May 2023
32 ArticlesClinical Insights
Clinical pearls and pitfalls of SARS-CoV-2 serology
Although the effort to provide updated and reliable statistics about coronavirus disease 2019 (COVID-19) remains a challenging enterprise due to the ongoing epidemiologic evolution and an almost... more
Combination therapy as a first step of treatment in diabetes: Changing the paradigm in KDIGO guidelines?
The use of more than one drug in the initial management of hypertension under certain instances has been recognized as paramount and is featured in several clinical guidelines for high blood pressure... more
The relationship between COVID-19 vaccines and increased blood pressure: A word of caution
COVID-19 vaccines substantially changed the course of the pandemic, saving millions of lives on a global scale [1]. According to the latest evidence, 64.85% of the world's population has been fully... more
Commentary
The environmental impact of unnecessary imaging: Why less is more
Global warming is a global health crisis of epidemic proportions. As glaciers melt, oceans and rivers rage and catastrophic weather events become more common, it is critical to do all we can to slow... more
Network meta-analysis: A map to navigate the maze of treatment for advanced hepatocellular carcinoma
The treatment landscape of advanced hepatocellular carcinoma (HCC) has become increasingly complex over the past few years [1]. After the decade-long multi-kinase inhibitor (MKI) monopoly of... more
Identifying patients at risk for chronic thromboembolic pulmonary hypertension
Patients with chronic thromboembolic pulmonary hypertension represent a subgroup of patients suffering from pulmonary hypertension. The disease is characterized by chronic, non-resolving... more
Internal Medicine Flashcard
Secondary amenorrhoea with absent axillary hair
A 39-year-old female presented with progressive fatigue, extreme tiredness, muscle pain, giddiness and shortness of breath for six months. On further questioning she reported lack of menses for 19... more
Sudden erythematous cutaneous eruption
A 43-year-old male with a history of hypertension, diabetes and obesity (BMI > 55) presented to the Emergency Department with a pruritic palpable rash for several days. It had started suddenly as... more
Eruptive yellowish red papules in a fat youth
A 22-year-old man presented with a 6-week history of generalized asymptomatic papules (Fig. 1A). The rashes were increasing gradually and predominantly distributed on the back and the extensor... more
Letter to the Editor
C-reactive protein level association with future cardiovascular events assessed by different risk scores among rheumatoid arthritis patients
We appreciate the interest of Noriaki Kou and colleagues [1] in our article [2], and we fully agree that beside disease activity, therapies, and systemic inflammation other non-traditional... more
Safety and efficacy of colchicine for the prevention of recurrent atrial fibrillation post-catheter ablation
Dear Editor,
Effectiveness and persistence with selexipag in pulmonary arterial hypertension in the real-life setting
The prostanoid analog epoprostenol, the first approved targeted therapy for pulmonary arterial hypertension (PAH), is also the only one that has shown any benefit for survival vs. placebo in PAH... more
Point of care ultrasound in internal medicine in Portugal – where we are and where we should go?
Point-of-care ultrasound (POCUS) is growing rapidly across a broad span of specialties in Medicine as a whole, worldwide. Further, POCUS is driving a revolution in every aspect of clinical practice [... more
The impact of atrial fibrillation on outcomes in patients hospitalized with COVID-19
Studies have shown that coronavirus disease 19 (COVID-19) is an independent predictor of incident atrial fibrillation (AF) but the impact of pre-existing AF on the outcomes of patients hospitalized... more
Hyperglycemia drives the transition from pre-frailty to frailty: The Monteforte study
Pre-frailty is a condition that precedes frailty; in 2001, Linda Fried and colleagues defined pre-frailty as the presence of 1 or 2 out of the 5 Fried criteria [1]. Hence, pre-frail older adults... more
Anakinra for macrophage activation syndrome
Macrophage activation syndrome (MAS) is a serious, life-threatening, complication, characterized by generalized, multisystem, inflammatory response, which can affect almost every organ system,... more
Outcomes of patients with cardiac arrest with and without COVID-19 in the United States
Cardiac arrest (CA) remains associated with very high mortality, with only one in ten patients surviving to hospital discharge [1–3]. Over the last three years, the widespread prevalence of COVID-19... more
Characteristics and outcomes of unvaccinated and vaccinated COVID-19 patients with acute respiratory failure treated with CPAP in a medical intermediate care unit
Vaccinations against coronavirus disease 2019 (COVID-19) have undoubtedly conferred widespread protection against infection worldwide and are strongly associated with prevention of serious illness,... more
Treatment efficacy of fecal microbiota-based live biotherapeutics (RBX2660) for the prevention of recurring Clostridioides difficile infection
Dear Editor, A first-in-class microbiota-based live biotherapeutic, originally termed RBX2660, was approved by the U.S. Food and Drug Administration (FDA), on November 30, 2022 [1]. RBX2660 works by... more
An elevated C-reactive protein level was associated with cardiovascular events among rheumatoid arthritis patients: What's next?
Although the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA) is frequently used to estimate cardiovascular risk among rheumatoid arthritis (RA) patients, it does not... more
Original Article
Association of IgG4-related disease and systemic rheumatic disorders
Autoimmune disorders are the result of largely unknown hypersensitivity reactions. As such, diverse rheumatic conditions with specific clinical manifestations can co-exist in the same individuals... more
The influence of comorbidities on the prognosis after an acute heart failure decompensation and differences according to ejection fraction: Results from the EAHFE and RICA registries
Heart failure (HF) is highly prevalent in people over the age of 65 years and constitutes a leading cause of hospitalization and death in this population [1,2]. Decompensations are a crucial point in... more
Predictors of relapse in Takayasu arteritis
Takayasu arteritis (TAK) is a chronic systemic large vessel vasculitis characterized by damage to the aorta and its major branches. TAK primarily occurs in young women in Asia, with a male-to-female... more
Hypertriglyceridemia is associated with decline of estimated glomerular filtration rate and risk of end-stage kidney disease in a real-word Italian cohort: Evidence from the TG-RENAL Study
This analysis investigated the role of hypertriglyceridemia on renal function decline and development of end-stage kidney disease (ESKD) in a real-world clinical setting.
Temporal relationship between hyperuricemia and hypertension and its impact on future risk of cardiovascular disease
Hyperuricemia and hypertension are important risk factors for cardiovascular disease (CVD), which is the leading cause of death in China and accounts for more than 40% of all deaths in both rural and... more
Association between cannabis use and ten-year estimated atherosclerotic cardiovascular disease risk in a middle-aged population survey
Cannabis is the most used illicit drug. There is a worldwide trend to legalize cannabis, therefore, it is important to better understand the health impacts associated with its regular use. Recent... more
Patients with Whipple's disease have a high prevalence of Helicobacter pylori infection
Whipple's disease (WD) is a chronic systemic infection due to Tropheryma whipplei (T. whipplei), a Gram-positive rod-shaped bacterium widespread in the environment, characterized by severe... more
High prevalence of incidental endoscopic findings at routine endoscopy after atrial fibrillation ablation: Do we need a screening endoscopy for the upper gastrointestinal tract in the general population?
Atrial fibrillation (AF) represents the most common cardiac arrhythmia. It is associated with a 1.5- to 3.5-fold increase in mortality in conjunction with accompanying heart failure and other... more
The environmental cost of unwarranted variation in the use of magnetic resonance imaging and computed tomography scans
Pollution and related climate changes have a major impact on global health. In 2015 pollution accounted for an estimated 9 million premature deaths and 16% of all deaths globally [1,2]. Humanity is... more
Dual immune checkpoint inhibitors or combined with anti-VEGF agents in advanced, unresectable hepatocellular carcinoma
Hepatocellular carcinoma is a worldwide common cancer with the fourth leading cause of cancer-related death [1,2]. Although the surgical resection, radiofrequency ablation or liver transplantation... more
Review Article
Metabolically healthy obesity: Misleading phrase or healthy phenotype?
A tripling of obesity in the last 50 years has resulted in more than 650 million individuals being obese worldwide [1],[2]. Obesity is associated with several important non-communicable diseases... more
Antiphospholipid antibodies in chronic thromboembolic pulmonary hypertension
Pulmonary hypertension (PH) is a chronic progressive condition characterized by an increase of mean pulmonary artery pressure above 25 mmHg at rest. Chronic thromboembolic pulmonary hypertension (... more