April 2022

34 Articles

Beyond the Guidelines

Critical appraisal of international adult bronchiectasis guidelines using the AGREE II tool

21 January 2022
Author(s): Sofia Tejada, Sergio Ramírez-Estrada, Alexandre M. Tejo, Carlos G. Forero, Xavier Pomares, Miguel Gallego, Joan B. Soriano, James D. Chalmers, Jordi Rello

Bronchiectasis is a chronic respiratory disease, characterized clinically by a persistent cough, excessive sputum production, bronchial infection, and abnormal and permanent dilatation of the bronchi... more

Clinical Insights

Psoriasis and risk of myocardial infarction: Uncertain link, costly implications

14 February 2022
Author(s): Stefano Savonitto, Giovanni Damiani, Delia Colombo

Psoriasis is a chronic, immune-mediated inflammatory disease of the skin affecting about two percent of the population with relatively similar burden among men and women throughout all age groups [1... more


High sensitivity troponins: From the acute setting to the general population

5 March 2022
Author(s): Daniel Caldeira

Troponins are proteins essential for the contraction of the myocardium and currently cardiac troponin I and cardiac troponin T are used as blood biomarkers to assess myocardial injury1,2.

A non-invasive score for nonalcoholic fatty liver disease (NAFLD) cirrhosis

3 March 2022
Author(s): Koen C. van Son, Maarten E. Tushuizen, Adriaan G. Holleboom, Joost P.H. Drenth

Currently the global prevalence of non-alcoholic fatty liver disease (NAFLD) is estimated to be around 25% for the general adult population [1], with estimates over 50% in populations with type 2... more

Internists or specialists-that is the question!

13 February 2022
Author(s): Antonello Pietrangelo

Over the past few decades the rising burden of chronic disorders and multimorbidity has heavily challenged health systems worldwide. In general terms, the architecture of a healthcare service should... more

Prediction tools in clinical practice: Carefully read instructions before use

4 February 2022
Author(s): Ludovico Furlan, Francesca Gianni, Giorgio Costantino

Decisions in clinical practice, especially in the acute setting where identification of potentially unstable patients is critical, are hard to be made. They rely, or should rely, on the clinical... more

Surprising outcomes of general internal medicine care versus specialty care in acutely admitted medical patients

6 January 2022
Author(s): Marcel Levi

Biomedical knowledge, resulting in better treatment for patients, is accumulating at a breathtaking pace. As these developments occur, in some situations medicine gets increasingly complex, requiring... more


Corrigendum to ‘Adiponectin involved in portal flow hepatic extraction of 13C-methacetin in obesity and non-alcoholic fatty liver.’ [European Journal of Internal Medicine 89C (2021) 56–64]

15 February 2022
Author(s): Agostino Di Ciaula, Federico Carbone, Harshitha Shanmugham, Emilio Molina-Molina, Leonilde Bonfrate, Stefano Ministrini, Fabrizio Montecucco, Piero Portincasa

The authors regret that a mistake was made in the spelling of one of the co-author's name. The third author's name is: Harshitha Shanmugam


Medicine before and after David Cox

28 February 2022
Author(s): Pavlos Msaouel, Paula Jimenez-Fonseca, Bora Lim, Alberto Carmona-Bayonas, Giancarlo Agnelli

Herein we recount the legacy of Sir David Roxbee Cox (15 July 1924 – 18 January 2022) from the perspective of practicing clinicians. His-pioneering work in developing the logistic and Cox... more

Internal Medicine Flashcard

A pretibial skin lesion in a patient with type 1 diabetes mellitus

10 January 2022
Author(s): Bruna Crea, Fabrizio Elia, Giulia Cavalot

A 17-years-old woman with type 1 diabetes mellitus known since the age of 9 was admitted in the high-dependency unit for diabetic ketoacidosis. She had a history of poor glycemic control and many... more

Palpitations in a middle-aged male… Searching a needle in a haystack

10 January 2022
Author(s): Abhishek Thakur, Anish Kapil, Sandeep Singh

A gentleman in his 50s presented with episodes of intermittent palpitations which were self-limiting. His symptoms were not related to exertion and had short duration with sudden onset and offset. He... more

A diagnosis at hand

10 January 2022
Author(s): Giorgia Protti, Fabrizio Elia, Franco Aprà

A 45-year-old man was found unconscious on the sidewalk and brought to the Emergency Department. He could not provide anamnestic information, but the hospital electronic archive revealed he was... more

Letter to the Editor

Intravenous insulin-dextrose repetition for hyperkalemia: How can we avoid subsequent hypoglycemia?

7 February 2022
Author(s): Hiroshi Ito

According to Humphrey and colleagues, one-third of patients with intravenous insulin-dextrose (IDex) for hyperkalemia needed repeated treatments with IDex [1]. Besides, approximately 20% of patients... more

Primary Raynaud's phenomenon, very early and early scleroderma tips for a timely diagnosis

1 February 2022
Author(s): Maria Maddalena Sirufo, Lina Maria Magnanimi, Lia Ginaldi, Massimo De Martinis

Dear Editor,

Usefulness of non-invasive methods for the monitoring of oxygenation parameters in patients with COVID-19 associated acute respiratory distress syndrome (ARDS)

30 January 2022
Author(s): Diego Alberto Pérez Pinzón, Cristian Camilo Villa Gomez, Julio Andrés Boada Garnica, Marlon Adrián Laguado Nieto

We have read with great interest the article recently published by Zaccagnini et al. [1], entitled "Correlation of non-invasive oxygenation parameters with PaO2/FiO2 ratio in patients with COVID-19... more

Atrial high rate episodes as a marker of atrial cardiomyopathy: In the quest of the Holy Grail. Author's reply

21 January 2022
Author(s): Marco Vitolo, Jacopo F. Imberti, Marco Proietti, Gregory Y.H. Lip, Giuseppe Boriani

We appreciate Doundoulakis and colleagues for the interest in our article [1,2]. We take advantage of the opportunity to reply focusing on some aspects that we believe are clinically important. In... more

“Which one should I choose, a glucagon-like peptide-1 receptor agonist or a sodium−glucose cotransporter 2 inhibitor? Or maybe both?”

27 December 2021
Author(s): Dimitrios Patoulias, Christodoulos Papadopoulos, Asterios Karagiannis, Michael Doumas

In a recently published narrative review article authored by Gomez-Huelgas and colleagues, authors propose an interesting treatment algorithm, based on the cardiovascular and renal protection offered... more

Admissions in a medical ward and factors independently associated with mortality

24 December 2021
Author(s): Petros Ioannou, Stamatis Karakonstantis, Diamantis P Kofteridis

Admission to a medical ward is commonly used for the management of conditions that are not amenable to outpatient management, either due to the need for specialized care or for practical reasons,... more

Glucocorticoid sparing in sarcoidosis using the Janus kinase (JAK) inhibitor tofacitinib

23 December 2021
Author(s): Collaborative group: MI study group

There is an unmet medical need to provide novel treatments with high efficiency and low side effects in patients with sarcoidosis resistant to glucocorticoids or second-line therapies (methotrexate,... more

Prediction of ischemic stroke in different populations: a comparison of absolute stroke risk and CHA2DS2-VASc in real-world and clinical trial patients

21 December 2021
Author(s): José Miguel Rivera-Caravaca, Wern Yew Ding, Francisco Marín, Vanessa Roldán, Gregory Y.H. Lip, Christina J.-Y. Lee MD, PhD; Christian Torp-Pedersen MD, DMSc

The CHA2DS2-VASc score is one of the most validated risk tools in atrial fibrillation (AF) [1], and remains a simple and practical clinical score to aid decision-making. However, it has limitations... more

Willingness to participate in a lung cancer screening program: Patients’ attitudes towards United States Preventive Services Taskforce (USPSTF) recommendations

20 December 2021
Author(s): Narjes Zarei Jalalabadi, Besharat Rahimi, Morteza Foroumandi, Alexandra Lackey, Soheil Peiman

Like many other cancers, the prognosis of lung cancer largely depends on the stage of cancer at the time of diagnosis and early detection could significantly improve cancer-related morbidity and... more

The impact of nutrition on cancer prevention in Europe: From the bench to the Parliament

12 December 2021
Author(s): Christos Tsagkaris, Dimitrios V. Moysidis, Andreas S. Papazoglou, Anna Loudovikou, Gizem Acar

Dear Editor,

Clinical significance of Staphylococcus aureus bacteriuria

3 December 2021
Author(s): Queralt Jordano, Ainhoa Garcia, Clara Gallego, Mariona Xercavins, Helena Monzon

Dear editor

Original Article

Reduced COVID-19 mortality linked with early antibodies against SARS-CoV-2, irrespective of age

13 February 2022
Author(s): Danila De Vito, Agostino Di Ciaula, Vincenzo O. Palmieri, Paolo Trerotoli, Angela Maria Vittoria Larocca, Maria Teresa Montagna, Piero Portincasa

COVID-19 pandemic has generated, to date, over 4.6 million deaths worldwide [1]. The high infection rate, however, is counterbalanced by variable clinical outcomes at the individual level. SARS-CoV-2... more

Truly unexplained falls after evaluation for syncope: A new diagnostic entity with severe prognosis

13 February 2022
Author(s): Andrea Ungar, Alice Ceccofiglio, Chiara Mussi, Mario Bo, Giulia Rivasi, Martina Rafanelli, Anna Maria Martone, Giuseppe Bellelli, Franco Nicosia, Daniela Riccio, Virginia Boccardi, Elisabetta Tonon, Francesco Curcio, Francesco Landi, Pasquale Abete, Enrico Mossello

Syncope and falls are a common concern in older adults with dementia [1,2]. In Literature, great importance has been established in the recognition of causes of falling in older patients, in... more

Mortality and its risk factors in critically ill patients with connective tissue diseases: A meta-analysis

9 February 2022
Author(s): Yanis KOUCHIT, Lucas MORAND, Nihal MARTIS

Connective tissue diseases (CTD) encompass entities such as systemic lupus erythematosus (SLE), primary Sjögren's syndrome (pSS), systemic sclerosis (SSc), idiopathic inflammatory myopathies (IIM),... more

Pulmonary embolism severity and in-hospital mortality: An international comparative study between COVID-19 and non-COVID patients

26 January 2022
Author(s): Òscar Miró, Sònia Jiménez, Pere Llorens, Melanie Roussel, Judith Gorlicki, Eric Jorge García-Lamberechts, Pierrick Le Borgne, Javier Jacob, Anthony Chauvin, Olivier Lucidarme, Guillermo Burillo-Putze, Alfons Aguirre, Fabien Brigant, Laura Lozano, Juan González del Castillo, Yonathan Freund, SIESTA and PEPCOV research teams

Infection by SARS-Cov-2 is mainly characterized by fever and respiratory symptoms, with dyspnea and lung infiltrates in more severe cases[1,2]. Many patients also present a procoagulant state, which... more

Obesity survival paradox in patients hospitalized with community-acquired pneumonia. Assessing sex-differences in a population-based cohort study

20 January 2022
Author(s): Javier de Miguel-Diez, Rodrigo Jimenez-Garcia, Valentin Hernandez-Barrera, Jose M. de Miguel-Yanes, David Carabantes-Alarcon, Jose J Zamorano-Leon, Ana Lopez-de-Andres

Community acquired pneumonia (CAP) is one of the most common infectious diseases and contributes significantly to morbidity, mortality and costs [1]. In fact, it has been ranked as the third leading... more

Derivation and validation of the nonalcoholic fatty liver disease cirrhosis score (NCS) to distinguish bridging fibrosis from cirrhosis

17 January 2022
Author(s): Christian Labenz, Gerrit Toenges, Ming-Hua Zheng, Dora Ding, Robert P. Myers, Peter R. Galle, Angelo Armandi, Javier Ampuero, Manuel Romero Gómez, Elisabetta Bugianesi, Quentin M. Anstee, Jörn M. Schattenberg

Non-alcoholic fatty liver disease (NAFLD) has become a major health burden [1]. Among the large group of patients that are affected, the subgroup progressing to end-stage disease exhibits the highest... more

High-sensitivity troponins for outcome prediction in the general population: a systematic review and meta-analysis

7 January 2022
Author(s): Alberto Aimo, Georgios Georgiopoulos, Giorgia Panichella, Giuseppe Vergaro, Claudio Passino, Michele Emdin, Aldo Clerico

High-sensitivity (hs) assays allow to measure cardiac troponin T and I (cTnT/I) even in healthy individuals. The higher hs-cTn values, the higher the ongoing cardiomyocyte damage, and then reasonably... more

Generalist vs specialist acute medical admissions - What is the impact of moving towards acute medical subspecialty admissions on efficacy of care provision?

22 December 2021
Author(s): Hannah Smyth, Sarah Gorey, Hannah O'Keeffe, Joanna Beirne, Shaunna Kelly, Cathal Clifford, Hilary Kerr, Martin Mulroy, Tomás Ahern

In an era of increasing hospital admissions and a growing older population with multiple co-morbidities [1], the discussion surrounding generalist versus specialist medical acute admissions continues... more

Review Article

The identity of the internist: A U.S. perspective

20 January 2022
Author(s): Gregory C. Kane, Heather E. Gantzer, Jacqueline W. Fincher

The etymology of Internal Medicine dates to an important development in the approach to patient care arising in 19th Century Germany and reflected by the term, Innere Medezin. This marked the... more

A systematic review of the discrimination and absolute mortality predicted by the National Early Warning Scores according to different cut-off values and prediction windows

31 December 2021
Author(s): Mark Holland, John Kellett

Early warning scores (EWS) were originally proposed by Morgan et al. to help identify patients who need immediate life-saving interventions, but not to predict their outcomes [1]. Ironically outcome... more

Sepsis-driven atrial fibrillation and ischaemic stroke. Is there enough evidence to recommend anticoagulation?

8 November 2021
Author(s): Isuru Induruwa, Eleanor Hennebry, James Hennebry, Mrinal Thakur, Elizabeth A. Warburton, Kayvan Khadjooi

Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice and is associated with significant morbidity and mortality [1]. Currently, it is estimated that between 2 and... more


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