January 2022

53 Articles

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Diagnosis is a probabilistic estimate of disease. A dynamic approach to diminish resource overuse

11 December 2021
Author(s): António Vaz Carneiro

Clinical reasoning (mostly diagnostic reasoning) is made of two sequential steps: firstly, problem-solving - estimating disease probabilities through information from the physical exam and sequential... more

Associations of Post-Acute COVID syndrome with physiological and clinical measures 10 months after hospitalization in patients of the first wave

25 November 2021
Author(s): Anna Staudt, Rudolf A. Jörres, Thilo Hinterberger, Nadine Lehnen, Thomas Loew, Stephan Budweiser

Since the beginning of the COVID-19 pandemic in 2020, in Germany almost 3.8 million inhabitants have been positively tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1], and... more

Infective endocarditis, is there a goal beyond antibiotics and surgery?

12 November 2021
Author(s): Benoit Guery, Matthaios Papadimitriou-Olivgeris

In the vast majority of infectious diseases, the primary endpoint to evaluate an intervention relies on short terms variables and, when relevant, in-hospital mortality, or 28 days mortality. In most... more

Optimal duration of anticoagulation therapy for venous thromboembolism in autoimmune diseases

9 November 2021
Author(s): Yugo Yamashita, Takeshi Morimoto, Takeshi Kimura

Venous thromboembolism (VTE) is a common issue in patients with autoimmune diseases. One of the clinically relevant issues for VTE in autoimmune disorders is the optimal duration of anticoagulation... more

Hydroxichloroquine for COVID-19 infection: Do we have a final word after one year?

26 October 2021
Author(s): Augusto Di Castelnuovo, Simona Costanzo, Alessandro Gialluisi, Licia Iacoviello, Giovanni de Gaetano

The results presently available from randomised clinical trials and their meta-analysis indicate that Hydroxychloroquine is not associated in COVID-19 patients with either decreased mortality or... more

Serum IgG4 elevation in hyper-inflamed COVID-19 patients. Author's reply

21 October 2021
Author(s): Emanuel Della-Torre, Marco Lanzillotta, Giuseppe Alvise Ramirez, Lorenzo Dagna, Moreno Tresoldi

Dear Editor, we thank Dulak and Trzciński for their insightful and pertinent comments on our observation about serum IgG4 levels predicting mortality in hospitalized patients affected by Coronavirus... more

Outcomes of patients with heart failure with preserved ejection fraction discharged on treatment with neurohormonal antagonists after an episode of decompensation

24 August 2021
Author(s): Josep Tost, Pere Llorens, Gad Cotter, Beth Davison, Javier Jacob, Víctor Gil, Pablo Herrero, Francisco Javier Martín-Sánchez, Ruxandra Donea, Beatriz Rodríguez, Francisco Javier Lucas-Imbernon, Juan Antonio Andueza, Ana Belén Mecina, Raquel Torres-Gárate, Pascual Piñera, Aitor Alquézar-Arbé, Begoña Espinosa, Alexandre Mebazaa, Ovidiu Chioncel, Òscar Miró, ICA-SEMES group

To analyze the frequency with which patients with heart failure with preserved ejection fraction (HFpEF) discharged after an acute heart failure (AHF) episode are treated with antineurohormonal drugs... more

A metabolomic index based on lipoprotein subfractions and branched chain amino acids is associated with incident hypertension

25 July 2021
Author(s): Jose L. Flores-Guerrero, Margery A. Connelly, Irina Shalaurova, Erwin Garcia, Stephan J.L. Bakker, Robin P.F. Dullaart

Hypertension is the leading preventable risk factor for cardiovascular disease (CVD) and all-cause mortality worldwide, with a sustained increment in mortality over the last 40 years [1]. Over the... more

Clinical Insights

Management of COVID patients with convalescent plasma: Do we have the final word?

30 November 2021
Author(s): Francesco Menichetti, Marco Falcone, Giusy Tiseo

Immunotherapy with convalescent plasma (CP) has been used in the past in several infectious diseases (influenza, SARS, MERS) with the aim to shorten or stop the phase of viral replication and to... more

Predicting adverse outcomes in patients with COVID-19: just an epidemiological debate or a valuable clinical approach?

22 October 2021
Author(s): Xavier Corbella

On February 16, 2020 the executive committee of the European Federation of Internal Medicine (EFIM) met in Malaga, Spain, to prepare for the EFIM annual congress to be held in March 2021. As usual,... more


Tocilizumab in severe COVID-19: A promise fulfilled

21 November 2021
Author(s): Marcel Levi

A proportion of patients who are infected with SARS-CoV-2 develop severe disease. Apart from a serious bilateral pneumonia organs other than the lungs may become involved as well. The clinical... more

Anticoagulation for stroke prevention after embolic stroke of undetermined source of presumably cardiac source: The sail to Ithaca

26 October 2021
Author(s): Dimitrios Sagris, George Ntaios

During the last decade, the term embolic stroke of undetermined source (ESUS) was introduced in a pursue to standardized diagnostic workup in a more targeted sub-population of cryptogenic stroke... more


One year later: The case of tocilizumab in COVID-19

22 October 2021
Author(s): Corrado Campochiaro, Alessandro Tomelleri, Marco Matucci-Cerinic, Lorenzo Dagna

In severe coronavirus disease 2019 (COVID-19) patients, SARS-CoV-2 infection induces a systemic immune activation characterized by an afinalistic release of inflammatory cytokines [1,2]. This... more

Ideas and Opinions

Should the European Union have an office of research integrity?

3 August 2021
Author(s): C Candal-Pedreira, A Ruano-Ravina, M Pérez-Ríos

Scientific misconduct is detrimental to both society and researchers, potentially resulting in a mistrust in science. When the results of a scientific publication are based on erroneous content or... more

Internal Medicine Flashcard

Multiple tumors on the pleura with pleural effusion mimicking malignant mesothelioma

26 October 2021
Author(s): Hisanori Machida, Keishi Naruse, Tsutomu Shinohara

A 68-year-old male presented with left chest pain and was referred to our hospital due to left-sided pleural effusion on a chest X-ray (Fig. 1 A). Initial laboratory data included a white blood cell... more

Multiple organ nodules or polyps

26 October 2021
Author(s): Junnan Hu, Zhen Li

A 48-year old female presented with intermittent epigastric pain for 2 months accompanied with belching, nausea, vomiting and occasionally melena. She had endometrial polypectomy and thyroidectomy in... more

New onset rectal bleeding

24 October 2021
Author(s): Brian M. Fung, Kelly M. Zucker, Joseph David

A 36-year-old male with no significant past medical history presented to the emergency department for new onset hematochezia. Prior to arrival, the patient reported having five episodes of passing... more

Stuck in my head as an old song

22 October 2021
Author(s): Ilaria De Benedetto, Alberto Gaviraghi, Francesco Giuseppe De Rosa

A 61-year-old piano man was admitted to the emergency department for loss of consciousness, aphasia and Glasgow coma scale of 13 points. His past medical history included hypertension, non-insulin-... more

“Comb and Target signs” in abdominal CT in patients with purpura

21 October 2021
Author(s): Hiroshi Hori, Takahiko Fukuchi, Hitoshi Sugawara

A 56-year-old woman complained of nausea, abdominal pain, and bloody diarrhea 10 days prior to the day of consult in our institution. Her abdominal pain worsened and was accompanied by joint pain for... more

COVID-19 vaccination and a severe pain in the neck

17 October 2021
Author(s): Angelos Kyriacou, Stamatina Ioakim, Akheel A. Syed

A 40-year-old woman developed malaise and severe anterior neck pain 12 hours after the second dose of COVID-19 mRNA vaccine (Pfizer/BioNTech). The pain peaked and plateaued at the fourth post-... more

Letter to the Editor

The prognostic value of malnutrition on duration of admission, financial cost and mortality in elderly, hospitalized patients

8 November 2021
Author(s): Christos E Lampropoulos, Maria Konsta, Afroditi Roumpou, Vicky Dradaki, Ioanna Papaioannou

Dear Editor,

Ankle-brachial index and the risk of hemorrhagic stroke

8 November 2021
Author(s): Lia Alves-Cabratosa, Marc Comas-Cufí, Ruth Martí-Lluch, Anna Ponjoan, Rafel Ramos

Dear editor,

Long COVID: A patient perspective

28 October 2021
Author(s): S. Harari, L. Ripamonti, P. Marveggio, P.M. Mannucci

Even though in this [1,2] and other journals [3–5] a number of articles described the long-term consequences of COVID-19 in patients who recovered from the acute illness, most reports mainly dealt... more

Disguised aspects of IgG4

27 October 2021
Author(s): Natalia Aleksandra Dułak, Rafał Trzciński

Dear Editor,

Venous thromboembolism treatment duration in autoimmune diseases. Research trends

26 October 2021
Author(s): Pablo Ruiz-Sada, Lara Palacios-García, Julia Sada-Sainz

Dear editor,

Humoral SARS-COV-2 IgG decay within 6 months in COVID-19 healthy vaccinees: The need for a booster vaccine dose?

26 October 2021
Author(s): Anat Achiron, Mathilda Mandel, Sapir Dreyer-Alster, Gil Harari, Michael Gurevich

The most effective approach to fight COVID-19 infection is prevention by targeted vaccines that prime the immune system prior to a first encounter with the virus. The BNT162b2 messenger RNA (mRNA)... more

Standardized PaO2/FiO2 ratio in COVID-19: Added value or risky assumption. Author's reply

22 October 2021
Author(s): Irene Prediletto, Stefano Nava, Paolo Palange

Dear Editor,

Cardiopulmonary exercise test with stress echocardiography in COVID-19 survivors at 6 months follow-up

10 October 2021
Author(s): Luca Vannini, Alejandro Quijada-Fumero, M Purificación Ramirez Martín, Nuria Castejón Pina, Julio S. Hernandez Afonso

Although many studies suggest different degrees of myocardial and pulmonary injury during the acute infection and early follow-up [1–3],there is disagreement about cardio-pulmonary injury and... more

Smartphone-based ECG devices: Beyond atrial fibrillation screening

5 October 2021
Author(s): Felix K. Wegner, Lars Eckardt

Dear Professor Agnelli,

Is serum hyperosmolality related with myocardial dysfunction in septic shock patients?

4 October 2021
Author(s): Cristina Murcia-Gubianas, Juan Carlos Yébenes, Maria Buxó, Sara Foradada, Elisabeth Pinart

Etiopathogenesis of cardiac dysfunction in septic shock is multifactorial, arising from autonomic dysregulation, increased capillary permeability, metabolic and mitochondrial dysfunction, oxidative... more

Association of new-onset atrial fibrillation in patients taking high-dose fish oil

27 September 2021
Author(s): Rajkumar Doshi, Monil Majmundar, Ashish Kumar, Krunalkumar Patel, Saraschandra Vallabhajosyula, Ankur Kalra

Atrial fibrillation (AF) is the most common cardiac arrythmia, with an estimate of 37.6 million cases (0.51% of the world population) in 2017. Its prevalence has increased by 33% in the last 20 years... more

A simple method to validate medical bed number calculations

7 September 2021
Author(s): Rodney P. Jones

Doctors are often called upon to make input into planning for hospital bed numbers. Unknown to doctors the models behind forecasting bed numbers can be deliberately manipulated. It is often the case... more

Do we really know what drives relapse in obesity management?

17 July 2021
Author(s): Catia Martins

I have read with much interest the narrative review by Busetto and colleagues entitled “Mechanisms of weight regain”, recently published in your journal [1]. There is no doubt that relapse in obesity... more

Original Article

The high-risk bleeding category of different scores in patients with venous thromboembolism: Systematic review and meta-analysis

1 November 2021
Author(s): Miguel Marques Antunes, Mariana Alves, Fausto J. Pinto, Giancarlo Agnelli, Daniel Caldeira

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is a potentially life-threatening condition associated with a high case-fatality rate [1], and... more

Extended venous thromboprophylaxis in patients hospitalized for acute ischemic stroke: A systematic review and meta-analysis

11 October 2021
Author(s): Emanuele Valeriani, Nicola Potere, Matteo Candeloro, Silvia Spoto, Ettore Porreca, Anne WS Rutjes, Marcello Di Nisio

Acute ischemic stroke is a major health burden worldwide due to high rates of ensuing hospitalizations, complications, disability, dependency, and death [1]. Venous thromboembolism (VTE), which... more

Clinical outcomes associated with the emergency treatment of hyperkalaemia with intravenous insulin-dextrose

5 October 2021
Author(s): Toby J.L. Humphrey, Glen James, Ian B Wilkinson, Thomas F. Hiemstra

Hyperkalaemia is a common, life-threatening electrolyte abnormality present in up to 10% of acute hospital admissions [1]. In patients receiving treatment with renin-angiotensin-aldosterone system (... more

Response to mepolizumab according to disease manifestations in patients with eosinophilic granulomatosis with polyangiitis

14 September 2021
Author(s): Roberto Ríos-Garcés, Sergio Prieto-González, José Hernández-Rodríguez, Ebymar Arismendi, Isam Alobid, Alessandra E. Penatti, María C. Cid, Georgina Espígol-Frigolé

Eosinophilic granulomatosis with polyangiitis

Sex differences in clinical presentation and risk stratification in the Emergency Department: An observational multicenter cohort study

12 September 2021
Author(s): Bart GJ Candel, Saimi Dap, Wouter Raven, Heleen Lameijer, Menno I Gaakeer, Evert de Jonge, Bas de Groot

Sex differences affect patient outcomes in many diseases, such as Coronavirus Disease 2019 (COVID-19), acute myocardial infarction, acute ischemic stroke and infectious diseases, while outcome... more

Prognostic value of NT-proBNP and CA125 across glomerular filtration rate categories in acute heart failure

7 September 2021
Author(s): Rafael de la Espriella, Antoni Bayés-Genís, Pau Llàcer, Patricia Palau, Gema Miñana, Enrique Santas, Mauricio Pellicer, Miguel González, José Luis Górriz, Vicent Bodi, Juan Sanchis, Julio Núñez

Heart and kidney function are heavily intertwined, and once both organs are affected, the patient's prognosis worsens dramatically [1–3]. Natriuretic peptides (NP) (brain natriuretic peptide [BNP]... more

Predictors of long-term mortality in left-sided infective endocarditis: an historical cohort study in 414 patients

31 August 2021
Author(s): Emanuele Durante-Mangoni, Giuseppe Giuffrè, Maria Paola Ursi, Domenico Iossa, Lorenzo Bertolino, Alessandra Senese, Pia Clara Pafundi, Fabiana D’Amico, Rosina Albisinni, Rosa Zampino

Infective endocarditis (IE) is a life-threatening disease associated, in 2010, with 1.58 millions of disability-adjusted life years lost due to death, concurrent illnesses and functional impairment [... more

Clinical presentation of secondary infectious complications in COVID-19 patients in intensive care unit treated with tocilizumab or standard of care

29 August 2021
Author(s): Lucia Taramasso, Laura Magnasco, Federica Portunato, Federica Briano, Antonio Vena, Daniele R. Giacobbe, Chiara Dentone, Chiara Robba, Lorenzo Ball, Maurizio Loconte, Nicolò Patroniti, Paolo Frisoni, Raffaele D'Angelo, Silvia Dettori, Malgorzata Mikulska, Paolo Pelosi, Matteo Bassetti

Tocilizumab is a recombinant humanized monoclonal antibody developed against soluble and membrane-bound isoforms of the interleukin-6 [IL-6] receptor. It prevents the binding of IL-6 to its receptor... more

Diagnostic yield of endoscopy in irritable bowel syndrome: A nationwide prevalence study 1987–2016

19 August 2021
Author(s): Kyle Staller, Ola Olén, Jonas Söderling, Bjorn Roelstraete, Hans Törnblom, Hamed Khalili, Mingyang Song, Jonas F Ludvigsson

Irritable bowel syndrome (IBS) affects 11.2% of the global population  [1], with significant impacts on patients’ quality of life despite no increased risk of mortality  [2]. Among this sizeable... more

Oral anticoagulants vs antiplatelets in cryptogenic stroke with potential cardiac emboli: Meta-analysis

18 August 2021
Author(s): Wen-Yi Huang, Bruce Ovbiagele, Meng Lee

Cryptogenic strokes are cerebral infarcts for which no probable underlying pathophysiologic cause is identified after adequate diagnostic evaluation [1]. However, it's been shown that some strokes... more

Dediagnosing – a novel framework for making people less ill

17 August 2021
Author(s): Marianne Lea, Bjørn Morten Hofmann

The vast progress in science and technology has greatly increased the number of diseases. Today, the International Classification of Diseases (ICD-11) consists of approximately 55,000 unique codes... more

Examination of the relationship between emergency department presentations and population mortality: a multicenter analysis of emergency department presentations during the COVID-19 pandemic

15 August 2021
Author(s): Monica Solbiati, Lorenzo Russo, Anna Beverina, Paolo Groff, Andrea Strada, Ludovico Furlan, Nicola Montano, Giorgio Costantino, Giovanni Casazza

The first deaths outside of China due to COVID-19 (coronavirus disease 2019), caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), occurred in February 2020 [1]. Subsequently,... more

The role of minor salivary glands’ biopsy in the diagnosis of Sjögren's syndrome and other systemic diseases

9 August 2021
Author(s): Ana Isabel Lopes, Raquel Machado-Neves, Mrinalini Honavar, P. Ricardo Pereira

Minor salivary gland biopsy (MSGB) is a minimally invasive, safe and low-cost diagnostic procedure. It is mainly used for the diagnosis of Sjögren's syndrome (SS), by identifying the presence of... more

Multidisciplinary team led by internists improves diabetic foot ulceration outcomes a before-after retrospective study

26 July 2021
Author(s): Gida Ayada, Yonatan Edel, Alon Burg, Adi Bachar, Yehiel Hayun, Tzippy Shochat, Jihad Bishara, Dafna Yahav, Alaa Atamna, Avishay Elis

Diabetic foot ulceration (DFU), one of the most serious complications of diabetes mellitus (DM), affects 25% of all patients with diabetes and is associated with high morbidity and mortality [1-5].... more

Review Article

One year after the ESC/EAS guidelines on cholesterol control. What's the new evidence? What's missing?

30 October 2021
Author(s): Maurizio Averna, Alberico L. Catapano

The recent ESC/EAS 2019 Guidelines for the management of dyslipidaemias are centred on the causal role of low density lipoprotein (LDL), or more generally apolipoprotein B (apoB)-containing... more

Electrocardiographic features of patients with COVID-19: One year of unexpected manifestations

14 October 2021
Author(s): Fabio Angeli, Gianpaolo Reboldi, Antonio Spanevello, Roberto De Ponti, Dina Visca, Jacopo Marazzato, Martina Zappa, Monica Trapasso, Sergio Masnaghetti, Leonardo M. Fabbri, Paolo Verdecchia

Coronavirus Disease 2019 (COVID-19) is the clinical manifestation of infection with Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) [1 -3]. COVID-19 is frequently characterized by... more

Should we continue surveillance for hepatocellular carcinoma and gastroesophageal varices in patients with cirrhosis and cured HCV infection?

23 September 2021
Author(s): Cas J. Isfordink, Raoel Maan, Robert A. de Man, Karel J. van Erpecum, Adriaan J. van der Meer


Recent advances in pericarditis

20 September 2021
Author(s): Emanuele Bizzi, Chiara Picchi, Greta Mastrangelo, Massimo Imazio, Antonio Brucato

Pericardial diseases are a heterogeneous group of entities, ranging from acute pericarditis (AP) to asymptomatic pericardial effusions. Diagnosis of AP can be made when two of the following criteria... more

Translational medicine in hereditary hemorrhagic telangiectasia

16 September 2021
Author(s): A. Riera-Mestre, P. Cerdà, A. Iriarte, M. Graupera, F. Viñals

Hereditary hemorrhagic telangiectasia (HHT) or Rendu–Osler–Weber syndrome (ORPHA:774) is a rare autosomal dominant vascular disease characterized by systemic telangiectases and larger vascular... more

Popular procedures without evidence of benefit: A case study of percutaneous coronary intervention for stable coronary artery disease

14 September 2021
Author(s): Vinay Guduguntla, Rita F. Redberg

Coronary artery disease is common, affecting more than an estimated 125 million people worlwide [1,2]. More than half of all patients with coronary artery disease (CAD) have anginal symptoms [3].... more


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