October 2021

103 Articles

No Section

Serum IgG4 elevation in hyper-inflamed COVID-19 patients. Author's reply

21 October 2021
Author(s): Emanuel Della-Torre, Marco Lanzillotta, Giuseppe Alvise Ramirez, Lorenzo Dagna, Moreno Tresoldi

Dear Editor, we thank Dulak and Trzciński for their insightful and pertinent comments on our observation about serum IgG4 levels predicting mortality in hospitalized patients affected by Coronavirus... more

The coupling between sarcopenia and COVID-19 is the real problem

22 September 2021
Author(s): Rizwan Qaisar, Asima Karim, Tahir Muhammad, Islam Shah, M. Shahid Iqbal

Dear Editor

Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation

24 August 2021
Author(s): Josep Tost, Pere Llorens, Gad Cotter, Beth Davison, Javier Jacob, Víctor Gil, Pablo Herrero, Francisco Javier Martín-Sánchez, Ruxandra Donea, Beatriz Rodríguez, Francisco Javier Lucas-Imbernon, Juan Antonio Andueza, Ana Belén Mecina, Raquel Torres-Gárate, Pascual Piñera, Aitor Alquézar-Arbé, Begoña Espinosa, Alexandre Mebazaa, Ovidiu Chioncel, Òscar Miró, ICA-SEMES group

To analyze the frequency with which patients with heart failure with preserved ejection fraction (HFpEF) discharged after an acute heart failure (AHF) episode are treated with antineurohormonal drugs... more

Sarcopenic obesity is the real problem in COVID-19 !

15 August 2021
Author(s): Murat Kara, Ayşe Merve Ata, Levent Özçakar

Dear Editor,

Multimodal rheumatologic complex treatment in patients with spondyloarthritis - a prospective study

2 August 2021
Author(s): Philipp Klemm, Paulina Preusler, Ole Hudowenz, Thomas Asendorf, Ulf Müller-Ladner, Elena Neumann, Uwe Lange, Ingo H. Tarner

The spondyloarthritides (SpA) are a group of related diseases comprising axial SpA (axSpA), namely non-radiographic (nr-axSpA) and radiographic axSpA (r-axSpA), psoriatic arthritis (PsA), arthritis/... more

A metabolomic index based on lipoprotein subfractions and branched chain amino acids is associated with incident hypertension

25 July 2021
Author(s): Jose L. Flores-Guerrero, Margery A. Connelly, Irina Shalaurova, Erwin Garcia, Stephan J.L. Bakker, Robin P.F. Dullaart

Hypertension is the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide, with a sustained increment in mortality over the last 40 years [1]. Over the... more

Detection of subclinical atrial fibrillation after cryptogenic stroke using implantable cardiac monitors

8 July 2021
Author(s): Andrea Ungar, Francesca Pescini, Martina Rafanelli, Maria Vittoria De Angelis, Massimiliano Faustino, Caterina Tomaselli, Alfredo Petrone, Giovanni Forleo, Giovanni Morani, Stefano Forlivesi, Giulio Molon, Alessandro Adami, Massimiliano Maines, Chiara Stegagno, Anna Poggesi, Leonardo Pantoni

Despite extensive vascular and cardiological evaluations, the etiology of approximately one third of ischemic strokes cannot be definitively identified, resulting in their classification as... more

Efficacy of Belimumab for refractory systemic lupus erythematosus (SLE) involving the central nervous system

2 July 2021
Author(s): Hao Cheng, Chen-sheng Zhao, Cheng-lan Yan, Chong Gao, Hong-yan Wen

Neuropsychiatric manifestations of SLE (NPSLE) is associated with increased morbidity and mortality, intractable, complicating, and poor prognosis [1–3]. Although the severity of NPSLE correlates... more

Device-detected atrial high rate episodes and the risk of stroke/thrombo-embolism and atrial fibrillation incidence: a systematic review and meta-analysis

19 June 2021
Author(s): Marco Vitolo, Jacopo F Imberti, Anna Maisano, Alessandro Albini, Niccolò Bonini, Anna Chiara Valenti, Vincenzo L Malavasi, Marco Proietti, Jeff S Healey, Gregory YH Lip, Giuseppe Boriani

Modern Cardiac Implantable Electronic Devices (CIEDs) allow continuous monitoring of cardiac electrical activity through one or more electrodes. Atrial High Rate Episodes (AHRE) are defined as device... more

Future directions in obesity pharmacotherapy

20 May 2021
Author(s): Nick Finer

Treatment of obesity remains problematic. Compared to other chronic diseases such as hypertension and type 2 diabetes, there are few pharmacological options for treating obesity: thus the treatment... more

Non-HACEK gram negative bacilli endocarditis: Analysis of a national prospective cohort.

9 May 2021
Author(s): Jorge Calderón Parra, Daniel De Castro-Campos, Patricia Muñoz García, Maria Olmedo Samperio, Mercedes Marín Arriaza, Aristides De Alarcón, Encarnación Gutierrez-Carretero, Maria Carmen Fariñas Alvarez, Jose María Miró Meda, Miguel Ángel Goneaga Sanchez, Raquel Rodriguez García, Guillermo Ojeda Burgos, Zeltia Valcarce-Gonzalez, Antonio Ramos-Martinez, the Spanish Collaboration on Infectious Endocarditis Group (GAMES) investigators

Infective endocarditis (IE) caused by Gram-negative bacilli (GNB) not included in the HACEK group (Haemophilus, Actinobacillus, Cardiobacterium, Eikenella corrodens, Kingella) is a rare infection... more

Clinical Insights

Predicting adverse outcomes in patients with COVID-19: just an epidemiological debate or a valuable clinical approach?

22 October 2021
Author(s): Xavier Corbella

On February 16, 2020 the executive committee of the European Federation of Internal Medicine (EFIM) met in Malaga, Spain, to prepare for the EFIM annual congress to be held in March 2021. As usual,... more


Personalized and tailored management of obesity at individual target brings success

13 October 2021
Author(s): Gabriele Perriello

Over the last decades, obesity has nearly tripled worldwide [1]. The current spread of obesity across sub-Saharan Africa and southeast Asia will end up with this condition becoming a global epidemic... more

KDIGO guidelines for the management of blood pressure in chronic kidney disease: A sprint to the curve

29 September 2021
Author(s): Nicolás Roberto Robles, Juan Villa, Francesco Fici

The KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease has been recently released [1]. The guidelines suggest (but do not recommend) that adults... more

18F-FDG PET-CT versus contrast enhanced CT for the diagnosis of fever of unknown origin

27 September 2021
Author(s): Nicolò Pipitone, Massimiliano Casali, Carlo Salvarani

Fever of unknown origin (FUO), also known as pyrexia of unknown origin, is commonly defined according to the Petersdorf criteria as fever ≥38.3° (101 Fahrenheit) lasting ≥3 weeks that remains... more

Standardised PaO2/FiO2 ratio in COVID-19: Added value or risky assumptions?

8 September 2021
Author(s): Luciano Gattinoni, Mattia Busana, Luigi Camporota

The coronavirus disease 2019 (COVID-19) causes acute respiratory failure (ARF) altering the pulmonary microvasculature with simultaneous vasoconstriction and thrombosis in ventilated areas,... more

The importance of non-pharmacological treatment in spondyloarthritis

7 September 2021
Author(s): Ana Sofia Alves, Fernando Salvador

Spondyloarthritis (SpA) is a related group of inflammatory joint diseases comprising axial SpA (axSpA), psoriatic arthritis (PsA), arthritis associated with inflammatory bowel disease, reactive... more

New insights in endocarditis caused by Gram negative bacilli not included in the HACEK group

7 September 2021
Author(s): Ricardo Serrano, Jordi Rello

Gram negative bacilli not included in the HACEK group (Haemophilus, Aggregatibacter spp -including A. Actinomycetemcomitans, A. Aprophilus, A. Paraphrophilus, A. Segnis-, Cardiobacterium, Eikenella... more

Long term consequences of COVID-19

1 September 2021
Author(s): Anna Berenguera, Constanza Jacques-Aviñó, Laura Medina-Perucha, Diana Puente

On March 11, 2020, the coronavirus disease-2019 (COVID-19) was declared a pandemic by World Health Organization (WHO). While mainly affecting the respiratory system to the point of causing severe... more

Is coronary microvascular dysfunction a cause or a marker of worse outcomes in MINOCA patients?

7 July 2021
Author(s): Francesco Radico, Sabina Gallina, Marco Zimarino

Myocardial infarction in the absence of obstructive coronary artery disease (MINOCA) is a frequent clinical scenario observed in approximately 5% of all patients with acute myocardial infarction (AMI... more


Corrigendum to: Antipsychotics and severe hyponatremia: A Swedish population-based case-control study. Eur J Intern Med. 2019 Feb;60:71-77.

23 June 2021
Author(s): Henrik Falhammar, Jonatan D. Lindh, Jan Calissendorff, Jakob Skov, David Nathanson, Buster Mannheimer

The authors regret that in preparation of a new article based on the same data as in the previous published article [1], we unfortunately discovered two errors in the dataset. Some cases of... more

Corrigendum to: Tramadol- and codeine-induced severe hyponatremia: A Swedish population-based case-control study. Eur J Intern Med. 2019 Nov;69:20-24.

22 June 2021
Author(s): Henrik Falhammar, Jan Calissendorff, Jakob Skov, David Nathanson, Jonatan D. Lindh, Buster Mannheimer

The authors regret that in preparation of a new article based on the same data as in the previous published article[1], we unfortunately discovered two errors in the dataset. Some cases of... more


One year later: the case of tocilizumab in COVID-19

22 October 2021
Author(s): Corrado CAMPOCHIARO, Alessandro TOMELLERI, Marco MATUCCI-CERINIC, Lorenzo DAGNA

In severe coronavirus disease 2019 (COVID-19) patients, SARS-CoV2 infection induces a systemic immune activation characterized by an afinalistic release of inflammatory cytokines [1, 2]. This... more

New insights in obesity development and possible value of microbiota transplantation

7 July 2021
Author(s): Hermann Toplak, Natascha Troester, Vanessa Stadlbauer

Obesity is possibly the most important non communicable disease of the 21st century. It has emerged from one of the “nutritional disorders” and has been suggested by the European Association for the... more

Ideas and Opinions

Exploring the possible link between myocarditis and mRNA COVID-19 vaccines

27 August 2021
Author(s): Gianfranco Sinagra, Marco Merlo, Aldostefano Porcari

Myocarditis is an inflammatory cardiomyopathy, most frequently caused by viral agents, affecting 10-20 individuals per 100.000 each year in the general population [1]. Myocarditis (sometimes... more

One year on: The impact of COVID-19 on clinical research

24 August 2021
Author(s): Luigi Tavazzi, Aldo P. Maggioni, Claudio Rapezzi, Roberto Ferrari

During COVID-19 epidemic ongoing clinical research slowed down while an unprecedented amount of individual research on the infection broke out disproportionately with results, low respect to the... more

Should the European Union have an office of research integrity?

3 August 2021
Author(s): C Candal-Pedreira, A Ruano-Ravina, M Pérez-Ríos

Scientific misconduct is detrimental to both society and researchers, potentially resulting in a mistrust in science. When the results of a scientific publication are based on erroneous content or... more

Internal Medicine Flashcard

New onset rectal bleeding

24 October 2021
Author(s): Brian M. Fung, Kelly M. Zucker, Joseph David

A 36-year-old male with no significant past medical history presented to the emergency department for new onset hematochezia. Prior to arrival, the patient reported having five episodes of passing... more

Stuck in my head as an old song

22 October 2021
Author(s): Ilaria De Benedetto, Alberto Gaviraghi, Francesco Giuseppe De Rosa

A 61-year-old piano man was admitted to the emergency department for loss of consciousness, aphasia and Glasgow coma scale of 13 points. His past medical history included hypertension, non-insulin-... more

“Comb and Target signs” in abdominal CT in patients with purpura

21 October 2021
Author(s): Hiroshi Hori, Takahiko Fukuchi, Hitoshi Sugawara

A 56-year-old woman complained of nausea, abdominal pain, and bloody diarrhea 10 days prior to the day of consult in our institution. Her abdominal pain worsened and was accompanied by joint pain for... more

COVID-19 vaccination and a severe pain in the neck

17 October 2021
Author(s): Angelos Kyriacou, Stamatina Ioakim, Akheel A. Syed

A 40-year-old woman developed malaise and severe anterior neck pain 12 hours after the second dose of COVID-19 mRNA vaccine (Pfizer/BioNTech). The pain peaked and plateaued at the fourth post-... more

An unusual cause of heart failure

11 September 2021
Author(s): Perryn Ng, Edgar Tay

A 59 year-old lady presents to the hospital with complaints of exertional shortness of breath for the past few months. This was associated with orthopnea and lower limb swelling. On examination, she... more

Subarachnoid hemorrhage as the key to the diagnosis

6 September 2021
Author(s): Miguel Miranda, Vera Montes, Sandra Sousa

A 70-year-old woman was admitted at the emergency department due to abdominal pain progressing over the last six hours. She had been feeling sick for the last month, with nausea and persistent fever... more

The truth comes out of children's mouths

6 September 2021
Author(s): Bénédicte Decoudier, Yohan N'Guyen

A 16 year-old patient of Hawaiian ancestry was admitted for confusion in April 2018. He had no relevant past medical history except he went to the dentist few months ago for patchy darkish pigmented... more

Facial hypertrichosis, hyperpigmentation, and hepatosplenomegaly

6 September 2021
Author(s): Paola E. Pizano, Edwin Uriel Suárez

A 51-year-old woman presented for evaluation of new-onset of facial hypertrichosis, hyperpigmentation and blistering on the back of the hands with sunlight exposure, additionally she referred change... more

Skin lesions, weakness, and axillary adenopathies in a 44-year-old woman

3 September 2021
Author(s): José Antonio Rueda-Camino, Ignacio Robles-Barrena, María Carmen Vegas-Sánchez

A 44-year-old woman was referred to the Internal Medicine clinic with a six months history of generalized, worsening myalgia, Raynaud's phenomenon and muscular weakness. These symptoms were... more

Man with pruritic rash

31 August 2021
Author(s): Eleanor Burton, Susrutha Kotwal

A 41-year-old previously healthy man presented with a 3-day history of fevers, headache, abdominal pain, and pruritic rash. The rash began on his forehead and extended to the rest of his body. He had... more

A febrile patient with an unusual eruption

28 August 2021
Author(s): Hitaishi Mehta, Sheetanshu Kumar, Anuradha Bishnoi

A 45-year-old man presented to dermatology outpatient department with complaints of sudden-onset, painful, clustered, monomorphic, punched-out erosions and ulcers, distributed symmetrically in the... more

Lupus pernio: Skin manifestation of systemic disease

28 August 2021
Author(s): Narat Srivali, Federica De Giacomi

62-year-old woman presented to our institution with the chief complaint of slowly progressive exertional dyspnea over the preceding two years in conjunction with a cough and facial rash. Physical... more

Letter to Editor

Validation of Takayasu arteritis, polyarteritis nodosa and Behcet's disease diagnosis codes in a French hospital database

10 August 2021
Author(s): Camille Mettler, Samir Bouam, Laurent Chouchana, Benjamin Terrier

Dear Editor,

Letter to the Editor

Standardized PaO2/FiO2 ratio in COVID-19: added value or risky assumption. Author's reply

22 October 2021
Author(s): Irene Prediletto, Stefano Nava, Paolo Palange

Dear Editor,

Cardiopulmonary exercise test with stress echocardiography in COVID-19 survivors at 6 months follow-up

10 October 2021
Author(s): Luca Vannini, Alejandro Quijada-Fumero, M Purificación Ramirez Martín, Nuria Castejón Pina, Julio S. Hernandez Afonso

Although many studies suggest different degrees of myocardial and pulmonary injury during the acute infection and early follow-up [1–3],there is disagreement about cardio-pulmonary injury and... more

Smartphone-based ECG devices: Beyond atrial fibrillation screening

5 October 2021
Author(s): Felix K. Wegner, Lars Eckardt

Dear Professor Agnelli,

Is serum hyperosmolality related with myocardial dysfunction in septic shock patients?

4 October 2021
Author(s): Cristina Murcia-Gubianas, Juan Carlos Yébenes, Maria Buxó, Sara Foradada, Elisabeth Pinart

Etiopathogenesis of cardiac dysfunction in septic shock is multifactorial, arising from autonomic dysregulation, increased capillary permeability, metabolic and mitochondrial dysfunction, oxidative... more

Gender gap in authorship: a study of 44,000 articles published in 100 high-impact general medical journals

28 September 2021
Author(s): Paul Sebo, Carole Clair

Dear Editor, the profile of the medical profession has changed dramatically in recent decades, with an increasing proportion of women physicians [1]. However, the gender gap in academic medicine... more

Association of new-onset atrial fibrillation in patients taking high-dose fish oil

27 September 2021
Author(s): Rajkumar Doshi, Monil Majmundar, Ashish Kumar, Krunalkumar Patel, Saraschandra Vallabhajosyula, Ankur Kalra

Atrial fibrillation (AF) is the most common cardiac arrythmia, with an estimate of 37.6 million cases (0.51% of the world population) in 2017. Its prevalence has increased by 33% in the last 20 years... more

Serum IgG4 level predicts COVID-19 related mortality

23 September 2021
Author(s): Emanuel Della-Torre, Marco Lanzillotta, Marta Strollo, Giuseppe Alvise Ramirez, Lorenzo Dagna, Moreno Tresoldi, COVID-BioB study group

Dear Editor,

Beyond atrial fibrillation detection: how digital tools impact the care of patients with atrial fibrillation

13 September 2021
Author(s): Yutao Guo, Gregory Y.H. Lip

The modern treatment approach to AF has evolved with the identification of frequency and duration of AF episodes. Current guidelines recommend the 4S-AF approach to AF characterization and evaluation... more

Vitamin D deficiency and inactivated SARS-CoV-2 vaccines

8 September 2021
Author(s): Chia-Chao Wu, Kuo-Cheng Lu

Vaccines are a critical tool in the battle against COVID-19. An amazing article regarding the effects of 2 inactivated SARS-CoV-2 vaccines in symptomatic COVID-19 patients, and stated that the... more

A simple method to validate medical bed number calculations

7 September 2021
Author(s): Rodney P. Jones

Doctors are often called upon to make input into planning for hospital bed numbers. Unknown to doctors the models behind forecasting bed numbers can be deliberately manipulated. It is often the case... more

Atrial high rate episodes as a marker of atrial cardiomyopathy: In the quest of the Holy Grail

17 August 2021
Author(s): Ioannis Doundoulakis, Dimitris Tsiachris, Konstantinos A Gatzoulis, Christodoulos Stefanadis, Konstantinos Tsioufis

Cardiac Implantable Electronic Devices (CIEDs) with atrial lead implanted allow detection of asymptomatic atrial tachy-arrhythmias defined as Atrial High Rate Episodes (AHRE) which are found in... more

ChAdOx1 nCoV-19 effectiveness during an unprecedented surge in SARS COV-2 infections

15 August 2021
Author(s): Ruma Satwik, Ambarish Satwik, Satendra Katoch, Satish Saluja


Quality of life in patients with antiphospholipid antibodies differs according to antiphospholipid syndrome damage index (DIAPS)

27 July 2021
Author(s): Massimo Radin, Silvia Grazietta Foddai, Irene Cecchi, Dario Roccatello, Savino Sciascia

Antiphospholipid syndrome (APS) is an acquired thrombophilia characterized by the presence of confirmed antiphospholipid antibodies (aPL) positive testing with thrombotic events potentially occurring... more

Do we really know what drives relapse in obesity management?

17 July 2021
Author(s): Catia Martins

I have read with much interest the narrative review by Busetto and colleagues entitled “Mechanisms of weight regain”, recently published in your journal [1]. There is no doubt that relapse in obesity... more

Safety and efficacy of oral anticoagulants in atrial fibrillation and bioprosthetic heart valves

13 July 2021
Author(s): Srikanth Yandrapalli, Rahul Gupta, Aaqib H. Malik

Atrial fibrillation (AF) is commonly encountered in clinical practice by internists and specialists, both in the inpatient and ambulatory settings. AF increases the risk of stroke or systemic... more

Comparison of supervised exercise therapy with or without revascularization for the management of intermittent claudication

9 July 2021
Author(s): Rajkumar Doshi, Priyank Shah, Monil Majmundar, Ashish Kumar, Saraschandra Vallabhajosyula

Peripheral artery disease (PAD) affects about 8.5 million Americans aged ≥ 40 years and is associated with significant morbidity and mortality [1]. In patients with claudication, a supervised... more

Hyperhomocysteinemia in patients with acute porphyrias: a possible effect of ALAS1 modulation by siRNAm therapy and its control by vitamin supplementation

2 July 2021
Author(s): Andrea Ricci, Matteo Marcacci, Chiara Cuoghi, Antonello Pietrangelo, Paolo Ventura

Acute hepatic porphyrias (AHPs) are a group of rare diseases caused by an enzymatic dysfunction in the biosynthesis of heme [1]. AHPs’ clinical landmarks are recurrent crisis of neurovisceral attacks... more

Recognition of sepsis in the pre-hospital environment one year after intensive traineeship

24 June 2021
Author(s): L.I. Veldhuis, M.L. Ridderikhof, P.W.B. Nanayakkara, M.W. Hollmann

The mortality of sepsis patients presented by the Emergency Medical Services (EMS) with unrecognized sepsis is twice as high as in patients with documented sepsis [1]. To improve the (pre)-hospital... more

SHARPEN score accurately predicts in-hospital mortality in infective endocarditis

14 June 2021
Author(s): Sofia Giusti Alves, Fernando Pivatto Júnior, Filippe Barcellos Filippini, Gustavo Paglioli Dannenhauer, Marcelo Haertel Miglioranza

Infective endocarditis (IE) has a significant in-hospital mortality [1]. There is evidence of improved clinical outcomes with protocols based on disease severity [2]. In this context, score-based... more

Original Article

Association between air temperature, air pollution and hospital admissions for pulmonary embolism and venous thrombosis in Italy

23 October 2021
Author(s): Chiara Di Blasi, Matteo Renzi, Paola Michelozzi, Francesca de’ Donato, Matteo Scortichini, Marina Davoli, Francesco Forastiere, Pier Mannuccio Mannucci, Massimo Stafoggia

Cardiovascular diseases (CVD) are the leading cause of death in the world [1], as well as in Europe and Italy [2], accounting for more than 1.8 million deaths (36% of total) every year. It has been... more

Risk factors for community-onset pneumonia caused by drug-resistant pathogens: A prospective cohort study

18 October 2021
Author(s): J. Vasco Barreto, Cláudia Camila Dias, Teresa Cardoso

It is presumed that 70% of Community-Acquired Pneumonias (CAP) are caused by bacteria [1], but, in clinical practice, microbial etiology remains unknown in at least 60% of the cases [2]. One of the... more

Estimated 10-year cardiovascular risk in a large Italian cohort of rheumatoid arthritis patients: Data from the Cardiovascular Obesity and Rheumatic DISease (CORDIS) Study Group

14 October 2021
Author(s): Fabio Cacciapaglia, Francesca Romana Spinelli, Matteo Piga, Gian Luca Erre, Garifallia Sakellariou, Andreina Manfredi, Ombretta Viapiana, Marco Fornaro, Sergio Colella, Alberto Floris, Arduino Aleksander Mangoni, Floriana Castagna, Caterina Vacchi, Giovanni Orsolini, Serena Bugatti, Giacomo Cafaro, Alberto Cauli, Elisa Gremese, Fabiola Atzeni, Elena Bartoloni

Rheumatoid Arthritis (RA) is a chronic, systemic inflammatory disease characterized by a relatively high risk of atherosclerotic cardiovascular (CV) events. Notably, such risk has been reported to be... more

Effectiveness of telemedicine in patients with heart failure according to frailty phenotypes: Insights from the iCOR randomised controlled trial

13 October 2021
Author(s): Sergi Yun, Cristina Enjuanes, Esther Calero-Molina, Encarnación Hidalgo, Núria José, Elena Calvo, José María Verdú-Rotellar, Paloma Garcimartín, David Chivite, Francesc Formiga, Santiago Jiménez-Marrero, Alberto Garay, Lídia Alcoberro, Pedro Moliner, Xavier Corbella, Josep Comín-Colet

Heart failure (HF) is a worldwide global healthcare problem due to its high prevalence, incidence and associated mortality and morbidity [1,2]. Moreover, HF is associated with impaired health-related... more

Extended venous thromboprophylaxis in patients hospitalized for acute ischemic stroke: A systematic review and meta-analysis

11 October 2021
Author(s): Emanuele Valeriani, Nicola Potere, Matteo Candeloro, Silvia Spoto, Ettore Porreca, Anne WS Rutjes, Marcello Di Nisio

Acute ischemic stroke is a major health burden worldwide due to high rates of ensuing hospitalizations, complications, disability, dependency, and death [1]. Venous thromboembolism (VTE), which... more

Clinical outcomes associated with the emergency treatment of hyperkalaemia with intravenous insulin-dextrose

5 October 2021
Author(s): Toby J.L. Humphrey, Glen James, Ian B Wilkinson, Thomas F. Hiemstra

Hyperkalaemia is a common, life-threatening electrolyte abnormality present in up to 10% of acute hospital admissions [1]. In patients receiving treatment with renin-angiotensin-aldosterone system (... more

Response to mepolizumab according to disease manifestations in patients with eosinophilic granulomatosis with polyangiitis

14 September 2021
Author(s): Roberto Ríos-Garcés, Sergio Prieto-González, José Hernández-Rodríguez, Ebymar Arismendi, Isam Alobid, Alessandra E. Penatti, María C. Cid, Georgina Espígol-Frigolé

Eosinophilic granulomatosis with polyangiitis

Sex differences in clinical presentation and risk stratification in the Emergency Department: An observational multicenter cohort study

12 September 2021
Author(s): Bart GJ Candel, Saimi Dap, Wouter Raven, Heleen Lameijer, Menno I Gaakeer, Evert de Jonge, Bas de Groot

Sex differences affect patient outcomes in many diseases, such as Coronavirus Disease 2019 (COVID-19), acute myocardial infarction, acute ischemic stroke and infectious diseases, while outcome... more

Prognostic value of NT-proBNP and CA125 across glomerular filtration rate categories in acute heart failure

7 September 2021
Author(s): Rafael de la Espriella, Antoni Bayés-Genís, Pau Llàcer, Patricia Palau, Gema Miñana, Enrique Santas, Mauricio Pellicer, Miguel González, José Luis Górriz, Vicent Bodi, Juan Sanchis, Julio Núñez

Heart and kidney function are heavily intertwined, and once both organs are affected, the patient's prognosis worsens dramatically [1–3]. Natriuretic peptides (NP) (brain natriuretic peptide [BNP]... more

Predictors of long-term mortality in left-sided infective endocarditis: an historical cohort study in 414 patients

31 August 2021
Author(s): Emanuele Durante-Mangoni, Giuseppe Giuffrè, Maria Paola Ursi, Domenico Iossa, Lorenzo Bertolino, Alessandra Senese, Pia Clara Pafundi, Fabiana D’Amico, Rosina Albisinni, Rosa Zampino

Infective endocarditis (IE) is a life-threatening disease associated, in 2010, with 1.58 millions of disability-adjusted life years lost due to death, concurrent illnesses and functional impairment [... more

Clinical presentation of secondary infectious complications in COVID-19 patients in intensive care unit treated with tocilizumab or standard of care

29 August 2021
Author(s): Lucia Taramasso, Laura Magnasco, Federica Portunato, Federica Briano, Antonio Vena, Daniele R. Giacobbe, Chiara Dentone, Chiara Robba, Lorenzo Ball, Maurizio Loconte, Nicolò Patroniti, Paolo Frisoni, Raffaele D'Angelo, Silvia Dettori, Malgorzata Mikulska, Paolo Pelosi, Matteo Bassetti

Tocilizumab is a recombinant humanized monoclonal antibody developed against soluble and membrane-bound isoforms of the interleukin-6 [IL-6] receptor. It prevents the binding of IL-6 to its receptor... more

The yield of F18 FDG PET-CT for the investigation of fever of unknown origin, compared with diagnostic CT

20 August 2021
Author(s): S. Buchrits, A. Gafter-Gvili, Y. Eynath, H. Bernstine, D. Guz, T. Avni

Fever of unknown origin (FUO) is a challenging diagnostic condition. The differential diagnosis of FUO includes a broad spectrum of highly diverse diseases which are mainly subdivided into four... more

Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987–2016

19 August 2021
Author(s): Kyle Staller, Ola Olén, Jonas Söderling, Bjorn Roelstraete, Hans Törnblom, Hamed Khalili, Mingyang Song, Jonas F Ludvigsson

Irritable bowel syndrome (IBS) affects 11.2% of the global population  [1], with significant impacts on patients’ quality of life despite no increased risk of mortality  [2]. Among this sizeable... more

Oral anticoagulants vs antiplatelets in cryptogenic stroke with potential cardiac emboli: Meta-analysis

18 August 2021
Author(s): Wen-Yi Huang, Bruce Ovbiagele, Meng Lee

Cryptogenic strokes are cerebral infarcts for which no probable underlying pathophysiologic cause is identified after adequate diagnostic evaluation [1]. However, it's been shown that some strokes... more

Dediagnosing – a novel framework for making people less ill

17 August 2021
Author(s): Marianne Lea, Bjørn Morten Hofmann

The vast progress in science and technology has greatly increased the number of diseases. Today, the International Classification of Diseases (ICD-11) consists of approximately 55,000 unique codes... more

Examination of the relationship between emergency department presentations and population mortality: a multicenter analysis of emergency department presentations during the COVID-19 pandemic

15 August 2021
Author(s): Monica Solbiati, Lorenzo Russo, Anna Beverina, Paolo Groff, Andrea Strada, Ludovico Furlan, Nicola Montano, Giorgio Costantino, Giovanni Casazza

The first deaths outside of China due to COVID-19 (coronavirus disease 2019), caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), occurred in February 2020 [1]. Subsequently,... more

Tocilizumab for the treatment of immune-related adverse events: a systematic literature review and a multicentre case series

12 August 2021
Author(s): Corrado Campochiaro, Nicola Farina, Alessandro Tomelleri, Roberto Ferrara, Chiara Lazzari, Giacomo De Luca, Alessandra Bulotta, Diego Signorelli, Anna Palmisano, Davide Vignale, Giovanni Peretto, Simone Sala, Antonio Esposito, Marina Garassino, Vanesa Gregorc, Lorenzo Dagna

Immune checkpoint inhibitors (ICI) have been a major breakthrough in the treatment scenario of patients affected by solid cancers and haematological malignancies. First-line pembrolizumab, a... more

The role of minor salivary glands’ biopsy in the diagnosis of Sjögren's syndrome and other systemic diseases

9 August 2021
Author(s): Ana Isabel Lopes, Raquel Machado-Neves, Mrinalini Honavar, P. Ricardo Pereira

Minor salivary gland biopsy (MSGB) is a minimally invasive, safe and low-cost diagnostic procedure. It is mainly used for the diagnosis of Sjögren's syndrome (SS), by identifying the presence of... more

Impact of implementing a Choosing Wisely educational intervention into clinical practice: The CW-SIMI study (a multicenter-controlled study)

2 August 2021
Author(s): Giorgio Costantino, Ludovico Furlan, Christian Bracco, Maria Domenica Cappellini, Giovanni Casazza, Vanessa Nunziata, Chiara Beatrice Cogliati, Anna Fracanzani, Raffaello Furlan, Giovanni Gambassi, Roberto Manetti, Raffaele Manna, Alfonso Piccoli, Alberto Moggi Pignone, GianMarco Podda, Teresa Salvatore, Stefania Sella, Alessandro Squizzato, Moreno Tresoldi, Francesco Perticone, Antonello Pietrangelo, Gino Roberto Corazza, Nicola Montano

In 2012, the American Board of Internal Medicine launched the Choosing Wisely (CW) campaign [1] with the purpose of reducing inappropriate and harmful procedures in clinical practice. The CW campaign... more

Multidisciplinary team led by internists improves diabetic foot ulceration outcomes a before-after retrospective study

26 July 2021
Author(s): Gida Ayada, Yonatan Edel, Alon Burg, Adi Bachar, Yehiel Hayun, Tzippy Shochat, Jihad Bishara, Dafna Yahav, Alaa Atamna, Avishay Elis

Diabetic foot ulceration (DFU), one of the most serious complications of diabetes mellitus (DM), affects 25% of all patients with diabetes and is associated with high morbidity and mortality [1-5].... more

Identification of chronic thromboembolic pulmonary hypertension on CTPAs performed for diagnosing acute pulmonary embolism depending on level of expertise

20 July 2021
Author(s): Gudula J.A.M. Boon, Pushpa M. Jairam, Gerie M.C. Groot, Cornelis J. van Rooden, Yvonne M. Ende-Verhaar, Ludo F.M. Beenen, Lucia J.M. Kroft, Harm Jan Bogaard, Menno V. Huisman, Petr Symersky, Anton Vonk Noordegraaf, Lilian J. Meijboom, Frederikus A. Klok

Chronic thromboembolic pulmonary hypertension (CTEPH) is the only potentially curable form of pulmonary hypertension, but is currently underrecognized. [1, 2] CTEPH is a rare complication of acute... more

Prognostic interplay of kidney function with sarcopenia, anemia, disability and cognitive impairment. The GLISTEN study

10 July 2021
Author(s): Luca Soraci, Francesco Corica, Andrea Corsonello, Francesca Remelli, Pasquale Abete, Giuseppe Bellelli, Mario Bo, Antonio Cherubini, Mauro Di Bari, Marcello Maggio, Anna Maria Martone, Maria Rosaria Rizzo, Giovanna Maria Manca, Andrea P Rossi, Antonella Zambon, Stefano Volpato, Francesco Landi, GLISTEN Group Investigators

Older patients may often be affected by several chronic conditions, including chronic kidney disease (CKD), anemia, sarcopenia and neurological disorders [1–4], that are known to contribute to... more

Systemic autoimmune disorders associated with thrombotic microangiopathy: A cross-sectional analysis from the French National TMA registry: Systemic autoimmune disease-associated TMA

23 June 2021
Author(s): Nihal Martis, Matthieu Jamme, Corinne Bagnis-Isnard, Claire Pouteil-Noble, Claire Presne, Cécile Vigneau, Steven Grangé, Stéphane Burtey, Jean-Philippe Coindre, Alain Wynckel, Mohamed A Hamidou, Tarik Kanouni, Elie Azoulay, Miguel Hié, Dominique Chauveau, Agnès Veyradier, Eric Rondeau, Paul Coppo, for the French Reference Centre for Thrombotic Microangiopathies

The term thrombotic microangiopathy (TMA) defines a syndrome characterised by the association of a peripheral thrombocytopenia, a mechanical haemolytic anaemia and organ failure [1]. Thrombotic... more

Standardizing PaO2 for PaCO2 in P/F ratio predicts in-hospital mortality in acute respiratory failure due to Covid-19: A pilot prospective study

16 June 2021
Author(s): Irene Prediletto, Letizia D'Antoni, Paolo Carbonara, Federico Daniele, Roberto Dongilli, Roberto Flore, Angela Maria Grazia Pacilli, Lara Pisani, Corina Tomsa, María Laura Vega, Vito Marco Ranieri, Stefano Nava, Paolo Palange

Up to fifteen percent of patients with novel pandemic coronavirus disease (Covid-19) have acute respiratory failure (ARF). Ratio between arterial partial pressure of oxygen (PaO2) and fraction of... more

Prevalence of post-COVID-19 symptoms in hospitalized and non-hospitalized COVID-19 survivors: A systematic review and meta-analysis

15 June 2021
Author(s): César Fernández-de-las-Peñas, Domingo Palacios-Ceña, Víctor Gómez-Mayordomo, Lidiane L Florencio, María L. Cuadrado, Gustavo Plaza-Manzano, Marcos Navarro-Santana

The world is suffering a dramatic situation of catastrophic proportions due to the rapid worldwide spread of the coronavirus disease 2019 (COVID-19) caused by the pathogen acute respiratory syndrome... more

Clinical utility of antigen carbohydrate 125 for planning the optimal length of stay in acute heart failure

12 June 2021
Author(s): Miguel Lorenzo, Patricia Palau, Pau Llàcer, Eloy Domínguez, Bruno Ventura, Gonzalo Núñez, Gema Miñana, Javier Solsona, Enrique Santas, Rafael De La Espriella, Vicent Bodí, Eduardo Núñez, Juan Sanchis, Antoni Bayés-Genís, Julio Núñez

The optimal length of stay (LOS) in patients hospitalized for acute heart failure (AHF) remains uncertain [1]. Classically, more extended stays have been associated with a higher risk of in-hospital... more

Prognostic impact of coronary microvascular dysfunction in patients with myocardial infarction with non-obstructive coronary arteries

3 June 2021
Author(s): Fuad A. Abdu, Lu Liu, Abdul-Quddus Mohammed, Guoqing Yin, Bin Xu, Wen Zhang, Siling Xu, Xian Lv, Rui Fan, Cailin Feng, Tingting Shi, Yunlong Huo, Yawei Xu, Wenliang Che

Myocardial infarction with non-obstructive coronary arteries (MINOCA) at coronary angiography (CAG) (stenosis

Autologous fecal microbiota transplantation can retain the metabolic achievements of dietary interventions

18 April 2021
Author(s): Ehud Rinott, Ilan Youngster, Anat Yaskolka Meir, Gal Tsaban, Alon Kaplan, Hila Zelicha, Elad Rubin, Omry Koren, Iris Shai

We recently reported that autologous fecal microbiota transplantation (aFMT), derived from the time of maximal weight-loss and administrated in the regain-phase, might preserve weight loss and... more

Review Article

The impact of nutrition and lifestyle modification on health

17 October 2021
Author(s): Lèlita Santos

According to the World Health Organization (WHO), Noncommunicable Diseases (NCDs), heart disease, stroke, diabetes, obesity, metabolic syndrome, chronic obstructive pulmonary disease, and some types... more

Electrocardiographic features of patients with COVID-19: One year of unexpected manifestations

14 October 2021
Author(s): Fabio Angeli, Gianpaolo Reboldi, Antonio Spanevello, Roberto De Ponti, Dina Visca, Jacopo Marazzato, Martina Zappa, Monica Trapasso, Sergio Masnaghetti, Leonardo M. Fabbri, Paolo Verdecchia

Coronavirus Disease 2019 (COVID-19) is the clinical manifestation of infection with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) [1 -3]. COVID-19 is frequently characterized by... more

Colchicine-new horizons for an ancient drug

14 October 2021
Author(s): Ami Schattner

Colchicine is a tricyclic alkaloid with anti-inflammatory properties extracted from the herbaceous Colchicum autumnale plant and first isolated and synthesized in the 19th century [1]. It is one of... more

Toxic nephropathy: Adverse renal effects caused by drugs

1 October 2021
Author(s): Robert J. Unwin

This is a brief overview of toxic nephropathy, which is an increasingly recognised problem with the continual introduction of new drugs and novel drug modalities, especially in oncology, and the... more

Should we continue surveillance for hepatocellular carcinoma and gastroesophageal varices in patients with cirrhosis and cured HCV infection?

23 September 2021
Author(s): Cas J. Isfordink, Raoel Maan, Robert A. de Man, Karel J. van Erpecum, Adriaan J. van der Meer


Recent advances in pericarditis

20 September 2021
Author(s): Emanuele Bizzi, Chiara Picchi, Greta Mastrangelo, Massimo Imazio, Antonio Brucato

Pericardial diseases are a heterogeneous group of entities, ranging from acute pericarditis (AP) to asymptomatic pericardial effusions. Diagnosis of AP can be made when two of the following criteria... more

The pivotal link between ACE2 deficiency and SARS-CoV-2 infection: One year later

19 September 2021
Author(s): Fabio Angeli, Martina Zappa, Gianpaolo Reboldi, Monica Trapasso, Claudio Cavallini, Antonio Spanevello, Paolo Verdecchia

The pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) generated much interest on the basic pathogenetic mechanisms through which SARS-CoV-2 damages diverse organ... more

Translational medicine in hereditary hemorrhagic telangiectasia

16 September 2021
Author(s): A. Riera-Mestre, P. Cerdà, A. Iriarte, M. Graupera, F. Viñals

Hereditary hemorrhagic telangiectasia (HHT) or Rendu–Osler–Weber syndrome (ORPHA:774) is a rare autosomal dominant vascular disease characterized by systemic telangiectases and larger vascular... more

Popular procedures without evidence of benefit: A case study of percutaneous coronary intervention for stable coronary artery disease

14 September 2021
Author(s): Vinay Guduguntla, Rita F. Redberg

Coronary artery disease is common, affecting more than an estimated 125 million people worlwide [1,2]. More than half of all patients with coronary artery disease (CAD) have anginal symptoms [3].... more

Surveillance and management of colorectal dysplasia and cancer in inflammatory bowel disease: Current practice and future perspectives

1 September 2021
Author(s): Anouk M. Wijnands, Remi Mahmoud, Maurice W.M.D. Lutgens, Bas Oldenburg

Almost a century ago, Crohn and Rosenberg described the first case of ulcerative colitis (UC) complicated by colorectal carcinoma (CRC). [1] Nowadays, it is widely recognised that patients with... more

State of the art approach to managing angina and ischemia: tailoring treatment to the evidence

18 August 2021
Author(s): Manolis AJ, Boden WE, Collins P, Dechend R, Kallistratos MS, Lopez Sendon J, Poulimenos LE, Ambrosio G, Rosano G

Cardiovascular disease (CVD) is the most common cause of death and disability worldwide [1-5]. Stable angina represents a chronic, often life-long condition involving approximately 2% and 4% of the... more

Physical activity in management of persons with obesity

21 May 2021
Author(s): Jean-Michel Oppert, Alice Bellicha, Cécile Ciangura

Physical inactivity is an important determinant of weight gain and development of obesity. Among multiple determinants of body fat gain over time, special consideration has indeed been given to... more

Obesity and sleep disturbances: The “chicken or the egg” question

14 May 2021
Author(s): Gabriel Dias Rodrigues, Elisa M. Fiorelli, Ludovico Furlan, Nicola Montano, Eleonora Tobaldini

Since 1980 obesity has seen a rapid increase in global prevalence, that has almost doubled in many countries and nowadays affects more than 12% of the general population [1]. Interestingly, the rapid... more

Sweet taste and obesity

13 February 2021
Author(s): Gabriela Ribeiro, Albino J. Oliveira-Maia

Obesity is associated with significant morbidity and mortality, and currently represents a global health challenge[1]. While it is associated with complex pathophysiology, increased availability of... more

Mechanisms of weight regain.

16 January 2021
Author(s): Luca Busetto, Silvia Bettini, Janine Makaronidis, Carl A. Roberts, Jason C.G. Halford, Rachel L. Batterham

Obesity is a chronic progressive disease with a high tendency to recidivism. Weight regain is frequent after any attempts of voluntary weight loss [1]. Weight regain is frequently attributed to the... more


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