May 2024
71 ArticlesNo Section
Exploring the Landscape of Familial Hypercholesterolemia: Unraveling Genetic Complexity and Clinical Implications
Familial hypercholesterolaemia (FH) is the most encountered inherited metabolic disorder and is associated with premature cardiovascular disease.[1] Although early diagnosis is imperative for... more
Clinical Insights
Monkeypox infection, 18 months later: A vanishing epidemic?
On July 25, 2022, the World Health Organization (WHO) declared the Monkeypox (MPX) outbreak a ‘public health emergency of international concern’. Indeed, starting from May 2022, 92,783 cases have... more
Detection of subclinical atrial fibrillation with cardiac implanted electronic devices: What decision making on anticoagulation after the NOAH and ARTESiA trials?
Atrial fibrillation (AF) may be asymptomatic and the extensive monitoring capabilities of cardiac implantable electronic devices (CIEDs) revealed asymptomatic atrial tachi-arrhythmias of short... more
The lowest well tolerated blood pressure: A personalized target for all?
Among the various clinical aspects related to the management of hypertension, the choice of blood pressure (BP) targets is probably one of the most challenging. Unfortunately, there is disagreement... more
Commentary
When to prescribe oral anticoagulation for patients with device-detected subclinical atrial fibrillation? Insights from the NOAH-AFNET 6 and ARTESiA trials
Device-detected, subclinical atrial fibrillation (AF), previously known as atrial high-rate episodes, is detected in roughly one-third of older patients with a pacemaker, defibrillator, or implanted... more
Subclinical atrial fibrillation patients, who are the best candidates for oral anticoagulant therapy?
Conventionally, atrial fibrillation (AF) is diagnosed by surface electrocardiogram (ECG) while cardiac implantable electronic devices (CIEDs) provides information of the cardiac electrical activity... more
Estimation of renal function: Different markers for different outcomes?
Sarcopenia is a condition characterized by loss of muscle strength and mass that is strongly associated with age and age-related conditions, and is therefore considered a typically geriatric disease... more
Direct oral anticoagulants: The new standard of care for cancer associated thrombosis
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), often complicates the course of cancer disease and represents an invariably distressing experience for... more
Action points for implementation of the lowest well-tolerated blood pressure
In a seminal review of hypertension trials [1], Verdecchia and coworkers noticed that more intensive compared to usual blood pressure (BP) control reduced major cardiovascular complications (MACE),... more
Combining electrocardiographic and echocardiographic indexes to detect cardiac amyloidosis: A step forward in the quest to diagnose cardiac amyloidosis without delay
Cardiac amyloidosis (CA) is a progressive and life-threatening cardiomyopathy characterized by deposition of misfolded proteins in the myocardium, leading to heart failure (HF), conduction disorders... more
A call to action: The need to apply guidelines recommendations with ABC or SOS to improve stroke prevention and cardiovascular outcomes in patients with atrial fibrillation
Atrial fibrillation (AF) and stroke are deeply interlinked, as AF may precede ischemic stroke, thus being related to cardioembolism, but also manifest after both ischemic and hemorrhagic stroke [1].
Uncomplicated outpatient deep venous thrombosis management with a novel care pathway: Is it ready for prime time?
The standard-of-care for patients presenting to a general practitioner (GP) with suspected deep vein thrombosis (DVT) in many regions involves the use of a clinical decision rule and/or a d-dimer... more
Stressful experiences and venous thromboembolism
Despite stress being an accepted cause of arterial thrombotic events (ATE) [1,2], for which underlying pathophysiological processes have also been identified, it has not yet been widely recognised as... more
Editorial
New horizons in the diagnosis and management of patients with MASLD
The collection 'New horizons in the diagnosis and management of patients with metabolic dysfunction-associated steatotic liver disease (MASLD)’ that is presented here, deals with the natural history... more
Guidelines
Acute heart failure – an EFIM guideline critical appraisal and adaptation for internists
Over the past two decades, several studies have been conducted that have tried to answer questions on management of patients with acute heart failure (AHF) in terms of diagnosis and treatment.... more
Ideas and Opinions
Is full transparency in clinical trials an achievable goal?
In the last two decades several requirements have been developed to enhance clinical trials transparency. Some are encouraged or recommended by ethics codes, journal editors, or funders. Others are... more
Internal Medicine Flashcard
A man with darkened neck
A 65-year-old man presented with a 12-month history of gradual darkening of his neck. He also reported a progressive increased right side mandibular mass and a weight loss of 4 kg over 3 months. He... more
Difficult to treat rheumatoid arthritis: Why profound differential diagnosis is important
A 47-year-old patient was referred to our rheumatology department due to treatment refractory rheumatoid arthritis, characterized by polyarthralgia, progressive joint destruction, and impaired... more
A young man with amnesia after drug overdose
A 29-year-old man was found unconscious on the side of the road. Examination revealed pinpoint pupils and bradypnea. He regained consciousness after intranasal naloxone.
Pruritic papules and reticular pigmentation
A 21-year-old male with a previous history of good health. One month earlier, scattered, pruritic, red papules and maculopapules had developed on the chest and back. After papules fades, left light... more
Beau‘s lines in a man with lower limb burning sensation
A 49-year-old man presented with several months of burning sensation and numbness in the lower extremities. According to his statement of the medical history, there were no excessive drinking, intake... more
Invited Review Article
Management of cardiovascular risk in patients with metabolic dysfunction-associated steatotic liver disease
Non-alcoholic fatty liver disease (NAFLD) has for years been the most common liver disease worldwide. In 2016, the prevalence of NAFLD was estimated to be approximately 25 % [1], and recent reports... more
Letter to the Editor
Bleeding heralding the diagnosis of essential thrombocythemia
We appreciate the opportunity to reply to the Letter to the Editor of Yang et al. [1], which refers to our recent publication [2] in order to present a case with a complementary clinical issue.
Benefits and challenges of bronchoalveolar lavage in immunocompromised patients
Jahn K et al. conducted a prospective single-center observational study and found that treatment management changed in approximately half of the patients with immunocompromised lower respiratory... more
Machine learning models for the early prediction of ventilator-associated pneumonia: Author's reply
Dear editor,
Association between direct oral anticoagulants and risk of gastrointestinal bleeding
We read with great interest the systematic review and meta-analysis by Kyriakoulis et al. comparing direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) in patients with atrial... more
Patient centered care: A multidisciplinary and holistic approach
Modern medical care is increasingly underpinned by evidence-based guidelines which are widely viewed as a cornerstone of current efforts to define standards of care and improve the quality of... more
The impact of sodium-glucose cotransporter-2 inhibitors on cardiac function
Dear Editor,
Comparing the risk of dementia in patients with atrial fibrillation taking different oral anticoagulants
Dear editor,
Efficacy and safety of eplerenone in heart failure management
Dear Editor,
Prevalence of post-COVID symptoms one-year after SARS-CoV-2 infection in patients with interstitial lung disease
The Global Burden of Disease Study revealed that chronic respiratory diseases remain to be leading cause of death and disability worldwide [1]. In the recent years, the world has experienced a... more
MEFV gene mutation (c.229G>T) as a cause of fever of unknown origin
Fever of unknown origin (FUO) was traditionally characterized by a temperature exceeding 38.3 °C on at least three occasions over a period of at least three weeks, with no apparent cause despite one... more
ACE inhibitors and lung cancer: There is more to it than just a cough
We are writing to highlight the findings of a recent meta-analysis suggesting a possible relationship between the long-term use of angiotensin-converting enzyme inhibitors (ACEIs) and an increased... more
Efficacy of canakinumab for mosaic tumor necrosis factor receptor associated periodic syndrome
Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) is one of the first monogenic autoinflammatory diseases to be described [1]. TRAPS is a dominant disease due to mutations in the... more
Longitudinal trends in acute pulmonary embolism hospitalizations during the COVID-19 pandemic
Existing studies have illustrated that the coronavirus disease 2019 (COVID-19) infection is an independent risk factor for pulmonary embolism (PE) [1–4]. However, longitudinal trends in incidence of... more
Histopathological necrotizing vasculitis predicts severe flare of eosinophilic granulomatosis with polyangiitis
Dear Editor, eosinophilic granulomatosis with polyangiitis (EGPA) is histologically defined by eosinophil-rich, necrotizing granulomatous inflammation primarily involving the respiratory tract along... more
Difficult to treat rheumatoid arthritis: Sequential therapy with different personalized biological targets could be an option
Difficult to treat (D2T) rheumatoid arthritis (RA) is considered a clinical setting that physicians already label as very complicated to address from a therapeutic point of view for various reasons [... more
Prognostic value of paradoxical pulsation after acute anterior myocardial infarction
After acute anterior myocardial infarction, most patients displayed paradoxical pulsation (the paradoxical expansion of left ventricular infarct segments), which is easily complicated by early... more
Previously undiagnosed asymptomatic peripheral arterial disease in patients undergoing coronary angiography
Atherosclerosis plays a significant role in developing coronary artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular disease. Atherosclerotic plaque rupture provokes... more
Bone infarction: A rare complication of essential thrombocytosis with JAK2-V617F mutation
We read with great interest the article by Yang et al., published in the European Journal of Internal Medicine [1]. We appreciate their great work. In addition to the finding that JAK2-V617F-mutated... more
Treatment with direct oral anticoagulants (DOACs) and secondary prophylaxis in patients affected by multiple episodes of superficial venous thrombosis
Superficial vein thrombosis (SVT) describes partial or total thrombotic lumen obstruction of a superficial vein and inflammatory alterations of the affected vessel wall [1]. The precise incidence of... more
Thrombocytopenia and bleeding events in patients with venous thromboembolism
Thrombocytopenia is a prevalent blood abnormality, especially in elderly patients or those with cancer [1], and could increase the risk of anticoagulation-associated bleeding. However, there is a... more
Imaging of lung structure destruction for predictive diagnosing acute exacerbation of chronic obstructive lung disease complicated with pulmonary thromboembolism or pulmonary thrombosis in situ
Chronic obstructive lung disease (COPD) is an independent risk factor for pulmonary thromboembolism (PTE), which often originates from deep vein thrombosis (DVT) and is a common comorbidity [1].... more
Machine learning models for the early prediction of ventilator-associated pneumonia
We read with interest the article by Frondelius et al. entitled ‘Early prediction of ventilator-associated pneumonia with machine learning models: A systematic review and meta-analysis of prediction... more
Combined guidance of fluoroscopy and transthoracic echocardiography for endomyocardial biopsy
Endomyocardial biopsy (EMB) is important in revealing the aetiology of cardiac disorders for individuals in whom non-invasive approaches are insufficient to gather a correct diagnosis, as well as in... more
Don't ignore the internists; Who do you think holds the holy grail?
Recently a new paradigm, cardiovascular-kidney-metabolic (CKM) syndrome, has been defined by the American Heart Association (AHA) as a health problem due to connections among diabetes, kidney disease... more
Original Article
Osteonecrosis risk after steroids-related treatment of COVID-19 is not negligible: A cross sectional study
Osteonecrosis is a common complication after steroid treatment for various etiologies more frequently affecting the hip, but also the humeral head, the knee, and the ankle joints [1]. Due to the... more
Transition of management strategies and long-term outcomes in cancer-associated venous thromboembolism from the warfarin era to the direct oral anticoagulant era
Cancer remains a progressive disease with a high mortality despite of multidisciplinary treatment. However, many patients with cancer have recently been living longer owing to advancement in early... more
Post-cardiac injury syndrome and pericardial effusion recurrence after pericardial effusion drainage in chronic idiopathic pericardial effusion
Chronic pericardial effusion in the absence of pericardial inflammation often represents both a diagnostic and management dilemma. Although pericardial effusion drainage should be promptly performed... more
Genetic heterogeneity of familial hypercholesterolaemia in two populations from two different countries
Familial hypercholesterolemia (FH) (MONDO:0007750) is a genetically determined monogenic disorder of predominantly autosomal dominant inheritance, which leads to a significant increase in low-density... more
Deferring diagnostic evaluation for suspected deep venous thrombosis using a single dose of anticoagulant: Real-world data from a regionwide care pathway
Timely diagnosis and treatment of deep venous thrombosis (DVT) are crucial to prevent potential life-threatening complications, such as pulmonary embolism (PE). As DVT cannot be reliably excluded... more
Intimate partner violence as a risk factor for venous thromboembolism in women on combined oral contraceptives: An international matched case-control study
Venous thromboembolism (VTE), deep vein thrombosis (DVT) and/or pulmonary embolism (PE) is a rare event in women of childbearing age, affecting 2–10/10,000 persons per year [1]. Exogenous sex... more
Thyroid and adrenal incidentalomas on chest CT: Prevalence, diagnostic work-up and outcomes in a cohort of COVID-19 suspected patients
Thyroid and adrenal incidentalomas are commonly detected on computed tomography (CT) imaging. Due to the increased use of advanced CT imaging prevalence rates are still rising, leading to an ‘... more
Adherence to an integrated care pathway for stroke is associated with lower risk of major cardiovascular events: A report from the Athens Stroke Registry
Despite improvements in overall stroke survival, patients surviving an ischaemic stroke are at increased risk of cardiovascular complications, both in the acute and chronic phase, and one-third of... more
Kidney function and other associated factors of sarcopenia in community-dwelling older adults: The SCOPE study
Sarcopenia has been drawing growing attention in recent years, with a rapidly increasing number of research studies being performed in this field. The establishment of an International Classification... more
Features of immune mediated diseases in JAK2 (V617F)-positive myeloproliferative neoplasms and the potential therapeutic role of JAK inhibitors
The Janus Kinase (JAK) 2 (V617F) mutation is the most frequently detected in myeloproliferative neoplasms (MPN). JAK2(V617F) mutation displays a pro-inflammatory phenotype that may be associated to a... more
Chronic thromboembolic pulmonary disease: Association with exercise-induced pulmonary hypertension and right ventricle adaptation over time
Chronic thromboembolic pulmonary disease (CTEPD) [1] is a newly described disease entity belonging to a broader group of diseases affecting the pulmonary arterial vasculature as a result of PE [1,2... more
Relation between high-sensitivity troponin I serum levels and myocardial ischemia in patients with suspected chronic coronary syndrome: The RESET-MI study
The detection of increased serum levels of cardiac troponins in a clinical context of acute myocardial ischemia is a crucial finding for the diagnosis of acute myocardial infarction (AMI) [1,2].... more
Long non-coding RNAs H19 and NKILA are associated with the risk of death and lacunar stroke in the elderly population
Aging is a multifaceted biological process characterized by a progressive decline in physiological function and increased vulnerability to various diseases [1]. It is associated with multiple... more
Muscularity and adiposity are differently associated with inflammatory and nutritional biomarkers among patients on hemodialysis and peritoneal dialysis
Changes in body composition, in particular in terms of distribution and quantity of adiposity and low muscularity, have been frequently observed in end-stage renal disease (ESRD) and associated with... more
Prognostic role of mitral regurgitation in patients with advanced heart failure
Mitral regurgitation (MR) is the most common valvular heart disease in patients with heart failure (HF) [1]. Left ventricular remodeling, left atrial enlargement, and cardiac dyssynchrony leading to... more
Risk of subclinical atherosclerosis in primary Sjogren's syndrome: A systematic review and meta-analysis
Cardiovascular disease (CVD) in systemic autoimmune disorders often goes unnoticed until a clinical event occurs. Given the lack of disease-specific prediction scores, the CVD risk stratification... more
Calprotectin serum levels on admission and during follow-up predict severity and outcome of patients with COVID-19: A prospective study
Coronavirus disease-2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is characterized by a broad spectrum of clinical manifestations [1]. SARS-CoV-2... more
Prognostic significance of the wall to lumen ratio of retinal arterioles evaluated by adaptive optics
The main characteristic of essential hypertension is the increase in peripheral vascular resistance to blood flow, located mostly in small arteries with a lumen diameter of 100 to 350 μm and in... more
ECG/echo indexes in the diagnostic approach to amyloid cardiomyopathy: A head-to-head comparison from the AC-TIVE study
Thickened left ventricle (LV) is the hallmark of amyloid cardiomyopathy (AC) and results from progressive amyloid deposition in the myocardial extracellular space rather than myocyte hypertrophy [1... more
Review Article
Dietary and pharmacological treatment in patients with metabolic-dysfunction associated steatotic liver disease
Metabolic-dysfunction Associated Steatotic Liver Disease (MASLD), previously known as Non-Alcoholic Fatty Liver Disease, is a spectrum of liver injury characterized by increased hepatocellular fat... more
Non-invasive testing and risk-stratification in patients with MASLD
The development and validation of non-invasive fibrosis tests (NITs) has changed clinical practice in Hepatology over the last 15 years. Metabolic associated steatotic liver disease (MASLD), formerly... more
Resistant hypertension: Diagnosis, evaluation, and treatment practical approach
Our learning objectives are to be able to identify patients with resistant hypertension (RH) in primary care practice, know the clinical and phenotypic characteristics of this group of patients, and... more
Breakthrough advances enhancing care in ATTR amyloid cardiomyopathy
Transthyretin amyloid cardiomyopathy (ATTR-CM) has been traditionally considered a rare and inexorably fatal condition. ATTR-CM now is an increasingly recognized cause of heart failure (HF) and... more
Enduring echoes: Post-infectious long-term changes in innate immunity
The human immune system is one of the main host defence mechanism against infections, initiating a complex response when confronted with pathogenic invaders. This response involves pathogen... more
Natural history of metabolic dysfunction-associated steatotic liver disease
Metabolic dysfunction-associated steatotic liver disease (MASLD) has been the term for non-alcoholic fatty liver disease (NAFLD) since June 2023 and will be used instead of NAFLD throughout this... more