March 2025
153 ArticlesNo Section
Chronicity of disease mandates quality-of-life prioritization – a role for digital health and patient-reported outcome measures
The field of internal medicine is evolving at unprecedented speed and humankind is steadily growing older. Progress in diagnostics and treatment have improved the prognosis of many diseases and led... more
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
The emperor's new clothes and the case of vitamin D and cardiovascular risk. A few thoughts after the guidelines of the American Society of Endocrinology
As in the famous Christian Andersen fairy tale, the recent guidelines of the American Society of Endocrinology [1] have confirmed that the king is naked, significantly diminishing the role of... more
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
Acute exacerbation of chronic obstructive pulmonary disease: An underestimated cardiovascular risk factor
Chronic obstructive pulmonary disease (COPD) is a widespread respiratory disease associated with significant morbidity and mortality [1,2]. It ranks among the leading causes of death and is expected... more
Sodium-glucose co-transporter 2 inhibitors in acute heart failure: What are you waiting for?
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) were initially discovered as a compound present in roots, leaves and fruits of the apple tree in 1835. However, it was not until the beginning of... more
The prothrombotic effects of Lipoprotein (a) and atherosclerosis
Lipoprotein (a) [Lp(a)] is a plasma lipoprotein consisting of a cholesterol-rich LDL particle with one molecule of apolipoprotein B100 and an additional protein which has sequence homology with... more
The misalignment between chronotype and sleep time: Friend or foe?
We spend approximately one third of our lifetime in sleep, a complex physiological process which is an established health determinant. In the last decades, it has been demonstrated that reduction of... more
Catheter ablation of atrial fibrillation in older patients: The need for a comprehensive evaluation and management
Atrial fibrillation (AF) affects approximately one-third of individuals aged 80 years and over and is associated with a wide range of adverse clinical outcomes, including heart failure (HF), ischemic... more
Redefining thiamine requirements in alcohol use disorder: Aligning treatment with neurocognitive needs
Alcohol Use Disorder (AUD) is a pervasive condition that often presents with marked neurocognitive consequences. From mild executive and memory deficits to severe conditions such as Wernicke–... more
Ischemic heart failure etiology: A misleading definition?
Heart failure (HF) remains a leading cause of morbidity and mortality despite advances in interventional and pharmacological therapies [1,2]. Beyond the classification based on left ventricular... more
Atrial fibrillation screening: The importance of the patient perspective
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with its prevalence increasing significantly in older adults and individuals with comorbidities [1]. Beyond being a major contributor... more
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
Chest pain, inflammatory syndrome and headache
A 51-year-old white man presented to the internal medicine department with altered general condition and significant weight loss of 14 kg in 3 months. The main symptom was cervical pain and headache... more
Linear lesions on the chest
A 70-year-old man with a history of lung adenocarcinoma was admitted to our hospital for chemotherapy. During his hospitalization, eruptive papules with a dermatomal distribution developed on his... more
When skin and lung meet
A 50-year-old male, heavy smoker (>30 p/Y), presented to E.R. because of chest pain. In his recent clinical history, he had relapsing papular-purpuric small lesions in the limbs, trunk and arms... more
A man with trismus and decubitus ulcers
A 65-year-old man with a history of binge drinking who had engaged in gardening was brought to our hospital for lethargy. On physical examination, temperature was 35.0 °C, blood pressure was 70/50... more
A 73-year-old man with purpura and fever
A 73-year-old man presented to our dermatology department with a four-week history of palpable purpura on the lower limbs. His medical history included a suspicion of polymyalgia rheumatica based on... more
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
What is new in the management of coeliac disease?
Coeliac disease is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals [1]. It is characterised by immune-mediated inflammation and damage to the... more
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
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
Building on the UTILY Study: Exploring uncharted aspects of multidrug-resistant pathogens in urinary tract infections. Author's reply
Dear Editor,
More on peripheral artery disease and air pollution. Author's reply
Dear Editor,
Critical considerations for sodium bicarbonate therapy in metabolic acidosis: Addressing confounding factors and methodological limitations
I recently read the paper by Tong et al., which explores the clinical effects of sodium bicarbonate (SOB) therapy in metabolic acidosis, focusing on the interaction between baseline chloride levels... more
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
Non-statistical significance and clinical relevance: Are we chasing shadows in the air pollution-peripheral artery disease debate?
The impact of air pollution on cardiovascular diseases has been a subject of extensive research, with compelling evidence linking long-term exposure to pollutants such as particulate matter (PM2.5),... more
Gut dysbiosis and leaky gut syndrome in moderately impaired amyotrophic lateral sclerosis patients
Dear Editor,
Considerations on the impact of apixaban on patient-reported outcomes in frail older adults
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,
Reevaluating hypoxia and cancer as determinants of prognosis in COPD and Takotsubo syndrome. Author's reply
We thank García-Martí et al. for the interest in our study recently published in the European Journal of Internal Medicine [1], and here we provide further analysis following their stimulating... more
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.
Refining risk assessment for intra-abdominal infections in immunocompromised intensive care unit patients. Author's reply
Dear Editor,
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
Building on the UTILY Study: Exploring uncharted aspects of multidrug-resistant pathogens in urinary tract infections
We have carefully reviewed the article by Onorato et al., published in the European Journal of Internal Medicine [1]. The study provides important insights into the prevalence of multidrug-resistant... more
Outcomes and readmissions in octogenarians and nonagenarians undergoing catheter ablation for atrial fibrillation in the United States
Dear Editor,
Frailty, disability and patient-reported outcomes in apixaban users
atrial fibrillation (AF) is the arrhythmia most frequently diagnosed in older patients with a prevalence higher than 10 % in subjects ≥70 years [1]. The incidence of venous thromboembolism (VTE),... more
Mortality in the first 24 hours after admission in the intensive care unit
Dear 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
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
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
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
Vaginal self-sampling for human papillomavirus to improve cervical cancer screening in patients with immune-mediated inflammatory diseases
Dear Editor,
Reevaluating hypoxia and cancer as determinants of prognosis in COPD and Takotsubo syndrome
Dear Editor,
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
Rituximab in Immune-mediated thrombotic thrombocytopenic purpura
Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially fatal thrombotic microangiopathy, defined by a mechanical hemolytic anemia, severe thrombocytopenia, and visceral ischemia due to... 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
Refining the understanding of cardiovascular risk following COPD exacerbations: Opportunities for stratified and multidisciplinary approaches
We have carefully reviewed the article by Calabria et al., published in the European Journal of Internal Medicine [1]. This study, based on a comprehensive database analysis, highlights the... more
Refining risk assessment for intra-abdominal infections in immunocompromised intensive care unit patients
The study by Paiva and colleagues [1] provides valuable insights into intra-abdominal infections (IAI) in immunocompromised intensive care unit (ICU) patients, highlighting similarities and... more
Analysis of “characteristics of familial mediterranean fever disease after 65 years of age”
I have read the article “Characteristics of Familial Mediterranean fever (FMF) after 65 years of age” with great interest. The study provides valuable insights into the clinical features and... 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
Hypertension – a global problem requiring a comprehensive approach
We read with great interest a recently published study by Rikuta Hamaya, Molin Wang, Ellen Hertzmark, et al. regarding modifiable lifestyle factors in the primordial prevention of hypertension [1].... more
Enhancing hypertension prevention research: Insights and opportunities for social work interventions. Author's reply
Dear Editor,
Risk for hospital-treated infections in dermatitis herpetiformis and coeliac disease
Dear Editor,
Risk of injurious falls in older people with atrial fibrillation
Dear editor,
Enhancing the understanding of hyperhomocysteinemia and MASLD: Addressing methodological limitations and future directions
To the editor:
Use of betablockers in post-myocardial infarction patients in a real-world setting
For many years, the main guidelines have been recommending the use of betablocker therapy in patients after myocardial infarction (MI) [1,2]. This recommendation entails a high class and grade for... more
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
High-risk allogeneic stem cells transplantation in advanced age patients with uncontrolled sickle cell disease
Sickle cell disease (SCD) is a recessive monogenic disease where a single nucleotide mutation of the HBB gene, encoding the β-globin chain of hemoglobin (Hb), leads to the synthesis of HbS.... 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,
Seasonality of diabetic ketoacidosis in hot climate
Diabetic ketoacidosis (DKA) is a life-threatening condition arising from an absolute or relative insulin deficiency, leading to hyperglycemia and ketone body accumulation in the blood with metabolic... more
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
Validating ChatGPT's role in systematic reviews and meta-analyses: A case study on GLP-1 receptor agonists and all-cause mortality
Dear Editor,
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
Optimizing socioeconomic and psychosocial factor analysis in myocardial infarction outcomes
Dear Editor,
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,
Refining metabolic health assessment in inflammatory bowel disease risk prediction
Mi et al.'s investigation [1], drawing upon the United Kingdom (UK) Biobank resource, delves into the interplay between metabolic health and genetic predisposition to inflammatory bowel disease (IBD... more
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
Gendered social determinants of health and risk of major adverse outcomes in atrial fibrillation
The global population is aging and the burden of atrial fibrillation (AF) is expected to rise sharply over the next decades [1,2]. Beyond a fivefold increase in stroke risk, individuals with AF... more
Assessment of nasal pressure swing predicts respiratory support dependency in patients with hypoxic respiratory failure
In recent years, particularly following the COVID-19 pandemic, there has been increasing interest in non-invasive respiratory support (RS) to manage the acute hypoxemic respiratory failure (AHRF) [1–... more
Assessment of cardiovascular, thromboembolic and cancer risk in patients eligible for treatment with Janus Kinase inhibitors: The JAK-ERA multidisciplinary consensus
Janus kinase inhibitors (JAKi), a class of targeted synthetic disease-modifying antirheumatic drugs, have significantly impacted clinical practice in the treatment of various autoimmune and... more
Promoting women's careers in life science and medicine: A position paper from the “International Women in Intensive Medicine” network
It is well-established that women are underrepresented in leadership positions [1], undervalued in their academic careers, and experience gender discrimination in scientific and healthcare... more
Hypertensive heart disease in older patients: considerations for clinical practice
Appropriate blood pressure (BP) control remains the main therapeutic strategy to address the adverse sequelae of hypertension irrespective of a patient's age [1]. A patient group that is continuously... more
Risk of hepatic decompensation or HCC is similar in patients with ALD- and MASLD-cirrhosis: A population-based cohort study
Patients with a chronic liver disease often develop liver cirrhosis after a certain time if their disease is not appropriately managed, and cirrhosis was the cause of death in 2.4 % of all deaths... 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
Comparative analysis of obesity indices in discrimination and reclassification of cardiovascular disease risk: The ATTICA study (2002–2022)
In the mid-2010s, after four decades of consistent decline, the mortality rate from heart disease began to show an increasing trend. This shift was largely attributed to the growing obesity epidemic... more
Characterization of ischemic etiology in heart failure with reduced ejection fraction randomized clinical trials: A systematic review and meta-analysis
Heart failure (HF) is a major cause of cardiovascular (CV) morbidity and mortality in developed countries with rising prevalence due to the aging of the population, the poor control of CV risk... more
Advancing women's health with a pioneering implant to treat breast cancer related lymphedema
Lymphedema (LE) is a frequent, but often overlooked condition, with secondary LEs accounting for approximately 82.5% of cases [1]. It typically arises from lymphatic vessel damage or obstruction... more
High-flow nasal oxygen therapy in patients with hypercapnic respiratory failure: A systematic review and meta-analysis
Noninvasive ventilation (NIV) has been used to treat acute respiratory failure for more than 30 years, and it is undoubtedly one of the most important advances in respiratory support [1]. With the... more
Lipoprotein(a) and prothrombotic effects: Evidence from a genetic association study
Lipoprotein(a) [Lp(a)] is an apoB-containing lipoprotein bound to a hydrophilic, highly glycosylated protein called apolipoprotein(a) [apo(a)] [1]. Apo(a) is encoded by the LPA gene, and Lp(a)... more
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
Risk trajectory of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis
Chronic obstructive pulmonary disease (COPD) is primarily a respiratory condition characterized by irreversible airflow limitation and multiple debilitating symptoms, including dyspnea, cough, and... 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
Safety and efficacy of early initiation of sodium-glucose co-transporter inhibitors 2 in patients hospitalized for acute heart failure: A meta-analysis of randomized controlled trials
Acute heart failure (HF) is a clinical syndrome with multiple aetiologies, among which acute coronary syndrome constitutes one of the most frequent precipitating factors, especially in developed... 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
What is the impact of thiamine deficiency on cognitive function in patients with alcohol use disorder? – A systematic review
Cognitive impairments, frequently observed in Alcohol Use Disorder (AUD) patients, range from severe memory impairment with other cognitive functions relatively preserved seen in Korsakoff's Syndrome... more
Effects of population-based screening for atrial fibrillation on quality of life
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an increased risk of stroke, heart failure, and mortality [1]. Many cases of AF remain undetected due to no or... 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:
Adverse effects of late sleep on physical health in a large cohort of community-dwelling adults
Human health is influenced by a myriad of factors, including genetics, environment, and behavior. One behavior that has received significant recent attention is the impact of sleep on human health.... more
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
Comprehensive management of pneumonia in older patients
Pneumonia is a bacterial, viral, fungal, or parasitic infection of lung parenchyma, resulting in significant local and systemic inflammation. Pneumonia is the leading infectious cause of... more
Bridging the gap: Time to integrate sex and gender differences into research and clinical practice for improved health outcomes
It is widely recognized that sex and gender interact with factors such as genetic background, ethnicity, socioeconomic status, disability, and age, thus influencing health status and disease. The... more
Beyond creatinine: New methods to measure renal function?
The kidneys play a central role in maintaining the body's homeostasis, performing a wide range of vital functions. They eliminate unnecessary and potentially toxic metabolic waste products, such as... more
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