May 2026
169 ArticlesNo Section
eGFR imbalance may confound DOAC-VKA comparisons in kidney transplant recipients
Dear Editor,
From algorithms to care: ten principles for responsible deployment of artificial intelligence in healthcare
Dear Editor,
Clinical Insights
Emerging evidence from combination therapy reinforces the role of β-blockers in resistant hypertension
Resistant hypertension (RHTN) represents a growing clinical challenge, affecting an estimated 10–15% of patients with treated hypertension [1–3]. Its prevalence might increase in the coming years,... more
Bedside contrast-enhanced ultrasound: Clinical applications for internal medicine
Point-of-care ultrasound (POCUS) is widely used in Internal Medicine for rapid bedside assessment, but conventional modalities such as B-mode and Doppler provide limited information on tissue... more
It’s time to improve antithrombotic therapy! A global perspective for antithrombotic stewardship
Antithrombotic stewardship (ATS) is a practical, evidence-based care model slowly gaining traction across the globe [1,2]. The impetus for this trend is the persistent evidence for low-quality... more
Intrinsic capacity in older adults: A concise guide for non-geriatricians
Over the past decades, there has been a radical and profound change in the population structure, characterised by a gradual increase in the prevalence of individuals in older age groups and a... more
Commentary
Social determinants of health in the era of precision medicine
“Man is by nature a social creature” Aristoteles used to say.
Sustained innovation in ATTR-CM - Twenty years of innovation in transthyretin amyloidosis
Transthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive disease caused by relentless accumulation of ATTR amyloid in the heart [1]. The past 20 years has seen ATTR-CM evolve from a seemingly... more
Rethinking atrial fibrillation classification: Static labels in a dynamic disease
Atrial fibrillation (AF) remains the most common arrhythmia worldwide and a major contributor to mortality and morbidity from stroke and heart failure (HF). Despite growing recognition that AF... more
Integrating multi-omics and artificial intelligence in internal medicine: Opportunities for precision care
Modern Internal Medicine stands at a critical inflection point. The traditional disease-centred paradigm, built on clinical phenotypes, organ-based classifications, and population-level evidence, is... more
Expanding the stroke risk paradigm: Left atrial size as a trigger for preventive action
Stroke is a vascular disease that impacts the brain and is one of the leading causes of disability and death worldwide; notably, heart diseases contribute significantly to its development and risk.... more
Lungs and heart in COPD exacerbations: it takes two to tango
The lungs and the heart are inseparably linked anatomically, physiologically, and functionally in their shared task of delivering oxygen to the body and removing the carbon dioxide generated by... more
Left atrial appendage closure for atrial fibrillation stroke prevention in hereditary hemorrhagic telangiectasia is effective and safe with simplified, time-limited antithrombotic therapy
In this issue of the European Journal of Internal Medicine, Torres-Iglesias and colleagues present an observational study of 23 patients with hereditary hemorrhagic telangiectasia (HHT) and atrial... more
The critical role of dietary adherence in secondary cardiovascular prevention: Beyond the nutrient composition
The management of patients with established coronary heart disease (CHD) has traditionally focused on pharmacological interventions and revascularization procedures. However, lifestyle modifications... more
Can heart failure be detected before it occurs? Insights from circulating microRNAs
Heart failure (HF) remains one of the most complex and heterogeneous syndromes in healthcare systems, where multiple biological processes converge long before the onset of symptoms. Despite... more
Corrigendum
Corrigendum to “Role of 12-lead Electrocardiogram for identifying very low mortality risk patients with non-hypotensive acute pulmonary embolism” [European Journal of Internal Medicine 140 (2025) 106373]
The authors regret that there is an error in the last row of Table 1, where the wrong information says:
Editorial
When more money does not mean more health- disparities in healthcare efficiency in OECD
How to improve the efficiency of the healthcare system is vividly debated, as states facing increased competition for resources struggle to contain healthcare costs. The question is: how do we ensure... more
Hospitalist co-management in multimorbid medical and surgical patients: Insights from the United States and Europe
None.
Ideas and Opinions
Should Ticagrelor in association with aspirin be still considered the standard dual antiplatelet treatment for acute coronary syndromes?
Ticagrelor, a potent inhibitor of P2Y12 platelet receptor, co-administered with aspirin in dual antiplatelet therapy (DAPT), received marketing authorization from the European Medicines Agency in... more
Internal Medicine Flashcard
Scurvy in a hemodialysis patient after prolonged hospitalization
A 64-year-old woman with a 38-year history of hemodialysis presented with general weakness. Until 3 days before presentation, she had been hospitalized for one month due to bullous pemphigoid... more
The central dot sign in liver
A 24-year-old man presented with a 2-year history of recurrent epistaxis and fatigue. Laboratory workup revealed persistent pancytopenia (white blood cell count 2.23 × 10⁹/L, platelet count 54 × 10⁹/... more
Multiple hepatic lesions and vascular lakes
An 86-year-old man with a history of polyarteritis nodosa on long-term corticosteroid therapy and prior splenic rupture requiring surgery presented with asthenia, low-grade fever, and jaundice. A CT... more
An unusual case of skin ulcer
A 29-year-old Italian woman presented at the emergency department with a 65-day history of cutaneous lesion on her left forearm, started while she was on a stay in Bolivia. Initially, the lesion was... more
Encephalitis with the temporal lobe signature
A 16-year-old boy presented with a fever and decreased responsiveness for one day. There was no history of focal neurological deficits or seizures. On examination, he was hemodynamically stable but... more
Painful leg nodules, fever, and ankle arthralgia in a middle-aged woman
A previously healthy 56-year-old woman presented with a 2-week history of painful erythematous-to-violaceous firm subcutaneous nodules involving the anterior and posterior aspects of both legs, with... more
A deceptive lung mass in a smoker man
A 50-year-old man presented with cough, streaky haemoptysis and left-sided chest pain for two weeks. He was a heavy smoker with 30 pack-years of smoking history. Clinical examination showed decreased... more
A woman with fever, feet hypostesia and disseminated papules
A previously healthy 75-year-old woman presented with a 3-day history of fever (39.3°C), distal paresthesias and hypoesthesia of both feet, and abrupt onset of disseminated erythematous papules with... more
Tongue atrophy following unexplained nausea, vomiting, and hiccups
A 45-year-old woman was admitted with aspiration pneumonia. She was found to have progressive dysphagia and severe dysarthria. Neurological examination showed a hypernasal voice, diminished gag... more
“Normally distended” bladder in an anuric hemodialysis patient
A 72-year-old man with end-stage kidney disease had been on maintenance hemodialysis for 18 years and was completely anuric. He presented with a two-week history of persistent low-grade fever (37 °C... more
Internal Medicine Flashcards
A hidden cause of sudden epigastric pain in a middle-aged man
A 45-year-old man with a history of smoking and dyslipidemia presented with a 3-day history of sudden-onset epigastric pain that occurred while walking. The pain had largely subsided by the time of... more
Invited Review Article
From unmet needs to new possibilities: PPAR-targeted therapies in the journey of people living with Primary Biliary Cholangitis
Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic liver disease characterized by progressive destruction of the small intrahepatic bile ducts. If is left untreated, the resulting... more
Erectile dysfunction and antihypertensive therapy: A critical reappraisal
Erectile dysfunction often coexists with arterial hypertension. They both share a common vascular pathophysiology, while antihypertensive treatment may also affect sexual function. Although some of... more
Letter to the Editor
Cumulative nocturnal hypoxemia, but not apnea-hypopnea index, is independently associated with vertebral fracture burden in obstructive sleep apnea
Obstructive sleep apnea (OSA) is a highly prevalent disorder characterized by recurrent upper airway collapse, intermittent hypoxemia, and sleep fragmentation [1]. Beyond its established... more
Cardiac amyloidosis trends: Methodological limitations in estimating incidence and mortality from inpatient data alone
Dear Editor,
Timing of brain biopsy in cryptogenic neurological diseases: beyond diagnostic yield
We read with great interest the study by Aboubakr et al [1] investigating the impact of brain biopsy timing on diagnostic yield and clinical outcomes in patients with neurological diseases of unknown... more
Rethinking renal protection in patients with heart failure and reduced ejection fraction
We read with great interest the review titled “Renal protection in heart failure with reduced ejection fraction: not all that glitters is gold” by Elisa Russo and colleagues, published in your... more
Dialysis, but not severe renal dysfunction, is associated with excess bleeding in venous thromboembolism: Insights from a nationwide registry
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a common and potentially fatal complication in patients with chronic kidney disease (CKD), including... more
Clinical applicability considerations for depot-specific miRNA profiling in gastrointestinal cancer
Dear Editor,
Serological and clinical features in patients with anti‐centromere antibody positivity
Dear Editor,
Bedside-oriented new risk stratification in acute pulmonary embolism: Implications and clinical utility of the 2026 ACC/AHA guidelines compared with the 2019 ESC guidelines
Recently, the American College of Cardiology (ACC) and American Heart Association (AHA) with scientific joint committees published the new clinical practice guidelines of acute pulmonary embolism (PE... more
Beyond the absolute value: A critical appraisal of the prognostic everest of lactate ratio in diabetic ketoacidosis
We read with great interest the recent study by Sebastian-Valles F et al. published in the European Journal of Internal Medicine, titled " Pre- and in-hospital lactate ratio as a predictor of... more
Refining cerebrovascular risk in left atrial enlargement: integrating CKM framework and atrial cardiomyopathy phenotyping
We read with great interest the article “Left atrial enlargement and 1-year cerebrovascular events in subjects without atrial fibrillation: A prospective cohort study” by Clerici et al. [1]. The... more
Uric Acid, Homocysteine, and comorbidities in sarcoidosis
Sarcoidosis (SA) is a multisystem granulomatous disease with a highly variable clinical course. To-date, there are no validated circulating biomarkers capable of reliably predicting long-term outcome... more
Is there a clinical benefit of mechanical CPR in obesity? Author’s reply
We thank Steffen et.al for their thoughtful and constructive comments regarding our study evaluating the use of mechanical versus manual CPR in obese patients with in-hospital cardiac arrest [1,2].... more
SGLT2 inhibitors for acute heart failure: Efficacy established, but for whom and when?
Dear editor,
Beyond survival: nuances in the robustness of SGLT2 inhibitor evidence for HFpEF
We read with great interest the article by Zuin et al., which provides a rigorous evaluation of the robustness of randomized controlled trial (RCT) evidence for sodium-glucose co-transporter 2... more
Heart failure and COPD – Disentangling undertreatment from the impact of severe comorbidities
We read with great interest the study by Vauterin et al. investigating the association between guideline-directed medical therapy (GDMT) and mortality in patients with heart failure (HF) hospitalized... more
Redefining “isolated” Whipple’s disease: bridging the gap between clinical phenotype and pathophysiological reality
We read with great interest the article by Eiferman et al., entitled “Isolated joint involvement in Whipple’s disease: a cohort study”, recently published in the European Journal of Internal Medicine... more
eGFR imbalance and DOAC-VKA comparisons in kidney transplant recipients. Author’s reply
We thank Jin et al [1] for the comment on methodological considerations regarding our study [2]. The observation of a higher mean eGFR in the DOAC group after propensity score matching (PSM) deserves... more
Universities and healthcare as privileged war targets. An urgent call for an international academic and institutional response to the attack on the Lebanese University and the health system
Attacks on universities during armed conflicts represent a profound threat to individual lives but also to the institutions that sustain knowledge, scientific progress, and social stability [1]. In... more
Time and transitions in cardiogenic shock: making the Cath lab–CICU–cardiac step-down pathway reliable
While the ImCU models described by Canetta et al. and Turcato et al. arise from Internal Medicine, their broader relevance to cardiology lies not in patient case-mix, but in the principle that... more
The paradox of increasing cardiac amyloidosis hospitalizations and persistent diagnostic delays
The recent population-based study by Ojeda-Fernández et al [1], provides a valuable and timely perspective on the evolving epidemiology of cardiac amyloidosis (CA). Leveraging two decades of... more
Advancing precision, accountability, and implementation in antithrombotic stewardship
We read with great interest the perspective by Ageno et al. addressing the urgent need for antithrombotic stewardship (ATS) within contemporary healthcare systems [1]. The synthesis of global data... more
Systemic inflammation and frailty in cirrhosis: Considerations regarding the role of the systemic immune-inflammation index
I read with great interest the study by Sogbe et al. entitled “Inflammatory spectrum of frailty: Association between the systemic immune-inflammation index and frailty in liver transplant candidates... more
Baseline asymptomatic bacteriuria in high-risk hematological patients: Does low concordance adequately reflect its true invasive potential?
We read with great interest the article by Tolosa-Ridao et al. published in the European Journal of Internal Medicine [1]. This study examined the prevalence of baseline asymptomatic bacteriuria... more
Pathophysiological and prognostic implications of psychological distress in non-obstructive coronary syndromes: When the mind breaks the heart
Cardiovascular disease remains the leading cause of death worldwide [1], yet the field’s diagnostic and treatment strategies continue to target obstructive epicardial coronary artery disease... more
Methodological considerations for translating the STAMP score in intermediate-high-risk pulmonary embolism
We read with interest the study by Zuin and colleagues reporting the STAMP score for predicting 48-hour clinical deterioration in hemodynamically stable patients with intermediate-high-risk acute... more
Interpreting observational comparisons of DOACs and VKAs in kidney transplant recipients
Dear Editor,
From structure to function: A commentary on left atrial enlargement and cerebrovascular events and the potential value of left atrial strain
I read with great interest the article by Clerici and colleagues titled "Left atrial enlargement and 1-year cerebrovascular events in subjects without atrial fibrillation: A prospective cohort study... more
Right ventricular-pulmonary circulation uncoupling in older patients with acute HFpEF: is TAPSE/PASP ratio a dichotomous or continuous prognostic marker?
We appreciated Pagnoni et al insightful comments [1] on our study as they raise important physiopathological and clinical questions that might further increase our understanding of right ventricular-... more
Tachycardia-induced electrocardiogram false positive diagnosis of left ventricular hypertrophy
Dear Editor:
The Oral PCSK9 inhibitor enlicitide for hypercholesterolemia
Heterozygous familial hypercholesterolemia (HeFH) and other forms of severe hypercholesterolemia are characterized by lifelong elevation of low-density lipoprotein cholesterol (LDL-C), resulting in... more
Resting Heart Rate: a risk marker or factor for outcomes?
Resting heart rate (HR) remains one of the most routinely recorded yet paradoxically underappreciated cardiovascular parameters in clinical practice. Easily obtainable and highly reproducible, it... more
Training for prevention: exercise prescription as an Olympic discipline in the era of GLP-1 receptor agonists
Dear Editor,
Optimizing tezepelumab use in severe asthma: future research directions
Dear Editor,
Causal inference and the risk of osmotic demyelination: A methodological critique of population-based hyponatremia research
We read with great interest this population-based study derived from the Stockholm sodium cohort [1], which examined the association between early sodium correction rates in severe hyponatraemia and... more
Beyond acute severity: Age as a determinant of in-hospital mortality in acute respiratory failure requiring non-invasive respiratory support in an intermediate care unit
The increasing burden of acute illness, together with the progressive reduction in hospital bed capacity across Europe, has intensified the need for optimized management strategies for high-acuity... more
Optimizing cardiorenal protection in HFrEF: from pharmacological mechanisms to clinical implementation. Author's reply
We thank Dr. Yuan and coll. [1] for their interest in our review, Renal protection in heart failure with reduced ejection fraction: not all that glitters is gold [2], and for their comments on the... more
Refining the impact of epicardial adipose tissue assessment
We read with great interest the correspondence by Momot et al. [1], which offers a thoughtful and constructive commentary on our recent narrative review exploring the role of epicardial fat... more
Personalizing PFO closure decisions: The emerging role of the CRISP-PFO score
We read with great interest the recent article by Rigatelli et al. in the European Journal of Internal Medicine, describing the development and validation of the CRISP-PFO score for optimizing... more
Small airway dysfunction and glucocorticoid (OCS) reduction in severe asthma: Clinical insights from real-world tezepelumab use
Dear Editor
Prehospital-to-hospital lactate ratio in severe hyperglycemic emergencies: how far can one cutoff travel?
Sebastian-Valles et al. reported that a prehospital-to-hospital lactate ratio <1.23 identifies a subgroup of patients with severe hyperglycemic emergencies at markedly higher risk of in-hospital... more
Transparency regarding publication charges in leading medical journals
The code of conduct for research transparency guides authors to preregister protocols, adhere to reporting guidelines, and fully disclose funding sources and conflicts [1]. Although article... more
Residual respiratory events and daytime sleepiness despite management of obstructive sleep apnoea with and without additional central apnoeas. A three-month follow-up study. Authors’ reply
We thank Fan Yuan, and coll [1] and Linru Zhong and coll [2] for their interest in our study [3]. They add pertinent reflections and critical analysis of our study. We are aware of the unavoidable... more
Microvascular angina: it’s time to move beyond fixed paradigms
Dear Editor,
Reconsidering “normal” in medicine
“There are no norms. All people are exceptions to a rule that does not exist.”-Fernando Pessoa-
sTREM2 as an early MASH biomarker: a commentary on generalizability and mechanistic interpretation
We read with great interest the study by Mahmoudian et al. investigating soluble TREM2 (sTREM2) as a non-invasive biomarker for early metabolic dysfunction-associated steatohepatitis (MASH) [1]. The... more
Long-term doctor–patient communication: a patient‑reported perspective from a large Italian survey
Recent reports on long COVID and disability [1,2] have shown the value of large, patient‑reported web surveys in capturing dimensions of illness that are poorly described in traditional clinical... more
Rethinking scoring strategies for patient selection in PFO-related stroke
We read with great interest the article regarding the CRISP-PFO score for optimizing patient selection for patent foramen ovale closure [1]. While refining risk stratification in patients with a Risk... more
Sotatercept for pulmonary arterial hypertension
Pulmonary arterial hypertension (PAH) is a progressive, fatal disease driven by proliferative vascular remodeling. While current therapies targeting the endothelin, nitric oxide, and prostacyclin... more
Ostreopsis-related illness: An emerging and underrecognized clinical syndrome
Since the early 2000s, clusters of acute irritative and flu-like syndromes temporally associated with coastal exposure have been documented along Mediterranean shores, including Italy, France and... more
Reassessing SGLT2 Trials in HFpEF: When robustness and fragility coexist
Zuin and colleagues are to be commended for their rigorous reappraisal of sodium–glucose co-transporter 2 inhibitor (SGLT2i) trials in heart failure with preserved and mildly reduced ejection... more
Rethinking readmission prediction in multiple chronic conditions: Clinical utility over accuracy
Hospital readmissions among patients with multiple chronic conditions (MCC) represent a persistent challenge in European healthcare systems, with rates approaching 20 % in Spain and similar figures... more
Access and Reimbursement Barriers to Guideline-Directed Cardiometabolic Therapy
Cardiometabolic medicine is entering an era in which the most effective therapies are also among the least accessible. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium–glucose... more
Prevalence of aortic stenosis in patients with amyloidosis in northern Sweden
Amyloidosis and aortic stenosis seem to frequently occur together [1]. This has mainly been found in patients suffering from wild-type transthyretin amyloidosis (ATTRwt) [2]. It is still unclear... more
Refining checklist-based screening for transthyretin cardiac amyloidosis: Methodological and pathophysiological considerations
We read with great interest the study by Pérez-Nieva and colleagues regarding the implementation of a systematic checklist-based strategy for the screening of transthyretin cardiac amyloidosis (ATTR-... more
Cardiorenal anemia syndrome: Are we ready for paradigm shifts?
To the Editor
Is there a clinical benefit of mechanical CPR in obesity?
We read with interest the article by Sujanyal et al. investigating the outcomes of LUCAS®-assisted versus manual cardiopulmonary resuscitation (CPR) in obese patients with in-hospital cardiac arrest... more
Unmeasured confounders in residual OSA: The roles of polypharmacy, loop gain, and weight trajectory
We read with interest the article by Vitacca et al. [1] In this retrospective cohort spanning ten years of cardiorespiratory monitoring (CRM), the authors assessed residual respiratory events (rAHI≥... more
Management of ANOCA and suspected microvascular angina: integration of plaque-directed and functional strategies
We read with interest the Ideas and Opinions article by De Servi and colleagues, who question the current emphasis on invasive coronary function testing (CFT) in patients with angina with no... more
Reconsidering residual sleepiness and respiratory events in treated obstructive sleep apnea
We read with great interest the article by Vitacca and colleagues regarding the persistence of respiratory events and daytime sleepiness in patients treated for obstructive sleep apnea [1]. The study... more
Cerebral small vessel disease: a potential risk modifier for future guidelines on management of dyslipidaemias
Cerebral small vessel disease (cSVD) is a highly prevalent and prognostically relevant condition in older adults, yet it is not specifically addressed in current dyslipidaemia management guidelines.... more
TAPSE/PASP ratio in older HFpEF patients: Prognostic insights and geriatric challenges
We read with interest the article by De Matteis et al. on the prognostic role of the TAPSE/PASP ratio in older patients with HFpEF hospitalized for acute heart failure [1]. The authors show that RV-... more
Epicardial adipose tissue assessment for earlier cardiovascular risk prediction: from association to clinical utility
Calcaterra and colleagues provide a timely narrative review on epicardial adipose tissue (EAT) as an imaging marker of cardiometabolic risk and a potentially modifiable therapeutic target [1]. Yet... more
Use of continuous morphine infusions in end-of-life care in an internal medicine ward
The use of continuous opioid infusions at the end of life remains a clinically and ethically sensitive area in acute hospital practice[1,2]. International recommendations emphasize that opioids are... more
Optimizing cardiorenal protection in HFrEF: From pharmacological mechanisms to clinical implementation
We read with great interest the review article by Russo et al. titled [1]. The authors provided a comprehensive and timely overview of the "four pillars" of heart failure therapy—RAAS inhibitors,... more
Comparison of primary prevention strategy guided by SCORE2 versus coronary artery calcium scoring in a non-diabetic population
Cardiovascular disease (CVD) remains the leading cause of death and disability worldwide [1]. The role of preventive medicine in reducing the burden of CVD tends to grow because prevention is better... more
Clinical incidents attended by the internal medicine on-call team at a tertiary care hospital
On-call duty is a cornerstone of hospital-based Internal Medicine, yet it remains one of the least quantified and most debated components of medical practice. Originally conceived to address... more
Survival outcomes with LUCAS-AssiSTED VS MANUal CPR in in-hospital cardiac arrest obese patients
Obesity has emerged as a global health challenge, contributing not only to chronic disease but also to poorer outcomes in acute, high-acuity situations such as cardiac arrest. In the in-hospital... more
Methodological and generalizability considerations in the study of bleeding risk with rivaroxaban vs apixaban in older VTE patients
We read with great interest the nationwide register-based cohort study by Roupe et al., recently published in the European Journal of Internal Medicine [1]. The authors should be commended for... more
Antiplatelet therapy in patients with stable coronary artery disease who require long-term oral anticoagulation
Coronary artery disease (CAD) and atrial fibrillation (AF) and frequently coexist, with overlapping cardiovascular risk factors [1]. Oral anticoagulants (OACs) are indicated for AF-related stroke... more
Refining cardio-kidney-metabolic phenotyping to strengthen interpretation and clinical translation in atrial fibrillation
We read with great interest the article by Mei and colleagues, who investigated cardiovascular-kidney-metabolic (CKM) domains in a large European cohort of patients with atrial fibrillation (AF) and... more
SGLT2 Inhibitors in musculoskeletal and connective tissue diseases: Is there a role?
Dear Editor,
Quality-of-life outcomes after sleeve gastrectomy versus Roux-en-Y gastric bypass: looking beyond mean differences
We read with great interest the article by ’t Hart et al. reporting long-term quality of life (QoL) outcomes after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) in the SleeveBypass... more
Most acute heart failure with preserved ejection fraction is not true HFpEF
Dear Editor,
Heart failure with preserved ejection fraction in the elderly: Clinical, imaging, and biomarker profiles according to global longitudinal strain by cardiac magnetic resonance
Dear editor,
The four ages of diagnosis: A physician’s journey through time
Dear Editor
Beyond ejection fraction: Small left ventricular volumes define a high-risk phenotype in acute heart failure with preserved ejection fraction
In patients with heart failure and reduced ejection fraction (HFrEF), larger indexed left ventricular volumes (iLVEDV) have been traditionally considered a surrogate of lower left ventricular... more
Communicating robustness and sex-specific benefit of SGLT2 inhibitors in HFpEF and HFmrEF
Dear Editor,
Integrating sTREM2 into non-invasive pathways for early MASH in MASLD
We read with great interest the article by Mahmoudian et al., who evaluated soluble triggering receptor expressed on myeloid cells 2 (sTREM2) as a non-invasive biomarker for early metabolic... more
Beyond systemic biomarkers: Future directions in understanding the inflammatory nexus of obstructive sleep apnea and atrial fibrillation
We read with great interest the article by Hunt et al. entitled “Systemic markers of inflammation and immune activation in patients with obstructive sleep apnea and paroxysmal atrial fibrillation,”... more
Original Article
Discharge medical treatment implementation and predictors of a successful decongestion in patients with acute heart failure: first data from the BRING-UP 3 Heart Failure Study
Current discharge management of acute heart failure patients and clinical predictors of successful decongestion in a large Italian network of cardiology sites.AF, atrial fibrillation; BMI, body mass... more
Early vasopressin administration in septic shock: A systematic review, meta-analysis, and multicenter retrospective observational study
To determine the optimal timing for initiating vasopressin in septic shock.
Hypertension and blood pressure profiles in patients with acute intermittent porphyria: a prospective case-control study
Acute intermittent porphyria (AIP), a rare disorder of heme biosynthesis, may manifest with neurovisceral crises affecting autonomic regulation. This study aimed to assess blood pressure (BP) pattern... more
Relationship between T90 and systemic hypertension in patients with obstructive sleep apnea: Data from the European sleep apnea database
Obstructive sleep apnoea (OSA) is a sleep disorder characterized by a partial or complete cessation of upper airway during sleep. It is estimated that approximately one billion individuals between... more
Specialist or generalist management of emergency medical admissions - immediate and long-term outcomes
To study whether the admission of unselected emergency medical patients, under either a Consultant with General Medicine (GIM) or Specialist accreditation, influenced either short or longer-term all-... more
Hospital-to-community care pathways for patients with heart failure, an inter-society consensus document
Heart failure (HF), defined as the inability of the heart to meet the metabolic requirements of peripheral tissues, or to do so only at the expense of elevated ventricular filling pressures,... more
Effects of urine uromodulin levels on the association between sodium intake and ambulatory blood pressure in individuals with chronic kidney disease
In CKD, hypertension is often accompanied by sodium sensitivity. Uromodulin promotes sodium sensitivity by activating tubular sodium transporters (NKCC2, NCC). In the general population, individuals... more
Efficacy of Aldosterone synthase inhibitors in uncontrolled and resistant hypertension: A systematic review and updated meta-analysis with grade assessment
The current therapy for resistant hypertension is often limited by hyperkalemia, renal decline, and a failure to prevent compensatory increases in circulating aldosterone. The aldosterone synthase... more
Prognostic impact of percutaneous coronary intervention in acute coronary syndrome vs. elective settings in heart transplant recipients
Cardiac allograft vasculopathy (CAV) affects >50% of patients following heart transplantation (HTX) within ten years and is one of the main reasons for late graft failure. The study aimed to... more
Fatty acid binding protein 4, resistin, diastolic dysfunction, and cardiovascular risk in patients with rheumatoid arthritis
Rheumatoid arthritis is a chronic autoimmune disease associated with CV system involvement [1]. Cardiovascular mortality and incidence of major adverse cardiovascular events (MACE) are increased by... more
Cocaine-induced ANCA-associated vasculitis: Cohort analysis from a referral center and literature review
Cocaine adulterated with levamisole has been implicated as a trigger of Cocaine-Levamisole-Associated Autoimmune Syndrome (CLAAS), frequently mimicking granulomatosis with polyangiitis (GPA).
Venous thromboembolism risk assessment in hospital-at-home setting: A prospective cohort study (the TROMBODOM study)
Venous thromboembolism (VTE) is a significant cause of preventable mortality in hospitalized patients. While risk assessment models such as Padua and IMPROVE-VTE scores have been validated in... more
Early brain biopsy in neurological diseases of unknown etiology improves functional outcome
Brain biopsy is established for diagnosing non-resectable neoplastic lesions, with yields approaching 95%, and for documenting brain infections [1,2]. However, the indications and timing of brain... more
Cause-specific mortality in patients with chronic pancreatitis: a nationwide population-based cohort study
Cause-specific mortality in chronic pancreatitis changes over time. Early deaths are driven by pancreatitis-related deaths and liver disease, whereas extra-pancreatic cancers, respiratory, and... more
Shaping rheumatoid arthritis treatment: Clinical and demographic drivers of tsDMARDs versus bDMARDs prescription post-EMA pronouncement on JAK inhibitors. Insights from the AMBI-RA study
Rheumatoid arthritis (RA) is a chronic autoimmune disease leading to progressive joint damage and functional disability [1,2]. The treatment landscape for RA has evolved substantially over the last... more
Prevalence of asymptomatic bacteriuria in high-risk hematological patients and its association with bacteremia: A prospective observational study on the need for antibiotic treatment
Antibiotic treatment for asymptomatic bacteriuria (AB) is not recommended in the general population, and its significance in oncohematological patients remains unclear.
Distinct miRNA expression profiles in subcutaneous and visceral adipose tissue of gastrointestinal cancer patients and their modulation based on adiposity level assessed by CT-scan
Metabolic and nutritional derangements during cancer are often characterized by significant loss of body weight, primarily due to the wasting of skeletal muscle and adipose tissue [1,2].
Long-term mortality in patients with first-time pulmonary embolism according to the presence of comorbidities at baseline: a nationwide register study
Venous thromboembolism (VTE), encompassing pulmonary embolism (PE) and deep vein thrombosis (DVT), represents a significant global health burden due to high morbidity and mortality rates associated... more
Rituximab limits glucocorticoid use in IgG4-related disease: Real-world evidence from a large European cohort
While the rituximab-treated patients in this study had more severe IgG4-RD than the glucocorticoid-treated comparators, treatment with rituximab was associated with similar effectiveness endpoints,... more
Lifestyle characteristics and plasma biomarkers for risk of MASLD differ by sex in the general population
The rise in global prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) has highlighted the importance of developing sex-specific risk profiles for MASLD based on readily... more
Hydroxychloroquine for recurrent pericarditis: A multicentre observational study
To assess the effect of hydroxychloroquine (HCQ) in recurrent pericarditis (RP).
Guideline-directed medical therapy and mortality in heart failure patients hospitalized for COPD exacerbation
Heart failure (HF) is highly prevalent (≥ 15-20%) among patients with chronic obstructive pulmonary disease (COPD) and associated with increased mortality [1,2]. In addition, approximately 20% of HF... more
Optical coherence tomography angiography: a window on systemic sclerosis microangiopathy
Systemic sclerosis (SSc) is a rare multisystem disease characterized by early microvascular damage that leads to fibrosis of skin and internal organs [1]. SSc-related ocular manifestations have been... more
Exercise testing in chronic thromboembolic pulmonary hypertension and chronic thromboembolic pulmonary disease without pulmonary hypertension: a comprehensive systematic review and meta-analysis
The role of exercise testing in the follow up of patients with persistent dyspnea after pulmonary embolism (PE) is currently limited, with cardiopulmonary exercise test (CPET) mainly recommended in... more
All-cause mortality and early cardiovascular complications in relation to lesion location and stroke subtype in haemorrhagic and ischaemic stroke: the Perugia stroke registry
Stroke is a major global cause of morbidity and mortality and is frequently complicated by early cardiovascular events, collectively referred to as stroke-heart syndrome (SHS)[1,2]. The SHS... more
Risk of infection shortly before and after a diagnosis of liver cirrhosis: a nationwide, population-based study in Sweden
Liver cirrhosis is a serious medical condition and an increasing cause of mortality and morbidity worldwide [1–3] Cirrhosis poses a major burden on health systems, with patients having high risk of... more
From hospital to home: Practical guidance when caring for patients with COPD and heart disease
Patients with chronic obstructive pulmonary disease (COPD) frequently suffer from other chronic conditions, with cardiovascular disease being especially common. The presence of cardiovascular disease... more
Morning urinary calcium/creatinine ratio as a sex-specific screening tool for detecting hypercalciuria in hypoparathyroidism
Hypercalciuria is a relevant complication in patients with treated hypoparathyroidism. While hypercalciuria is usually estimated by 24-hour urinary calcium excretion (24hUCa), the calcium/creatinine... more
When social issues become medical emergencies: Prevalence and patient characteristics of social emergency admissions in internal medicine
Hospitalisations constitute the largest share of healthcare expenditures, and recent evidence suggests that a growing number of admissions are driven primarily by non-acute or non-medical factors... more
Trends in cardiac amyloidosis hospital admissions and associated mortality risk over 20 years: a population-based study using healthcare administrative databases
Cardiac amyloidosis (CA) remains substantially underdiagnosed despite greater awareness. This study evaluated hospital admissions for CA as a proxy of its incidence in Lombardy over the last two... more
Peripheral ulcerative keratitis (PUK) in autoimmune diseases: a severe ocular manifestation not always associated with systemic disease activity
Peripheral ulcerative keratitis (PUK) is a rare and severe ocular manifestation frequently associated with systemic autoimmune diseases. This retrospective two-center observational study including... more
Assessing the proportion of patients with type 2 diabetes in tertiary care eligible for combination therapy with GLP-1 receptor agonist and SGLT2 inhibitors
That almost half of the patients with type 2 diabetes in tertiary care were eligible for combination therapy with GLP-1 RA and SGLT2i highlight the potential negative impact of restricting access to... more
Left atrial enlargement and 1-year cerebrovascular events in subjects without atrial fibrillation: A prospective cohort study
Left atrial enlargement (LAE) is a cardiac structural abnormality linked to adverse cardiovascular events, including stroke. However, its independent prognostic role in patients without atrial... more
Efficacy and harms of polypills for cardiovascular disease prevention: A systematic review and meta-analysis of randomized controlled trials
To systematically evaluate polypill effects on cardiovascular (CV) risk factors, CV outcomes, and adverse events in CV disease (CVD) prevention populations.
Major adverse cardiovascular and bleeding outcomes in paroxysmal vs. non-paroxysmal atrial fibrillation: an individual patient-level data analysis of a large cohort of patients from the COMBINE-AF
Background: We performed an individual patient data analysis of COMBINE AF to assess differences in 14 clinically relevant outcomes between patients with paroxysmal (PAF) vs. non-PAF.Methods: Cox-... more
MBL2 deficiency and IgA Nephropathy in transplant patients: Is complement inhibition always beneficial?
Immunoglobulin A nephropathy (IgAN) represents the most prevalent form of primary glomerulonephritis globally and constitutes a major contributor to the burden of end-stage renal disease (ESRD) [1].... more
The changing prognosis of infective endocarditis. A 15-year analysis
Infective endocarditis (IE) mortality remains high. Population aging makes the aim of improving IE prognosis particularly difficult, as age is associated with comorbidity and mortality. Our objective... more
Genetic, and clinical features in Italian and lebanese subjects with familial mediterranean fever (FMF)
Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease with variable manifestations across Mediterranean regions. This study compares FMF cohorts from Italy (Apulia) and Lebanon... more
Direct oral anticoagulants versus Vitamin K antagonist in kidney transplant recipients with atrial fibrillation: A study from a global federated research network
The risk-benefit profile of direct oral anticoagulants (DOACs) in kidney transplant recipients (KTRs) with atrial fibrillation (AF) remains under-investigated.
Identifying distinct clinical phenotypes and outcomes in adult-onset IgA vasculitis using unsupervised clustering analysis
IgA vasculitis (IgAV) is a systemic vasculitis of the small vessels characterized by immune complexes including immunoglobulin A1 (IgA1) [1]. The clinical picture is a vascular purpura with or... more
Incidence of major adverse cardiovascular events decreases with greater adherence to both Mediterranean and low-fat dietary patterns in secondary prevention patients: a randomized controlled trial
Diet plays a crucial role in lifestyle interventions for secondary cardiovascular prevention [1–5]. Recent guidelines for reducing cardiovascular risk in secondary prevention populations recommend,... more
Mechanistic insights into heart failure progression and therapeutic target discovery through plasma microRNA profiling: Findings from HOMAGE
Identifying early pathobiological mechanisms associated with the onset and progression of heart failure (HF) could guide development of preventive strategies.
Left atrial appendage closure in patients with hereditary hemorrhagic telangiectasia and atrial fibrillation: a prospective study and systematic review
Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disease with a high risk of iron deficiency anemia secondary to epistaxis and gastrointestinal bleeding. Atrial... more
Review Article
Assessment and management of cardiovascular–kidney–liver metabolic-syndrome in the primary care setting: A multidisciplinary consensus statement
The recently introduced cardiovascular–kidney–metabolic (CKM) syndrome captures the close interplay between metabolic risk factors, chronic kidney disease, and cardiovascular disease, but... more
Organization and delivery of home-based care for chronic obstructive pulmonary disease patients receiving long-term home non-invasive ventilation: a systematic review
The delivery of LTHNIV remains heterogeneous, even within countries. This variability in care organization and reporting mandates establishing harmonized, patient-centred pathways that integrate... more
Trigger-induced atrial fibrillation for the hospitalist: a review
Atrial fibrillation (AF) is a common arrhythmia that a hospitalist may encounter. It is known to occur transiently or in response to specific triggers (trigger-induced AF), which presents a challenge... more
“Unpatients” in haemostasis and thrombosis. A yardstick of current paths in healthy carriers of a genetic susceptibility
Thrombophilia is defined as either an inherited or acquired abnormality of haemostasis inclining affected subjects to thrombosis, mainly because of interaction of multiple inherited and/or acquired... more
Alcohol use: less is better. An umbrella systematic review of clinical interventions, policies, and dose–response health risks in adults
Alcohol is a major modifiable cause of morbidity, premature mortality and health inequalities, yet evidence informing “low-risk” thresholds and prevention strategies is fragmented.
Chronic therapeutic non-adherence: Toward a new nosological entity
In 2021, non-communicable diseases caused approximately 43.8 million deaths and 1.73 billion DALYs globally, posing a major challenge for healthcare systems [1]. Despite significant advances in... more
Discontinuation of incretin-based therapies in obesity: the complexity of a breakup
Incretin-based therapies, including mono-, dual-, and emerging triple-agonists, have transformed the pharmacological management of obesity by inducing substantial and sustained weight loss together... more
How to monitor disease progression in ATTR amyloid cardiomyopathy: Implications for clinical practice and trial design
Transthyretin amyloid cardiomyopathy (ATTR-CM) has been traditionally considered a rare and inexorably fatal condition. However, the development of therapies able to slow or halt ATTR-CM progression... more
Pitfalls of autoimmune serological markers and practical diagnostic workflows in connective tissue diseases and rheumatoid arthritis
Laboratory markers represent a highly valuable tool to support the diagnosis of systemic autoimmune diseases. However, their correct interpretation is essential to avoid misdiagnoses, with particular... more
Redefining optimal medical therapy for heart failure in amyloid transthyretin cardiomyopathy
Amyloid transthyretin cardiomyopathy (ATTR-CM) is an infiltrative cardiomyopathy and an underdiagnosed cause of heart failure (HF) across the left ventricular ejection fraction spectrum. As disease-... more
Omics medicine: what the clinicians should know
Omics technologies analyze comprehensive molecular datasets, enabling the detailed characterization of pathological processes. Genomic, transcriptomic, proteomic, and metabolomic approaches, as well... more
Chronic obstructive pulmonary disease (COPD) and cardiovascular comorbidities: Shedding light on key interactions and therapeutic approaches
Chronic obstructive pulmonary disease (COPD) is often associated with cardiovascular disease and the both conditions share common risk factors (smoke), associated pathophysiological mechanisms (... more
Precision medicine with pioneering RNAi therapeutics in ATTR amyloidosis: from bench to bedside
Transthyretin (ATTR) amyloidosis is a multisystem disease caused by misfolding and aggregation of the plasma protein transthyretin (TTR) into insoluble amyloid fibrils in various organs [1]. This... more
Detecting dementia symptoms in internal medicine settings: clinical red flags, frailty and intervention perspectives
This paper provides a comprehensive overview of dementia in internal medicine hospital settings, highlighting its clinical detection, key red flags and frailty factors, as well as intervention... more
The evolving landscape of screening, management and treatment strategies of aortic stenosis in ATTR amyloidosis
Transthyretin amyloid cardiomyopathy (ATTR-CM) and aortic stenosis (AS) frequently coexist in elderly patients, particularly men, creating a complex clinical scenario with overlapping symptoms and... more