September 2026
43 ArticlesBeyond the Guidelines
Beyond the guidelines: Preventing heatwave-related admissions and decompensations through thermopharmacological frailty
Heatwaves are becoming more frequent, intense, and prolonged in Europe, creating a predictable clinical stressor for multimorbid patients and increasing pressure on Internal Medicine services.... more
Clinical Insights
Multiparametric and multi-organ ultrasound assessment of adiposity for cardiovascular risk stratification
For decades, clinical practice relied on deceptively simple anthropometric measures—most notably body mass index (BMI), waist circumference, waist-to-hip ratio, and waist-to-height ratio (WHtR)—to... more
Commentary
Inflammatory disbalance marks high-risk multi-morbid patients with COPD
Lung cancer, neuropsychiatric and musculoskeletal comorbidities are major drivers of transitioning from a never to frequent exacerbator phenotype in COPD and cardiovascular comorbidities... more
Broad-minded or highly specialised: Which physician provides the best care for acutely Ill medical patients?
Driven by major advances in molecular genetics, cell biology, physics, and data science, medicine is evolving at an unprecedented pace. Across virtually all areas of internal medicine, therapeutic... more
Early vasopressin in septic shock: Which evidence should we trust?
Choosing the best treatment for septic shock, which remains one of the leading causes of death in the world, is still one of the most difficult challenges facing emergency physicians, despite timely... more
Positive urine cultures before neutropenia: Interpreting the organism through the host
In this issue of the European Journal of Internal Medicine, Tolosa-Ridao and colleagues address a deceptively simple but clinically consequential question: should asymptomatic bacteriuria detected... more
Corrigendum
Corrigendum to “Identifying distinct clinical phenotypes and outcomes in adult-onset IgA vasculitis using unsupervised clustering analysis” [European Journal of Internal Medicine 147 (2026) 106742]
The authors regret the partial omission of Dr Antoine Hankard’s affiliation details. The correct affiliation information is listed above, and subsequent affiliations have been renumbered accordingly... more
Editorial
Would a single centralized ethical review in Europe be feasible for multinational trials in public health emergencies?
In the development of clinical research guidelines and regulations over the past 60 years, those relating to research ethics have deserved special attention. Among these, all those referring to the... more
Ideas and Opinions
Disease clearance in immune-mediated gastrointestinal disorders: A new standard or a semantic trap?
Immune-mediated gastrointestinal disorders, including eosinophilic oesophagitis, coeliac disease, and inflammatory bowel disease, are increasingly managed with therapeutic goals that extend beyond... more
Internal Medicine Flashcard
The “flame sign” in a young painter with acute neurologic deterioration
A 24-year-old man, a painter with two years of occupational exposure to paints and thinners under poorly ventilated conditions (8–10 h daily), presented with a three-month history of headache,... more
Facial swelling with unexpected pelvic hypermetabolism
A 59-year-old man with a history of smoking and adult-onset asthma with recurrent eosinophilia presented with fatigue and weight loss, along with a progressive left facial swelling involving the... more
Invited Review Article
A clinically oriented review of cystatin c in hospitalized adults: when creatinine misleads—A practical guide for internists and its role in heart failure risk stratification
Accurate assessment of kidney function is essential in hospitalized patients. However, serum creatinine does not always reflect true kidney function because it can be influenced by factors such as... more
Physical activity in older patients: Push your performance capacity to prevent and limit frailty!
Optimal aging is characterized by older adults maintaining good functional reserves, complete independence, and physiological resilience to stress. Conversely, some elderly individuals exhibit... more
Letter to the Editor
Dismantling the routine use of prophylactic volume expansion in contrast-associated acute kidney injury. Author's reply.
Dear Editor,
Lower incidence of venous thromboembolism in hospital-at-home patients: Do unequal detection opportunities and between-group non-equivalence affect the interpretation of the findings? Author's Reply
Dear Editor,
Early brain biopsy in neurological diseases of unknown etiology: Moving the diagnostic clock forward, not skipping the work-up
Dear editor,
Have mediators and at-risk time shaped the Lipoprotein(a)-dementia null? Author’s reply
Dear Editor,
“Non-reproducible mortality data in a hyponatremia–TBI meta-analysis”. Author's Reply
We would like to thank Huang et al [1] for their careful review of our systematic review and meta-analysis [2] and for raising concerns regarding the presentation and reproducibility of the mortality... more
Non-reproducible mortality data in a hyponatremia–TBI meta-analysis
Dear Editor,
Have mediators and at-risk time shaped the Lipoprotein(a)-dementia null?
Rossi and colleagues report no association between elevated lipoprotein(a) [Lp(a)] and incident dementia in a large propensity-score-matched TriNetX cohort [1]. The study is valuable because Lp(a) is... more
Lower incidence of venous thromboembolism in hospital-at-home patients: Do unequal detection opportunities and between-group non-equivalence affect the interpretation of the findings?
We read with great interest the prospective cohort study by Dos Santos et al. published in the European Journal of Internal Medicine [1]. This study focused on VTE risk assessment in patients with... more
Hydroxychloroquine for recurrent pericarditis
We thank Zhang and Xu [1,2] for their interest in our work [3]. Regarding the observations of Zhang [1], we agree that observational studies can suggest that a treatment may be beneficial but cannot... more
Dismantling the routine use of prophylactic volume expansion in contrast-associated acute kidney injury
We read with profound clinical interest the recent prospective analysis by Ragnarsdottir et al., [1] in the European Journal of Internal Medicine regarding the evolving risk factors for hospital- and... more
Evaluating the use of hydroxychloroquine in recurrent pericarditis: Methodological concerns and public health implications
We were highly interested in the article by Trotta et al. regarding the use of hydroxychloroquine (HCQ) for treating recurrent pericarditis (RP) [1]. The authors reported that HCQ significantly... more
Hydroxychloroquine for recurrent pericarditis: A necessary balance between therapeutic benefit and potential adverse risk
Dear Editor,
Cumulative nocturnal hypoxemia, but not apnea-hypopnea index, is independently associated with vertebral fracture burden in obstructive sleep apnea
Obstructive sleep apnea (OSA) is a highly prevalent disorder characterized by recurrent upper airway collapse, intermittent hypoxemia, and sleep fragmentation [1]. Beyond its established... more
Timing of brain biopsy in cryptogenic neurological diseases: beyond diagnostic yield
We read with great interest the study by Aboubakr et al [1] investigating the impact of brain biopsy timing on diagnostic yield and clinical outcomes in patients with neurological diseases of unknown... more
Uric Acid, Homocysteine, and comorbidities in sarcoidosis
Sarcoidosis (SA) is a multisystem granulomatous disease with a highly variable clinical course. To-date, there are no validated circulating biomarkers capable of reliably predicting long-term outcome... more
Universities and healthcare as privileged war targets. An urgent call for an international academic and institutional response to the attack on the Lebanese University and the health system
Attacks on universities during armed conflicts represent a profound threat to individual lives but also to the institutions that sustain knowledge, scientific progress, and social stability [1]. In... more
Pathophysiological and prognostic implications of psychological distress in non-obstructive coronary syndromes: When the mind breaks the heart
Cardiovascular disease remains the leading cause of death worldwide [1], yet the field’s diagnostic and treatment strategies continue to target obstructive epicardial coronary artery disease... more
Methodological considerations for translating the STAMP score in intermediate-high-risk pulmonary embolism
We read with interest the study by Zuin and colleagues reporting the STAMP score for predicting 48-hour clinical deterioration in hemodynamically stable patients with intermediate-high-risk acute... more
Tachycardia-induced electrocardiogram false positive diagnosis of left ventricular hypertrophy
Dear Editor:
Original Article
Neutrophil-to-lymphocyte ratio: A disease severity biomarker in stable chronic obstructive pulmonary disease?
The neutrophil-to-lymphocyte ratio (NLR) is a biomarker of systemic inflammation that has been investigated in different chronic diseases. However, its role as biomarker of severity in patients with... more
Early vasopressin administration in septic shock: A systematic review, meta-analysis, and multicenter retrospective observational study
To determine the optimal timing for initiating vasopressin in septic shock.
Relationship between T90 and systemic hypertension in patients with obstructive sleep apnea: Data from the European sleep apnea database
Obstructive sleep apnoea (OSA) is a sleep disorder characterized by a partial or complete cessation of upper airway during sleep. It is estimated that approximately one billion individuals between... more
Specialist or generalist management of emergency medical admissions - immediate and long-term outcomes
To study whether the admission of unselected emergency medical patients, under either a Consultant with General Medicine (GIM) or Specialist accreditation, influenced either short or longer-term all-... more
Hospital-to-community care pathways for patients with heart failure, an inter-society consensus document
Heart failure (HF), defined as the inability of the heart to meet the metabolic requirements of peripheral tissues, or to do so only at the expense of elevated ventricular filling pressures,... more
Effects of urine uromodulin levels on the association between sodium intake and ambulatory blood pressure in individuals with chronic kidney disease
In CKD, hypertension is often accompanied by sodium sensitivity. Uromodulin promotes sodium sensitivity by activating tubular sodium transporters (NKCC2, NCC). In the general population, individuals... more
Prognostic impact of percutaneous coronary intervention in acute coronary syndrome vs. elective settings in heart transplant recipients
Cardiac allograft vasculopathy (CAV) affects >50% of patients following heart transplantation (HTX) within ten years and is one of the main reasons for late graft failure. The study aimed to... more
Fatty acid binding protein 4, resistin, diastolic dysfunction, and cardiovascular risk in patients with rheumatoid arthritis
Rheumatoid arthritis is a chronic autoimmune disease associated with CV system involvement [1]. Cardiovascular mortality and incidence of major adverse cardiovascular events (MACE) are increased by... more
Prevalence of asymptomatic bacteriuria in high-risk hematological patients and its association with bacteremia: A prospective observational study on the need for antibiotic treatment
Antibiotic treatment for asymptomatic bacteriuria (AB) is not recommended in the general population, and its significance in oncohematological patients remains unclear.
Review Article
Device-based therapies for cardiorenal syndrome: A comprehensive, mechanism-driven framework for next-generation decongestion
Cardiorenal dysfunction is a major contributor to morbidity, rehospitalization, and mortality in advanced heart failure (HF) and cardiogenic shock. Traditional decongestive approaches—loop diuretics... more
Organization and delivery of home-based care for chronic obstructive pulmonary disease patients receiving long-term home non-invasive ventilation: a systematic review
The delivery of LTHNIV remains heterogeneous, even within countries. This variability in care organization and reporting mandates establishing harmonized, patient-centred pathways that integrate... more