September 2025
135 ArticlesNo Section
Publisher's note
Within the publishing industry, article numbering has emerged as an easy and efficient way to cite journal articles. Article numbering has already been successfully rolled out to Elsevier's... more
Differences in indications, contraindications, and prescribing patterns for heart failure between specialties: the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry
Heart failure (HF) is a major public health challenge affecting over 64 million adults worldwide and a leading cause of hospitalization [1]. Despite therapeutic advances, the prognosis remains poor,... more
Renal outcomes following anticoagulation in atrial fibrillation: urgent need for randomized evidence
We read with interest the well-written meta-analysis by Adamou et al. [1], focused on studies of atrial fibrillation (AF) patients, investigating the comparative effect of direct oral anticoagulants... more
Optimising the Caravaggio score: developing a more universally applicable and comprehensive venous thromboembolism risk stratification tool
Dear Editor,
Diagnostic contribution of minor salivary glands biopsy in clinical practice
Dear Editor,
Clinical Insights
New perspectives on heart-brain interactions: Is it time to classify cardio-neurological syndromes?
The interplay between heart and brain is bi-directional, complex and profound. Each system influences the other in health as well as in disease, when dysfunction in one organ has broad and as yet... more
Stroke prevention in atrial fibrillation patients with end-stage renal disease: how far from Ithaca after a long Odyssey?
Atrial fibrillation (AF) and chronic kidney disease (CKD) are closely interlinked clinical entities that frequently coexist [1–3] . CKD predisposes to AF through structural, inflammatory and... more
From vectors to victims: understanding the threat of West Nile virus infection
Growing numbers of West Nile virus infection cases are sparking fears among citizens and health care providers in Europe. In this Clinical Insight, we provide Internal Medicine physicians with a... more
Commentary
Navigating the pitfalls of pulmonary function testing in chronic lung allograft dysfunction and chronic pulmonary graft-versus-host disease
Chronic lung allograft dysfunction (CLAD) and pulmonary chronic graft-versus-host disease (Pc-GVHD) represent the major late non-infectious pulmonary complications following lung and allogeneic... more
Addressing polymorbidity in chronic obstructive pulmonary disease: an opportunity to improve outcomes
Comorbid diseases are a common feature of chronic obstructive pulmonary disease (COPD), with most deaths among COPD patients from diseases other than chronic respiratory disease [1,2]. The importance... more
Molecular echoes of CPAP: Tracking hypoxia-sensitive non-coding RNAs in obstructive sleep apnea
Obstructive sleep apnea (OSA) is a common and increasingly recognized disorder with complex systemic implications [1]. Beyond intermittent hypoxia and sleep fragmentation, OSA has been linked to... more
When the discovery of a biomarker stimulates basic interdisciplinary work on disease’s biology and pathophysiology
The paper by Aimo et al. [1] reported in the current issue of the European Journal of Internal Medicine highlights a significant increase in the gamma-glutamyltransferase enzyme (GGT) in patients... more
Standard acute myocardial infarction without standard modifiable risk factors
The identification of risk factors for cardiovascular diseases (CVD) using longitudinal cohort studies has been a major advance in medicine during the second half of the past century and, stimulating... more
Hijacked medical journals rank first via search engine optimization and threaten academic integrity
The rise of questionable journals poses a significant threat to academic integrity, resulting in substantial waste of institutional and university resources. This commentary analysis focuses on six... more
Artificial intelligence in ECG interpretation: Promise and pitfalls of AI in modern medicine
The integration of artificial intelligence (AI) into cardiovascular diagnostics, particularly through electrocardiogram (ECG) analysis, represents one of the most promising frontiers in contemporary... more
Senolytic drugs to slow down aging: The Fountain of Youth, revisited
Aging leads to progressive organ dysfunction, and many chronic degenerative diseases are characterized by accelerated aging of organs and apparatus. Thus, disentangling the effects of aging and age-... more
Uric acid and heart failure with mildly reduced ejection fraction (HFmrEF): one more step
Uric acid (UA) is the terminal product of purine catabolism and arises from both endogenous nucleic acid turnover and exogenous intake—particularly from diets rich in animal protein and fructose [1... more
Hypochloremia no longer a “Carneades” in heart failure
“Carneades! Who was he?” is the opening phrase of Chapter VIII in *The Betrothed* (*I Promessi Sposi*), the most significant Italian novel of the 19th century, written by Alessandro Manzoni. Whit... more
In the line of fire: Sleep well as the first step of care
Sleep is a fundamental biological process that is essential for human life. A substantial body of research has indicated a correlation between inadequate sleep and adverse health consequences... more
Oral semaglutide in HFpEF: Real-world evidence and causal considerations
Heart failure with preserved ejection fraction (HFpEF) represents a significant and growing public health burden, with obesity and type 2 diabetes (T2D) emerging as major predisposing factors [1].... more
Redrawing the map for corticosteroids in severe community-acquired pneumonia
Current guidelines give a positive recommendation for the use of corticosteroids in severe community-acquired pneumonia (CAP) [1,2]. This is largely based on positive results from one of two recently... more
Modern data on blood pressure distribution in European children and adolescents
Prevalence of hypertension in childhood is around 2–5 % [1,2] and it is progressively rising, particularly among adolescents from low-income countries [3]. Despite the solid evidence that... more
Corrigendum
Corrigendum to “Telemedicine in Internal Medicine: a statement by the European Federation of Internal Medicine” [European Journal of Internal Medicine 112C (2023) 138-139]
The authors regret that the author names were listed incorrectly in the manuscript, resulting in the author forenames and surnames becoming reversed. The correct presentation of the authorship is as... more
Editorial
“Limits to medicine” still needed after 50 years
“The medical establishment has become a major threat to health” [1]. This opening statement and main point of Ivan Illich’s book Limits to medicine (Medical Nemesis) is more urgent than ever – but... more
Internal Medicine Flashcard
Ataxia, dysarthria and brainstem lesions in an elderly patient: a diagnostic challenge
A 75-year-old Hispanic man presented with a 3-year history of frequent falls conditioned by gait instability and generalized weakness. His symptoms progressed with worsening of gait imbalance,... more
A man with fever, retinal artery occlusion, atrioventricular block and bilateral renal masses
A 61-year-old man with a history of recurrent otitis and recent evaluation for submandibular salivary gland enlargement presented with sudden vision loss in the left eye. He also reported fever and... more
Progressive nodules in bilateral lower extremities
A 58-year-old female patient presented with asymptomatic nodules that had been on her lower legs for 10 years. The nodules appeared spontaneously without any discernible cause and progressively... more
Smoking-induced “Scleroderma-like Pattern” and digital clubbing in a young adult
A 24-year-old man with a 10-year history of heavy cigarette smoking (approximately 20 cigarettes per day) was evaluated for recurrent episodes of cold-induced hand erythema and bilateral digital... more
Recurrent bilateral infrapatellar subcutaneous nodules: what is the diagnosis?
A 32-year-old Hispanic man presented with a one-month history of bilateral infrapatellar tender erythematous subcutaneous nodules (Fig. 1, a and b), accompanied by dysesthesias in the same area and... more
Fever and eye swelling in a teenager
A 16-year-old male with a history of atopic dermatitis presented to his primary care clinic after 7 d of nasal discharge and obstruction, followed by fever and periorbital swelling, which resulted in... more
Dropped fingers
A woman in her 60s presented with a one year history of a slowly-growing painful mass at the dorsal right wrist and sudden inability to actively lift her ring and little fingers without any trauma.... more
Constrictive pericarditis and tuberculosis: A second look
A 42-year-old man presented with cough and nocturnal sweats since 3 weeks. He was being treated for pulmonary and lymph node tuberculosis (TB) since 5 months, and had improved both clinically and... more
Progressive skin thickening in a young adult
A 22-year-old man was referred to the dermatology service for the appearance of thickening of the skin, predominantly on the hands, feet and face, accentuation of the folds of the forehead and... more
Atypical and fatal presentation of acute liver failure
A 44-year-old female presented to the emergency department with fever (38 °C) and general malaise three days after an elective hysterectomy for bleeding uterine fibroids. The procedure was... more
Invited Review Article
Lipoprotein (a): A new target for pharmacological research and an option for treatment
Lipoprotein(a) [Lp(a)] is increasingly recognised as a crucial and independent risk factor for atherosclerotic cardiovascular disease (ASCVD), calcific aortic valve stenosis (AVS), and possibly heart... more
Senolytic therapies for cardiovascular aging: tackling fibrosis and metabolic dysfunction
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality worldwide, with its prevalence rising sharply with age [1,2]. Cellular senescence has emerged as a pivotal... more
Letter to the Editor
Aortic valve calcification as a novel risk marker for kidney function deterioration: insights from the MESA study
Dear Editor,
Association of social isolation with excess mortality risk and life expectancy in people with prediabetes and diabetes
Diabetes affects 589 million adults globally and significantly increases mortality risk by 1.6- to 2-fold, with an additional 1.1 billion people estimated to have early-stage glucose metabolism... more
Unaddressed limitations in triglyceride management among CHD patients: A call for methodological rigor
We have carefully reviewed the article by Ilay Shani and Avishay Elis, “The Approach to Triglyceride Levels in Patients with Coronary Heart Disease,” and commend the authors for their comprehensive... more
Potassium instability and prognosis in acute heart failure: Practice-oriented reflections
We read with interest the article, “Association between serum potassium variability during admission for decompensated heart failure and outcomes,” published in the European Journal of Internal... more
Critical considerations on sTREM2 as a biomarker for early MASH in women with severe obesity
We commend Mahmoudian et al. for their insightful study investigating soluble TREM2 (sTREM2) as a noninvasive biomarker for early metabolic dysfunction-associated steatohepatitis (MASH) in women with... more
Phosphatidylethanol and venous thromboembolism risk – clinical implications and future directions
I read with great interest the prospective study by Johansson et al. [1] published in the European Journal of Internal Medicine, which investigates the association between phosphatidylethanol (PEth)... more
Optimizing potassium control in hospitalized heart failure patients: Unanswered questions and future perspectives
We read with great interest the recent article by Suzuki et al., recently published in the European Journal of Internal Medicine [1]. The authors address an important and often overlooked aspect of... more
PFKP, EP300, and VCAN as causal drivers of migraine: Integrating genetics and epigenetics through mendelian randomization
Dear Editor,
Not just the level – the importance of potassium stability in patients with heart failure
We read with great interest the manuscript by Suzuki et al. investigating the prognostic impact of changes of serum potassium levels during index hospitalization in a large cohort of 1280 patients... more
Unmeasured burdens in nonagenarian ICU survivors: A cohort-based perspective
I read with interest the recent study by Weller and colleagues on excess mortality in ICU patients aged 90 years and older. Their use of relative survival provides instructive information about... more
Cardiac outcomes in hypertrophic cardiomyopathy treated with beta-blockers or verapamil
In hypertrophic cardiomyopathy (HCM), beta-blockers (BBs) and non-dihydropyridine calcium channel blockers (particularly verapamil) are both used to manage symptoms such as dyspnea, chest pain, and... more
Effect of resmetirom on lipid profile and adiponectin levels
Resmetirom, a novel liver-targeted selective thyroid hormone receptor-beta (THR-β) agonist, has shown positive effects for the treatment of dyslipidemia and other metabolic disorders, including non-... more
Classification of coronary syndromes: Need for refinement?
In addition to providing a common language, and thus facilitating communication among professionals, medical classifications aim to incorporate clinical and pathophysiological elements that help... more
Doctor on board: Ethical, legal, and practical reflections on responding to in-flight medical emergencies
To the Editor,
DOACs vs. VKAs for renal protection: An established superiority gives rise to a new clinical paradox
I commend Adamou and colleagues for their important meta-analysis, which reinforces the established superiority of direct oral anticoagulants (DOACs) over vitamin K antagonists (VKAs) for preserving... more
In ageing research the slope matters
We appreciate the thoughtful commentaries by Ye & Huang and Incalzi & Pedone regarding our study on relative survival in intensive care unit (ICU) patients aged 90 years and over [1–3].
Drug-induced hyponatremia in clinical care. Authors' reply
We extend our sincere gratitude to Ben Salem et al. for their letter commenting on the review “Drug-induced hyponatremia in clinical care” recently published [1,2].
Mapping the clinical trial landscape of gut microbiota modulation in neurodegenerative diseases
Neurodegenerative diseases, such as Alzheimer's disease (AD), Parkinson's disease (PD), and multiple sclerosis (MS), are increasingly recognized as major contributors to the global burden of disease... more
Association of serum potassium time in target range with all-cause and cardiovascular mortality in HFrEF patients
Dyskalemia is relatively common in heart failure with reduced ejection fraction (HFrEF). Both hypokalemia and hyperkalemia exhibit U-shaped associations with adverse outcomes in HFrEF, including... more
Extended anticoagulation therapy on clinical outcomes in patients with gastrointestinal cancer and isolated distal deep vein thrombosis: Insights from the ONCO DVT Study
The current guidelines have recommended prolonged anticoagulation therapy with direct oral anticoagulants (DOACs) as a potential treatment option for patients with cancer-associated venous... more
Cancer treatment-associated hypomagnesemia: Analysis from a large pharmacovigilance database
Hypomagnesemia is common among patients with cancer, and can lead to increased morbidity and mortality as well as discontinuation of potentially life-saving treatments. Hypomagnesemia may occur due... more
Are ACE2 rs2285666 and TMPRSS2 rs12329760 polymorphisms a risk factor for the development of Post-COVID-19 condition?
Evidence on viral mechanisms of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the agent causing the coronavirus disease, 2019 (COVID-19), suggests the involvement of several receptors... more
Efficacy and safety of beta-blockers in patients with comorbid chronic obstructive pulmonary disease and cardiovascular disease
To the editor: Chronic Obstructive Pulmonary Disease (COPD) and cardiovascular disease (CVD) often co-occur, presenting complex management challenges due to concerns over the effects of beta-blockers... more
Substantial variety in point of care ultrasound training across EFIM
Dear Editor,
Addressing unmet needs in the use of SGLT2 inhibitors in critical and acute care setting
Despite mounting evidence of benefit in acute heart failure (AHF), acute myocardial infarction (AMI), arrhythmias, and even intensive care settings, there remains a significant lack of clear guidance... more
Role of 12-lead electrocardiogram for identifying very low mortality risk patients with non-hypotensive acute pulmonary embolism
Pulmonary embolism (PE) is the third leading cause of cardiovascular mortality and a significant global health issue [1]. The simplified Pulmonary Embolism Severity Index (sPESI) is a practical tool... more
Real-world glucose-lowering strategies for managing glucocorticoid-induced diabetes in non-intensive hospital settings
A prolonged administration of glucocorticoids (GCs) can lead to side effects such as glucocorticoid-induced diabetes (GC-DM), a form of secondary diabetes, namely drug- or chemical-induced diabetes [... more
Gastroenteritis caused by Shiga-toxigenic Escherichia coli. Are antibiotics always prohibited in this disease?
Dear Editor-in-Chief and editorial team,
Validation of different acute kidney injury scores in patients undergoing transcatheter aortic valve implantation
Contrast-associated acute kidney injury (CA-AKI) remains one of the most relevant procedural complications in patients undergoing transcatheter aortic valve implantation (TAVI). Beyond contrast dye... more
Drug-induced hyponatremia in clinical care
In their excellent literature review, Mannheimer B et al. do not include several drugs that may induce hyponatremia [1]. Various dopaminergic agents are associated with hyponatremia.
Unmasking atrial cardiomyopathy in middle-aged patients with AF: A call for early detection
Atrial cardiomyopathy (AtCM) has emerged as a critical clinical entity in recent years, encompassing structural, architectural, electrical, and functional abnormalities in the atria [1]. Atrial... more
Nonarteritic anterior ischemic optic neuropathy and glucagon-like peptide-1 receptor agonists: Evaluating a potential association
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for type 2 diabetes mellitus (T2DM) and obesity due to their efficacy in glycemic control, weight reduction, and... more
The role of the hospitalist in Europe: results by EFIM multimorbidity working group survey
The increasing prevalence of chronic diseases has led to a population with a higher level of care complexity. Multimorbidity (MM) has emerged as the most prevalent patient profile in both outpatient... more
Abrupt fluoroquinolone-associated suicides: a SONAR report from North America, Europe, Australia, and Asia
One billion doses of fluoroquinolone (FQ) antibiotics have been administered since 1987. In 1998, the German Pharmaceutical Regulatory Agency received “a few” suicide reports that occurred shortly... more
Hyponatremia and mortality: Marker of disease or modifiable risk? Rethinking causality in large-scale observational research. Authors’ reply
We would like to thank Xia et al. for their thorough evaluation of our recent work based on the Stockholm Sodium Cohort (SSC) [1,2], in which they raise several concerns, some of which are inherent... more
Genotype-phenotype correlations and resistance to colchicine in a familial Mediterranean fever cohort in southwestern Spain
Familial Mediterranean Fever (FMF) is the most frequent autoinflammatory disease, characterized by recurrent episodes of fever, abdominal pain, arthritis, and rash. It primarily affects people in the... more
Disabling hearing loss in ischemic stroke: Prevalence, predictors, and prognostic implications
Growing evidence suggests that hearing loss may be an overlooked risk factor and consequence of ischemic stroke [1]. Several large-scale cohort analyses indicate that individuals with hearing loss... more
Hyponatremia and mortality: Marker of disease or modifiable risk? Rethinking causality in large-scale observational research
We read with great interest the article by Mannheimer et al. investigating mortality and causes of death in patients hospitalized with hyponatremia using a large propensity-matched cohort from the... more
Prognostic impact of bone scintigraphy in elderly patients with hypertrophic cardiomyopathy
Hypertrophic cardiomyopathy (HCM) is a heterogeneous condition that may result from sarcomeric mutations or infiltrative disorders such as transthyretin amyloid cardiomyopathy (ATTR-CM) [1].... more
Prevalence, awareness, and control of cardiovascular risk factors among specialists in cardiovascular field: A survey
Dear Editor,
Short term variability of peripheral blood eosinophil count in individuals with stable COPD
Chronic obstructive pulmonary disease (COPD) is typically considered a neutrophil-driven inflammatory disease [1], but some individuals, particularly those with frequent exacerbations, show... more
Trends in cardiovascular disease-related mortality among adults with sleep apnea in the United States from 1999-2020
Cardiovascular disease-related mortality in adults with comorbid sleep apnea in the United States from 1999 to 2020.
Cardiovascular safety and efficacy of intensive blood pressure control: how low should we go?
Dear Editor,
Excess risk or misestimated baseline? Reconsidering relative survival in the oldest ICU patients
We commend Weller et al. for their important and timely contribution, which provides a rigorous and impressively sized analysis of 1076 ICU patients aged 90 years and older, using relative survival... more
Original Article
The Implementation of the Acute Basic Palliation Concept in Newly introduced Hospital Departments: An Explorative Observational Study of Non-Specialized Palliative Patients Discharged to Die at Home in Denmark
Palliative Care (PC) is a key component of patient-centred healthcare, focusing on relieving the symptoms, pain, dignity and stress of patients with serious, life-limiting conditions. A widely... more
Sex differences in venous thromboembolism outcomes: findings from the GARFIELD-VTE registry
Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a major cause of morbidity and mortality [1] VTE is linked to several risk factors, including age,... more
Impact of a Checklist-Based Strategy for Cardiac Amyloidosis Screening on Diagnosis Rates in Heart Failure Patients (CHECKAMIC Study)
Amyloidosis is a storage disease caused by the extracellular deposition of fibers derived from structural alterations of unstable proteins, which after folding and aggregation are finally deposited... more
An exploratory model for short-term risk stratification in intermediate-high-risk pulmonary embolism running head: The STAMP score
Patients with acute pulmonary embolism (PE) characterized by hemodynamic stability, evidence of right ventricular (RV) dysfunction (RVD), positive cardiac biomarkers and high simplified pulmonary... more
Effectiveness and safety of rituximab across the four phenotypes of IgG4-related disease: a European multi-center cohort study of 115 patients
IgG4-related disease (IgG4-RD) is a systemic fibroinflammatory condition with marked clinical heterogeneity [1]. Common manifestations include autoimmune pancreatitis and cholangitis, orbital... more
Non cardiovascular comorbidities in Heart Failure. An updated position paper from the Heart Failure Working Group of the Italian Society of Cardiology (SIC)
Heart Failure (HF) affects more than 64 million people worldwide[1]. While the incidence of HF has stabilized, its prevalence is increasing due to the ageing of the population, improvements in the... more
Long term fluid volume fluctuations and mortality in kidney failure patients on long term hemodialysis treatment
The prognosis of patients kidney failure (KF) patients on long term hemodialysis treatment is one of the most severe among chronic diseases, and only modest progress has been made over the last... more
A person-centred clinical approach to the multimorbid patient with COPD
Multimorbidity, the coexistence of multiple non-communicable diseases in an individual, is a growing concern, especially in an aging population [1]. Patients with chronic obstructive pulmonary... more
Bleeding risk on rivaroxaban versus apixaban in older patients with venous thromboembolism: a nationwide observational register-based study
During primary treatment, apixaban was associated with a lower risk of major bleeding than rivaroxaban without a corresponding increase in recurrent PE risk. During secondary treatment, no difference... more
Venous thromboembolism associated with infections: a systematic review and meta-analysis
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), has long been a significant cause of severe disease and death. At the same time, its etiology is... more
A prospective study of the association between phosphatidylethanol concentration and risk of first-ever venous thromboembolism
Venous thromboembolism (VTE) is a common term for deep vein thrombosis (DVT) and pulmonary embolism. The overall incidence rate of VTE in adults is 1–2 per 1000 person-years and has increased... more
Transthyretin serum levels and clinical outcomes in patients with transthyretin amyloid cardiomyopathy
Over the last decade, significant advances have been made regarding the knowledge of the biological bases, diagnosis and treatment of transthyretin amyloid cardiomyopathy (ATTR-CM), which currently... more
Cluster analysis for clinical, radiological, and histopathological profiling in chronic pulmonary graft-versus-host disease
Chronic pulmonary graft-versus-host disease (Pc-GVHD) is a non-infectious complication of allogeneic hematopoietic stem cell transplantation (HSCT), typically presenting >100 days post-... more
sTREM2 evaluation in women with metabolic dysfunction-associated steatotic liver disease: Advancing diagnostic approaches for early MASH
Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as non-alcoholic fatty liver disease (NAFLD) [1], is an emerging public health concern affecting approximately 32.4... more
Whether an optimal strategy exists for VTE prevention in critically ill patients: Insights from guidelines and randomized controlled trials
Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a significant concern in critically ill patients. Effective prevention is vital due to its high... more
Performance of enhanced liver fibrosis test and indirect serum fibrosis markers for exclusion of advanced liver fibrosis in alpha-1 antitrypsin deficiency
Alpha-1 antitrypsin deficiency (AATD) is a hereditary condition caused by mutations in the SERPINA1 gene, encoding alpha-1 antitrypsin (AAT), an important antiprotease in the lungs that is primarily... more
Baseline risk and outcome benefit from intensive blood pressure targeting. A systematic review
The definition of blood pressure (BP) targets in treated hypertensive patients remains controversial. Some Guidelines recommend an ideal systolic BP target of <140 mmHg, with different targets... more
Association between serum potassium variability during hospitalization and clinical outcomes in patients with heart failure
Serum potassium levels are tightly regulated within a narrow physiological range, typically 3.5–5.0 mEq/L [1]. Potassium homeostasis involves maintaining a concentration gradient between... more
Clinical characteristics and outcomes of patients with acute myocardial Infarction without standard modifiable risk factors (SMuRFs)
The etiology as well as the prevalence of acute myocardial infarction (AMI) in patients without history of standard modifiable risk factors (SMuRFs) remains unclear, especially in European... more
Venous thromboembolism associated with weak transient risk factors in young women: risk of late recurrence. An international cohort study
After a first episode of venous thromboembolism (VTE) treated according to the guidelines, the risk of thrombotic recurrence must be assessed in order to guide medical treatment. The clinical risk... more
Deterioration of renal function is delayed in patients with atrial fibrillation treated with direct oral anticoagulants compared to vitamin K antagonists: systematic review and meta-analysis
The use of anticoagulants has been linked to anticoagulant-related nephropathy (ARN), a condition initially reported in patients treated with warfarin [1]. However, cases have also been documented in... more
Prognostic impact of uric acid levels in heart failure with mildly reduced ejection fraction: Insights from a large retrospective registry
Elevated uric acid (UA) levels represent an established risk factor for cardiovascular morbidity and mortality [1–3]. Numerous investigations have demonstrated an association between increased UA and... more
Point of care ultrasound (POCUS) applications in the ambulatory internal medicine setting: A scoping review
Point of care ultrasound (POCUS) is an increasingly recognized tool in internal medicine, with evidence supporting its use largely derived in the inpatient setting. We endeavored to provide an... more
Modulation of hypoxia-sensitive non-coding RNAs following continuous positive airway pressure therapy in obstructive sleep apnea in peripheral blood
Obstructive sleep apnea (OSA) is a chronic clinical condition characterized by recurrent apnea or hypopnea during sleep, leading to intermittent hypoxemia, arousal, and sleep fragmentation. OSA... more
Sex-related differences in the management and outcome of intubated adults with community-acquired pneumonia in Europe: A multicentre study
Sex and gender are increasingly recognized determinants in the epidemiology, clinical presentation, management, response to treatment, and prognosis of chronic and acute diseases [1]. Sex refers to... more
Incidence and prevalence of systemic lupus erythematosus across Italian referral centers and its clinical burden in terms of disease severity, treatment and hospitalization: The ESCULAPIO study
Systemic Lupus Erythematosus (SLE) is a multifaceted systemic autoimmune disorder distinguished by a diverse array of clinical manifestations that can potentially impact any organ or system in the... more
Neurologic and psychiatric disorders following correction of profound hyponatremia - A cohort study
Hyponatremia, defined as a serum sodium concentration <135 mmol/L, is the most common electrolyte imbalance, seen in 15–20 % of all acute hospital admissions [1]. Women, elderly, and individuals... more
Survival effect of early high-flow nasal oxygen after the extubation of patients in the intensive care unit
Spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) protocols for mechanically ventilated patients in the intensive care unit (ICU) have been shown to reduce the duration of... more
Prognostic value of N-terminal prohormone B-type natriuretic peptide modified by renal function in patients with acute heart failure
Heart failure (HF), as the final phase of various cardiovascular disorders, imposes a formidable global healthcare challenge due to its diverse morbidity and high rate of mortality [1]. HF and kidney... more
Determinants of time to first palliative care consultation in hospitalized patients with advanced or terminal illness – A retrospective analysis
The Yentl Syndrome, a term coined by Dr. Bernadine Healy in 1991, refers to the phenomenon that women are less likely to receive accurate diagnosis and treatment because their symptoms do not align... more
Blood pressure values in healthy normal weight children and adolescents in eight European countries: auscultatory and oscillometric measurements
The importance of high blood pressure (BP) as a modifiable risk factor for early disability and death is well established [1]. Although the majority of adverse outcomes occur in adulthood, high BP is... more
Long-term quality of life after sleeve gastrectomy vs Roux-en-Y Gastric Bypass in patients with severe obesity: Results from the SleeveBypass multicentre randomised controlled trial
Obesity is a chronic condition and a worldwide problem that poses health risks, reduces quality of life (QoL), contributes to psychosocial issues and increases public healthcare costs [1]. While,... more
Efficacy and safety of once-daily oral semaglutide in patients with heart failure with preserved ejection fraction, type 2 diabetes and obesity: a real-world study
Heart failure with preserved ejection fraction (HFpEF) is a complex and multifactorial heart disease. It has become the most common type of heart failure (HF), which can be explained in part by its... more
Identification of risk factors for permanent visual loss in patients with giant cell arteritis
Giant cell arteritis (GCA) is the most common systemic vasculitis affecting older people in Western countries, being more prevalent in females [1–4]. Vascular inflammation predominantly affects the... more
Current epidemiology, risk factors and influence on prognosis of multidrug resistance in Klebsiella spp. bloodstream infection. Insights from a prospective cohort
Klebsiella spp. are the third most common cause of bloodstream infections, only after Escherichia coli and Staphylococcus aureus, both in the community and nosocomial infections [1]. Usually arising... more
Systemic markers of inflammation and immune activation in patients with obstructive sleep apnea and paroxysmal atrial fibrillation
Sleep apnea and AF are both associated with adverse cardiovascular outcomes [1,2]. Obstructive sleep apnea (OSA) is more prevalent in patients with atrial fibrillation (AF) than in patients with... more
Hypochloremia in chronic and acute heart failure scenarios: Prevalence and risk factors
Traditionally, sodium and potassium disorders have been considered the most relevant ionic disturbances in heart failure (HF)., [1] However, in recent years, hypochloremia has emerged as a critical... more
Gamma-glutamyltransferase independently predicts mortality and heart failure hospitalization in cardiac transthyretin amyloidosis
Transthyretin cardiac amyloidosis (ATTR-CA) is an infiltrative cardiomyopathy caused by extracellular deposition of misfolded transthyretin (TTR) fibrils within the myocardium, leading to progressive... more
The approach to triglyceride levels in patients with coronary heart disease
Hypercholesterolemia is one of the major modifiable cardiovascular risk factors, while current guidelines mark the low-density lipoprotein cholesterol (LDL-C) levels as the primary target of... more
Long-term secondary prevention with colchicine in patients with CAD: an updated systematic review and meta-analysis
Randomized clinical trials (RCTs) for the prevention of vascular events in patients with coronary artery disease (CAD) over the past decade have clearly demonstrated that colchicine is able to reduce... more
Latent class analysis identifies novel coeliac disease subgroups with distinctive clinical features: a multicentric study
Coeliac disease (CD) is a chronic, lifelong, immune-mediated disorder causing villous atrophy in genetically susceptible individuals upon the ingestion of gluten in the diet [1,2]. It has been... more
The effects of sleep improving interventions in medical hospital wards: the WEsleep study - A randomized clinical trial
Multiple studies indicate that sleep in hospitals is suboptimal.1,2 Disturbed and inadequate sleep occurs in 48 to 77 % of hospitalized patients.3,4 Sleep-disturbing factors in hospitals include... more
Review Article
The role of the senescence-associated secretory phenotype in cardiovascular disease among the elderly
Aging is a major independent risk factor for cardiovascular disease (CVD), the leading cause of death worldwide, particularly in older adults [1,2]. With global population aging, the burden of age-... more
Earlier Prediction of Cardiovascular Risk with Epicardial Fat Assessment
Obesity is no longer considered a cosmetic problem. The World Health Organisation (WHO) and the European Parliament, as well as many international medical and scientific societies, have recognised... more
Fever and inflammation of unknown origin in the 21st century
Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are among the most complex and challenging clinical syndromes in Internal Medicine. Internists, by virtue of their broad... more
Management of asymptomatic patients with abnormal liver function tests
Liver function tests (LFTs) are regularly included in screening blood panels, making them among the most frequently requested laboratory tests in clinical practice [1–3]. Their widespread use and... more
Charting the future of AL amyloidosis: Diagnostic advancements, prognostic insights, and therapeutic challenges
Light-chain (AL) amyloidosis is a form of plasma cell dyscrasias characterized by deposition of misfolded monoclonal immunoglobulin light chain-derived amyloid fibrils, resulting in abnormal... more
Optimizing PCSK9 inhibitor therapy: Understanding and managing suboptimal LDL-C response in clinical practice
Atherosclerotic cardiovascular disease (ASCVD) remains a leading cause of morbidity and mortality globally[1]. Elevated levels of low-density lipoprotein cholesterol (LDL-C) are a well-recognized... more
The climate crisis in clinical practice: Addressing air pollution, heat, and microplastics
The climate crisis has evolved from a future threat into a present-day health emergency. Rising global temperatures, worsening air pollution, and frequent extreme weather events, all driven by... more
Crystal clear – part I: The role of uric acid in cardiorenal disease
Uric acid (UA), the terminal product of purine catabolism in humans, arises from both endogenous nucleic acid turnover and exogenous sources—particularly diets rich in animal protein and fructose.... more
Effect of sodium-glucose cotransporter-2 inhibitors on skeletal muscle
Sodium-Glucose Cotransporter-2 inhibitors (SGLT2i) are increasingly prescribed for diabetic and nondiabetic patients with and without heart failure (HF) or renal insufficiency [1]. SGLT2i reduce... more
Impact of micro- and nanoplastics on gastrointestinal diseases: Recent advances
Plastics are light, durable, low-cost daily necessities used in packaging, medical treatment, electronics, and transportation [1]. Global plastic production has increased from less than two megatons... more
When inflammatory bowel disease meets pregnancy
Inflammatory bowel disease (IBD) is a group of chronic and relapsing inflammatory conditions of the gastrointestinal tract with two major forms: Crohn’s disease (CD) (affecting any segment of the... more
Point of care ultrasound: focus on evidence for a critical appraisal
The term point of care ultrasound (POCUS) refers to a sonographic examination directly performed at the patient’s bedside, ideally by the treating physician, to interpret and integrate images into... more
Artificial intelligence and the electrocardiogram: A modern renaissance
The electrocardiogram (ECG) is a fundamental, non-invasive diagnostic tool in cardiology, widely accessible and crucial for assessing the heart's electrical and structural conditions [1].... more