May 2022
30 ArticlesClinical Insights
Saving the kidneys in the lupus patient: Beyond immunosuppression, the need to collaborate across multiple disciplines
Systemic lupus erythematosus (SLE) is the classical systemic autoimmune disease with heterogeneous manifestations and unpredictable behaviour in which almost 70% may have a relapsing-remitting course... more
Commentary
Preventing re-admission: Are general practitioners the solution?
In the United States the Hospital Readmissions Reduction Program (HRRP) is a Medicare value-based purchasing program that encourages hospitals to improve communication and care coordination to better... more
Embolic stroke of undetermined source and atrial cardiopathy: Towards a personalized antithrombotic strategy for secondary stroke prevention
An 82-year-old hypertensive woman with a history of myocardial infarction is admitted with aphasia and weakness of the right arm and leg. Admission electrocardiogram shows sinus rhythm. During... more
Uric acid and cardiovascular risk stratification in the acute coronary syndromes: a friend we should mind
Uric acid (UA) is the end product of purine metabolism. Whilst being primarily known as the leading risk factor for the onset of gout [1], UA has also been acknowledged as a significant CV risk... more
Atrial fibrillation and troponin elevation: It's time to give up the chase to diagnosis and step forward with prognosis
Atrial fibrillation (AF) is the most common sustained arrhythmia with an estimated prevalence in adults as high as 4%. AF negatively affects the quality of life and it is associated with incident... more
Internal Medicine Flashcard
Chest pain in a Ukrainian woman living in Italy immediately after news of homeland Russian invasion.
A 54-year-old Ukrainian woman without cardiovascular risk factors presented with left-sided chest pain. The symptom appeared as soon as she got the news from her relatives in Ukraina of the beginning... more
Extrapyramidal dysfunction in cirrhosis: Is hepatic encephalopathy the only answer?
A 68-year-old male with a history of alcohol-related cirrhosis presented with persistent tremor, gait ataxia and choreiform movements of upper limbs over the past 4 days. The patient, that assured... more
Telangiectasias in a row
A 29-year-old man presented with an 11-year history of asymptomatic venous telangiectasias forming a sinuous line along the anterolateral part of the thorax at the level of the lower ribs and xiphoid... more
A diagonal earlobe crease
A 67-year-old man had a medical history of type 2 diabetes mellitus, dyslipidemia, hypertension, and alcohol-related liver disease. His vital signs were normal, and he had no symptoms. On physical... more
Letter to the Editor
Advocating early identification and diagnosis of IgG4-related disease in various clinical specialties
IgG4-related disease (IgG4-RD) is a multi-system immune disease. An elevated serum level of IgG4 is one of the characteristics of IgG4-RD and can be used as an index for preliminary screening. While... more
P-wave dispersion as a marker of atrial cardiopathy in embolic stroke of undetermined source. Author's reply.
Dear Editor,
P-wave dispersion as a marker of atrial cardiopathy in embolic stroke of undetermined source
Dear editor,
Acute coronary syndromes during the first and the second wave of COVID-19
The deleterious side effects of the coronavirus disease 2019 (COVID-19) pandemic on cardiovascular disease have been widely reported [1–3]. However, most data refer to March and April 2020.... more
T-cell response to 3 doses of Sars-Cov2 BNT162b2 Pfizer vaccine in long term rituximab treated patients
B-depleting therapies increase the risk of severe COVID-19 [1] and have been shown to induce an impaired immune response to the SARS-COV2 vaccine [2]. There is a lack of data exploring the T-cell... more
Efficacy and safety of therapeutic vs. prophylactic bemiparin in noncritically ill patients with COVID-19 pneumonia
Thrombotic and thromboembolic phenomena are one of the leading complications and causes of poor outcomes in COVID-19 patients admitted to hospital [1]. In the pathophysiology of pulmonary and... more
The impact of oral anticoagulant drugs for arterial thromboembolism in patients with cancer
cancer is a known independent risk factor for venous thromboembolism (VTE)[1]. However, in recent years, its role also as a risk factor for arterial thrombotic events (ATE) has been elucidated[2].... more
Secondary hyperaldosteronism and liver fibrosis in patients with compensated chronic liver disease or portal hypertension
Among edematous disorders, liver cirrhosis (LC) is considered one of the main models of secondary hyperaldosteronism (SH), as pointed out by several studies in the past [1]. Aldosterone is expected... more
Appropriate dosing of the individual direct oral anticoagulants in atrial fibrillation: Differences in the questions to be answered
Direct oral anticoagulants; Apixaban; Dabigatran; Edoxaban; Rivaroxaban
One-year mepolizumab for Allergic bronchopulmonary aspergillosis: Focus on steroid sparing effect and markers of response
Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to Aspergillus fumigatus, mainly characterized by severe asthma symptoms, hyper eosinophilia in blood, lung and... more
Original Article
Physical decline and cognitive impairment in frail hypertensive elders during COVID-19
Frailty is a biological syndrome of decreased physiological reserves with incremented vulnerability to stressors and its prevalence among older adults has been estimated at ∼10% [1]. Hypertension is... more
Thrombotic events following Covid-19 vaccines compared to Influenza vaccines
The actual risk of thrombotic events after Covid-19 vaccination is unknown.
Heart failure and catheter ablation of atrial fibrillation: Navigating the difficult waters of heart failure phenotypes
The use of catheter ablation of atrial fibrillation (AFA) is increasing and it has now been extended to include higher risk patients, e.g. those with heart failure (HF). Most observational studies... more
Cardiac troponins and adverse outcomes in European patients with atrial fibrillation: A report from the ESC-EHRA EORP atrial fibrillation general long-term registry
Cardiac troponins (cTn) are the preferred biomarkers for the detection of myocardial injury and the diagnosis of myocardial infarction (MI) [1–3]. However, with the advent of high-sensitivity (hs)-... more
Antiseptic barrier caps in central line-associated bloodstream infections: A systematic review and meta-analysis
Central venous access devices are indispensable in modern healthcare but their use come with an inherent patient safety risk [1,2]. Catheter-associated bloodstream infections represent 10%-20% of all... more
In postmenopausal women, lower limb peripheral arterial disease, assessed by ankle-brachial index, may be a strong predictor of cardiovascular risk
Lower limb peripheral arterial disease (PAD) is the third most common clinical manifestation of atherosclerosis after ischemic heart disease and stroke [1]. It is associated with both significant... more
Prevalence of markers of atrial cardiomyopathy in embolic stroke of undetermined source: A systematic review
The majority of cryptogenic strokes are likely embolic; these have been termed “embolic strokes of undetermined source’’ (ESUS) [1]. One out of four ischemic strokes occurring in young (≤50 years)... more
Uric acid associated with acute heart failure presentation in Acute Coronary Syndrome patients
Uric Acid (UA) has been related to the development of fatal and non-fatal Cardio-Vascular (CV) events in the general population [1] as well as in patients experiencing an Acute Coronary Syndromes (... more
Associations between post-discharge medical consultations and 30-day unplanned hospital readmission: A prospective observational cohort study
Early readmission after hospital discharge is frequent, partly preventable, and puts a heavy burden on healthcare systems [1,2]. Many risk factors—like adverse drug events [3], physician workload [4... more
Review Article
Optimizing antibiotic therapies to reduce the risk of bacterial resistance
The incidence of infections caused by bacteria that are resistant to antibiotics is constantly increasing. Infections with resistant bacteria are associated with higher morbidity, mortality and costs... more
Heart failure with preserved ejection fraction: Squaring the circle between comorbidities and cardiovascular abnormalities
The original descriptions of Heart Failure (HF) with preserved ejection fraction (HFpEF) dates back to the mid-1980s, and, for approximatively a decade, studies on this HF subtype consisted of... more