November 2026
196 ArticlesClinical Insights
Biostatistics with small effect size in the computerized age: the illusion of certainty?
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Commentary
Metabolic dysfunction associated chronic liver disease in Europe: much has to be done before we are really united
Metabolic dysfunction associated liver disease (MASLD) is the most common liver disease worldwide, and a leading cause of liver-related morbidity and mortality. Current prevalence is approximately 30... more
The Underused Metric: Non-HDL cholesterol in cardiometabolic care
In this issue of the European Journal of Internal Medicine, Carlos Baeza-Delgado et al. present a compelling real-world analysis utilizing a large electronic health record database [1]. The study... more
Access, equity, and implementation: The unfinished agenda of cardiac rehabilitation
Cardiac rehabilitation (CR) is a comprehensive, multidisciplinary intervention that improves survival, reduces hospitalizations, enhances functional capacity, and increases health-related quality of... more
Beyond ejection fraction: Right ventricular dysfunction and cardio-hepatic involvement in heart failure with mildly reduced ejection fraction
Left ventricular ejection fraction (LVEF) remains the principal parameter through which heart failure (HF) is classified, investigated, and treated. Yet, in heart failure with mildly reduced ejection... more
Hyponatremia among frail and elderly: still poorly managed, but at what cost?
Hyponatremia affects between 10% and 30% of hospitalized patients, making it by far the most common electrolyte disorder in clinical practice. Symptoms vary but often include confusion, nausea, and... more
Subclinical hypotension in acute decompensated heart failure: a warning signal, not a therapeutic barrier
Acute decompensated heart failure (ADHF) is characterized by marked clinical and hemodynamic heterogeneity, making the interpretation of blood pressure (BP) particularly challenging[1]. Low BP is... more
Fluid balance in critical illness: From arbitrary thresholds to outcome-linked stewardship
Fluid therapy remains one of the most common, powerful, and potentially hazardous interventions in intensive care. For decades, clinicians have understood that both under-resuscitation and over-... more
Editorial
Promoting equity in academic medicine: a call for coordinated action across journals, healthcare organisations and professional societies
The recent paper by Hamzaoui et al. in the European Journal of Internal Medicine makes an important, timely case for targeted interventions to promote women’s careers in life sciences and medicine [1... more
P‑values aren’t the problem - 0.05 and our interpretation are. The 7 deadly sins that distort health research
Randomness describes non-deterministic events and is measured through probability. A Galton board illustrates this. Each pin represents a 50/50 chance of moving left or right, like repeated coin... more
When the prescribing of medications triggers a diagnostic cascade
Prescribing cascades are traditionally defined as a sequence in which an adverse effect of a medication is misinterpreted as a new medical condition, leading to the prescription of additional... more
Ideas and Opinions
Targeting the kidney-gut axis in chronic kidney disease: From biological insight to therapeutic opportunity
Chronic kidney disease (CKD) is increasingly recognized as a systemic disorder characterized by complex metabolic, inflammatory, and cardiovascular interactions [1]. Beyond the progressive decline in... more
Internal Medicine Flashcard
Blurred vision and acute confusion in a young woman: what is the diagnosis?
A previously healthy woman in her late 30 s presented with blurred vision in the right eye and an acute confusional state. Five months earlier she had experienced a self-limited right sixth-nerve... more
Blood-filled colonic blebs in a patient with abdominal pain and hematochezia
An elderly anuric man receiving maintenance haemodialysis was admitted with a 10-day history of abdominal pain and distension, followed by recurrent haematochezia. His haemoglobin concentration... more
Left ventricle echocardiographic “spade-like” configuration
Editor - in - Chief
Reverse Fitz-Hugh–Curtis syndrome
A 40-year-old woman presented with left lower abdominal pain that had begun 2 days earlier and subsequently shifted to the left hypochondrium. The pain was persistent, worsened with deep inspiration... more
Disseminating subcutaneous nodules without systemic symptoms in an elderly man
A man in his 90 s presented with a 1-month history of more than ten 1–2-cm, elastic-hard, mildly bluish subcutaneous nodules distributed across the chest, abdomen, and thighs, without associated pain... more
When blood doesn’t flow: a 21-year-old man with recurrent arthralgia and muscle soreness
A 21-year-old patient presented with intermittent episodes of myalgia, arthralgia, and bone pain in the extremities and spine, triggered by physical exertion and dating back 9 years. The patient had... more
A flower blooming in the Lung
A 63-year-old Italian woman was referred to our outpatient pulmonology clinic with a three-month history of productive cough associated with yellowish, flake-like sputum and profound asthenia. She... more
Opportunistic infections in a patient with T-cell lymphocytopenia of unclear cause
A 57-year-old Moroccan woman with no relevant personal and family history presented with a 2 month history of progressive loss of vision of the left eye. Vital signs were normal. Ophthalmologic... more
Invited Review Article
Multiorgan protective therapy for CKM syndrome: the role of GLP-1-based therapies and SGLT2 inhibitors
The definition, epidemiology and pathophysiology of the cardiovascular-kidney-metabolic (CKM) syndrome are detailed in the preceding articles in this collection. For many years risk-modifying therapy... more
Artificial intelligence in medicine: An ethical and legal review
The integration of artificial intelligence (AI) and machine learning (ML) into medical practice marks a transformative shift within healthcare delivery, diagnostics, and treatment paradigms. Although... more
Artificial intelligence in diagnostics and medical decision making
Artificial intelligence (AI) applications bear a great promise for healthcare. If successfully implemented, AI could reduce the workload for healthcare professionals and enhance the quality of work... more
Letter to the Editor
Accounting for time in infections and outcomes of ANCA-associated vasculitis
We read with interest the study by Morin et al. describing infectious complications and long-term outcomes in ANCA-associated vasculitis (AAV) [1]. Their findings underscore the value of continued... more
Hypertonic saline in acute heart failure: Caution in interpreting real-world evidence
We read with great interest the study by Ropero-Luis et al. [1].published in the European Journal of Internal Medicine, on the real-world use of hypertonic saline solution combined with high-dose... more
Urinary calcium excretion as a potential biomarker of diuretic resistance in heart failure
Loop diuretic resistance (DR) is a major challenge in acute heart failure (HF) hindering adequate decongestion. DR is partly driven by distal convoluted tubule (DCT) remodelling and enhanced sodium... more
Thromboembolic risk associated with desmopressin use in patients with central diabetes insipidus
Central diabetes insipidus (DI), now formally termed arginine vasopressin deficiency (AVP-D) [1], is a rare endocrine disorder characterized by insufficient secretion of arginine vasopressin (AVP),... more
Defining sustained treatment benefit in low-renin hypertension with adrenal incidentalomas
Uslar and colleagues show how an incidental adrenal adenoma can prompt a useful reassessment of hypertension [1]. Their prospective cohort identified suppressed renin in 138 of 290 patients, and... more
Contextualizing the economic and survival benefits of daily home haemodialysis: A critical appraisal. Author's reply
We read with great interest the Letter to the Editor by Miduturu Sukumar and Kabilan Annadurai [1], submitted to our article recently published in the European Journal of Internal Medicine (EJIM) [2... more
Contextualizing the economic and survival benefits of daily home haemodialysis: A critical appraisal
We read with great interest the recent article by Rostoker et al. [1] evaluating the cost-effectiveness of daily home haemodialysis compared with conventional in-centre haemodialysis using real-world... more
The changing long-term clinical course of deep vein thrombosis in the direct oral anticoagulant era
Dear Editor,
Residual vulnerability after decompensated heart failure: what remains unmet after the 2026 ESC guidelines for the management of heart failure?
The 2026 European Society of Cardiology (ESC) Guidelinеs for the management of heart failure (HF) introduce several important changes [1]. First, they return to two types based on left ventricular... more
Depressive symptoms in older patients with atrial fibrillation: From clinical phenotype to targeted intervention
Fumagalli et al. [1] examined depressive symptoms in older patients undergoing electrical cardioversion for persistent atrial fibrillation (AF) and identified associations with clinical complexity... more
Beyond the ApoB/ApoA1 ratio: divergent apolipoprotein trajectories after sleeve gastrectomy
To the Editor,
Central pulmonary emboli: from prognostic association to clinical utility
Vedovati and colleagues provide a timely analysis of central embolic localization in acute pulmonary embolism (PE) using the large, multicentre Contemporary Management of Acute Pulmonary Embolism (... more
Abatacept in RA-ILD: further clarification of the potential pulmonary window of opportunity
Dear Editor,
Polycythemia after SGLT2 inhibition: A post-treatment state, not a baseline subgroup
We read with interest the pooled analysis by Marques and colleagues examining polycythemia and cardiovascular outcomes across five randomized trials of sodium-glucose cotransporter 2 inhibitors (... more
Study selection and translational NNTs in severe asthma and COPD: methodological considerations
Dear Editor,
Mediterranean diet adherence and sleep quality in polyendocrine metabolic ovarian syndrome: association or independent predictor? Author's reply
We would like to thank Hussain for taking the time to reflect on our paper [1,2]. His comment raised some points of great interest.
Diuretic response after hypertonic saline and high-dose furosemide: beyond urine output
To the Editor,
Interpreting the neutrophil-to-lymphocyte ratio in stable chronic obstructive pulmonary disease: severity, case mix, and clinical utility. Author's reply
We thank Zhang and colleagues for their thoughtful comments on our study and for the opportunity to further clarify the interpretation and clinical implications of our findings [1].
Pulmonary artery diameter and sudden death in PAH. Is 40 mm a true threshold or a warning value? Author’s reply
Dear Editor,
Obesity care in internal medicine: A gap between recognition and treatment competence
Dear Editor,
Infarction or injury? Diagnostic labeling and coronary angiography after troponin elevation
Dear Editor,
Early C-reactive protein change and mortality in emergency admissions: a trajectory, not a target
Internists repeat C-reactive protein a few days after an emergency admission almost as a reflex, and many of us act on the second value: a fall reassures, a rise prompts a rethink. Yet the evidence... more
LDL cholesterol lowering before a first cardiovascular event: interpreting relative efficacy through absolute risk
Low-density lipoprotein cholesterol (LDL-C) lowering before a first cardiovascular event is often discussed as if “primary prevention” were a single clinical setting. It is not. The term includes... more
Orthostatic hypotension in heart failure: Prevalence as a first step for future research
We were pleased to read the commentary by Shen et al. [1] dwelling upon our work that investigated the prevalence of orthostatic hypotension (OH) in patients with heart failure (HF) [2]. Their letter... more
Conflicting health information and skepticism toward clinical trials among U.S. adults
Dear Editor,
The sepsis paradox in 2026: defining dysregulation, treating the syndrome
Dear Editor,
Limited incremental value of metabolic and inflammatory profiling for arterial stiffness beyond anthropometry: data from the Brisighella Heart Study
Carotid-femoral pulse wave velocity (PWV) is the reference non-invasive measure of aortic stiffness and provides prognostic information beyond conventional cardiovascular risk factors [1,2]. Obesity... more
Quality Matters after acute myocardial infarction: making LDL-C risk visible, actionable, and accountable
We thank Wang and Ge for their comments [1] and interest in our multicentre Quality Matters audit [2]. Their letter usefully extends the discussion from the description of low-density lipoprotein... more
Obstructive sleep apnea as an important modifier of cardiovascular-kidney-liver-metabolic syndrome (CKLMS)
obstructive sleep apnea (OSA) is increasingly recognized as a determinant of cardiometabolic health, and intersects with hypertension, metabolic dysfunction, and cardiorenal disease [1]. Its... more
Fast-tracking internal medicine: An American debate with European implications
A recent New England Journal of Medicine Clinical Decisions article asked whether selected internal medicine residents in the United States should be allowed to enter subspecialty fellowship after 2... more
Interpreting diagnosis-specific hospitalisation after atrial fibrillation screening: Diagnostic attribution and time origin
We read with interest the study by Kongebro and colleagues examining long-term healthcare utilisation after atrial fibrillation (AF) screening in the LOOP study [1]. The study provides valuable... more
Interpreting the role of biological sex in adults with candidemia: beyond mortality prediction
Dear Editor,
Timely allopurinol in asymptomatic hyperuricemia: modelling a hypothesis worth prospective investigation. Authors’ reply
We thank Liu and Jin for their thoughtful comments on our study [1,2]. We agree that the modelled cardiovascular and renal outcomes should be interpreted cautiously and conditionally on the... more
Unmasking the hidden burden of stroke-heart syndrome through phenotype-informed risk stratification
I read with great interest the article by Rigutini and colleagues regarding all-cause mortality and early cardiovascular complications in relation to lesion location and stroke subtype in the Perugia... more
Preclinical coronary artery disease: From early detection to cardiovascular prevention
Dear Editor,
From ECOG performance status to bedside anticoagulation decisions in cancer-associated thrombosis
We read with great interest the multicenter cohort study by Talerico et al. examining the association between Eastern Cooperative Oncology Group performance status and clinical outcomes in patients... more
Association between air pollution and preeclampsia: a nationwide study from 2018 to 2023
Preeclampsia (PE) represents a major cause of maternal morbidity and mortality worldwide, and a risk factor for future maternal cardiovascular disease [1]. Therefore, there is a crucial need to... more
Andes hantavirus in children: extending clinical recognition across age groups
To the Editor,
Aligning exposure and outcome clocks in fluid-balance research
Dear Editor,
Beyond TSH and FT4: reconsidering thyroid hormone dynamics in metabolic dysfunction-associated steatotic liver disease in type 2 diabetes mellitus
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide and is particularly prevalent among patients with type 2 diabetes mellitus (T2DM) [... more
Sex differences in candida bloodstream infection: Beyond 30-day mortality
I have read with great interest the recent multicentre study by Bartalucci et al. investigating sex-based differences and clinical outcomes among older adults with Candida bloodstream infection (C-... more
Deprescribing after hypotensive syncope: Recurrence burden and ambulatory blood pressure targets
The multicentre, prospective study by Russo et al. [1] evaluated a deprescribing strategy supported by ambulatory blood pressure monitoring in 92 hypertensive patients with severe hypotensive syncope... more
Urinary albumin-to-creatinine ratio in heart failure: Methodological and clinical considerations
We read with great interest the study by Rubio-Gracia J et al., which evaluated the prognostic significance of the urinary albumin-to-creatinine ratio (UACR) in the RICA-2 heart failure (HF) registry... more
Alcohol withdrawal syndrome severity as a care pathway marker, not a prognostic determinant: refining sex-specific interpretations in Alcohol use disorder
Dear Editor,
Prurigo nodularis: time to look beyond the skin—towards cardiovascular and metabolic comorbidity
Prurigo nodularis (PN) is increasingly recognised as a systemic disease marker rather than an isolated dermatological disorder. Although the dominant clinical manifestation is chronic, often severe... more
Early allopurinol in asymptomatic hyperuricemia: caution in interpreting modelled cardiorenal benefits
We read the article by Inotai et al. with interest [1]. Whether allopurinol should be started before the first gout flare is a practical question, especially in people already at high cardiovascular... more
Malnutrition predicts adverse clinical outcomes in older patients hospitalized in internal medicine wards
Dear Editor, malnutrition is a frequent but often overlooked condition among hospitalized older adults that substantially affects their prognosis [1,2]. Patients admitted to internal medicine wards... more
Can device-derived digital biomarkers detect physiological response to SGLT2 inhibition in heart failure?
Heart failure (HF) remains a leading cause of morbidity and mortality despite substantial advances in guideline-directed medical therapy [1]. Alongside therapeutic developments, cardiac implantable... more
Orthostatic hypotension in heart failure: Moving from prevalence to phenotype
To the Editor Coscetta and colleagues provide the first systematic estimate of orthostatic hypotension (OH) in patients with heart failure (HF), pooling nine studies (10 cohorts; 2036 patients) and... more
Protein supplementation and diaphragmatic function in hospitalized older adults
Acute hospitalization accelerates muscle loss in older adults through inflammation, immobility, inadequate nutritional intake, and anabolic resistance. Respiratory muscles may also be affected,... more
A tale of two trials: A father-daughter perspective on the bureaucracy of clinical trials in Europe
To the editor,
Should LDL cholesterol targets be individualized according to bleeding risk?
The recently published Ez-PAVE trial has further consolidated one of the fundamental principles of cardiovascular prevention by demonstrating that an intensive low-density lipoprotein cholesterol (... more
Pulmonary artery diameter and sudden death in PAH: Is 40 mm a true threshold or a warning value?
We read with great interest the study by Dardi and colleagues investigating the haemodynamic determinants and prognostic implications of pulmonary artery dilation in pulmonary arterial hypertension (... more
Comparable 1-year effectiveness of tezepelumab and dupilumab after anti–IL-5/IL-5Rα biologic failure in severe asthma
Since 2003, multiple biologics targeting specific inflammatory pathways have been developed for severe asthma. Despite guideline-recommended selection based on clinical characteristics and biomarkers... more
Serum uric acid trajectories in women: Why elevated levels in younger women warrant attention
Serum uric acid (SUA) is usually interpreted as a single measurement against a fixed threshold. In women, however, this static approach may be particularly misleading. SUA follows a dynamic course... more
Hemodynamic renal adaptation, cardiorenal pharmacotherapy, and the case for structured monitoring in HFrEF
We read with great interest the reply by Russo et al. [1], in which the authors addressed comments on their review of renal protection strategies in heart failure with reduced ejection fraction (... more
Mediterranean diet adherence and sleep quality in polyendocrine metabolic ovarian syndrome: Association or independent predictor?
Dear Editor,
Clarifying the lipid signal: non-HDL cholesterol, remnant cholesterol and metabolic risk in primary care
I read with great interest the study by Baeza-Delgado et al. [1], which assessed the prevalence of elevated non-high-density lipoprotein cholesterol (non-HDL-C) in 820,318 individuals not receiving... more
Candida bloodstream infection in older adults: sex as a pathway marker, not a mortality shortcut
We read with great interest the multicentre analysis by Bartalucci and colleagues, who evaluated sex-based differences and 30-day mortality in 1132 adults aged 65 years or older with Candida... more
Abatacept in RA-ILD: defining rather than assuming a pulmonary window of opportunity
We read with great interest the multicentre study by Serrano-Combarro and colleagues evaluating abatacept in rheumatoid arthritis-associated interstitial lung disease (RA-ILD). The authors should be... more
Factor XIa inhibitors after acute non-cardioembolic ischemic stroke or high-risk TIA
Dear Editor,
Retatrutide and the urinary tract infection signal: Is the answer hidden in timing?
Dear editor,
Persistent hyponatremia at discharge: Undertreatment or unresolved diagnosis?
Dear Editor,
Beyond fixed BMI cutoffs after paroxysmal atrial fibrillation ablation
Dear Editor,
The missing piece in severe acquired brain injury care: Integrating neurophysiological screening for critical illness polyneuropathy and myopathy. Author’s reply
We thank Messina for his insightful comments on our recent article describing a novel Neuro-ICU-Neurorehabilitation Unit (INRU) co-management model for patients with severe acquired brain injury (... more
The denominator matters: Interpreting urinary albumin-to-creatinine ratio in older patients with heart failure
We read with great interest the study by Rubio-Gracia and colleagues examining the clinical and prognostic significance of the urinary albumin-to-creatinine ratio (UACR) in patients with heart... more
The challenge of innovation in lupus between abstraction and reality
“He that will not apply new remedies, must expect new evils.”Francis Bacon, Essays, “Of Innovations”, 1625.
In-flight human physiology at high-altitudes: not everyone should fly
Dear Editor,
Cultural congruence in mindfulness-based interventions for diabetes-related distress
We read with interest the pilot study by Kortegaard et al. [1] on a group-based intervention targeting diabetes-related emotional distress among emerging adults with type 1 diabetes. While the study... more
Beyond comorbidities: Age as an independent predictor of survival in pulmonary arterial hypertension
Dear Editor,
Reconsidering stepwise lipid-lowering titration and outpatient adherence dynamics after acute myocardial infarction
We read with great interest the recent multicenter quality improvement audit by Gragnano and colleagues regarding diagnostic and therapeutic inertia in low density lipoprotein cholesterol management... more
Rethinking residual sex effects in frailty-adjusted ICU mortality
Dankl et al. provide a valuable frailty-adjusted analysis of sex and 30-day mortality in older critically ill adults, and the combination of frequentist and Bayesian estimates is a particular... more
Interpreting the neutrophil-to-lymphocyte ratio in stable chronic obstructive pulmonary disease: Severity, case mix, and clinical utility
We read with interest the retrospective study by Vanetti et al. [1], which evaluated the neutrophil-to-lymphocyte ratio (NLR) in 247 clinically stable patients with chronic obstructive pulmonary... more
Using latent class analysis for identifying clinical phenotypes associated with prognosis in patients with atrial high-rate episodes
Atrial high-rate episodes (AHRE) detected by cardiac implantable electronic devices are frequently encountered in clinical practice [1,2] and are associated with an increased risk of atrial... more
Severe hyperkalaemia during liposomal amphotericin B treatment, independent of nephrotoxicity
Dear Editor,
Artificial intelligence and clinical responsibility in the multimorbid patient
Artificial intelligence (AI) is not simply transforming clinical practice; it is reshaping how clinical responsibility is organised. Much of the current debate has focused on whether AI will replace... more
Risk reclassification and implementation challenges in the 2026 AHA/ACC pulmonary embolism guideline
The recently published 2026 AHA/ACC guideline for the evaluation and management of acute pulmonary embolism (PE) introduces several conceptual innovations that may influence clinical practice beyond... more
Recurrent Pericarditis, Hydroxychloroquine, and the Unrecognized Risk of Myasthenia Gravis
We read with great interest the article by Trotta et al. evaluating the role of hydroxychloroquine (HCQ) in recurrent pericarditis (RP), as well as the accompanying commentary by Tan et al. [1,2].... more
Obstructive sleep apnea syndrome as the missing piece in the puzzle of cardiovascular–kidney–liver–metabolic syndrome
Dear Editor, the staging framework of cardiovascular–kidney–metabolic (CKM) syndrome initially proposed by the American Heart Association in November 2023 represents an impressive conceptual advance... more
Considerations regarding the diagnosis of short telomere syndrome in a patient with opportunistic infections
The recent manuscript by Belhabib et al., presents an interesting and educational case of opportunistic infections associated with severe CD4+ lymphocytopenia, yet the central conclusion, that the... more
Interpreting echocardiographic improvement in EGPA: pulmonary vascular reversal, cardiac involvement, or disease activity?
We read with interest the study by Carlucci et al., “Eosinophil-linked pulmonary circulation in EGPA Improves under anti-IL-5/R therapy: A longitudinal study” [1]. The authors should be commended for... more
The missing piece in severe acquired brain injury care: Integrating neurophysiological screening for critical illness polyneuropathy and myopathy
We read with great interest the recent article by Grifoni and Bucciardini, regarding the implementation of an interdisciplinary co-management model between the Neuro-Intensive Care Unit (Neuro-ICU)... more
Logistic regression ignores time-to-event in competing risks analysis
We read with interest the study by Brunetti et al. on oral anticoagulant (OAC) nonprescription in older atrial fibrillation patients with reduced expected survival [1]. The authors should be... more
Readmission risk after protected discharge: are multidimensional tools superior to functional scales?
Early hospital readmissions remain one of the major challenges for healthcare systems and are widely recognized as an indicator of healthcare quality, effective discharge planning, and continuity of... more
Optical coherence tomography angiography in systemic sclerosis: from a microvascular signal to clinical utility
Comment on.
Baseline or dynamic prediction after venous thromboembolism? Clarifying the clinical use of the CAVE score for occult cancer
Jara-Palomares and colleagues should be congratulated for developing and externally validating an international score to estimate the risk of cancer within one year after venous thromboembolism (VTE... more
The time has come for comprehensive geriatric assessment in internal medicine
Complexity has become a defining feature of modern internal medicine. Older adults with multimorbidity, polypharmacy, biological and functional vulnerability, and multidimensional frailty now... more
GLP-1 receptor agonists for the management of obesity in individuals treated with antipsychotics
Individuals with psychotic disorders treated with antipsychotic drug classes are at high risk for developing overweight/obesity and related cardiometabolic complications, resulting in excess... more
Reporting clinical escalation in Hospital-at-Home: from a single rate to a structured framework
Hospital-at-Home (HaH) programmes are expanding rapidly across European health systems as substitutive acute care models [1,2]. As they consolidate, unplanned transfer back to hospital — termed... more
Microplastics in drinking water: A silent threat amplifying health inequities in low-resource settings
Microplastics have become ubiquitous contaminants in global drinking water supplies. Detected in tap water, bottled water, and untreated sources across both high- and low-income countries, these... more
Male hypogonadism and incretin therapy response
Dear Editor,
Coronary microvascular dysfunction as a plausible convergent mechanism in cancer therapy-related MINOCA: evidence synthesis and a call for diagnostic standardization
Myocardial infarction with non-obstructive coronary arteries (MINOCA) accounts for 6–10 % of all acute myocardial infarctions (MI), carries a non-trivial long-term risk of major adverse... more
Initial misdiagnoses in Sjögren’s disease patients
Sjögren’s disease (SjD) is a chronic systemic autoimmune disease affecting exocrine glands, causing sicca symptoms, arthralgias and fatigue. It is highly heterogenous and may have variable clinical... more
Original Article
Circulating metabolites in adolescence associated with clinical obesity in young adulthood
In 2025, the Lancet Diabetes & Endocrinology Commission defined clinical obesity as excess body fat that is causing organ dysfunction, symptoms and physical limitations [1]. Unlike body mass... more
Cognitive impairment in uncontrolled vs controlled hypertension – systematic review and meta-analysis
Hypertension is a well-recognized risk factor for the development of cognitive impairment (CImp) and brain vasculogenic lesions. The aim of this systematic review was to assess whether adequate blood... more
Recovery of worsening renal function after acute heart failure
Worsening renal function (WRF) is common during hospitalization for acute decompensated heart failure (ADHF). However, the post-discharge trajectory of renal function in these patients remains... more
Assessment of serum micronutrient concentration in chronic pancreatitis: insights from the nationwide COMBO randomised trial,
In patients with chronic pancreatitis (CP), pancreatic exocrine insufficiency (PEI) and poor dietary intake may cause malnutrition. International guidelines recommend monitoring key micronutrients (... more
Phenotypes of diabetic kidney disease and cardiovascular outcomes
To quantify the association between diabetic kidney disease (DKD) phenotypes and cardiovascular disease (CVD) mortality and incident major adverse cardiovascular events (MACE), atrial fibrillation (... more
Receptivity and susceptibility to care models for Metabolic dysfunction-Associated Steatotic Liver Disease (MASLD) in Europe: a mixed-methods, landscaping study
Metabolic dysfunction-associated steatotic liver disease (MASLD), including metabolic dysfunction-associated steatohepatitis (MASH) and its fibrotic and cirrhotic stages, poses a growing burden on... more
External validation of the SHARPEN score for predicting in-hospital mortality in infective endocarditis
Risk stratification of infective endocarditis (IE) using IE-specific variables remains limited. In this study, we evaluated SHARPEN in an Italian cohort and performed an exploratory paired comparison... more
Implementation of guideline-directed cardioprotective therapy in patients living with type 2 diabetes in outpatient cardiology ambulatory setting: the Italian CardioMET registry
To assess the implementation of guideline-directed glucose-lowering therapies with proven cardiovascular (CV) benefit in individuals with type 2 diabetes mellitus (T2DM) attending Italian outpatient... more
Statins are associated with decreased risk of disease progression and death in non-cirrhotic patients with primary biliary cholangitis
We evaluated whether statins in non-cirrhotic patients with primary biliary cholangitis (PBC) might influence disease progression, including cirrhosis development, hepatic decompensation, all-cause... more
Unsupervised clustering of undifferentiated systemic autoinflammatory diseases (USAID)
Autoinflammatory diseases induce recurrent systemic inflammatory attacks—often accompanied by fever—that occur independently of infectious triggers [1]. In daily practice, a major challenge arises... more
Respiratory-hypoxic burden and multimorbidity-related vulnerability are distinct dimensions of obstructive sleep apnea: A retrospective cohort analysis
Obstructive sleep apnea (OSA) is a heterogeneous disorder in which conventional apnea-hypopnea index (AHI)-based severity classification incompletely captures respiratory burden, nocturnal hypoxemia... more
European practices for screening and follow-up in mixed connective tissue disease: a survey of clinicians from the European Federation of Internal Medicine and ERN ReCONNET
Mixed connective tissue disease (MCTD) is a rare systemic autoimmune disorder defined by the co-occurrence of clinical features overlapping with other connective tissue diseases (CTD) such as... more
DEED-FRAIL trial: A cluster-randomized trial of a frailty-oriented multicomponent ED discharge intervention for older adults with geriatric vulnerability and acute heart failure
Heart failure (HF) is a common chronic condition characterized by progressive cardiovascular and global functional decline, often punctuated by recurrent episodes of decompensation that accelerate... more
Circulating angiogenic and inflammatory biomarkers profiling in patients with hereditary hemorrhagic telangiectasia
Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic disease (ORPHA:774), with an estimated prevalence of approximately 1 in 5000 individuals, and is considered the second most common... more
Hypertonic saline and high-dose furosemide in very elderly patients hospitalized for acute heart failure: A real-world cohort study
The combination of hypertonic saline solution (HSS) and high-dose furosemide may enhance diuretic response in acute heart failure (AHF), but evidence in real-world populations, particularly very... more
Central embolic localization in acute pulmonary embolism: Prognostic marker or target for intervention?
In clinical practice, and in accordance with international guidelines, computed tomography pulmonary angiography (CTPA) is currently the gold-standard imaging test for diagnosing acute pulmonary... more
Modified Sequential Organ Failure Assessment score for prehospital critical care: defining thresholds and clinical implications
The modified Sequential Organ Failure Assessment (mSOFA) score demonstrates excellent discrimination for short-term mortality in prehospital settings; however, actionable risk stratification... more
Circulating Growth Hormone-Releasing Hormone Increases After Kidney Transplantation and Shows Divergent Associations with Gut-Derived Uremic Toxins
The growth hormone/insulin-like growth factor-1 (GH/IGF-1) axis is disrupted in chronic kidney disease (CKD), yet its upstream regulator, growth hormone–releasing hormone (GHRH), has never been... more
Sex differences in triage priority, predictors, and outcomes in consecutive emergency department patients with chest pain
Chest pain (CP) is a common reason for Emergency Department (ED) presentation and may signal life-threatening cardiovascular emergencies (CVE). Sex-related differences in CP management are... more
Phenotypic clustering and ABC pathway adherence in patients with atrial fibrillation at high risk of bleeding and stroke: Insights from three global registries
Patients with atrial fibrillation (AF) who are at increased risk of both thrombotic and haemorrhagic events represent a heterogeneous and broad clinical entity, characterized by the presence of... more
Long-term vascular outcomes and biological predictors of thrombosis in systemic lupus erythematosus: a 10-year prospective cohort study
Systemic lupus erythematosus (SLE) is associated with increased cardiovascular morbidity, but the long-term prognostic value of subclinical atherosclerosis and circulating biomarkers remains... more
Recurrent venous thromboembolism and bleeding during anticoagulation in patients with deep-vein thrombosis treated with vitamin K antagonists or direct oral anticoagulants: insights from the RIETE registry
Randomized trials have shown that direct oral anticoagulants (DOACs) are as effective as vitamin K antagonists (VKAs) for treating venous thromboembolism (VTE), with less major bleeding. Whether... more
Steroid-sparing biologics in severe asthma and chronic obstructive pulmonary disease: a systematic review, cross-disease meta-analysis, and translational estimate of corticosteroid-related harm prevented
Oral corticosteroids (OCS) remain widely used in uncontrolled severe asthma and frequently exacerbating chronic obstructive pulmonary disease (COPD), but cumulative exposure is associated with dose-... more
Effects of bariatric surgery on apolipoprotein A1, apolipoprotein B, and apolipoprotein B/ apolipoprotein A1 ratio: Findings from a prospective cohort
Bariatric surgery is associated with significant improvements in cardiometabolic health. The apolipoprotein B (ApoB)/apolipoprotein A1 (ApoA1) ratio has been demonstrated to be a strong predictor of... more
Comparative risks of dementia and Parkinson’s disease with GLP-1 RAs versus other oral glucose-lowering medications in obese patients with type 2 diabetes: a large real-world cohort study
This study evaluates dementia and Parkinson's disease (PD) risk among patients with type 2 diabetes (T2D) and obesity initiating GLP-1 receptor agonists (GLP-1 RAs) compared with other oral glucose-... more
Sex-specific differences in the clinical and psychiatric phenotype of hospitalized patients admitted to a tertiary alcohol-related disease unit
Alcohol Use Disorder (AUD) is a chronic disease characterized by impaired control over alcohol intake, cravings, and continued use despite physical, psychological, and social consequences [1].
Hospitalisation and healthcare use in persons screened for atrial fibrillation compared with usual care
The impact of screening for incident atrial fibrillation (AF) on healthcare use and hospitalisation is largely unknown.
“Hospital-at-home and 30-day readmission among clinically eligible patients: a prospective cohort study with a capacity-constrained comparator group”
To evaluate the association between hospital-at-home (HaH) care and unplanned 30-day hospital readmission using a capacity-based comparator group of clinically eligible patients admitted to... more
Prevalence and incidence of diabetes in patients with non-functional adrenal tumors
The association between non-functional adrenal tumors (NFAT) and diabetes is unclear.
Deprescribing of blood pressure-lowering medications in patients with hypotensive syncope
The hypotensive phenotype of autonomic syncope is characterized by hypotension as the predominant hemodynamic mechanism underlying loss of consciousness [1,2]. The term hypotensive phenotype... more
Prevalence of orthostatic hypotension in heart failure: a systematic review and meta-analysis
Orthostatic hypotension (OH), defined as a reduction in systolic/diastolic blood pressure ≥20/10 mmHg upon standing, is common in older adults and may interfere with the optimization of guideline-... more
Educational professional activities for enhancing heart failure guidelines implementation: data from the Optimization of Therapy in the Italian Management of Heart Failure (OpTIMa-HF) Registry
European guidelines recommend for heart failure with reduced ejection fraction (HFrEF) rapid initiation and later up-titration of four foundation drugs. We assessed whether an educational... more
Cardiac rehabilitation referral and access by country income class: Comparisons from the International Council of Cardiovascular Prevention and Rehabilitation’s 2025 Global Audit Update
To characterize CR: (1) referral practices, (2) systematic referral barriers, (3) wait listing, (4) program-level approaches to mitigating patient access barriers, as well as (5) CR reimbursement... more
Biological therapy in Takayasu arteritis. Results from the REVAS registry
Biological therapy in patients with Takayasu arteritis is frequently used, but the factors associated with its use have not been determined. The present study aims to describe and identify predictors... more
Exercise-based prehabilitation programs reduce hospital stay and postoperative complications in surgical patients with cancer: a systematic review and meta-analysis
Cancer prevalence and mortality rates are rapidly increasing worldwide, making it a leading cause of morbidity and death [1]. Although surgery is considered the primary treatment for most cancers [2... more
The cardio-hepatic syndrome and right ventricular dysfunction in heart failure with mildly reduced ejection fraction
Right ventricular dysfunction (RVD) is common in patients with heart failure (HF) and reduced ejection fraction and may lead to cardio-hepatic syndrome (CHS). The present study investigates the... more
Weight-adjusted fluid balance and its impact on days alive without life support in critical illness – an observational cohort study
In the last decade, intravenous fluid therapy in critically ill patients and its adverse side effects have received increasing attention. The total of resuscitation fluids, maintenance fluid therapy... more
Subclinical hypotension in acute decompensated heart failure: prognosis and treatment implementation
Patients hospitalized for acute decompensated heart failure (ADHF) with low blood pressure (BP) represent a clinically challenging yet frequently encountered subgroup in daily practice [1,2].... more
Impact of ECOG performance status on cancer-associated thrombosis treated with DOACs: Data from a multicenter cohort study
Data on safety and effectiveness of direct oral anticoagulants (DOACs) in patients with cancer-associated thrombosis (CAT) and impaired functional status are limited. We evaluated the impact of... more
non-HDL-C: The missing parameter in primary care
Lipid assessment forms part of routine healthcare assessments of the general population, primarily to identify the risk of atherosclerotic cardiovascular disease (ASCVD). It is recommended that these... more
Adipose tissue and adherence to the Mediterranean diet: Key factors for sleep quality in Polyendocrine Metabolic Ovarian Syndrome (PMOS)?
Sleep disturbances are common findings in women with Polyendocrine Metabolic Ovarian Syndrome (PMOS), though mechanisms remain unclear. This observational case-control study aimed to identify... more
Clinical and prognostic significance of urinary albumin-to-creatinine ratio in heart failure: insights from the RICA-2 registry
Heart failure (HF) is frequently accompanied by renal dysfunction and systemic congestion, reflecting the complex interaction between the heart and the kidneys within the cardiorenal syndrome. The... more
Diagnosis, treatment and outcomes of euvolemic hyponatremia among geriatric hospitalised patients
Hyponatremia is the most common electrolytic disturbance among inpatients. It is associated with poor outcomes in frail older patients, even for mild disturbances. Prevalence increases with age, and... more
Sex-based differences and clinical outcomes in older adults with Candida bloodstream infection: a post-hoc secondary analysis of a multicentre study
Candida bloodstream infections (BSI) are a major cause of disease in hospitalized patients, with particularly high morbidity and mortality among older adults. However, the impact of biological sex on... more
Low-renin hypertension in incidental adrenal adenomas and response to aldosterone-targeted therapy: a prospective study
Incidental adrenal adenomas are common, yet renin status is infrequently assessed in hypertensive patients. Emerging evidence supports a spectrum of renin-independent aldosterone excess associated... more
Pharmacokinetic robustness of direct oral anticoagulants vs. phenprocoumon in the emergency setting: impact of renal and hepatic impairment
Direct oral anticoagulants (DOACs) are increasingly used, but their pharmacokinetic stability compared to vitamin K antagonists during acute illness remains poorly characterized. We aimed to evaluate... more
SARS-CoV-2 infection, viral burden, and variant-specific outcomes in hospitalized patients with heart failure
Patients with heart failure (HF) are particularly vulnerable to systemic infection; however, the combined impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, viral... more
Eosinophil-linked pulmonary circulation in EGPA Improves under anti-IL-5/R therapy: A longitudinal study
Eosinophilic Granulomatosis with Polyangiitis (EGPA) is a rare, multisystemic vasculitis that primarily affects small to medium-sized blood vessels. It is characterized by a well-defined triad of... more
Vitamin D at hospital admission as an independent predictor of outcome of sepsis patients: Results of a secondary analysis from a “Need-Speed” trial prospective cohort
Sepsis is currently defined as a life-threatening organ dysfunction caused by a dysregulated host response to an infection, according to the Sepsis-3 consensus [1].
Depressive symptoms in older patients undergoing electrical cardioversion of persistent atrial fibrillation. A possible association with clinical complexity, physical performance and inflammation
Atrial fibrillation is the most frequently sustained arrhythmia diagnosed in older individuals. In 15 years, the prevalence of AF greatly increased in subjects ≥85 years approaching 40% [1]. The... more
Fibroblast growth factor 23 and mortality, heart failure and cardiovascular events across the chronic kidney disease spectrum - A systematic review and meta-analysis
Chronic kidney disease (CKD) is a highly prevalent condition worldwide and is associated with a substantial cardiovascular burden and premature mortality [1,2]. The risk of cardiovascular events and... more
How many blood eosinophil measurements are needed to identify COPD patients eligible for biologic therapy? A multi-source decision analysis simulation
Biologic therapies for eosinophilic COPD require a blood eosinophil count (BEC) ≥300 cells/µL for eligibility. Landmark trials used a single screening measurement, yet BEC exhibits substantial within... more
Window of opportunity with abatacept in Rheumatoid arthritis-associated interstitial lung disease
ABA stabilised lung function, improved RA control, and reduced glucocorticoid use.Earlier initiation was associated with better DLCO preservation in adjusted analyses, suggesting a possible pulmonary... more
Cardiological hypertensive emergencies: Real word data compared to guidelines indications
Hypertensive Emergencies (HE) are defined as a severe elevation in Blood Pressure (BP), i.e. higher than 180/120 mmHg, associated with the evidence of a new or worsening Hypertension Mediated Organ... more
Polycythemia, SGLT2 inhibitors, and associated outcomes across the cardio-kidney-metabolic spectrum: a pooled analysis of randomized trials
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) increase hemoglobin and hematocrit, effects that have emerged as key statistical mediators of the cardiorenal benefits observed with SGLT2i... more
Recurrent t(9;12) translocation disrupting ACVRL1 intron 9 causes hereditary haemorrhagic telangiectasia missed by standard exome sequencing in four unrelated families
Hereditary haemorrhagic telangiectasia (HHT) (MIM #187300, ORPHA:774), also known as Rendu-Osler-Weber disease, is a rare autosomal dominant vascular disorder and the second most common inherited... more
Phase III maintenance telerehabilitation in elderly patients with chronic heart failure and type 2 diabetes (TELEMECHRON study)
Heart failure (HF) and type 2 diabetes (T2DM) are significant public health concerns. This study evaluated a 6-month home-based telemedicine program for older patients with combined HF and T2DM. The... more
Sex and 30-day mortality in elderly critically Ill adults: A frailty-adjusted multinational analysis with frequentist and bayesian estimates
Evidence on sex-related mortality differences in critically ill older adults is inconsistent, and frailty is rarely incorporated despite its major prognostic relevance in geriatric intensive care.
Prevalence and impact of psychiatric and neurocognitive comorbidities on pulmonary rehabilitation outcomes
Chronic respiratory diseases are associated with psychiatric/neurocognitive comorbidities; prevalence, clinical impact and responsiveness to in-patient pulmonary rehabilitation (PR) remain poorly... more
Pre-admission and in-hospital embolisms have a different prognostic significance in infective endocarditis
To describe the clinical profile of a large cohort of patients with left-sided IE (LSIE) and embolic events (EE); to explore differences between those who present with an embolism at admission (EEa)... more
Innovative co-management between Neuro-ICU and Neurorehabilitation Unit in patients with severe acquired brain injury: enhancing clinical care pathways
Severe acquired brain injury (sABI) is a major challenge in post-acute care, affecting disability, quality of life, and healthcare resources. Traditional sequential care from acute units to... more
Anti-Ro/SSA and rheumatoid factor antibodies are associated with more severe lung involvement in patients with systemic sclerosis: a study from the EUSTAR database
In the large EUSTAR cohort, anti-Ro/SSA antibodies are detected in 15% of SSc patients and represent an independent risk factor for the presence and severity of ILD, particularly for cases with anti-... more
Exercise pulmonary hypertension in asymptomatic patients with HIV infection Insights from the RIGHT-NET registry
Asymptomatic patients with Human Immunodeficiency Virus (HIV) infection may remain at increased risk for pulmonary vascular disease. We therefore explored the pulmonary circulation in these patients... more
Pulmonary artery dilation in pulmonary arterial hypertension: haemodynamic determinants and association with sudden death
Pulmonary arterial hypertension (PAH) is a progressive disease characterized by increased pulmonary vascular resistance and pressure, leading to right ventricular failure and reduced survival.... more
Sex-related disparities in sepsis in western Europe: A systematic review and meta-analysis
Sepsis is a potentially fatal systemic disease characterized by dysregulated immune response to infection [1]. Despite significant improvements in early detection and management, sepsis continues to... more
Review Article
Exercise-induced epigenetic remodeling in COPD skeletal muscle dysfunction: From sedentary behavior to molecular rehabilitation
Chronic obstructive pulmonary disease (COPD) is increasingly recognized as a multisystem disorder in which extrapulmonary manifestations substantially contribute to disease burden. Among these,... more
Innovative holistic treatment for CKM: what lies ahead?
Cardiovascular-kidney-metabolic (CKM) syndrome, as defined by the American Heart Association, encompasses interrelated metabolic, kidney, and cardiovascular disorders that mutually reinforce one... more
Gastrointestinal ultrasound in systemic sclerosis: A scoping review of current evidence
Systemic sclerosis (SSc) is a rare systemic autoimmune rheumatic disease frequently associated with gastrointestinal (GI) involvement. GI manifestations are heterogeneous, may occur throughout the... more
CKM: Epidemiology, current clinical implications and future burden
Cardiovascular–kidney–metabolic (CKM) syndrome was formalized by the American Heart Association in 2023 to capture the biological and clinical continuum linking excess adiposity, metabolic... more
Microvascular and macrovascular complications of diabetes in people with HIV
Diabetes mellitus (DM) is increasingly prevalent in people with HIV, with reported prevalence estimates generally ranging from 5% to 15% across contemporary cohorts. It represents a major contributor... more
Sex and gender specific considerations on frailty: what have we learned?
Aging entails a progressive impairment of functions and, ultimately, leads to increased susceptibility to disability, morbidity, and mortality. Around 85% of people aged more than 75 years suffer... more
Personalizing cardiovascular prevention in chronic kidney disease: an operational framework for risk-treatment mapping
Patients with chronic kidney disease (CKD) bear a disproportionate burden of cardiovascular (CV) morbidity and mortality, yet preventive strategies in clinical practice remain remarkably conservative... more
Particle engineering, aerosol physics, and pulmonary deposition of single-inhaler triple ICS/LABA/LAMA therapies in obstructive airway diseases
Search Strategy
Sugar and artificial sweeteners and risk of cardiovascular disease
Humans have an innate preference for sweetness; in this regard, dietary sugar consumption patterns are established early in life. Although moderate consumption of naturally occurring sugars from... more
Acute cardio-renal and Reno-Cardiac syndromes in critical care
Cardiorenal syndrome (CRS) encompasses a spectrum of disorders in which acute or chronic dysfunction of the heart or kidneys are the key drivers of injury. CRS types 1 and 3 are the subtypes most... more
Alcohol withdrawal syndrome in hospitalized patients: a practical review
Alcohol withdrawal syndrome (AWS) develops in patients with alcohol use disorder (AUD) and physical dependence after abrupt cessation or substantial reduction of sustained heavy alcohol use. It is... more
Cardiovascular complications of antineoplastic treatment in prostate cancer patients and compensatory strategies for clinical management
Prostate cancer (PCa) represents one of the most prevalent malignancies affecting men worldwide and constitutes a major public health challenge. According to the most recent GLOBOCAN estimates,... more
Understanding the Barriers to Translating Artificial Intelligence into the Clinical Laboratory
Artificial intelligence (AI) is having a transformational impact on society, yet its adoption in laboratory medicine has proceeded notably slower than in many other industries and even different... more
From technology adoption to noise reduction: Behavioral and psychological dimensions of clinical artificial intelligence deployment
For more than five decades, patients with the same condition have received markedly different care depending on which clinician they happen to see. This unwarranted clinical variation has been... more
Artificial intelligence in cardiovascular care for internal medicine: from promising algorithms to useful clinical services
Cardiovascular disease is a core part of internal medicine, where clinicians manage patients with multimorbidity, polypharmacy, repeated transitions of care, and a high burden of fragmented... more