March 2024
64 ArticlesNo Section
The prophylaxis of venous thromboembolism in medical patients: If you do it, do it right
The study by Le Gal et al. [1] published in this issue of European Journal of Internal Medicine, offers the starting point for a series of remarks on the prophylaxis of venous thromboembolism (VTE)... more
Asymptomatic hyperuricemia and cardiovascular mortality: A matter of mechanisms?
Chronic hyperuricemia may result from increased purine catabolism through endogenous and/or dietary sources including fructose, alcohol, and purine-rich foods like certain meats and seafood [1]. In... more
Impact of rehabilitation treatment during the acute phase of SARS-CoV-2 infection
The coronavirus disease 2019 (COVID-19) pandemic had major repercussions on the health status of the general population, with significant health-related economic and social consequences [1]. A long... more
Beyond the Guidelines
Rationale of treatment recommendations in the 2023 ESH hypertension guidelines
We thank Drs. Verdecchia, Grossmann and Whelton for their interest and comments on the 2023 Guidelines on Hypertension of the European Society of Hypertension (ESH) [1]. The points they raise are... more
Clinical Insights
Interventions targeting LGBTQIA+ populations to advance health equity
The role of the physician is not limited to the provision of clinical care, but must also extend to identifying barriers to accessing care that patients encounter. As doctors we are called and must... more
Colchicine and cardiovascular prevention
“Scientia semper incerta est, expedit ut iudicium suspendat”Attributable to Marcus Tullius Cicer (106 b.C. – 43 b.C.)
Differences and similarities in interatrial shunts management
The most common types of interatrial communications are represented by the ostium secundum, ostium primum and sinus venosus defects. Specifically, the ostium secundum atrial septal defects (ASD)... more
Commentary
Harnessing machine learning for the early prediction of ventilator-associated pneumonia: A leap towards precision in critical care
The potential of medical applications of Artificial Intelligence (AI)/ Machine Learning (ML) has generated growing interest in recent years as AI/ML is anticipated to significantly influence not only... more
Beyond sex and gender: Call for an intersectional feminist approach in biomedical research
In recent years, a growing focus on the theme of gender has emerged in biomedical research. Inclusion of sex and gender dimensions is crucial to conduct “rigorous, reproducible and responsible... more
A pulmonary perspective on current challenges in connective tissue diseases
Connective tissue diseases (CTD) are systemic diseases and as such can affect any organ. Why then should we focus on the lungs in particular, now more than ever? And why do we need a review on... more
Long COVID autonomic syndrome: Improved understanding through translational research
SARS-CoV-2 descended on humanity in 2020 as an acute virus causing millions of excess deaths and suffering [1]. Early research into antibody use, antivirals and the development of vaccines lead to... more
Electrocardiogram to guide early discharge in hemodynamically stable pulmonary embolism patients
The current European Society of Cardiology guidelines (ESC) on the management of patients with acute pulmonary embolism (PE) recommend a risk adapted management for therapy and discharge [1].... more
When the responsibility for a crime is shared between several actors. The case of hypertensive heart failure with preserved ejection fraction
The current issue of the Journal hosts an important Review Article authored by leaders in Hypertension research [1]. The title of the Review may leave the mind open to the hope that at least one of... more
Ideas and Opinions
Trial sequential analysis methodology for interpreting meta-analytical findings
In evidence-based medicine, systematic reviews and meta-analyses lie on top of the hierarchy of evidence [1]. This holds true also in the field of cardiovascular medicine, with meta-analyses often... more
Urgent and emergency care in europe: Time for a rational network?
Spanning from helicopters and ambulances to hospital intensive care units, emergency and urgent care are required for respectively life-threatening and non-life-threatening sudden needs that require... more
Internal Medicine Flashcard
Unexpected myocardium: Benign finding or pathological debut?
A 24-year-old male without cardiovascular risk factors or family history, presented with a ten-day history of recurrent angina pectoris, accompanied by diaphoresis, dyspnea and nausea. Physical... more
Recurrent generalized rounded plaques
A 40-year-old man attended to the emergency department with a one-day history of generalized painful lesions. He was on tramadol for a clavicle fracture. Six hours before the appearance of the... more
A keloid-like tumour
A 37-year-old male with no relevant past medical history, had a 5-year work history as a farmer in the Colombian Amazon River area, and presented with a 2-year history of a nodular, hyperpigmented... more
An unusual cause of ischemic stroke
A 60-year-old Japanese woman had a history of ischemic stroke. She had no risk factors including a history of transient ischemic attack (TIA), hypertension, myocardial infarction, atrial fibrillation... more
Letter to the Editor
Strengthening insights into sleep duration and chronic diseases: A call for comprehensive consideration of family history, socioeconomic factors, dietary patterns, and age dynamics
We read the article by Yaoling Wang et al. [1] with great interest. We extend our heartfelt gratitude to the authors for their thorough and careful examination of this crucial subject, which merits... more
The role of novel nicotine-containing products on SARS-CoV-2 infection and COVID-19 progression
A relatively low smoking prevalence was observed among COronaVIrus Disease 19 (COVID-19) patients [1]. Some researchers, whose link to the tobacco industry cannot be ruled out in some cases [2],... more
JAK2-V617F-mutated myeloproliferative neoplasms: A cannot be missed cause of symptomatic postoperative epidural hematoma after lumber spine surgery
We read with great interest the article by Gregoire Stalder published in the European Journal of Internal Medicine [1]. We appreciate the authors’ great work. Compared with their findings that... more
Effect of tirzepatide on blood pressure levels in overweight/obese individuals without diabetes
Tirzepatide is a novel dual gastric inhibitory polypeptide (GIP)/glucagon-like peptide-1 (GLP-1) receptor co-agonist recently approved for the treatment of type 2 diabetes (T2D) and obesity. It... more
Risk factors and complications associated with superficial venous thrombosis
I am writing to shed light on the critical and multifaceted issue of superficial venous thrombosis (SVT), a condition which is evolving from its perceived benign nature to one that is potentially... more
“Exploring sarcoidosis systemic treatment: Patient factors and therapeutic strategies. Author's reply”
We appreciate Rahman et al.’s interest and positive comments [1] in relation to our article published in the European Journal of Internal Medicine [2]. In this regard, we would like to make some... more
Early intervention is important when administering glucarpidase for methotrexate intoxication
Giuseppe Miceli and colleagues describe in a letter recently published in the European Journal of Internal Medicine [1] the case of a patient with methotrexate intoxication who received treatment... more
Elevated cardiac biomarkers in relatively healthy U.S. adults
Cardiovascular disease (CVD) is the leading cause of death in the United States [1]. Prevention of CVD events often relies on early identification of higher risk individuals based on known CVD risk... more
Prognosis of hospitalized patients during different pandemic waves in Greece: Omicron innocent until proven guilty?
The coronavirus disease 2019 (COVID-19) pandemic had a tremendous impact on almost all aspects of life. More than 776 million confirmed cases of COVID-19 globally have resulted in 7 million deaths,... more
Novel technique of measuring diaphragm thickness using computed tomography and its potential for predicting prognosis of pneumonia
The diaphragm is an essential skeletal muscle responsible for respiration [1]. However, the significance of measuring its muscle mass and function remains largely unexplored. In particular, it is... more
The medical history taking in elderly patients from Hippocrates to the Health Care Information Technology age
The reorganization of the healthcare system in the last decades has dramatically reduced the time available for medical examination, so collecting medical history can be particularly challenging for... more
Association of incident cardiovascular events with unilateral low ankle-brachial index and bilateral low ankle-brachial index
The ankle-brachial index (ABI) represents a dependable approach to the early detection of lower extremity peripheral arterial disease, rendering it a valuable vascular marker for cardiovascular (CV)... more
Pyrin-associated autoinflammatory disease with p.Thr577Ala MEFV somatic mutation
Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease worldwide. FMF is classically a recessive disease due to mutations in exon 10 of the MEFV gene and affects... more
Novel antidiabetics for the primary prevention of cardiopulmonary diseases
Glucagon-like peptide 1 receptor agonists (GLP1RAs) have been recommended for preventing cardiorenal events in patients with type 2 diabetes (T2D) [1], and sodium-glucose cotransporter-2 inhibitors (... more
Phenotyping pleural effusion in patients hospitalized in Internal Medicine wards with decompensated heart failure
Acute decompensation of heart failure (ADHF) is the most common reason for hospitalization in patients above the age of 65 years in Western countries [1]. Congestion represents a key clinical feature... more
Visualizing diagnostic “hotspots” in a tertiary hospital
The Current healthcare system in the tertiary hospital has become highly specialized to focus on patients’ organ-specific problems, and patients expect to receive such specialized care [1]. On the... more
Chronic heart failure: An appropriate clinical context to search for GH deficiency?
Until the beginning of the 90′s, it was commonly thought that adult-onset Growth Hormone Deficiency (GHD) did not bear any clinical relevance. Since then, several studies have systematically... more
Non-pharmacological home remedies used by primary care patients
Non-pharmacological home remedies (NPHRs) have been used for generations, yet there is limited evidence on their conditions of use, effectiveness, and safety profile in high-income countries. However... more
Usefulness of multi-organ point-of-care ultrasound as a complement to the diagnostic process in an Internal Medicine outpatient clinic
Point-of-care ultrasound (POCUS) has experienced a great development in the last decade. As it was initially used in emergencies, it accelerated the diagnosis process and improved the diagnostic... more
Original Article
Event rates and risk factors for venous thromboembolism and major bleeding in a population of hospitalized adult patients with acute medical illness receiving enoxaparin thromboprophylaxis
Venous Thromboembolism (VTE) related morbidity in patients hospitalized with acute medical illness may account for over 50 % of the overall burden of VTE. [1–7] Several randomized controlled trials (... more
Early prediction of ventilator-associated pneumonia with machine learning models: A systematic review and meta-analysis of prediction model performance✰
Although lifesaving, mechanical ventilation predisposes patients to ventilator-associated pneumonia (VAP), which is the most serious respiratory infection, occurring in 23.5–39.3 % (12.2 to 22.4... more
How to recognize pulmonary embolism in syncope patients: A simple rule
Pulmonary embolism (PE) is a known and potentially serious cause of syncope but the prevalence of PE in patients presenting with syncope remains unclear. In particular, while PE is reported as a rare... more
Direct oral anticoagulants are associated with lower risk of dementia in patients with atrial fibrillation
Both atrial fibrillation (AF) and dementia have evolved into silent epidemics which convey significant health-related, societal and financial burden. The number of patients with AF are expected to... more
Long-term cardiovascular events, graft failure, and mortality in kidney transplant recipients
Kidney transplant recipients are at increased risks of cardiovascular events, but contemporary risk estimates are sparse. Using the Danish nationwide administrative databases, we quantified 1- and 5-... more
Prevalence, predictors and outcomes of physician care left undone in acute care hospitals across six European countries during COVID-19: A cross-sectional study
Healthcare is becoming increasingly complex [1]. The COVID-19 pandemic arose, in many countries, in a context of prolonged underinvestment, with reduced staffing levels relative to need and poor... more
Anticoagulation in atrial fibrillation. A large real-world update
Oral anticoagulant treatment (OAT) is strongly recommended for the prevention of ischemic stroke or systemic embolism in patients with non-valvular atrial fibrillation (NVAF) and additive risk... more
Glycemic control and prescription profiles in internal medicine inpatients: The role of frailty
The number of adults over 65 years of age with diabetes mellitus (DM) is increasing worldwide and is estimated to reach 26.7 million by 2050 [1]. Accordingly, hospital admissions for adults over 65... more
One-year outcomes following a hypertensive urgency or emergency
Hypertensive urgencies (HU) or emergencies (HE) are characterized by a variable clinical presentation in patients with acute blood pressure (BP) increase to levels > 180/110 mmHg. According to the... more
Crohn´s disease is an independent risk factor for liver fibrosis in patients with inflammatory bowel disease and non-alcoholic fatty liver disease
Inflammatory Bowel Diseases (IBD) are chronic inflammatory pathologies that mainly affect gastrointestinal tract, including Crohn´s Disease (CD), Ulcerative Colitis (UC) and Indeterminate Colitis (IC... more
Hyperuricaemia-associated all-cause mortality risk effect is increased by non-impaired kidney function – Is renal hyperuricaemia less dangerous?
Elevated serum uric acid (SUA) level, i.e., hyperuricaemia, is independently associated with all-cause mortality as well as with several cause-specific types of mortality [1–9]. It has been... more
Role of sex and gender-related variables in development of metabolic syndrome: A prospective cohort study
Metabolic syndrome (MetS), defined as clustering of abdominal obesity, insulin resistance, dyslipidemia, and elevated blood pressure, is strongly associated with cardiovascular related mortality and... more
Systolic blood pressure is associated with abnormal alterations in brain cortical structure: Evidence from a Mendelian randomization study
Hypertension, a prevailing global health concern, has long been recognized as a critical risk factor for cerebrovascular diseases [1–3] and cognitive impairment [4–6]. It is characterized by... more
Chronic inflammatory diseases increase the risk of post-thrombotic syndrome: A prospective cohort study
Clinical management of patients with deep vein thrombosis (DVT) is centered around their risk of recurrent venous thromboembolism (VTE) and post-thrombotic syndrome (PTS) [1]. In both conditions,... more
Effects of the implementation of the dynamic silver code in the emergency department
Older patients represent an increasing share of Emergency Department (ED) visitors worldwide [1]. Because of their complex medical and social problems, older patients in the ED require longer... more
Uncovering a dose-response relationship between positive fecal immunochemical test (FIT) and all-cause, cardiovascular and cancer-related mortality
The introduction of the fecal immunochemical test (FIT) for colorectal cancer (CRC) screening has brought significant advantages over the previous guaiac fecal occult blood test (gFOBT), particularly... more
Legionella pneumonia in hospitalized adults with respiratory failure: Quinolones or macrolides?
Legionellosis represents an important public health problem throughout the world, although it is considered as an underdiagnosed and underreported disease. Morbidity and mortality remain high, as... more
Impact of bronchoalveolar lavage on the management of immunocompromised hosts
BAL leads to changes in management in the majority of immunosuppressed patients. There is a high prevalence of multimicrobial infections and respiratory viral infections in immunocompromised patients... more
Prognostic significance of quantitative electrocardiographic parameters in patients with non-high-risk pulmonary embolism
Acute pulmonary embolism (PE), a common acute cardiovascular disease, has an annual incidence of 39∼120 cases per 100 000 population [1,2]. The incidence is increasing because of global population... more
The Long-COVID autonomic syndrome in hospitalized patients: A one-year prospective cohort study
A growing body of evidence [1–6] suggests that some patients who survive an acute SARS-CoV-2 viral infection (COVID-19) may experience persistent symptoms for months, resulting in a clinical syndrome... more
Review Article
Whipple's disease: A rare disease that can be spotted by many doctors
Whipple's disease (WD) is a chronic, systemic, relapsing infection theoretically capable of affecting any organ, but primarily affects the joints, the mucosa of the small intestine, and the central... more
The diagnostic approach and management of hypertension in the emergency department
Cardiovascular disease is the leading cause of death worldwide, and hypertension is the main cardiovascular risk factor. Despite the increased use of antihypertensive medications, the prevalence of... more
Non-conventional immunomodulation in the management of sepsis
Sepsis remains a critical global health issue, demanding novel therapeutic strategies. Traditional immunomodulation treatments such as corticosteroids, specific modifiers of cytokines, complement or... more
The current best drug treatment for hypertensive heart failure with preserved ejection fraction
Heart failure (HF) affects 2.4 % of the American population and is expected to rise to 3 % by 2030 [1]. The prognosis of HF remains poor, with 5-year mortality above 50 % [2,3]. The fact that ACEIs... more
Residual cardiovascular risk: When should we treat it?
Cardiovascular disease (CVD) remains a major health problem worldwide and especially in the European Union (EU) with an incidence of 12.7 million new CVD cases per year, 2.2 million deaths in females... more
Respiratory involvement in connective tissue diseases
Rheumatology is a special area of internal medicine engaged with the diagnosis and care of rheumatic, autoimmune and auto-inflammatory diseases (ARD) involving not only the muscles and the bones but... more