May 2025
183 ArticlesNo Section
Refining the predictive value of nasal pressure swing in acute hypoxemic respiratory failure management. Author's reply
Dear Editor,
Diagnostic contribution of minor salivary glands biopsy in clinical practice
Dear Editor,
The role of achieving blood pressure targets in renal protection: Insights from the VALUE trial
We have read with great interest the article by Olsen et al. on the VALUE trial [1], which investigated the comparative effectiveness of valsartan versus amlodipine in reducing the incidence of end-... more
Demographic features in patients with acute mountain sickness
Dear editor,
Chronicity of disease mandates quality-of-life prioritization – a role for digital health and patient-reported outcome measures
The field of internal medicine is evolving at unprecedented speed and humankind is steadily growing older. Progress in diagnostics and treatment have improved the prognosis of many diseases and led... more
The Declaration of Helsinki protects clinical trial participants
Dear Editor,
Some comments on Tecovirimat and mpox
The paper by Rizk et al., "Tecovirimat and mpox: A regulatory balancing act between hope, hurdles, and high-risk populations," presents a detailed discussion on the antiviral Tecovirimat (TPOXX) and... more
Hydroxychloroquine use in patients with primary immune thrombocytopenia and antiphospholipid antibodies
The prevalence of antiphospholipid antibodies (aPL) among patients with immune thrombocytopenia (ITP) is high, at 20 % or higher according to previous studies [1,2].
Clinical Insights
Clinical trajectories in liver cirrhosis: An evidence-based reappraisal for the internist
Over the last few years, the approach to clinical recognition and risk stratification of advanced liver disease has changed substantially, and liver cirrhosis has been increasingly conceptualized as... more
Undiagnosed celiac disease. The conundrum of unveiling the dark side of the moon
Celiac disease (CD) is a gluten-induced, inflammatory disease of the small intestine, characterized by high and rising prevalence, huge clinical variability, and increased co-morbidity and mortality... more
The emperor's new clothes and the case of vitamin D and cardiovascular risk. A few thoughts after the guidelines of the American Society of Endocrinology
As in the famous Christian Andersen fairy tale, the recent guidelines of the American Society of Endocrinology [1] have confirmed that the king is naked, significantly diminishing the role of... more
Commentary
Intermediate care units in internal medicine – From concept to consolidation
The traditional organization of hospital care along rigid specialty lines is increasingly challenged by the complex clinical profiles of today’s inpatients. Multimorbidity, polypharmacy and... more
Predicting the unpredictable: Personalizing VTE risk in cancer with the Caravaggio Score
Patients with cancer account for >20 % of all patients newly diagnosed with venous thromboembolism (VTE), which remains a leading cause of morbidity and mortality in this patient population [1].... more
The oldest old and critical care: a potentially successful binomial
Very old people are frequently denied advanced care on the assumption that they will not benefit from such interventions, even in absence of coexisting conditions that may impact their prognosis [1... more
Lymphangioplasty 4.0 as a therapeutic and educational opportunity for (Lymph)edema
In this issue of the European Journal of Internal Medicine (EJIM), Mazzolai et al. report on safety and preliminary efficacy of a novel device, that uses subcutaneously implanted catheters to provide... more
Wheels within wheels: Diagnostic and risk modifiers for familial hypercholesterolemia in the community
Familial hypercholesterolaemia (FH) is an autosomal dominant condition, marked by elevated plasma concentrations of low-density lipoprotein (LDL)-cholesterol from birth. It confers a substantial risk... more
Acute exacerbation of chronic obstructive pulmonary disease: An underestimated cardiovascular risk factor
Chronic obstructive pulmonary disease (COPD) is a widespread respiratory disease associated with significant morbidity and mortality [1,2]. It ranks among the leading causes of death and is expected... more
Sodium-glucose co-transporter 2 inhibitors in acute heart failure: What are you waiting for?
Sodium-glucose co-transporter 2 inhibitors (SGLT2i) were initially discovered as a compound present in roots, leaves and fruits of the apple tree in 1835. However, it was not until the beginning of... more
The prothrombotic effects of Lipoprotein (a) and atherosclerosis
Lipoprotein (a) [Lp(a)] is a plasma lipoprotein consisting of a cholesterol-rich LDL particle with one molecule of apolipoprotein B100 and an additional protein which has sequence homology with... more
The misalignment between chronotype and sleep time: Friend or foe?
We spend approximately one third of our lifetime in sleep, a complex physiological process which is an established health determinant. In the last decades, it has been demonstrated that reduction of... more
Catheter ablation of atrial fibrillation in older patients: The need for a comprehensive evaluation and management
Atrial fibrillation (AF) affects approximately one-third of individuals aged 80 years and over and is associated with a wide range of adverse clinical outcomes, including heart failure (HF), ischemic... more
Redefining thiamine requirements in alcohol use disorder: Aligning treatment with neurocognitive needs
Alcohol Use Disorder (AUD) is a pervasive condition that often presents with marked neurocognitive consequences. From mild executive and memory deficits to severe conditions such as Wernicke–... more
Ischemic heart failure etiology: A misleading definition?
Heart failure (HF) remains a leading cause of morbidity and mortality despite advances in interventional and pharmacological therapies [1,2]. Beyond the classification based on left ventricular... more
Atrial fibrillation screening: The importance of the patient perspective
Atrial fibrillation (AF) is the most common cardiac arrhythmia, with its prevalence increasing significantly in older adults and individuals with comorbidities [1]. Beyond being a major contributor... more
Ideas and Opinions
Fast versus slow fibrosers: Risk factors for fibrosis progression in eosinophilic oesophagitis
Oesophageal fibrosis is a progressive and severe complication of long-standing, T-helper type 2-driven, allergen-mediated inflammation in untreated patients with eosinophilic oesophagitis (EoE) [1].... more
Pharmaceutical policy in europe: Time for a common priceless solution?
Over the last decade, the prices of new medicines have increased dramatically, raising a major challenge for health systems and stressing the divergent values which underlie business and medicine [1... more
Internal Medicine Flashcard
Electrocardiographic changes associated with hypothermia
A 69-year-old Japanese man, who lived alone and was undergoing treatment for diabetes at another hospital was found unconscious in an unheated room at his residence in February 2025. He was... more
Black discoloration of the esophageal mucosa
A 66-year-old man with type 2 diabetes mellitus and chronic alcohol consumption presented to an acute care hospital with generalized fatigue, anorexia, and melena. On arrival, he was in hypovolemic... more
A protrusion of the left abdominal wall
A 73-year-old male presented to the dermatology department following a 5-day history of vesicular rash accompanied with serious pain in the left waist and abdomen. Constipation-associated symptom... more
A man with chronic progressive mucositis and extensive skin detachment
A 62-year-old man was referred to our department with a 6-week history of a progressively worsening rash. Three weeks earlier, he had been admitted for gastric perforation, which was ultimately... more
Omalizumab-associated purpura fulminans
A 27-year-old male with chronic urticaria began omalizumab treatment. Before treatment, blood count, coagulation profile, and liver function were normal. After one dose, he developed chest, back, and... more
An umbilical nodule
A 94-year-old male patient, with previous history of atrioventricular block carrying a pacemaker and right inguinal hernioplasty, and recent history of a painless umbilical nodule suspicious of... more
A man with brown macules on the limbs
A 35-year-old man presented with multiple brown macules on the limbs without associated pruritus or pain for 2 years. He observed these changes with no identifiable triggers, and noted a gradual... more
A febrile woman with gas collection in the right upper abdomen
A 69-year-old woman with uncontrolled diabetes mellitus presented to the emergency department with a 5-day history of loss of appetite and fever. She reported no sore throat, cough, or abdominal pain... more
Chest pain, inflammatory syndrome and headache
A 51-year-old white man presented to the internal medicine department with altered general condition and significant weight loss of 14 kg in 3 months. The main symptom was cervical pain and headache... more
Linear lesions on the chest
A 70-year-old man with a history of lung adenocarcinoma was admitted to our hospital for chemotherapy. During his hospitalization, eruptive papules with a dermatomal distribution developed on his... more
When skin and lung meet
A 50-year-old male, heavy smoker (>30 p/Y), presented to E.R. because of chest pain. In his recent clinical history, he had relapsing papular-purpuric small lesions in the limbs, trunk and arms... more
A man with trismus and decubitus ulcers
A 65-year-old man with a history of binge drinking who had engaged in gardening was brought to our hospital for lethargy. On physical examination, temperature was 35.0 °C, blood pressure was 70/50... more
A 73-year-old man with purpura and fever
A 73-year-old man presented to our dermatology department with a four-week history of palpable purpura on the lower limbs. His medical history included a suspicion of polymyalgia rheumatica based on... more
Invited Review Article
What is new in the management of coeliac disease?
Coeliac disease is a chronic immune-mediated disorder triggered by gluten ingestion in genetically predisposed individuals [1]. It is characterised by immune-mediated inflammation and damage to the... more
Letter to the Editor
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
Insights from the VALUE Trial: Achieving blood pressure targets for renal protection
We thank Wang, Jiang and Zhou [1] for their interest in our paper [2]. We agree in their conclusions that the VALUE Trial [2,3] provides critical evidence to guide antihypertensive therapy in high-... 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
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
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
Benefits of intensive blood pressure control on cardiovascular mortality: ESPRIT and BPROAD change the scene
Two recent randomized clinical trials (RCTs) [1,2] are likely to influence upcoming Hypertension Guidelines regarding the blood pressure (BP) targets. The important findings of these two studies... more
Serum IL-18 in autoinflammatory diseases diagnosis: unresolved challenges
We read with great the article by Elhani et al. recently published in the European Journal of Internal Medicine [1]. This study attempts to establish the relationship between interleukin-18 (IL-18)... 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
Evidence that adequate vitamin D intake reduces cardiovascular disease risk. Author's reply
I thank the colleagues Grant and Boucher for their interest in my clinical insight article [1]. And I also thank them for giving me the opportunity to better clarify a concept already present in my... 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
Clinical epidemiological characteristics of BRASH syndrome
BRASH syndrome—characterized by bradycardia, renal failure, atrioventricular (AV) nodal blockade, shock, and hyperkalemia—has recently been recognized as a distinct clinical entity. This syndrome is... more
Protected discharge and combined interventions: A viable path to reduce hospital readmissions
Hospital readmissions within 30 days continue to be a challenge for healthcare systems, particularly in the case of frail, elderly patients and those with chronic diseases. From international studies... more
Clinical trial landscape for pulmonary arterial hypertension targeted therapy: Beyond vasodilators
Pulmonary arterial hypertension (PAH) is a multifaceted and lethal disorder characterized by elevated pulmonary pressures and right ventricular failure, ultimately leading to premature death. With an... more
Thromboembolic and bleeding risks in patients on anticoagulation after noncardiac surgery for malignancy
Atrial fibrillation (AF) and pulmonary embolism/deep vein thrombosis (DVT), all of which have an indication for anticoagulation, are observed commonly in patients with malignancy, regardless of... more
Refining the predictive value of nasal pressure swing in acute hypoxemic respiratory failure management
With great interest, we read about the study by Tonelli et al. on the predictive value of nasal pressure swing (Pnose) in assessing respiratory support dependency among patients with acute hypoxemic... more
Critical considerations for sodium bicarbonate therapy in metabolic acidosis: Addressing confounding factors and methodological limitations. Author's reply
Dear Editor,
Efficacy and safety of crinecerfont for the treatment of congenital adrenal hyperplasia
Congenital adrenal hyperplasia (CAH) is an autosomal recessive genetic disease that leads to an enzyme deficiency, the main consequence of which is the reduction in the production of cortisol and... more
Clinical factors associated with limited therapeutic implementation in patients with heart failure and reduced ejection fraction hospitalized in internal medicine wards
Heart failure (HF) affects over 56 million people globally and accounts for 1–2 % of all hospitalizations in the Western world [1]. Prevalence of HF rises with age, as patients over 70 years of age... more
Accuracy of glomerular filtration rate estimating equations in systemic sclerosis
Kidney involvement in Systemic Sclerosis (SSc) is primarily due to vasospasm induced by renal Raynaud's phenomenon, leading to hypoxia, impaired angiogenesis and microvascular dysfunction. Renal... more
Apixaban and the improved psychologic profile in frailty and disability. Myth or reality?
We thank Hung and Chao for their interest in our work [1]. Their letter [2] allowed us to specify some relevant aspects about APULEIO (Treatment satisfaction of Italian patients undergoing Apixaban... more
Serum angiopoietin-like protein 4 levels correlate with hypertriglyceridemia and renal function decline in pediatric patients with lupus nephritis
Lupus nephritis (LN) is the most common complication of systemic lupus erythematosus (SLE), with up to 70 % of pediatric SLE patients experiencing kidney involvement, and LN also aggravates the... more
Atrial fibrillation ablation versus medical therapy in heart failure with preserved ejection fraction
Heart failure with preserved ejection fraction (HFpEF) is a multifaceted and increasingly prevalent clinical syndrome that presents significant challenges in both diagnosis and management. Its... more
Why did it take forty years to uncover long-term fluoroquinolone associated toxicities?
Since fluoroquinolones (FQs) were introduced in 1986, 1 billion courses have been administered [1]. Safety announcements have been disseminated since 2016 in the United States (US), European Union (... more
Diastolic blood pressure variability predicts adverse outcomes in stabilized acute heart failure patients
Blood pressure variability; heart failure; Cardiovascular outcome; Diastolic blood pressure
Building on the UTILY Study: Exploring uncharted aspects of multidrug-resistant pathogens in urinary tract infections. Author's reply
Dear Editor,
More on peripheral artery disease and air pollution. Author's reply
Dear Editor,
Critical considerations for sodium bicarbonate therapy in metabolic acidosis: Addressing confounding factors and methodological limitations
I recently read the paper by Tong et al., which explores the clinical effects of sodium bicarbonate (SOB) therapy in metabolic acidosis, focusing on the interaction between baseline chloride levels... more
Utilizing D-dimer levels for predicting survival probability in unplanned hospital admissions: Insights from a 5-year nationwide population-based register study
Although the most common clinical use of D-dimer measurements is to rule out thromboembolic disease [1], it is also elevated in several other serious illnesses and raised levels are associated with a... more
Evidence that adequate provision of vitamin D reduces cardiovascular disease risks
We read with interest the clinical insight by Cimminiello regarding the role of vitamin D and cardiovascular risk [1]. He dismissed the epidemiological evidence that vitamin D deficiency is... more
Why doesn't sepsis rhyme with Internal Medicine?
I am writing to share some reflections on the challenges that internists face in the management of sepsis, a complex and multifactorial condition requiring a multidisciplinary approach. Despite the... more
Glucagon-like peptide–1 receptor agonist for patients with heart failure with preserved ejection fraction and obesity
Dear Editor,
Effect of newer glucose-lowering medications on chronic obstructive pulmonary disease exacerbations among individuals with type 2 diabetes
Type 2 diabetes mellitus (T2D) and chronic obstructive pulmonary disease (COPD) are prevalent chronic conditions that frequently coexist, contributing to significant morbidity and healthcare burden... more
Non-statistical significance and clinical relevance: Are we chasing shadows in the air pollution-peripheral artery disease debate?
The impact of air pollution on cardiovascular diseases has been a subject of extensive research, with compelling evidence linking long-term exposure to pollutants such as particulate matter (PM2.5),... more
Gut dysbiosis and leaky gut syndrome in moderately impaired amyotrophic lateral sclerosis patients
Dear Editor,
Considerations on the impact of apixaban on patient-reported outcomes in frail older adults
Dear Editor
Hemoglobin levels for the diagnosis of polycythemia vera: How high is high enough?
The World Health Organization (WHO) diagnostic criteria for Polycythemia Vera (PV), initially published in 2001 and 2008, were last revised in 2016. According to these criteria, evaluation for PV is... more
Evolution of care pathways in clinical practice guidelines for heart failure
In the context of the increasing complexity of patients with heart failure (HF) and the rapid expansion of available therapies, clinical practice guidelines (CPGs) have become indispensable for... more
Direct oral anticoagulants guided by CHA2DS2-VASc stratification for stroke prevention in patients with device-detected atrial fibrillation
Atrial fibrillation (AF) significantly increases stroke risk, with affected individuals having a fivefold higher likelihood compared to the general population. Oral anticoagulation (OAC),... more
Sodium-glucose cotransporter2 inhibitor-associated ketoacidosis in nondiabetic patients
Sodium-Glucose Cotransporter2-inhibitors (SGLT2i) were developed for treating diabetic patients. Empagliflozin and dapagliflozin, frequently prescribed SGLT2i, are now also recommended for... more
Factor XI/XIa inhibitors versus direct oral anticoagulants in atrial fibrillation
Dear Editor,
Reevaluating hypoxia and cancer as determinants of prognosis in COPD and Takotsubo syndrome. Author's reply
We thank García-Martí et al. for the interest in our study recently published in the European Journal of Internal Medicine [1], and here we provide further analysis following their stimulating... more
Rising ischemic stroke-related mortality among young adults in the United States: Insights from CDC WONDER
Ischemic Stroke-related mortality among young adults aged 25–64 years in the United States from 1999 to 2020.
Bedside CEUS: A feasible option to consider
Contrast-enhanced ultrasound (CEUS) is widely used for assessing the perfusion of specific organs or lesions. While CEUS has been extensively studied in outpatient settings, its use as a bedside... more
Refining risk assessment for intra-abdominal infections in immunocompromised intensive care unit patients. Author's reply
Dear Editor,
Tecovirimat and mpox: A regulatory balancing act between hope, hurdles, and high-risk populations
Tecovirimat (marketed as TPOXX in the United States and other regions) is an antiviral drug that targets orthopoxviruses, including smallpox, monkeypox (now mpox), and cowpox. Tecovirimat inhibits... more
Disability and caregivers in Italy: Results from an online survey
Disability is a condition with a significant impact on the quality of life of patients, on families who are often acting as their caregivers and on the society at large, with important economic... more
Building on the UTILY Study: Exploring uncharted aspects of multidrug-resistant pathogens in urinary tract infections
We have carefully reviewed the article by Onorato et al., published in the European Journal of Internal Medicine [1]. The study provides important insights into the prevalence of multidrug-resistant... more
Outcomes and readmissions in octogenarians and nonagenarians undergoing catheter ablation for atrial fibrillation in the United States
Dear Editor,
Frailty, disability and patient-reported outcomes in apixaban users
atrial fibrillation (AF) is the arrhythmia most frequently diagnosed in older patients with a prevalence higher than 10 % in subjects ≥70 years [1]. The incidence of venous thromboembolism (VTE),... more
Mortality in the first 24 hours after admission in the intensive care unit
Dear Editor,
Telerehabilitation in patients with long COVID-19 syndrome
Post-acute sequelae of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19), known as long COVID syndrome, is defined as new symptoms that occur beyond 3 months after... more
Obesity in Europe: Less impact on chronic diseases thanks to internists?
Defined by the WHO as the ‘new epidemic of the 21st century’, nowadays obesity has become an international public health issue [1], since it can cause a wide range of diseases and a growth in both... more
Trends in industry-sponsored research payments to internist principal investigators
In the United States, the Physician Payments Sunshine Act, passed by Congress as part of the 2010 Affordable Care Act, has brought greater transparency to financial relationships between industry and... more
Refining insights into rheumatoid arthritis-associated liver dysfunction: Opportunities for methodological advancements and clinical implications
We read with great interest the article by Arias-de la Rosa et al., published in the European Journal of Internal Medicine [1]. This study provides valuable evidence that patients with rheumatoid... more
Vaginal self-sampling for human papillomavirus to improve cervical cancer screening in patients with immune-mediated inflammatory diseases
Dear Editor,
Reevaluating hypoxia and cancer as determinants of prognosis in COPD and Takotsubo syndrome
Dear Editor,
Rituximab in Immune-mediated thrombotic thrombocytopenic purpura
Thrombotic thrombocytopenic purpura (TTP) is a rare and potentially fatal thrombotic microangiopathy, defined by a mechanical hemolytic anemia, severe thrombocytopenia, and visceral ischemia due to... more
Refining the understanding of cardiovascular risk following COPD exacerbations: Opportunities for stratified and multidisciplinary approaches
We have carefully reviewed the article by Calabria et al., published in the European Journal of Internal Medicine [1]. This study, based on a comprehensive database analysis, highlights the... more
Refining risk assessment for intra-abdominal infections in immunocompromised intensive care unit patients
The study by Paiva and colleagues [1] provides valuable insights into intra-abdominal infections (IAI) in immunocompromised intensive care unit (ICU) patients, highlighting similarities and... more
Analysis of “characteristics of familial mediterranean fever disease after 65 years of age”
I have read the article “Characteristics of Familial Mediterranean fever (FMF) after 65 years of age” with great interest. The study provides valuable insights into the clinical features and... more
Hypertension – a global problem requiring a comprehensive approach
We read with great interest a recently published study by Rikuta Hamaya, Molin Wang, Ellen Hertzmark, et al. regarding modifiable lifestyle factors in the primordial prevention of hypertension [1].... more
Risk for hospital-treated infections in dermatitis herpetiformis and coeliac disease
Dear Editor,
Risk of injurious falls in older people with atrial fibrillation
Dear editor,
Enhancing the understanding of hyperhomocysteinemia and MASLD: Addressing methodological limitations and future directions
To the editor:
Use of betablockers in post-myocardial infarction patients in a real-world setting
For many years, the main guidelines have been recommending the use of betablocker therapy in patients after myocardial infarction (MI) [1,2]. This recommendation entails a high class and grade for... more
High-risk allogeneic stem cells transplantation in advanced age patients with uncontrolled sickle cell disease
Sickle cell disease (SCD) is a recessive monogenic disease where a single nucleotide mutation of the HBB gene, encoding the β-globin chain of hemoglobin (Hb), leads to the synthesis of HbS.... more
Seasonality of diabetic ketoacidosis in hot climate
Diabetic ketoacidosis (DKA) is a life-threatening condition arising from an absolute or relative insulin deficiency, leading to hyperglycemia and ketone body accumulation in the blood with metabolic... more
Validating ChatGPT's role in systematic reviews and meta-analyses: A case study on GLP-1 receptor agonists and all-cause mortality
Dear Editor,
Optimizing socioeconomic and psychosocial factor analysis in myocardial infarction outcomes
Dear Editor,
Refining metabolic health assessment in inflammatory bowel disease risk prediction
Mi et al.'s investigation [1], drawing upon the United Kingdom (UK) Biobank resource, delves into the interplay between metabolic health and genetic predisposition to inflammatory bowel disease (IBD... more
Original Article
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
Natural history of the severe subtype of MYH9-related disease (Epstein syndrome)
Congenital thrombocytopenia, giant platelets, and Döhle-like bodies in granulocytes characterize MYH9-related disease (MYH9-RD). Clinical manifestations include deafness, nephritis, and cataracts [1,... more
Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome: A comprehensive review of cases across different ethnicities
Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic (VEXAS) syndrome is a recently described somatic autoinflammatory disease [1]. A genetic mutation in the UBA1 gene results in a deficiency of... more
Metabolic dysfunction-associated steatotic liver disease (MASLD). Assessing metabolic dysfunction, cardiovascular risk factors, and lifestyle habits
Steatotic liver disease (SLD), a hallmark of metabolic dysfunction, is closely associated with atherosclerotic cardiovascular disease (ASCVD). This study investigated gender differences, metabolic... more
Effectiveness and safety of telemonitoring compared with standard of care in people with type 2 diabetes treated with insulin: a national multicenter randomized controlled trial
The trial demonstrated that telemonitoring is superior to standard of care in T2D for improving glycemic control.
PEPPER – Prehospital prediction in pulmonary embolism: The association of the national early warning score with mortality, thrombolysis, and clinical outcomes
Pulmonary embolism (PE) requires careful risk assessment for informed care decisions. We evaluated the value of the National Early Warning Score (NEWS) in patients with PE when used by emergency... more
New onset left atrial dilatation in the general population: A quarter-century follow-up
Left atrial (LA) anatomical remodeling, detected by measuring the diameter or, more comprehensively, the volume with echocardiography is regarded as a marker of left ventricular (LV) diastolic... 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
Difficult-to-treat rheumatoid arthritis among elderly patients from the KOBIO registry
Rheumatoid arthritis (RA) is a chronic autoimmune disorder characterized by systemic inflammation the primarily affects the joints, resulting in pain, swelling, stiffness, and functional impairment [... more
Chronic kidney disease classification according to different formulas and impact on adverse outcomes in patients with atrial fibrillation: A report from a prospective observational European registry
Atrial fibrillation (AF) has an increasing incidence and prevalence with an aging population, and is associated with adverse cardiovascular events, stroke in particular, that can result in... more
Cost-effectiveness of daily home haemodialysis versus in-centre haemodialysis: A propensity score matching analysis based on real-world data from the French healthcare system
Home haemodialysis (HD) offers several advantages over conventional in-centre 3-times-weekly HD which have been summarised in recent reviews [1,2]. Among them are better preservation of health-... more
Impact of L-arginine and liposomal vitamin C supplementation on quality of life and daily life activities in patients with COPD: a randomized, multicenter, single blind, placebo-controlled trial (ILDA study)
Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease that involves lung parenchyma and the airways characterized by progressive airflow obstruction, reduced lung elastic recoil,... more
NT-proBNP to guide risk stratification after cardiac rehabilitation in patients with ST-segment elevation myocardial infarction
The use of N-terminal pro-brain natriuretic peptide (NT-proBNP) after ST-segment elevation acute myocardial infarction (STEMI) is unclear. We evaluated its prognostic significance after post-STEMI... more
Cerebral small vessel disease and cognitive dysfunction in relation to central systolic blood pressure
Cerebral small vessel disease (CSVD) represents cerebral microvascular disorders [1,2] and visualizes on magnetic resonance imaging (MRI) as white matter hyperintensities (WMH), microinfarcts,... more
Burden and risk factors for 30-day readmission and mortality after CAP hospitalization: A population-based cohort study
Community-acquired pneumonia (CAP) is considered the world’s most fatal infectious disease and is associated with a fundamental burden in healthcare and society [1]. 30-day mortality ranges from <... more
ICD-10-CM coding uncovers the gap between serological and clinically identified coeliac disease prevalence: A population-based study
Coeliac disease (CD) is one of the most common lifelong disorders and affects people of all ages worldwide [1]. A systematic review and meta-analysis reported that the global CD seroprevalence was 14... more
Aortic valve calcium as a novel risk marker for kidney function deterioration: The MESA study
Chronic kidney disease (CKD) is a major cause of morbidity and mortality globally [1,2] and shares many risk factors with atherosclerotic cardiovascular disease (ASCVD) [3,4]. Increasing evidence has... more
Derivation and validation of the Caravaggio score for the risk stratification for recurrence in patients with cancer-associated venous thromboembolism
Cancer associated venous thromboembolism (CAT) has a high risk of recurrence and treatment-emergent bleeding [1–4]. The identification of risk factors for venous thromboembolic (VTE) recurrence and... more
Mortality and causes of death in patients hospitalized with hyponatremia – a propensity matched cohort study
Hyponatremia is the commonest electrolyte imbalance, affecting more than one in 10 patients admitted to hospital [1]. Women, elderly, and individuals with comorbid burdens are generally at greater... more
The impact of sensitization patterns on COPD severity and exacerbations: Insights from a case-control and longitudinal study
Common to several allergic diseases is the generation of immunoglobulin E (IgE) by plasma cells, when exposed to an innocuous antigen [1]. Upon initial exposure to allergen, antigen presenting cells... more
Performance and costs of rule-out protocols for acute aortic syndromes: analysis of pooled prospective cohorts
Acute aortic syndromes (AASs) are life-threatening cardiovascular emergencies affecting 5–15 individuals per 100,000 person-years [1]. They are characterized by dissection, hematoma, ulceration or... more
Diagnostic accuracy of emergency department ECGs in hyperkalemia detection: A cross-sectional study
Hyperkalemia is a common condition in Emergency Departments (EDs) and can be fatal [1–3]. Hyperkalemia reduces conduction velocity and renders myocytes refractory to excitation. Dysrhythmias are... more
Serum interleukin-18 levels are specifically elevated in auto-inflammatory diseases involving the pyrin inflammasome: A study on 516 patients
Auto-inflammatory diseases (AIDs) are defined as dysfunction of innate immunity [1]. They can involve different pathways. Familial Mediterranean fever (FMF), Still's disease, Mevalonate Kinase... more
Isolated joint involvement in Whipple's disease: a cohort study
Whipple's disease was first described in 1907 by George Hoyt Whipple. Significant microbiological advances have since revolutionised our understanding of the disease, first with molecular biology and... more
Intermediate Care Units in Internal Medicine
A cornerstone of the reorganization challenge of hospital systems has been provided by the Progressive Patient Care (PPC) model [1], lying on the concept of pooling patients around the acuity of... more
Differential modulations of miRNAs in patients with systemic sclerosis-associated skeletal muscle loss
Systemic sclerosis (SSc) is a rare, complex autoimmune disease characterized by vasculopathy and fibrosis of the skin and internal organs. Clinical manifestations of SSc are the result of the... more
The role of an intermediate care unit in reducing intensive care unit admissions and improving patient outcomes in internal medicine: A quasi-experimental study
The optimal management of non-intensive critical patients remains a debated topic. This debate is further complicated by the fact that Intensive Care Units (ICUs) bed availability is regulated by... more
Association of miR-126-3p, miR-1260b and miR-374a-5p with the incidence of heart failure in a population-based cohort: the Hortega Follow-Up Study
The potential use of microRNAs (miRNAs), endogenous RNAs of approximately 22 nucleotides that play a regulatory role by targeting mRNAs for translational excision or repression [1,2], has gained... more
Doppler ultrasound unveils splanchnic arteries ischemia allowing early successful revascularization in symptomatic systemic sclerosis patients
Systemic sclerosis (SSc) is an autoimmune rheumatic disease where vasculopathy is one of the main hallmarks, and the gastrointestinal (GI) tract is one of the most affected systems [1,2]. In fact,... more
Excess mortality of critically ill patients aged ≥90 years in intensive care units: A retrospective cohort study
We live in an aging society, which is foremost caused by increasing life expectancy, next other factors. In concordance, at least the sheer number of older patients increases, too. When those older... more
R202Q homozygosity of Mediterranean fever gene is associated with atypical clinical phenotype of familial Mediterranean fever
Autoinflammatory disorders represent a heterogenous group of genetic or acquired systemic diseases characterized by febrile episodes and chronic inflammation, due to dysregulation of innate immunity... more
Recurrent pericarditis with normal C-reactive protein: Clinical and laboratory features, biomarkers and outcome in a non-inflammatory phenotype
Idiopathic recurrent acute pericarditis (IRAP) significantly affects patients’ quality of life, imposing a psychosocial burden, alongside risks of complications, treatment-related adverse effects,... more
Gendered social determinants of health and risk of major adverse outcomes in atrial fibrillation
The global population is aging and the burden of atrial fibrillation (AF) is expected to rise sharply over the next decades [1,2]. Beyond a fivefold increase in stroke risk, individuals with AF... more
Assessment of nasal pressure swing predicts respiratory support dependency in patients with hypoxic respiratory failure
In recent years, particularly following the COVID-19 pandemic, there has been increasing interest in non-invasive respiratory support (RS) to manage the acute hypoxemic respiratory failure (AHRF) [1–... more
Assessment of cardiovascular, thromboembolic and cancer risk in patients eligible for treatment with Janus Kinase inhibitors: The JAK-ERA multidisciplinary consensus
Janus kinase inhibitors (JAKi), a class of targeted synthetic disease-modifying antirheumatic drugs, have significantly impacted clinical practice in the treatment of various autoimmune and... more
Promoting women's careers in life science and medicine: A position paper from the “International Women in Intensive Medicine” network
It is well-established that women are underrepresented in leadership positions [1], undervalued in their academic careers, and experience gender discrimination in scientific and healthcare... more
Hypertensive heart disease in older patients: considerations for clinical practice
Appropriate blood pressure (BP) control remains the main therapeutic strategy to address the adverse sequelae of hypertension irrespective of a patient's age [1]. A patient group that is continuously... more
Risk of hepatic decompensation or HCC is similar in patients with ALD- and MASLD-cirrhosis: A population-based cohort study
Patients with a chronic liver disease often develop liver cirrhosis after a certain time if their disease is not appropriately managed, and cirrhosis was the cause of death in 2.4 % of all deaths... more
Clinical familial hypercholesterolemia - factors influencing diagnosis and cardiovascular risk in the general population
Heterozygous familial hypercholesterolemia (FH) is an autosomal, dominant disorder of lipoprotein metabolism. The disease is estimated to affect 1:250 of individuals in Western populations [1–3].... more
Comparative analysis of obesity indices in discrimination and reclassification of cardiovascular disease risk: The ATTICA study (2002–2022)
In the mid-2010s, after four decades of consistent decline, the mortality rate from heart disease began to show an increasing trend. This shift was largely attributed to the growing obesity epidemic... more
Characterization of ischemic etiology in heart failure with reduced ejection fraction randomized clinical trials: A systematic review and meta-analysis
Heart failure (HF) is a major cause of cardiovascular (CV) morbidity and mortality in developed countries with rising prevalence due to the aging of the population, the poor control of CV risk... more
Advancing women's health with a pioneering implant to treat breast cancer related lymphedema
Lymphedema (LE) is a frequent, but often overlooked condition, with secondary LEs accounting for approximately 82.5% of cases [1]. It typically arises from lymphatic vessel damage or obstruction... more
High-flow nasal oxygen therapy in patients with hypercapnic respiratory failure: A systematic review and meta-analysis
Noninvasive ventilation (NIV) has been used to treat acute respiratory failure for more than 30 years, and it is undoubtedly one of the most important advances in respiratory support [1]. With the... more
Lipoprotein(a) and prothrombotic effects: Evidence from a genetic association study
Lipoprotein(a) [Lp(a)] is an apoB-containing lipoprotein bound to a hydrophilic, highly glycosylated protein called apolipoprotein(a) [apo(a)] [1]. Apo(a) is encoded by the LPA gene, and Lp(a)... more
Risk trajectory of cardiovascular events after an exacerbation of chronic obstructive pulmonary disease: A systematic review and meta-analysis
Chronic obstructive pulmonary disease (COPD) is primarily a respiratory condition characterized by irreversible airflow limitation and multiple debilitating symptoms, including dyspnea, cough, and... more
Safety and efficacy of early initiation of sodium-glucose co-transporter inhibitors 2 in patients hospitalized for acute heart failure: A meta-analysis of randomized controlled trials
Acute heart failure (HF) is a clinical syndrome with multiple aetiologies, among which acute coronary syndrome constitutes one of the most frequent precipitating factors, especially in developed... more
What is the impact of thiamine deficiency on cognitive function in patients with alcohol use disorder? – A systematic review
Cognitive impairments, frequently observed in Alcohol Use Disorder (AUD) patients, range from severe memory impairment with other cognitive functions relatively preserved seen in Korsakoff's Syndrome... more
Effects of population-based screening for atrial fibrillation on quality of life
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an increased risk of stroke, heart failure, and mortality [1]. Many cases of AF remain undetected due to no or... more
Adverse effects of late sleep on physical health in a large cohort of community-dwelling adults
Human health is influenced by a myriad of factors, including genetics, environment, and behavior. One behavior that has received significant recent attention is the impact of sleep on human health.... more
Review Article
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
Cogan's syndrome. A comprehensive review
Cogan Syndrome (CS) is a rare systemic vasculitis affecting the inner ear and the eye with systemic manifestations described first in 1945 by David G. Cogan as a “syndrome of non-syphilitic... more
The medical ward round: evidence, pitfalls, and tips
Ward rounds are pivotal for patient-centered care and bedside teaching. In today’s hospitals, care is provided by multidisciplinary and multiprofessional teams. To conduct an effective and efficient... more
Drug-induced hyponatremia in clinical care
Over the last decades, advances in understanding of previously described associations have important implications for diagnosis and workup of hyponatremia. In addition, new drug groups potentially... more
Tailoring non-invasive respiratory supports in acute hypoxemic respiratory failure: A practical approach for clinicians
The use of non-invasive respiratory support (NIRS) for acute respiratory failure (ARF), particularly hypoxemic respiratory failure, has advanced in recent years, especially during the COVID-19... more
Avian flu: a swooping threat or just a volatile menace? What clinicians need to know
Avian flu is a cause of emerging fears among citizens and health care providers. In this review article, we provide the practicing Internal Medicine physician with a concise update regarding... more
A physico-chemical explanation for the litho-protective effects of obeticholic acid in low phospholipid-associated cholelithiasis
Prevalence of gallstones in the adult European population is ̴20 % (mostly cholesterol stones in the gallbladder). Obesity, metabolic syndrome, type 2 diabetes, female sex, pregnancy, multiparity and... more
Cancer genetic profile and risk of thrombosis
The occurrence of a venous thromboembolic event (VTE) among cancer patients has been rising steadily by up to threefold in some series with respect to the general population [1–3]. This risk is... more
Ultra-processed foods and cardio-kidney-metabolic syndrome: A review of recent evidence
The rapid rise in ultra-processed foods (UPFs) has become a significant public health concern worldwide [1]. UPFs are typically high in unhealthy fats, refined sugars, refined carbohydrates, sodium,... more
Tularemia for clinicians: An up-to-date review on epidemiology, diagnosis, prevention and treatment
After its first description in the 1910s in the Tulare county of California associated with a massive die off of ground squirrels and initially misdiagnosed with bubonic plague, by 1935 tularemia had... more
How to promote healthy aging across the life cycle
The global population of older adults has grown rapidly in recent years. In Europe, this percentage ranks among the highest, with 21.3 % of the population aged over sixty-five [1]. Projections... more
Comprehensive management of pneumonia in older patients
Pneumonia is a bacterial, viral, fungal, or parasitic infection of lung parenchyma, resulting in significant local and systemic inflammation. Pneumonia is the leading infectious cause of... more
Bridging the gap: Time to integrate sex and gender differences into research and clinical practice for improved health outcomes
It is widely recognized that sex and gender interact with factors such as genetic background, ethnicity, socioeconomic status, disability, and age, thus influencing health status and disease. The... more
Beyond creatinine: New methods to measure renal function?
The kidneys play a central role in maintaining the body's homeostasis, performing a wide range of vital functions. They eliminate unnecessary and potentially toxic metabolic waste products, such as... more