May 2025
71 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
Clinical Insights
Undiagnosed celiac disease. The conundrum of unveiling the dark side of the moon
Celiac disease (CD) is a gluten-induced, inflammatory disease of the small intestine, characterized by high and rising prevalence, huge clinical variability, and increased co-morbidity and mortality... more
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
Commentary
Lymphangioplasty 4.0 as a therapeutic and educational opportunity for (Lymph)edema
In this issue of the European Journal of Internal Medicine (EJIM), Mazzolai et al. report on safety and preliminary efficacy of a novel device, that uses subcutaneously implanted catheters to provide... more
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
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
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
Letter to the Editor
Critical considerations for sodium bicarbonate therapy in metabolic acidosis: Addressing confounding factors and methodological limitations. Author's reply
Dear Editor,
Apixaban and the improved psychologic profile in frailty and disability. Myth or reality?
We thank Hung and Chao for their interest in our work [1]. Their letter [2] allowed us to specify some relevant aspects about APULEIO (Treatment satisfaction of Italian patients undergoing Apixaban... more
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
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
Considerations on the impact of apixaban on patient-reported outcomes in frail older adults
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
Refining risk assessment for intra-abdominal infections in immunocompromised intensive care unit patients. Author's reply
Dear Editor,
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
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,
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
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
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
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
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
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
Validating ChatGPT's role in systematic reviews and meta-analyses: A case study on GLP-1 receptor agonists and all-cause mortality
Dear Editor,
Optimizing socioeconomic and psychosocial factor analysis in myocardial infarction outcomes
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
Original Article
Differential modulations of miRNAs in patients with systemic sclerosis-associated skeletal muscle loss
Systemic sclerosis (SSc) is a rare, complex autoimmune disease characterized by vasculopathy and fibrosis of the skin and internal organs. Clinical manifestations of SSc are the result of the... more
Association of miR-126-3p, miR-1260b and miR-374a-5p with the incidence of heart failure in a population-based cohort: the Hortega Follow-Up Study
The potential use of microRNAs (miRNAs), endogenous RNAs of approximately 22 nucleotides that play a regulatory role by targeting mRNAs for translational excision or repression [1,2], has gained... more
Doppler ultrasound unveils splanchnic arteries ischemia allowing early successful revascularization in symptomatic systemic sclerosis patients
Systemic sclerosis (SSc) is an autoimmune rheumatic disease where vasculopathy is one of the main hallmarks, and the gastrointestinal (GI) tract is one of the most affected systems [1,2]. In fact,... more
Recurrent pericarditis with normal C-reactive protein: Clinical and laboratory features, biomarkers and outcome in a non-inflammatory phenotype
Idiopathic recurrent acute pericarditis (IRAP) significantly affects patients’ quality of life, imposing a psychosocial burden, alongside risks of complications, treatment-related adverse effects,... more
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
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
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
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
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
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
Review Article
Tularemia for clinicians: An up-to-date review on epidemiology, diagnosis, prevention and treatment
After its first description in the 1910s in the Tulare county of California associated with a massive die off of ground squirrels and initially misdiagnosed with bubonic plague, by 1935 tularemia had... more
How to promote healthy aging across the life cycle
The global population of older adults has grown rapidly in recent years. In Europe, this percentage ranks among the highest, with 21.3 % of the population aged over sixty-five [1]. Projections... more
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