November 2024
151 ArticlesBeyond the Guidelines
Elevated blood pressure and hypertension in older persons: A comment on the recent ESC guidelines
The recently published European Society of Cardiology (ESC) Guidelines (GLs) for the management of elevated blood pressure (BP) and hypertension [1] introduced substantial changes in recommendations... more
Clinical Insights
The assessment, interpretation and implementation of lung ultrasound examinations in Heart Failure: Current evidence and gaps in knowledge
Pulmonary congestion is a common finding of volume overload or volume shift in heart failure (HF) and its detection is essential to facilitate timely therapy initiation or adjustment prior to frank... more
The screening of cognitive impairment in the emergency department: A valuable clinical and epidemiological goal
The screening of cognitive impairment is a critical and underestimated problem in the Emergency Department (ED). Overall, dementia remains unrecognized in more than a half of the Italian population,... more
Oropouche virus infection: What internal medicine physicians should know
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Internal medicine in the 21st century: Back to the future
Healthcare systems face multiple challenges arising from demographic factors (population aging) and epidemiological factors (rise of chronic diseases and patients with multimorbidity) as well as... more
Commentary
Exploring predictors of pulmonary embolism in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease
In this issue of the European Journal of Internal Medicine, Mismetti et al. published an original article titled "Predictors of pulmonary embolism in chronic obstructive pulmonary diseases patients... more
Hypertension management: The lesson from the SARS-CoV-2 pandemic
Hypertension is a major risk factor for cardiovascular diseases and a major cause of premature death worldwide [1]. Its regular monitoring is crucial for reducing cardiovascular risk, since it is the... more
“Obesity management in the older age, new understanding for old challenges”
Obesity, a silent pandemic, is rapidly spreading across all age groups and populations worldwide. >1 billion individuals are expected to be living with obesity by 2030 [1]. Parallel to the obesity... more
The new ESC 2024 guidelines on the management of peripheral arterial and aortic diseases: Lights and shadows
The new guidelines on the management of peripheral arterial and aortic diseases have been released at the European Society of Cardiology (ESC) Annual Congress 2024 and published simultaneously [1].... more
Hyperhomocysteinaemia and MASLD: Causal relationship or spurious correlation?
Metabolic dysfunction-associated liver disease (MASLD) is the most common chronic liver disease worldwide and a leading cause of liver-related morbidity and mortality, affecting one-third-of the... more
Linking functional capacity and heart failure outcomes: Easy assessment, major implications
Heart failure (HF) is a global pandemic that affects nearly 60 million people worldwide. Despite continuous and significant advances in treatment, HF continues to be associated with poor prognosis... more
Realizing the scope of venous and arterial thrombosis in cyclin-dependent kinase 4/6 inhibitors in hormone positive breast cancer
In hormone positive, human epidermal growth factor receptor 2 (HER2)-negative advanced and metastatic breast cancer, the cyclin-dependent kinase (CDK) 4/6 inhibitors palbociclib, ribociclib and... more
Treatment of systemic lupus erythematosus in real life
The study by Du et al., published in this issue of the European Journal of Internal Medicine [1] adds significant information regarding the treatment patterns in systemic lupus erythematosus (SLE),... more
Putting frailty at the forefront of hypertension management in the elderly
In a progressively aging world, the concept of frailty is becoming increasingly relevant. Frailty is a dynamic, age-related biological syndrome with multifactorial causes leading to impaired... more
A potential novel stratification model to predict cardiovascular disease in patients with metabolic dysfunction-associated steatotic liver disease
Steatotic Liver Disease (SLD) is defined as excessive built-up of fat in the liver (>5 %) diagnosed by imaging or a liver biopsy [1]. Recently, a novel term metabolic dysfunction-associated... more
Cannabis is probably not the best choice for weight reduction
The field of medical cannabis has made significant advancements in recent years from both research and clinical perspectives [1]. These developments were driven by substantial shifts in public... more
Deprescribing in reflex syncope
Reflex syncope is generally considered a benign condition. It is due to a reflex response (parasympathetic enhancement and decreased sympathetic tone) to several stimuli (e.g. micturition, defecation... more
Optimal timing of antibiotic administration in septic patients: The need to reformulate this question
Sepsis represents the most severe clinical manifestation of infectious diseases. Despite advances in understanding this pathology, recent global data document an estimated incidence of 48.9 million... more
It is time to get all the job done: For patients’ sake
Guidelines prioritize cardiovascular (CV) prevention by controlling all risk factors: this is a commitment for every healthcare professional following patients with type 2 diabetes. Not doing so... more
Unmasking eosinophilic granulomatosis with polyangiitis (EGPA)
Eosinophilic granulomatosis with polyangiitis (EGPA) remains a challenging diagnosis due to its rarity and heterogeneous presentation. The article by Solans-Laqué et al. represents a significant step... more
Navigating the bleeding risk dilemma in patients with atrial fibrillation on therapy with direct-acting oral anticoagulants: Comparing the HAS-BLED vs. DOAC Score
Oral anticoagulation (OAC) is pivotal in preventing stroke in atrial fibrillation (AF), but its use poses inherent risks, notably an increased susceptibility to bleeding, especially in clinically... more
Editorial
Two recent European guidelines on hypertension
During the past year, two influential Hypertension Guidelines from Europe have been released. The first, published in year 2023, was issued by the European Society of Hypertension [1]. The second,... more
Internal Medicine Flashcard
A woman with unconsciousness and tachycardia after drug overdose.
A 44-year-old female was brought to our emergency department due to impaired consciousness. On arrival, her Glasgow Coma Scale score was 6. Her blood pressure was 102/60 mmHg, her heart rate was 132... more
A tiny green lesion mimicking a big problem
A 75-year-old smoker patient presented to our hospital with shortness of breath and mild hemoptysis. A chest radiograph demonstrated a suspicious left parahilar opacity (Fig. 1A). A thoracic computed... more
Reversible polyneuropathy with multiple hypochromic lesions, digital ulcers and onychodystrophy
A 40-year-old Brazilian woman with a medical history of a subclinical hypothyroidism came to our clinic because of progressive distal numbness, weakness and polyarthralgia. She denied fever nor... more
A man with large periumbilical masses
A 82-year old man presented to the Outpatient Department due to difficult-to-treat type 2 diabetes mellitus (T2DM), initially diagnosed 15 years ago. His rest medical history included coronary artery... more
A peculiar cause of dysphagia
An 82-year-old man with middle stage Alzheimer's dementia presented to the emergency clinic with poor general condition, productive cough, sputum, wheezing, and falling. He was found on the floor by... more
Diagnostic challenge of hemoptysis in a hemodialysis patient
A 60-year-old male with a history of chronic kidney disease (CKD) diagnosed 3 years ago, on thrice-weekly hemodialysis, presented to the emergency department with a one-month history of hemoptysis... more
Man with progressed cognitive impairment
A 69-year-old man presented to the neurology department with progressed cognitive impairment for two years. He had medical history of diabetes but without remarkable family history of dementia. On... more
Invited Review Article
Behaviour therapy for obesity in older adults
Obesity is a major public health concern, with global data highlighting that 650 million adults are living with obesity and 1.9 billion adults are living with overweight [1]. Current epidemiological... more
Treat the patient, not the disease: The embolic stroke of undetermined source as an opportunity to optimize cardiovascular prevention in a holistic approach
“It is much more important to know what sort of patient has a disease than what sort of disease a patient has.”“The good physician treats the disease; the great physician treats the patient who has... more
Managing and discharging COPD patients hospitalized because of an exacerbation of respiratory symptoms: An opportunity to improve outcomes
Many patients with chronic obstructive pulmonary disease (COPD) develop episodes of exacerbation of respiratory symptoms (ECOPD) that may require hospitalization (H-ECOPD). Long-term prognosis during... more
Advances in the pathophysiology, diagnosis and management of chronic diarrhoea from bile acid malabsorption: a systematic review
Excessive biosynthesis or secretion of bile acids (BAs) and their malabsorption (BAM) in the terminal ileum or the colon [1] generates chronic diarrhoea (cholorrhea). This symptom depends on a... more
Pharmacotherapy for older people with obesity
The prevalence of obesity continues to rise in Europe, particularly in adults aged between 60 and 74 years [1]. Despite this rising prevalence of obesity in older adults, use of medication for weight... more
Letter to the Editor
GLP-1 receptor agonists for the treatment of obstructive sleep apnea and obesity
Obstructive sleep apnea (OSA) syndrome is a common disorder of repeated upper airway collapse during sleep, leading to recurrent hypoxia and hypercapnia [1]. Continuous positive airway pressure (CPAP... more
Switching from hospital centered to community based, person centered and integrated social health and care systems; Mission impossible or key objective?
Length of Stay (LOS) is a widely recorded metric used in hospital management and considered an important indicator of healthcare efficiency [1]. Despite its strategic value and one of the longest... more
Vaccination trends and recent therapeutics to encounter resurgence of monkeypox
The World Health Organization (WHO) declared a public health emergency of international concern (PHEIC) on the resurgence of monkeypox after the 2022–2023 epidemic, a zoonotic ailment with primary... more
Optimizing socioeconomic and psychosocial factor analysis in myocardial infarction outcomes
Dear Editor,
The potential impact of educational attainment on NAFLD risk
We read with great interest the article by Florian Koutny and his colleagues, recently published in the European Journal of Internal Medicine [1]. In this article, Florian Koutny and his colleagues... more
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
Characteristics of familial Mediterranean fever after 65 years of age
Dear Editor,
External factors affecting weight loss during intermittent fasting. Author's reply
Dear Editor,
Comparative safety and efficacy analysis of GLP-1 receptor agonists and SGLT-2 inhibitors among frail individuals with type 2 diabetes in the era of continuous population ageing
Dear Editor,
Co-management hospitalist services for neurosurgery. Where are we?
Dear Editor, the increase in the average age of the population and in the prevalence of chronic comorbidities has made healthcare extremely difficult and sometimes with difficult home management [1,2... more
Clinical significance of the anti-Nucleolar Organizer Region 90 antibodies (NOR90) in systemic sclerosis
We read with great interest the article by Dima et al. on the clinical significance of the anti-Nucleolar Organizer Region antibodies (NOR90) in systemic sclerosis (SSc) [1]. The authors conducted a... more
Factors associated to multiple chronic conditions in internal medicine patients
Dealing with patients with multiple chronic conditions (MCC) is certainly one of the most compelling healthcare challenges [1]. Most of the available data about MCC derive from large administrative... more
The prediction of alterations in plasma sodium levels in acutely ill patients should be more comprehensive. Author's reply
We thank Jaguszewski et al. [1] for their interest in our article [2] and their thoughtful comments.
FIB-4 score association with operative outcomes, truth or fibs?
In recent years, liver disease has become established as a significant predictor of poor perioperative outcomes [1]. Despite declining rates of hepatitis B and hepatitis C-related morbidity and... more
External factors affecting weight loss during intermittent fasting
we read with great interest a recently published study by Mohamad Khalil, Hala Abdallah, et al. regarding distinct biophysiological effects of Ramadan fasting and traditional intermittent fasting on... more
Diagnostic value of pleural calprotectin in differentiating complex parapneumonic effusions
Dear Editor,
Predictive performance of hepatocellular carcinoma risk scores in chronic hepatitis C patients with advanced fibrosis after achieving sustained virological response: Insights from European Association for the study of the Liver Policy recommendations
Current European guidelines recommend hepatocellular carcinoma (HCC) surveillance in patients with an annual HCC risk of 1.5% or higher comprising serial ultrasound imaging ± alpha fetoprotein (AFP)... more
Oh no, all we needed was monkeypox!
Four years after the spread of the coronavirus disease 2019 (COVID-19) pandemic, with a worldwide epidemiology largely under control thanks to widespread immunity against severe acute respiratory... more
A bibliometric analysis of awake prone positioning for non-intubated patients
The global coronavirus disease 2019 (COVID-19) pandemic led to severe medical, economic, and social challenges, including a critical shortage of mechanical ventilators and intensive care unit beds [1... more
Enhancing immunization strategies in heart failure: A call to action
Heart failure (HF) is a severe cardiovascular pathology with escalating prevalence and notable morbidity and mortality on a global scale. Addressing this condition presents an imperative, in order to... more
DNA methylation levels of the ACE2 promoter are not associated with symptoms-severity and related-disability in previously hospitalized COVID-19 survivors
The presence of long-lasting symptoms after suffering an acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has recently extensive attention in the last years. One of the first meta-... more
Compassion in medicine: Are we failing our future doctors?
Dear editor,
Empagliflozin controls cirrhotic refractory ascites along with improvement of natriuresis and circulatory, cardiac, and renal function: A pilot study
Ascites is the most common decompensating event in cirrhosis [1]. Its pathophysiology involves splanchnic arterial vasodilation and reduced effective arterial blood volume, which activate potent... more
Combining L-arginine and vitamin C improves physical frailty in hypertensive elders
Hypertension is one of the most common comorbidities which has been suggested to play a pivotal role in the transition to pre-frailty and physical frailty (hereafter called frailty), especially in... more
The prediction of alterations in plasma sodium levels in acutely ill patients should be more comprehensive
We read with great interest the article by Simon et al. entitled "Prediction of plasma sodium changes in the acutely ill patients: the potential role of tissue sodium content"[1]. The study focuses... more
Antimicrobial therapy and patient management for severe Legionnaires’ pneumonia
Legionellosis (LD) becomes a major public health problem, predominantly presenting as Pontiac fever or pneumonia with predominance of Legionella pneumophila (Lp) throughout the world, as reported in... more
Immune heterogeneity associated with disease severity and activity in eosinophilic granulomatosis with polyangiitis patients
Dear Editor,
Challenges in using the clock drawing test for prognosis prediction in patients with non-specific complaints
Espejo and colleagues, using data from a prospective cross-sectional study, discovered that patients visiting the emergency department with non-specific complaints who had poor results on the Clock... more
Inhaled corticosteroids in severe COPD patients with cardiovascular diseases. Authors’ reply
We thank Pruc and Szarpak [1] for their interest in our article [2]. They address several questions, nicely summarised in the last sentence of their letter, “future research should focus on the... more
Atrial fibrillation-related mortality trends among adults with comorbid chronic obstructive pulmonary disease in the United States from 1999 to 2020
Atrial fibrillation-related mortality in adults with comorbid chronic obstructive pulmonary disease in the United States from 1999 to 2020.
Effect of tirzepatide on leptin and adiponectin levels
In the field of innovative treatments for type 2 diabetes, tirzepatide emerges as a novel dual agonist of the glucose-dependent insulinotropic polypeptide (GIP) receptor and the glucagon-like peptide... more
Clinical trial landscape for immune thrombocytopenia: Progress and the long road ahead
Immune thrombocytopenia (ITP) has seen the development and evaluation of several breakthroughs in recent clinical trials [1-4]. The clinical trial landscape for ITP provides valuable insights into... more
Quinolones or macrolides for adults with Legionnaires’ disease and respiratory failure?
We recently read the systematic review entitled “Legionella pneumonia in hospitalized adults with respiratory failure: Quinolones or macrolides?” by Ruiz-Spinelli A, and Rello J published in the... more
Long-term inhaled corticosteroid treatment in patients with chronic obstructive lung disease, cardiovascular disease, and recent hospitalization for exacerbation
The article “Long-term inhaled corticosteroid treatment in patients with chronic obstructive pulmonary disease, cardiovascular disease, and recent hospitalization for exacerbation: A pragmatic... more
Integrated care and lean management in internal medicine: An ideal mix for a functioning health system?
Many European health systems are still under pressure in the post pandemic period, mainly because of the long-term trend of ageing people requiring more and more health care. Therefore, a rational... more
Precision medicine in COPD: A possible contribution of vitamin D?
we read the interesting review by Gilda Varricchi and Remo Poto on the most innovative and recent therapeutic approaches for COPD [1].
Sudden death in congenitally corrected transposition of the great vessels
Transposition of the great arteries (TGA) comprises dextro-TGA and levo-TGA (L-TGA). In dextro-TGA, the aorta, arising from the right ventricle (RV), is positioned to the right of the pulmonary... more
How do we diagnose Miyoshi Muscular Dystrophy in the absence of symptoms?
Elevated liver enzyme is a common incidental laboratory finding. Evaluating such problems particularly in asymptomatic patients might be challenging. Alterations in liver enzymes are not enterily... more
Impact of an active case-finding strategy in autoimmune gastritis
Dear Editor,
Sodium–Glucose Co-transporter 2 Inhibitors treatment improve pancreatic β-cells function and insulin resistance in patients with Type 2 diabetes
Diabetes is a leading cause of death and disability [1]. Approximately, more than 1.31 billion people will have diabetes by 2050 [1,2]. Insulin resistance in target tissues and insufficient insulin... more
Insights into recurrence of hypertriglyceridemia-associated acute pancreatitis: Methodological challenges
We read the article by Ling Ding et al. with great interest [1]. We would like to commend the authors for their comprehensive study, which found that hypertriglyceridemia-associated acute... more
Glucagon-like peptide-1 receptor agonists and sodium-glucose cotransporter-2 inhibitors combination therapy versus monotherapy and major adverse cardiovascular events: Do the benefits add up?
Dear Editor,
Predictive performance of HAS-BLED, ORBIT, ABC, and DOAC scores for major bleeding in atrial fibrillation patients on DOACs
Atrial fibrillation (AF) is the most common type of irregular heartbeat in clinical practice. It has been found to increase the risk of ischemic stroke by 5 times. To mitigate this risk, oral... more
The relationship between large vessel vasculitis and glucocorticoid responsiveness of musculoskeletal inflammation: An unverified issue on polymyalgia rheumatica
Dear Editor,
Risk of psoriatic arthritis development with interleukin-17 inhibitors compared to tumour necrosis factor inhibitors
Psoriatic arthritis (PsA) is one of the most important comorbidities in patients with psoriasis (PsO), with approximately one third of PsO patients developing arthritis over their whole lifetime [1... more
Direct oral anticoagulants or vitamin K antagonists in adult patients with congenital heart disease?
Dear Editor,
Divergent views on prescription adherence: A qualitative comparison of perspectives from the patient, pharmacist, and physician triad
Up to 70 % of patients fail to follow prescribed regimens [1], resulting in detrimental health and economic consequences. While existing adherence research often focuses on either the traditional... more
Myocardial infarction in foreign-born individuals in the total population of Sweden
Cardiovascular diseases (CVD) are still frequent globally with a high mortality rate, even if the incidence has decreased since the 1980s in Europe, especially in Northern Europe [1], including a... more
Beneficial effects of early low-dose methylprednisolone with long-term treatment in ARDS
Since the concept of acute respiratory distress syndrome (ARDS) was first proposed by Ashbaugh in 1967 [1], it has been refined several times for better reflect the phenotype in recent decades. The... more
Cardiovascular outcome with SGLT2i and GLP1RA
Dear editor,
Clostridioides difficile infection as a potential trigger for Familial Mediterranean Fever attacks and fecal transplantation as a rescue
Sir,
Definition of an algorithm to identify patients with sickle-cell disease in the French National Health Database
Sickle cell disease (SCD) is the most frequent inherited disease with monogenic transmission (300,000 newborns per year in the world) [1]. SCD is due to a mutation on both alleles of the gene coding... more
Navigating the challenges: Would onboarding bootcamps enhance comfort and wellbeing of residents in medicine?
Medical interns (first-year residents) and residents (second-to fourth-year residents) in France are junior medical staff in charge of overseeing up to 200 medicine beds during night shifts, with no... more
Dual tobacco smoking, electronic cigarette use and COVID-19 outcomes
We congratulate Scala and colleagues on the publication of their paper on electronic cigarette (e-cigarette) use and Coronavirus Disease 2019 (COVID-19) outcomes [1]. Scala et al. focused on e-... more
Survival analysis of diabetes cardiovascular outcome trials using reconstructed Kaplan-Meier curves
The management of type 2 diabetes mellitus (T2DM) has witnessed a treatment paradigm in the light of recent cardiovascular outcomes trials (CVOTs) which have placed more emphasis on cardiovascular... more
Multi-organ abnormalities assessed by a single MRI scan in individuals with blood cancer
During the COVID-19 pandemic individuals with all blood cancers were classified as clinically vulnerable and at high risk of complications and death. Our study sought to determine if individuals with... more
The association between long-acting muscarinic antagonist-based therapy and the risk of urinary tract infection in patients with chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is a common respiratory disease featuring persistent respiratory symptoms and progressive airflow limitation. Long-acting muscarinic antagonists (LAMAs)... more
Self-publishing in the history of medicine: The paradoxical case of Edward Jenner's science-changing monograph (1798)
According to the Cambridge Dictionary, self-publishing is regarded as the act of arranging or paying for one's ‘own book to be published, rather than having it done by a publisher’ [1]. Whether it be... more
Original Article
Clinical characteristics and outcomes of Takotsubo syndrome in patients with chronic obstructive pulmonary disease
Takotsubo syndrome (TTS) is an acute heart failure syndrome characterized by a transient impairment of systolic function [1]. Adverse outcomes have been described both in the acute phase and, despite... more
Modifiable lifestyle factors in the primordial prevention of hypertension in three US cohorts
Hypertension is a leading cause of cardiovascular diseases (CVD). The prevalence has doubled from 1990 to 2019 [1] and now impacts almost half of the US adult population [2], and the condition... more
Adherence to the 2019 ESC/EAS guidelines for dyslipidaemia management in a large rheumatoid arthritis cohort: Data from the CORDIS Study Group of the Italian Society of Rheumatology
The evidence that several variables, including inflammation, autoimmunity and traditional cardiovascular (CV) risk factors, closely interact to enhance atherosclerotic risk burden in rheumatoid... more
Association of non-cardiac comorbidities and sex with long-term Re-hospitalization for heart failure
Heart failure (HF) is a complex clinical syndrome, the course of which is usually complicated by concomitant comorbidities [1–6]. However, in spite of this long-held notion, the impact of non-cardiac... more
Hyperhomocysteinemia is linked to MASLD
Arterial Hypertension
Clinically relevant bleeding according to location of metastases in cancer-associated thrombosis
Venous thromboembolism (VTE), comprising deep vein thrombosis (DVT) and pulmonary embolism (PE), is a frequent complication in patients with cancer [1]. It is estimated that 20–30 % of VTE cases are... more
Systolic blood pressure, a predictor of mortality and life expectancy following heart failure hospitalization, 2010–2023
Each year, over 1 million Americans are admitted to hospitals with heart failure (HF) as the primary discharge diagnosis [1]. Hospitalization for acute decompensated HF (ADHF) represents a critical... more
Association between trajectory of systolic blood pressure and outcomes in heart failure patients with preserved ejection fraction (HFpEF)
Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous disease which accounts for 50 % of all heart failure [1–3]. Currently, treatment for HFpEF not only focuses on improving... more
TLR4 and TNF-α single nucleotide polymorphisms in patients with brucellosis: Association with infection complications
Brucellosis is a zoonotic infectious disease caused by Brucella spp, an intracellular facultative anaerobe Gram negative bacteria transmitted to humans by domestic (cattle, goats, sheep, swine, dogs... more
External validation of a prognostic score to identify low-risk outpatients with acute deep venous thrombosis in the lower limbs
Deep vein thrombosis (DVT) and pulmonary embolism (PE) stand as the primary manifestations of venous thromboembolism (VTE) [1-3]. Nonetheless, the absence of national surveillance systems for VTE... more
Hyperchloremic metabolic acidosis potentially benefiting sodium bicarbonate therapy: A multi-center cohort study
Metabolic acidosis is a type of acid-base imbalance that significantly impacts prognosis. It can be caused by poisoning, infections, surgeries, acute and chronic renal failure, diabetic ketosis, and... more
Prediction of left ventricular thrombus after myocardial infarction: a cardiac magnetic resonance-based prospective registry
Left ventricular thrombus (LVTh) is a rare but serious complication following ST-segment elevation myocardial infarction (STEMI) [1–4]. During the prethrombolytic era, LVTh was detected in up to 60%... more
Prospective study of risk factors for community-acquired acute kidney injury
Acute kidney injury (AKI) is a common condition, both in hospital and outpatient settings, and is associated with increased mortality, prolonged hospital stay, progressive chronic kidney disease (CKD... more
A large language model-based clinical decision support system for syncope recognition in the emergency department: A framework for clinical workflow integration
Syncope is a common presenting symptom in the emergency department (ED), [1,2] the management of which poses inherent challenges, starting from recognition. Crucial information is collected during... more
Carotid plaque offsets sex-related differences in cardiovascular risk of young hypertensive patients
Risk for cardiovascular disease (CVD), in particular risk for coronary artery disease and acute coronary syndrome, is lifelong higher in men than in women [1], although this difference is attenuated... more
Impaired insulin sensitivity measured by estimated glucose disposal rate is associated with decreased myocardial mechano-energetic efficiency in non-diabetic individuals
Atherosclerotic cardiovascular diseases encompassing coronary artery disease, and stroke, remain major causes of death worldwide regardless the substantial advances in the prevention and treatment of... more
The impact of the COVID-19 Pandemic on hypertension phenotypes (ESH ABPM COVID-19 study)
The COVID-19 pandemic had a significant impact on various aspects of public health. The imposed restrictions forced people to spend more time at home, which may have resulted in a decline in physical... more
Predictors of pulmonary embolism in chronic obstructive pulmonary diseases patients admitted for worsening respiratory symptoms: An individual participant data meta-analyses
Chronic obstructive pulmonary disease (COPD) is a widespread condition with significant morbidity and mortality [1,2]. It is one of the leading causes of death and is already expected to experience a... more
Distinct biophysiological effects of Ramadan fasting and traditional intermittent fasting on markers of body fat storage. A real-life study
Obesity is a metabolic disease characterized by fat over-storage in multiple districts. The continuous increase of the obesity epidemic makes mandatory innovative interventions and new guidelines to... more
Thrombosis in breast cancer patients on cyclin-dependent kinase inhibitors: Survival impact and predictive factors - A study by the cancer and thrombosis group of the spanish society of medical oncology (SEOM)
TESEO registry data indicate that breast cancer ranks third in cases of cancer-associated thrombosis [1]. This cannot be solely attributed to the prevalence of malignant breast pathology, as a study... more
Towards a comprehensive approach to the management and prognosis of systemic sclerosis's patients: The role of comorbidities in the SPRING-SIR registry
In systemic sclerosis (SSc), widespread skin and visceral fibrosis are associated with poor outcome and increased mortality [1]. For this reason, SSc management remains a challenge due to clinical... more
Treatment of systemic lupus erythematosus: Analysis of treatment patterns in adult and paediatric patients across four European countries
Systemic lupus erythematosus (SLE) is a multisystem autoimmune disorder of connective tissue with a highly variable clinical presentation, disease course and prognosis [1]. SLE is characterised by... more
Prevalence and clinical determinants of rapid eGFR decline among patients with newly diagnosed type 2 diabetes
Diabetic kidney disease (DKD) is the most common cause of end-stage kidney disease (ESKD) in the western world, accounting for more than 40 % of patients that require kidney replacement therapy [1].... more
Prevalence and clinical predictors of vasodepressor syncope during head up tilt test
Head-up tilt test (HUTT) is a useful diagnostic tool for patients with suspected reflex syncope after initial clinical assessment [1]. When using the Italian protocol, HUTT allows to confirm the... more
Prognostic role of gait speed in worsening heart failure
Heart failure (HF) is a progressive disease, affecting more than 60 million people worldwide [1]. Despite advances in treatment options, HF is associated with a high risk of mortality and morbidity.... more
Prediction of plasma sodium changes in the acutely ill patients: the potential role of tissue sodium content
Dysnatremias, disorders of plasma sodium concentration ([Na+]), are frequently encountered in daily clinical practice and pose a diagnostic and therapeutic challenge for many clinicians[1]. Rapid... more
Functional limitation predicts mortality in heart failure with preserved ejection fraction
Globally, more than 64 million people are affected by HF [1]. The estimated prevalence of HF is 1 % to 3 % in Europe and 2.1 % in the USA [2,3]. The estimated incidence is 1 to 4 cases per 1000... more
Intra-abdominal infection and sepsis in immunocompromised intensive care unit patients: Disease expression, microbial aetiology, and clinical outcomes
Sepsis-related multiple organ dysfunction is fundamentally driven by the host response to infection, rather than by the direct effect of the microorganism. This was accepted in the consensus... more
Native skeletal muscle T1-time on cardiac magnetic resonance: A predictor of outcome in patients with heart failure with preserved ejection fraction
Heart failure (HF) with preserved ejection fraction (HFpEF) is a major public health problem that is associated with a high morbidity and mortality [1] leading to an excess in hospitalizations and... more
Door-to-antibiotic time and mortality in patients with sepsis: Systematic review and meta-analysis
Timely administration of antibiotics is one of the most important interventions in sepsis management to improve patient outcomes and reduce mortality. However, the impact on mortality of the early... more
Distribution and prognostic impact of different heart failure etiologies in patients with heart failure with mildly reduced ejection fraction
As a result of ongoing demographic changes and an ageing population, the overall number of patients with heart failure (HF) has significantly increased. It is estimated that more than 60 million... more
Plasma levels of myeloperoxidase and resistin independently predict mortality in dialysis patients
Dialysis is a vital treatment for patients with kidney failure on dialysis (KF). Yet, it associates with a high risk of death mainly due to both cardiovascular (CV) and non-CV causes [1,2]. Indeed,... more
A machine learning algorithm for stratification of risk of cardiovascular disease in metabolic dysfunction-associated steatotic liver disease
Steatotic liver disease (SLD) has emerged as a prevalent and significant condition that contributes to the rising burden of liver diseases worldwide [1]. Given the increasing prevalence of SLD, it is... more
Associations of cannabis use and body mass index–The Coronary Artery Risk Development in Young Adults (CARDIA) study
In the US in 2020, 18 % of the population reported use of cannabis in the past year. Use among middle and older-aged people is rising [1,2]; from 2016 to 2018 the percentage of US adults ≥55 years... more
Long-term inhaled corticosteroid treatment in patients with chronic obstructive pulmonary disease, cardiovascular disease, and a recent hospitalised exacerbation: The ICSLIFE pragmatic, randomised controlled study
Patients with chronic obstructive pulmonary disease (COPD) are typically older [1], and have multiple comorbidities, including heart failure, ischaemic heart disease, and arrhythmias [2–5]. The... more
Performance of HAS-BLED and DOAC scores to predict major bleeding events in atrial fibrillation patients treated with direct oral anticoagulants: A report from a prospective European observational registry
Atrial fibrillation (AF) is the most common arrhythmia worldwide and it is associated with a 3–5-fold higher risk of stroke [1]. This risk has been significantly reduced after the introduction of... more
Metabolic health and genetic predisposition in inflammatory bowel disease: Insights from a prospective cohort study
Inflammatory bowel disease (IBD), encompassing Crohn's disease (CD) and ulcerative colitis (UC), is a chronic inflammatory disease of the gastrointestinal tract driven by an inappropriate and... more
Effectiveness Of Tocilizumab In Aortitis And Aneurysms Associated With Giant Cell Arteritis
Giant Cell Arteritis (GCA) is a vasculitis involving the large and medium vessels, especially the extracranial branches of the carotid arteries, and particularly, the temporal artery. Arterial wall... more
Red flags for clinical suspicion of eosinophilic granulomatosis with polyangiitis (EGPA)
Eosinophilic granulomatosis with polyangiitis (EGPA), formerly known as Churg-Strauss syndrome [1], is a systemic vasculitis classified as an anti-neutrophil cytoplasm antibody (ANCA)-associated... more
Beta-cell function and glucose metabolism in patients with chronic pancreatitis
Diabetes of the exocrine pancreas (DEP), - also defined as pancreatic, pancreatogenic, or type 3c diabetes - arises from the structural or functional loss of insulin secretion secondary to exocrine... more
Diagnosis of acute aortic syndromes with ultrasound and d-dimer: the PROFUNDUS study
Acute aortic syndromes (AASs), including aortic dissection (AD), intramural aortic haematoma (IMH) and penetrating aortic ulcer (PAU), affect 5–7/100,000 individuals/year [1]. They are time-dependent... more
A group-based intervention for diabetes-related emotional distress among emerging adults with type 1 diabetes: A pilot study
Emerging adulthood is a critical period with increased risk of acute and chronic health complications, psychological problems, and psychosocial issues for emerging adults with type 1 diabetes (T1D) [... more
Relationship between degree of risk factor control and all-cause mortality in individuals with type 2 diabetes: A prospective cohort study
Risk of death is approximately twice higher in people with diabetes than in those without, mainly though not exclusively due to an increased risk of cardiovascular disease (CVD) [1]. However, death... more
Association between socioeconomic and psychosocial factors with use of interventional and surgical treatments and outcomes in patients with myocardial infarction – Inpatient data of the largest European health care system
Myocardial infarction (MI) remains a leading contributor for morbidity and mortality worldwide [1,2]. While the medical progress regarding diagnostic and therapeutic approaches has improved outcomes... more
Targets for deprescribing in patients with hypertension and reflex syncope
In hypertensive patients with reflex syncope, detection of transient hypotension as possible trigger mechanism of syncope may prompt deprescribing of hypotensive medications to counteract the risk of... more
Early palliative care program in idiopathic pulmonary fibrosis patients favors at-home and hospice deaths, reduces unplanned medical visits, and prolongs survival: A pilot study
Idiopathic Pulmonary Fibrosis (IPF) is a relentlessly progressive fibrotic interstitial lung disease (ILD) with an unfavourable prognosis1. The median survival is 3 to 5 years form the time of... more
Comparison of different frailty instruments for prediction of functional decline in older hypertensive outpatients (HYPER-FRAIL pilot study 2)
Frailty is a geriatric syndrome characterized by a cumulative decline in multiple body systems, which results in the reduction of individuals’ physiological functional reserve with increased... more
Evolution and outcomes of aortic dilations in giant cell arteritis
Giant cell arteritis (GCA) is a systemic vasculitis that typically affects large and medium vessels in patients over 50 years of age [1–3]. In addition to the cephalic presentation mainly explained... more
Review Article
Transforming organ donation and transplantation: Strategies for increasing donor participation and system efficiency
Organ transplantation stands as one of the most significant advancements in modern medicine, providing life-saving solutions for patients with end-stage organ failure [1]. From the first successful... more
Translating evidence into practice: Managing electrolyte imbalances and iron deficiency in heart failure
Heart failure (HF) is defined as a clinical syndrome with symptoms and/or signs caused by a structural and/or functional cardiac abnormality, corroborated by elevated natriuretic peptides and/or... more
New strategies for the treatment of hyperkalemia
Potassium (K+) is the most abundant cation in the body (50–75 mEq/L/kg body weight). Under physiological conditions, approximately 98 % of total body K+ is located in the intracellular space and only... more
Triglyceride glucose (TyG) index: A promising biomarker for diagnosis and treatment of different diseases
Insulin resistance (IR) is a metabolic condition in which insulin levels are elevated due to insensitivity to insulin and associated with elevated triglyceride levels. Hypertriglyceridemia leads to... more
Chronic obstructive pulmonary disease's eosinophilic phenotype: Clinical characteristics, biomarkers and biotherapy
COPD is a complex, heterogeneous, and chronic inflammatory disorder of the airways characterized by persistent and poorly reversible airflow limitation, along with significant respiratory symptoms... more
Gliflozines use in heart failure patients. Focus on renal actions and overview of clinical experience
In the past decades impressive progress in heart failure (HF) treatment has been achieved by adoption of therapeutic tools ranging from renin angiotensin system antagonists to beta blocking agents,... more
The clinical relevance of the reversal of coronary atherosclerotic plaque
Despite tremendous progress in study of the pathophysiological mechanisms underlying atherosclerosis and the subsequent development of innovative preventive therapies, atherosclerotic cardiovascular... more
Diet and physical exercise in elderly people with obesity: The state of the art
“Obesity and ageing: two side of the same coin” in 2020 Tam et al. have summarised the complex pathophysiological interaction and mutual relationship between obesity and ageing in a comprehensive... more
Pulmonary hypertension associated to left heart disease: Phenotypes and treatment
According to the last updated ESC guidelines 2022, the term Pulmonary Hypertension (PH) describes a clinical condition characterised haemodynamically by the presence of mean pulmonary artery pressure... more
Exploring Cardiovascular Risk Factors and Atherosclerosis in Rheumatoid Arthritis
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting the synovium of the joints, leading to joint destruction and bone damage. It affects 0, 5–1 % of the general population,... more
Metabolic Bariatric surgery in People with Obesity aged ≥65 Years
The World Health Organization (WHO) estimated that 1.4 billion people in the world will be aged 60 years and older in 2030 and 2.1 billion by 2050, comprising 12–22 % of the global population [1].... more