January 2020
46 ArticlesNo Section
Defensive medicine: Everything and its opposite
Defensive medicine (DM) refers to all medical care provided by physicians mainly for preventing the risk of litigation. Redundant DM practices induced by the threat of medical liability are expected... more
Cardiac arrest: The need for integrated multi-disciplinary actions for a continuum of care both in acute and at long-term
Out-of-hospital cardiac arrest (OHCA) is a devastating and dramatic event, with a mortality of around 90% prior to hospitalization and a severe in-hospital outcome, since less than 6 percent of... more
Development of heart failure in asymptomatic patients with Bendopnea
A new symptom of heart failure (HF) has been described in recent years, that is being called bendopnea [1]. This type of dyspnea is experienced while bending forward when putting on shoes or tying... more
Impact of HCV eradication with direct-acting antiviral agents on serum gamma globulin levels in HCV and HCV/HIV coinfected patients
Both HIV and HCV infection exert B-cell dysregulation possibly leading to polyclonal hypergammaglobulinemia, polyclonal B-cell hyperactivity, mixed cryoglobulinemia and non-Hodgkin lymphoma, as a... more
Hyperuricemia and mortality in heart failure: Is it time to change the route?
The prevalence of heart failure (HF) is increasing worldwide and in particular in the industrialized countries [1,2]. This is associated with a parallel increase in the rate of hyperuricemia and gout... more
Mortality in patients with intracerebral hemorrhage associated with antiplatelet agents, oral anticoagulants or no antithrombotic therapy
Intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes and results in significant morbidity and mortality [1]. Short-term mortality in patients with ICH is about 30% [2-4]. In these... more
Left atrial diameter thresholds and new incident atrial fibrillation in embolic stroke of undetermined source
Embolic Stroke of Undetermined Source (ESUS) is used to describe patients with cryptogenic stroke despite adequate diagnostic work-up, i.e. non-lacunar strokes without proximal arterial stenosis or a... more
Management of hyperuricemia in asymptomatic patients: A critical appraisal
There is consensus on starting urate-lowering therapy (ULT) in cases of symptomatic hyperuricemia, but the frequent condition of asymptomatic hyperuricemia (AH), remains a challenge, given the... more
One-year clinical events and management of patients with atrial fibrillation hospitalized in cardiology centers: Data from the BLITZ-AF study
Atrial fibrillation (AF) is associated with a significant risk of ischemic stroke, death and other cardiovascular events as well as with higher medical costs and reduced quality of life [1–3]. The... more
Usefulness of serum amyloid a protein dosage for monitoring patients receiving tocilizumab
Tocilizumab (TCZ) is a humanized monoclonal antibody directed against the interleukin-6 (IL-6) receptor licensed for the treatment of rheumatoid arthritis, systemic juvenile idiopathic arthritis and... more
Gastrointestinal bleeding in a young male
A previously healthy 17-year-old male was admitted for pain in the right lower quadrant of the abdomen and emission of blood with stools. Abdominal angio-CT (computed tomography) was negative for... more
A breathtaking spectacle
A 36-year-old woman was referred to our department with a 4-day history of spiking fever up to 100.4 °F, nausea, vomiting and loss of appetite. She also complained of slight dyspnea and a mild cough... more
Limited skin lesions in a haemodialysis patient
An 82-year old hemodialysis patient presented with a painful rash on his left arm. His-dialysis access was on this arm for more than ten years (synthetic PTFE graft). Within a week there was a non-... more
Dyspnea of a woman living in an old wooden house
A 38-year-old woman presented to the emergency department with aggravated dyspnea at rest and productive cough for one week from late July. She was born and married in Brazil. Then she immigrated to... more
Case Report
Worth a careful look at the blood film
A 46-year-old man with a history of alcohol abuse came to the emergency department with fever and a purpuric rash. He had been bitten by a dog on the left hand 3 days earlier. Minimal bleeding... more
Commentary
Clinical trial results – A closer look under the surface
When reading the report of a clinical study in a medical journal, the typical question an overly busy clinician-reader asks is the following: do the results convince me and are they valid? In the era... more
Cardiac and vascular damage in systemic erythematosus lupus. Is disease activity the mediator?
Cardiovascular (CV) risk associated with Systemic Erythematosus Lupus (SLE) yet remains an issue of great interest and current debate. Results from a large number of epidemiological studies clearly... more
Light anti-thrombotic regimen after interatrial shunt device closure: A strategy for all patients?
During the recent years, catheter-based closure of atrial septal defect (ASD) or patent foramen ovale (PFO) has become an effective and safe therapy for the curative treatment of patients with... more
Clinical trial publications: A sufficient basis for healthcare decisions?
Clinical studies remain the single most important information source of the scientific basis on which healthcare decisions are taken. This applies to population-level decisions taken by drug... more
Primum non nocere does not justify clinical inertia for stroke prevention in elderly patients with atrial fibrillation in the era of direct oral anticoagulants
Stroke prevention with oral anticoagulation represents the cornerstone of atrial fibrillation (AF) management.
Internal Medicine Flashcard
A blue, painful limb in a cancer patient
A 40-year-old man with metastatic colorectal cancer (peritoneum and lymph-node metastases) under therapy with palliative chemotherapy, with a previous history of deep venous thrombosis in the lower... more
The unintended consequences of a bowl of soup
A 33-year-old Romanian woman presented with a one day history of “cola-coloured” urine with associated fevers. She reported generalised malaise, arthralgia and reduced appetite for 24 h. The patient... more
An elderly man with diarrhea and weight loss
A 77-year-old Japanese man presented to the author's department with diarrhea and weight loss (8 kg in the past 3 months). Vital signs were normal. Furthermore, abdominal examination was normal, and... more
A middle-aged woman with severe disorders of consciousness
A 47-year-old woman presented to the emergency department of the author's hospital with severe disorder of consciousness. She had been epileptic since early childhood and had many epileptic family... more
Elderly patient with prostate cancer and back pain
A 72-year-old man with hypertension came to our hospital with a history of severe posterior chest pain 3 months ago and worsened 1 week before admission. He denied a history of recent trauma but was... more
Letter to the Editor
Improving survival outcome among elderly lung transplant recipients
To the Editor:
Characterisation of patients with acute myocardial infarction complicated by left ventricular thrombus
Left ventricular (LV) thrombus is a known complication of acute myocardial infarction (AMI), with a reported incidence ranging from 0.7 to 4.3% in the era of primary percutaneous coronary... more
Video-thoracoscopy for the evaluation of undiagnosed pleural effusion: Is it possible to optimize its indication?
According to clinical guidelines, thoracoscopy is the investigation of choice in exudative pleural effusions when a diagnostic thoracocentesis is inclonclusive and malignancy is suspected [1].
The age-adjusted Charlson comorbidity index: A significant predictor of clinical outcome in patients with heart failure
Heart failure (HF) has emerged as a major epidemic and a significant public health burden, associated with considerable morbidity and mortality [1]. Parameters specific for HF such as NYHA class and... more
Authors’ reply to ‘Reply to EC de Haas and HJ Luijendijk, Eur J Intern Med. 2019 Apr; 62: e8-e9’ by S Portsmouth et al.
In response to our comment, Dr Portsmouth and colleagues provide additional information about the results of the CAPSTONE-1 trial [1], which we appreciate. In our comment, we underlined that the... more
Letters to the Editor
Reply to EC de Haas EC and HJ Luijendijk, Eur J Intern Med. 2019 Apr;62: e8-e9
RE Baloxavir for influenza: Enrichment obscured lack of effect in North-American adults [1]
Original Article
Assessing the association between fluoroquinolones and emerging adverse drug reactions raised by regulatory agencies: An umbrella review
Systemic fluoroquinolones remain commonly prescribed broad-spectrum antibiotics, both in hospital and outpatient settings, despite rising resistance rates [1–7]. Since their approval,... more
Admission glucose level was associated with increased short-term mortality and length-of-stay irrespective of diagnosis, treating medical specialty or concomitant laboratory values
Diabetes is a global public health problem with serious and costly consequences for patients and for health care systems worldwide [1]. The global prevalence of diabetes in 2017 was estimated to 8.6... more
The association between education level and chronic liver disease of any etiology
Epidemiological surveys performed in several countries [1–7] have shown that a low socioeconomic status (SES) unfavorably influences liver-related mortality. In Denmark, a low SES has been shown to... more
Mild to moderate hyponatremia at discharge is associated with increased risk of recurrence in patients with community-acquired pneumonia
Hyponatremia, defined as a serum sodium < 135 mmol/l, is a common electrolyte disorder with a reported incidence of up to 30% in hospitalized patients [1–3]. Profound, symptomatic hyponatremia... more
Light anti-thrombotic regimen for prevention of device thrombosis and/or thrombotic complications after interatrial shunts device-based closure
Transcatheter closure of both symptomatic atrial septal defect (ASD) and patent foramen ovale (PFO) has become a standard procedure in daily clinical practice, guaranteeing excellent technical... more
Predictors of mortality of influenza virus infections in a Swiss Hospital during four influenza seasons: Role of quick sequential organ failure assessment
Influenza virus infections have been associated with increased morbidity and they play an important role in the excess mortality reported every winter season in the northern hemisphere; this... more
Long-term efficacy of maintenance therapy with Rituximab for IgG4-related disease
IgG4-related disease (IgG4-RD) is a recently recognized fibro-inflammatory disorder involving virtually any organ system [1,2]. Clinical-pathological hallmarks of IgG4-RD include mass-forming lesions... more
Fibroblast growth factor 23 predicts carotid atherosclerosis in individuals without kidney disease. The CORDIOPREV study
The fibroblast growth factor 23 (FGF23) is a hormone produced mainly by bone cells that plays a fundamental role in the regulation of mineral metabolism through acting on different key actors [1].... more
Review Article
ANCA associated vasculitis
Vasculitis is a pathological process characterized by inflammation of the blood vessels [1]. This inflammation causes vascular destruction, translating histologically with fibrinoid necrosis, hence... more
Multimorbidity in COPD, does sleep matter?
Sleep constitutes approximately one-third of the average lifetime, and good sleep quality is important for both physical and mental health, especially for patients with a chronic disease. A growing... more
Understanding the impact of chronic obstructive pulmonary disease exacerbations on patient health and quality of life
Chronic obstructive pulmonary disease (COPD) was the third leading cause of mortality in 2016 and was responsible for an estimated 3 million deaths worldwide that year, representing a vast global... more
The pleura and the endocrine system
The endocrine system is a network of glands and organs which produces, stores, and secretes hormones. It has an essential role in the correct functioning of many vital organs and in the maintenance... more
Prevalence of gastrointestinal malignancy in iron deficiency without anaemia: A systematic review and meta-analysis
Gastrointestinal (GI) cancers are the most common malignancy worldwide, leading to over 1.6 million deaths per annum [1]. The significant burden from this disease and its association with iron... more
Speckle tracking echocardiography in patients with systemic lupus erythematosus: A meta-analysis
Systemic lupus erythematosus (SLE), an autoimmune disease with unknown pathophysiological mechanisms, is characterized by systemic involvement. In particular, patients with SLE show an accelerated... more
The ESC 2019 CCS guidelines: Have we left our patients and scientific evidence behind?
The ESC CCS 2019 guidelines recognize that successful management of anginal symptoms relies on effective therapy tailored to individual patient characteristics but do not provide any specific advice... more