May 2021
54 ArticlesNo Section
Influence of gender on the performance of urine dipstick and automated urinalysis in the diagnosis of urinary tract infections at the emergency department
Urinary tract infections (UTIs) are generally more common in women compared to men [1-3]. Beside incidence, also differences in presentation and course of UTI exist between men and women. This is due... more
When and how did the air come in?
An 84-year-old man with cognitive dysfunction was taken to the emergency room because of a change in consciousness. He came in with a Glasgow Coma Scale (GCS) score of E4V4M5. According to his family... more
SGLT2 inhibitors should be recommended in patients with one or more of the three diseases: type 2 diabetes, chronic kidney disease, and HFrEF
Patoulias and colleagues have made a relevant commentary entitled “Chronic kidney disease and diabetes status do not affect efficacy of SGLT-2 inhibitors in patients with heart failure with reduced... more
Infective endocarditis in patients with solid organ transplantation. A nationwide descriptive study
Infective endocarditis (IE) is a serious condition with a poor prognosis [1,2]. Solid organ transplantation (SOT) is an established and practical definitive treatment option for patients with end-... more
Estimated glomerular filtration rate and renal resistive index as possible predictive markers of mortality in systemic sclerosis
Systemic sclerosis (SSc) is an autoimmune disease characterized by immune system activation, microvascular damage and fibrosis of skin and internal organs. Renal manifestations of SSc include... more
Risk factors and current management of venous thromboembolism in patients with primary immune thrombocytopenic purpura.
immune thrombocytopenic purpura (ITP) is a rare hematologic disorder characterized by isolated thrombocytopenia due to platelet destruction, without abnormalities of erythrocyte or leukocyte number... more
Pulmonary congestion and mortality during venoarterial extracorporeal membrane oxygenation (VA-ECMO): does time matter?
In a recent edition of this Journal, an intriguing study was published which examined the association between (development of) pulmonary congestion (PC) and mortality in patients with post-cardiotomy... more
Commentary
SGLT2 inhibitors: Do we need other evidences?
The five cardiovascular outcome trials (CVOT) conducted in patients with type 2 diabetes mellitus so far have shown that renal sodium-glucose cotransporters two inhibitors (SGLT2i) are cardiovascular... more
Colorectal cancer and cardiovascular diseases: Are we closing the gap between knowledge and action?
Colorectal cancer (CRC) and cardiovascular diseases (CVD) are amongst the two leading causes of death in western countries and have dramatic impact on the financial sustainability of the health... more
Colorectal cancer and cardiovascular disease: A thrombo-inflammatory link?
One of the few advantages of the Covid-19 pandemic is a renewed focus on the benefits of a healthy lifestyle, as a way to reduce both the risk of contracting SARS-CoV-2 infection and, in case of... more
When is it reasonable to extrapolate during a pandemic?: The case of broad UK labeling for AstraZeneca COVID-19 vaccine
Amid an unprecedented surge of COVID-19 cases in the UK, with an increasing number due to a novel more infectious SARS-CoV-2 variant,[1] the UK regulatory agency (MHRA) granted emergency approval to... more
Venous lactate: The new “magic marker” for stratification in intermediate-risk pulmonary embolism?
Risk stratification in patients with acute pulmonary embolism (PE) is essential to guide the choice of appropriate therapy. The stratification of risk is first and foremost based on the presence of... more
Editorial
Implementation of Guidelines on Atrial Fibrillation Management in the Global Arena: So Many Actors on Stage!
According to the seminal definition by the Institute of Medicine released in 1990, clinical guidelines represent “systematically developed statements to assist practitioner and patient decisions... more
Internal Medicine Flashcard
No more than meets the eye
A 33-year old Ivorian woman was admitted for fever and thrombocytopenia. She had been previously treated in France by tocilizumab then anti TNF-α for rheumatoid arthritis since 7 and 2 years... more
Atypical cause of episodic abdominal pain and unintentional weight loss
A 23-year-old female with past medical history of generalized anxiety disorder and migraine presents to the clinic with unintentional weight loss of approximately 20 lbs and chronic episodic... more
The long toenail sign in older adults
A 78 year old male attended a geriatric medicine outpatient clinic accompanied by his son. He described a history of falls, memory impairment and difficulty completing activities of daily living... more
Letter to the Editor
The power of choice: Experimental evidence that freedom to choose a vaccine against COVID-19 improves willingness to be vaccinated
Ending the COVID-19 pandemic will require rapid and large-scale uptake of vaccines against the disease. The European Commission has authorized three vaccines so far, and first doses have already been... more
Chronic kidney disease and diabetes status do not affect efficacy of SGLT-2 inhibitors in patients with heart failure with reduced ejection fraction
We have read with great interest the meta-analysis performed by Qiu et al. [1] published in the European Journal of Internal Medicine, assessing the cardio-renal efficacy of different sodium-glucose... more
Acute coronary syndrome-related hospital admissions during and after lockdown in Southern Germany
The Covid-19 pandemic has affected all aspects of our daily life and challenged our health care system in an unprecedented manner [1]. The crisis even altered the health behavior resulting in... more
Cor homini lupus? Identification of risk factors implicated in cardiovascular events in patients with Systemic Lupus Erythematosus in Romania
Cardiovascular disease (CVD) accounts for up to 35% of mortality in patients with systemic lupus erythematosus (SLE) [1]. Emerging evidence supports that SLE disease activity is associated with up to... more
Treating life-threatening TAFRO syndrome with interleukin-1 inhibition
TAFRO syndrome (Thrombocytopenia, Anasarca, Fever, Reticulin fibrosis, and Organomegaly) is a newly recognized variant of idiopathic - human herpesvirus-8 (HHV-8) negative - Multicentric Castleman... more
Diagnosis of infection by SARS-COV-2: Is one molecular test enough?
A pandemic phase of SARS-CoV-2 infection is currently ongoing, with a particular diffusion in Italy [1]. Accurate diagnosis of asymptomatic carriers of the virus as well as of patients with acute... more
“Let me choose my COVID-19 vaccine”
In the first half of 2021, many millions of Europeans will be offered vaccination against SARS -CoV-2. Four vaccines, two mRNA-based vaccines (Pfizer-BioNTech and NIH-Moderna) and two non-replicating... more
SARS-CoV-2 seroprevalence in the Vatican City State
The ongoing Coronavirus Disease 19 (COVID-19) pandemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has affected so far 218 countries with over 94 million cases, about 2... more
How specific are elevated IgG4 levels for IgG4-related disease?
IgG4-Related Disease (IgG4-RD) is a systemic inflammatory disorder with potential to affect almost every organ [1]. The diagnosis of IgG4-RD is primarily based upon characteristic histological... more
Longitudinal trends and outcomes of adult heart transplantation in the U.S.
Heart transplantation is the treatment of choice for patients with end-stage heart failure [1, 2]. Evaluation of outcome trends is imperative to identifying areas of improvement and making goal-... more
A systematic bias assessment of top-cited full-length original clinical investigations related to COVID-19
With the emergence of coronavirus disease 2019 (COVID-19) pandemic, there has been an exponential rise in the number of scientific publications to convey relevant information about this novel disease... more
Vertebral level identified by the intercristal line: Confirmation by ultrasound
Prior to performing a lumbar puncture (LP) at the bedside, the intercristal line, formed posteriorly between the superior aspect of the iliac crests, commonly serves as a landmark to identify the L4... more
Do four SGLT2 inhibitors lead to different cardiorenal benefits in type 2 diabetes, in chronic heart failure, and in chronic kidney disease?
Large randomized trials have confirmed the cardiorenal benefits from sodium-glucose transporter 2 (SGLT2) inhibitors for patients with type 2 diabetes (T2D), for patients with chronic heart failure... more
Serum uric acid levels: A surrogate marker of oxidative stress or dehydration?
Dear Editors,
Less is more: Perspectives from the European Code Against Cancer
We have read the article of Kherad et al. with great interest. The authors elaborate on the “less is more” principle, which has become quite relevant in various areas of medicine including cancer [1... more
Flying higher than politics: The goal of preventive medicine at the time of the COVID-19 pandemic
The present SARS-CoV-2-caused COVID-19 pandemic [1] has clearly shown that great health crises can elicit heated political and scientific debates. The history of medicine teaches us how, throughout... more
Heart rate turbulence in obstructive sleep apnea syndrome: The effect of short-term CPAP therapy
Patients affected by obstructive sleep apnea (OSA) present an increased risk of cardiovascular (CV) events [1]. This is likely due to the imbalance in the autonomic nervous system, with cardiac... more
Low influenza vaccination coverage among hospitalized COVID-19 patients in Milan: A gap to be urgently filled
The first wave of the COVID-19 epidemic in Italy during March and April 2020 put extreme pressure on the national healthcare system, particularly on the hospitals in the most affected regions of... more
Original Article
Effect of SGLT-2 inhibitors on cardiovascular outcomes in heart failure patients: A meta-analysis of randomized controlled trials
Heart failure (HF) is a highly prevalent disease with considerable morbidity and mortality. It is estimated that approximately 50 million people are afflicted with this disease worldwide. The disease... more
TGF-β1 +869T/C (rs1982073) gene polymorphism and susceptibility to rheumatoid arthritis: Updated systematic review and meta-analysis
Rheumatoid arthritis (RA) is a complex autoimmune disease that affects about 1% of the world's population, which is characterized by the erosion and destruction of cartilage and bone [1,2]. As a... more
Incidence and risk factors for preneoplastic and neoplastic lesions of the colon and rectum in patients under 50 referred for colonoscopy
According to estimates from the International Agency for Research on Cancer (2018), colorectal cancer (CRC) occurred in approximately 1.8 million patients and accounted for 900000 deaths worldwide,... more
Non–Specific Clinical Presentations are Not Prognostic and do not Anticipate Hospital Length of Stay or Resource Utilization
Up to 20% of patients arriving at an emergency department (ED) may have a non-specific presentation (NSP). Previous studies have suggested that a NSP, despite the similarity of patient demographics... more
Prediction and primary prevention of major vascular complications in systemic sclerosis
Systemic Sclerosis (SSc) is a chronic autoimmune disease, characterized by immune system activation, vascular abnormalities and uncontrolled fibrotic response in the skin and internal organs [1]. The... more
Venous lactate improves the prediction of in-hospital adverse outcomes in normotensive pulmonary embolism
Pulmonary embolism (PE) is associated with high morbidity and mortality, making it a major contributor to global disease burden. [1,2] Thus, current guideline recommendations emphasize the importance... more
Long-term effectiveness and safety of anticoagulation therapy in oldest old, frail people with atrial fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia in clinical practice [1] with a prevalence destined to progressively increase due to population aging [2]. As a fact, AF represents a... more
Anakinra for patients with COVID-19: a meta-analysis of non-randomized cohort studies.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affected 104.956.439 people worldwide and caused the death of 2.290.488 as of February 7, 2121[1]. Life-threatening cases of the... more
Assessing the impact of COVID-19 on the health of geriatric patients: The European GeroCovid Observational Study
Older adults have been the part of the population most burdened by COVID-19 pandemic. Indeed, the disease mortality rate was reported to rise, in men and women, from 4.6% and 2.5% among those aged 30... more
Age-Related Changes in Clinical Presentation of Covid-19: the EPICOVID19 Web-Based Survey
The burden posed by the Covid-19 pandemic on healthcare systems requires strategies to identify high-risk people in order to better allocate the available health resources and plan targeted care... more
Impact of the number of comorbidities on cardiac sympathetic derangement in patients with reduced ejection fraction heart failure
Heart failure (HF) is a very prevalent condition associated with high morbidity and mortality rates, thus representing a relevant global health burden. It affects more than 26 million people... more
Cannabis is associated with blood pressure reduction in older adults – A 24-hours ambulatory blood pressure monitoring study
Background: Medical cannabis use is increasing rapidly in the past several years, with older adults being the fastest growing group. Nevertheless, the evidence for cardiovascular safety of cannabis... more
Non-retrieved inferior vena cava filters: causes and long-term follow-up
Inferior vena cava (IVC) filters are implantable devices created to trap thrombi from the lower extremities and prevent clinically significant pulmonary embolism (PE). According to guidelines, the... more
Predictors of mortality among adult, old and the oldest old patients with bloodstream infections: An age comparison
In recent years, incidence of bloodstream infections (BSIs) has been increasing worldwide, with over 1.2 million estimated episodes of BSI per year in Europe and around 600 000 in North America [1].... more
Neuraminidase inhibitors are effective and safe in reducing influenza complications: meta-analysis of randomized controlled trials.
Influenza is an infection of variable severity resulting in high accumulated mortality worldwide [1]. Seasonal influenza deaths occur mainly in young children and the elderly, while during influenza... more
Is there excessive troponin testing in clinical practice? Evidence from emergency medical admissions
Troponin assays are a relatively common laboratory diagnostic request in emergency medical admissions. Following cardiac injury these macromolecules diffuse into the cardiac interstitium with... more
Review Article
Non-invasive respiratory support in the treatment of acute hypoxemic respiratory failure secondary to CoViD-19 related pneumonia
While many of the epidemiological aspects and clinical characteristics of CoViD-19 disease have been understood [1-3], little has been clarified regarding the best ventilatory support to offer to... more
Sustainable and personalized nutrition: From earth health to public health
In the difficult times amidst the SARS-CoV-2 pandemic, the whole world has become more conscious of the importance of primary and secondary prevention. COVID-19 is already having a triple hit on... more
Multidisciplinary prevention and management strategies for colorectal cancer and cardiovascular disease
Colorectal cancer (CRC) and Cardiovascular disease (CVD) represent leading causes of morbidity and mortality in industrialized countries [1]. While they are typically thought of as separate disease... more
Beyond the 2020 guidelines on atrial fibrillation of the European society of cardiology
The history of guidelines began in 1990 when the Institute of Medicine (IOM) published a report defining guidelines as "systematically developed statements to assist practitioner and patient... more