
We read with great interest the recent article by Hamaya et al. published in the European Journal of Internal Medicine [1]. The Authors conducted a comprehensive analysis of the impact of lifestyle... more
GLP-1 receptor agonists for the treatment of obstructive sleep apnea and obesity
Obstructive sleep apnea (OSA) syndrome is a common disorder of repeated upper airway collapse during sleep, leading to recurrent hypoxia and hypercapnia [1]. Continuous positive airway pressure (CPAP... more
Switching from hospital centered to community based, person centered and integrated social health and care systems; Mission impossible or key objective?
Length of Stay (LOS) is a widely recorded metric used in hospital management and considered an important indicator of healthcare efficiency [1]. Despite its strategic value and one of the longest... more
The potential impact of educational attainment on NAFLD risk
We read with great interest the article by Florian Koutny and his colleagues, recently published in the European Journal of Internal Medicine [1]. In this article, Florian Koutny and his colleagues... more
Characteristics of familial Mediterranean fever after 65 years of age
Dear Editor,
Co-management hospitalist services for neurosurgery. Where are we?
Dear Editor, the increase in the average age of the population and in the prevalence of chronic comorbidities has made healthcare extremely difficult and sometimes with difficult home management [1,2... more
Factors associated to multiple chronic conditions in internal medicine patients
Dealing with patients with multiple chronic conditions (MCC) is certainly one of the most compelling healthcare challenges [1]. Most of the available data about MCC derive from large administrative... more
FIB-4 score association with operative outcomes, truth or fibs?
In recent years, liver disease has become established as a significant predictor of poor perioperative outcomes [1]. Despite declining rates of hepatitis B and hepatitis C-related morbidity and... more
Diagnostic value of pleural calprotectin in differentiating complex parapneumonic effusions
Dear Editor,
Oh no, all we needed was monkeypox!
Four years after the spread of the coronavirus disease 2019 (COVID-19) pandemic, with a worldwide epidemiology largely under control thanks to widespread immunity against severe acute respiratory... more
Original Article
Opt-In versus opt-out for the secondary use of routinely recorded health data: A randomized controlled trial
Optimal data availability is crucial for continuous improvement and innovation in healthcare. In moving toward learning health systems, data need to be constantly generated, reused and learned from.... more
Prediction of mortality in heart failure by machine learning. Comparison with statistical modeling
Heart failure (HF) is a complex, increasingly prevalent syndrome burdened by poor quality of life, compromised capability to accomplish activities of daily living, high healthcare costs, and still... more
Comparative effectiveness of bictegravir versus dolutegravir, raltegravir, and efavirenz-based antiretroviral therapy among treatment-naïve individuals with HIV
Bictegravir or dolutegravir (two integrase strand inhibitors) in combination with two nucleoside reverse transcriptase inhibitors are recommended as first-line antiretroviral therapy [1,2].Both have... more
The impact of hypoalbuminemia on the long-term prognosis of patients with acute heart failure: The modifying role of carbohydrate antigen 125
The main novelty of the present study is:
Prevalence and impact of multidrug resistance in a cohort of patients admitted to emergency department for urinary tract-infections: The UTILY study, a prospective multicentre study
Urinary tract infections (UTIs) are among the most frequent bacterial infections both in community and healthcare settings [1]. The Global Burden of Diseases (GBD) has estimated an incidence of 0.4... more
The effect of a new thinking guidance of OPACCUS for shock on the 30-day mortality: A multicenter, prospective, observational, cohort study
Shock is the final common pathway before death and a constant focus of ICU physicians due to its high morbidity and mortality [1] (ranging from 27 % to 60 %) in critically ill patients. Recent... more
Effects of valsartan vs amlodipine and achieved lower blood pressure on the incidence of end-stage kidney disease: The VALUE Trial
There is a strong relationship between high blood pressure (BP) and the risk of developing chronic kidney disease (CKD) [1–8]. In people with CKD, a high BP is associated with a faster decline of... more
Length of hospital stay, delayed pneumonia diagnosis and post-discharge mortality. The Pneumonia in Italian Acute Care for Elderly units (PIACE)-SIGOT study
The ageing of populations in high-income countries has increased the number of vulnerable older persons requesting medical care, including care for acute and complex illnesses that warrant medical... more
Effect of continuous positive airway pressure on non-fatal stroke and paroxysmal atrial fibrillation recurrence in obstructive sleep apnoea elderly patients
Obstructive sleep apnoea (OSA) is a respiratory disorder characterised by repeated events of upper airway collapse leading to airflow limitation [1]. OSA is often under-recognised, and if untreated,... more
Exploring phenotypes to improve long-term mortality risk stratification in obstructive sleep apnea through a machine learning approach: an observational cohort study
Obstructive sleep apnea (OSA) is a highly prevalent [1] and heterogeneous sleep disorder [2], characterized by frequent collapses of the upper airway that induce intermittent hypoxia and sleep... more
Evaluations of metabolic and innate immunity profiles in subjects with familial hypercholesterolemia with or without subclinical atherosclerosis
Atherosclerosis is a chronic and progressive process promoted by several environmental and genetic factors [1,2]; among these, low-density lipoprotein cholesterol (LDL-C) has been recognized to have... more
Long-term follow-up of hereditary hemorrhagic telangiectasia patients without significant pulmonary right-to-left shunt at screening
Hereditary hemorrhagic telangiectasia (HHT) is a vascular genetic rare disease (ORPHA: 774) characterized by systemic telangiectases and larger vascular malformations [1]. HHT can be diagnosed using... more
Different impact of chronic kidney disease in older patients with heart failure according to frailty
Chronic kidney disease (CKD) affects up to 10 % of the general population, being one-third of these individuals over 65 years old [1]. A bidirectional interaction, has been described between CKD and... more
Association between long-term exposure to air pollution and incidence of peripheral artery disease: Evidence from a longitudinal study
Cardiovascular disease (CVD) is one the most frequent cause of death and disability globally, including Europe. CVD causes 3.9 million annual deaths in the European Union and the loss of 26 million... more
Comorbidity patterns and the risk of injurious falls in older people with atrial fibrillation: Findings from a Swedish nation-wide population-based study
Atrial fibrillation (AF) is the most common arrhythmia in the general population, increasing by 30 % over the last 20 years primarily as a result of the better diagnostics and ageing population [1],... more
Clinical characteristics and outcomes of Takotsubo syndrome in patients with chronic obstructive pulmonary disease
Takotsubo syndrome (TTS) is an acute heart failure syndrome characterized by a transient impairment of systolic function [1]. Adverse outcomes have been described both in the acute phase and, despite... more
Modifiable lifestyle factors in the primordial prevention of hypertension in three US cohorts
Hypertension is a leading cause of cardiovascular diseases (CVD). The prevalence has doubled from 1990 to 2019 [1] and now impacts almost half of the US adult population [2], and the condition... more
Clinically relevant bleeding according to location of metastases in cancer-associated thrombosis
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent complication in patients with cancer [1]. It is estimated that 20–30 % of VTE cases are... more
External validation of a prognostic score to identify low-risk outpatients with acute deep venous thrombosis in the lower limbs
Deep vein thrombosis (DVT) and pulmonary embolism (PE) stand as the primary manifestations of venous thromboembolism (VTE) [1-3]. Nonetheless, the absence of national surveillance systems for VTE... more
Hyperchloremic metabolic acidosis potentially benefiting sodium bicarbonate therapy: A multi-center cohort study
Metabolic acidosis is a type of acid-base imbalance that significantly impacts prognosis. It can be caused by poisoning, infections, surgeries, acute and chronic renal failure, diabetic ketosis, and... more
Practice Guidelines
Treatment of hospitalized patient with hyperglycemia: An EFIM critically appraised and adapted guideline
Over the past decade, diabetes mellitus (DM) has emerged as a growing epidemic with an estimated global prevalence of 10.5 % (537 million people) in 2021, according to the International Diabetes... more
Review Article
Chronic obstructive pulmonary disease: A narrative synthesis of its hallmarks for palliative care clinicians
Chronic obstructive pulmonary disease (COPD) accounts for approximately 55 % of cases of respiratory diseases and is now the third cause of both death and morbidity worldwide [1]. Its prevalence is... more
Practical management of severe acute pancreatitis
Diagnosis of acute pancreatitis (AP) is based on the Revised Atlanta Classification[1] (Table 1) requiring at least two of three criteria: i) typical epigastric pain radiating to the back, ii) serum... more
Transforming organ donation and transplantation: Strategies for increasing donor participation and system efficiency
Organ transplantation stands as one of the most significant advancements in modern medicine, providing life-saving solutions for patients with end-stage organ failure [1]. From the first successful... more
New strategies for the treatment of hyperkalemia
Potassium (K+) is the most abundant cation in the body (50–75 mEq/L/kg body weight). Under physiological conditions, approximately 98 % of total body K+ is located in the intracellular space and only... more
Gliflozines use in heart failure patients. Focus on renal actions and overview of clinical experience
In the past decades impressive progress in heart failure (HF) treatment has been achieved by adoption of therapeutic tools ranging from renin angiotensin system antagonists to beta blocking agents,... more