July 2020
44 ArticlesCommentary
No double-edged sword and no doubt about the relation between smoking and COVID-19 severity
At the beginning of March 2020, with the publication of the first Chinese epidemiological studies on the determinants of a severe form of COVID-19, tobacco smoking consistently appeared as one of the... more
Cluster analysis for clinical sarcoidosis’ phenotyping
In the current issue of the European Journal of Internal Medicine, we read with interest a new cluster-analysis to distinguish clinical phenotypes of sarcoidosis [1]. Six phenotype clusters emerged... more
Assessing complexity through simplicity
Older patients admitted to medical wards have a disproportionately high risk of dying. Although mortality rate estimates vary according to the case mix of patients and the hospital characteristics,... more
From meta-analysis to the individual patient with atrial fibrillation and coronary artery disease: the complexity of antithrombotic treatment in real-world clinical practice and the need for a tailored approach
The management of antithrombotic therapy in atrial fibrillation (AF) patients presenting with acute coronary syndromes (ACS) and/or undergoing percutaneous coronary interventions (PCI) is highly... more
The 2019 ESC guidelines on pulmonary embolism: some further insights
This manuscript represents original work, and it is not under consideration for publication elsewhere. It has never been neither submitted nor published in another scientific journal. All authors... more
First episode of acute heart failure: Can we already predict the risk of short-term mortality?
This commentary refers to “Short-term mortality risk score for de novo acute heart failure (ESSIC-FEHF)” by S. García-Gutiérrez et al., published in this issue.
Internal Medicine Flashcard
A 44-year-old man with cough, arthralgia, and fever
A 44-year- old man presented with dry cough, diffuse joint pain, fevers, and night sweats for one month and poor appetite and weight loss for three months. Physical examination showed... more
Sudden onset headache, dizziness, unilateral facial numbness, and speech disturbance
A 48-year-old woman presented to the emergency department with acute onset of headache, dizziness, right facial numbness, and difficulty of swallowing and speech. She was not a smoker and consumed... more
Letter to the Editor
Need for innovative and timely synthesis of evidence during Covid-19 outbreak
Amid the Covid-19 pandemic, one major challenge for health-care providers is to navigate the outstanding number of new studies released every day, looking for evidence to improve clinical practice.... more
Protective role of chronic treatment with direct oral anticoagulants in elderly patients affected by interstitial pneumonia in COVID-19 era
Since December 2019, coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing global health emergency [1]. Elderly patients... more
COVID-19, a viral endocrinological disease?
Ever since Chinese health officials informed the WHO of the presence of 44 patients suffering from an anomalous pneumonia apparently linked with the Huanan Seafood Wholesale Market (Wuhan City) on... more
COVID-19: The Waterloo of governments, healthcare systems, and large health organizations
To the editor
Active smoking and severity of coronavirus disease 2019 (COVID-19): Differences in measurement of variables could cause errors in the results
In this letter to the editor, we would like to address some main points presented in the manuscript by Lippi G, and Henry BM. [1] regarding smoking as a risk factor for SARS-CoV-2. Even though the... more
The eighth alternative to evidence based medicine in the early era of the COVID-19 pandemic: Too much emergency and emotion, too little evidence
“Clinical decisions should, as far as possible, be evidence based. So runs the current clinical dogma. We are urged to lump all the relevant randomised controlled trials into one giant meta-analysis... more
Covid-19 in Italy: Lesson from the Veneto Region
The day after the first case of Italian COVID-19 patient in Codogno (Lombardy, Italy) on February 20, 2020, a second outbreak was detected at the “Riuniti Hospitals Padova Sud” of Monselice (Veneto,... more
Does active smoking worsen Covid-19?
Probably it does.
Balancing the need for rapid and rigorous scientific data during early phase of the COVID-19 pandemic: A further role for the scientific community
The primary focus of biomedical sciences is to apply scientific methodology to the biology of human disease with the aim of producing recommendations to be adopted in healthcare. The scientific... more
Why should we use convalescent plasma for COVID-19?
Coronavirus, an enveloped virus belonging to the family of Coronaviridae which initially caused enzootic infections, has shown in the last decades to be capable of crossing the species barrier... more
Good times, bad times: A diary of a physician in the COVID-19 era
7:30 a.m.
Active smoking and severity of coronavirus disease 2019 (COVID-19): The use of significance testing leads to an erroneous conclusion
In their letter to the Editor, “Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19)”, Lippi et al. [1] present a timely and important meta-analysis to evaluate if... more
Bleeding in COVID-19 severe pneumonia: The other side of abnormal coagulation pattern?
A novel coronavirus (SARS CoV-2) spread in China in December 2019, becoming soon a relevant problem of international public health concern [1]. In Italy the SARS-CoV-2 officially spread around the... more
Do we know when to end isolation of persons affected with COVID-19?
The pathogen responsible for coronavirus disease 2019 (COVID-19) is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This novel coronavirus was first detected in Wuhan, China in late... more
Active smoking and COVID-19: a double-edged sword
We are thankful to Garufi et al [1] for the comments on our recent article published in this journal [2], and we wish to add some further pieces to the intricate puzzle linking active cigarette... more
Reorganizing Italian Internal Medicine wards for COVID 19
most of the Internal Medicine wards in the Lombardy hospitals, have beens almost completely reorganized to accommodate the management of patients with COVID-19. Analysis of the data coming from... more
Covid-19 cases in a no-Covid-19 geriatric acute care setting. A sporadic occurrence?
The pandemic outbreaks of coronarovirus disease 2019 (Covid-19) is associated to a higher risk of complications and mortality in older patients because of their greater complexity and the frequent... more
The quality of the reported sample size calculation in clinical trials on COVID-19 patients indexed in PubMed
Given the utmost priority of COVID-19 research, many medical journals, especially the leading ones, expedited the review process of these papers. It was expected that the amount of submitted papers... more
Non-SARS CoV2 positive critical patients: Sons of a lesser God?
As the number of confirmed cases of coronavirus in Italy continues to rise, the reorganization of the hospitals outlined by Grasselli et Al. [1] across the country made wards slowly emptied, elective... more
Smoking habit and hospitalization for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related pneumonia: The unsolved paradox behind the evidence.
Since the beginning of the SARS-CoV-2 pandemic earthquake (more than 1.8 million infected subjects worldwide as of mid-April), differences across countries with regard to hospitalization and death... more
Acute hemolysis by hydroxycloroquine was observed in G6PD-deficient patient with severe COVD-19 related lung injury
The coronavirus disease COVID19 is a global health pandemic emergency. The disease, named coronavirus disease 2019 (COVID-19) by the WHO, presents symptoms that range from mild to severe and fatal... more
COVID-19: Timing is Important
On March 23, 2020, the Bergamo hospital team, one of the most challenged teams fighting against COVID-19 web-broadcasted a 1-hour conference on the state of their experience, seeking for discussion... more
Original Article
Clinical practice guidelines adaptation for internists - An EFIM methodology
With the easy access to internet, the increasing number of clinical studies and the better quality of these studies, the main challenge for the clinicians nowadays is to quickly find a relevant... more
Clinical phenotypes and prediction of chronicity in sarcoidosis using cluster analysis in a prospective cohort of 694 patients
Sarcoidosis is a multisystem granulomatous disease with high variability and sometimes unpredictable behavior. This great variability necessitates the search for clinical patterns of observed... more
Coffee Consumption is Associated with a Decreased Risk of Incident Chronic Kidney Disease: A Systematic Review and Meta-analysis of Cohort Studies
Coffee is a popular beverage that is consumed in every corner of the world. It has been estimated that at least 50 percent of adults in the United States drink coffee on a regular basis [1]. With its... more
Clinical utility of fecal calprotectin in monitoring disease activity and predicting relapse in pregnant patients with inflammatory bowel diseases
Inflammatory bowel disease (IBD) is frequently diagnosed among reproductive-aged women, with 25% of women conceiving after diagnosis [1]. Associations of IBD with pregnancy outcomes have been... more
Impact of treatment strategies on long-term outcome of CTO patients
Chronic total occlusions (CTO) are a common entity in patients with stable coronary artery disease undergoing coronary angiography with a point-prevalence between 15 and 30% [1–3]. CTO... more
Anticoagulation in thrombocytopenic patients with hematological malignancy: A multinational clinical vignette-based experiment
Thrombocytopenia in cancer patients with an indication for anticoagulation is not uncommon [1], and poses a unique clinical challenge. Clinical trials evaluating anticoagulants for treatment of... more
Abnormal ankle-brachial index (ABI) predicts primary and secondary cardiovascular risk and cancer mortality
An abnormal ankle-brachial pressure index (ABI) is a marker of the risk for increased total and cardiovascular (CV) mortality. However, it is not clear whether it is associated with an even worse... more
Short-term mortality risk score for de novo acute heart failure (ESSIC-FEHF)
Acute heart failure (AHF) is one of the most common reasons for emergency department (ED) attendance in Spain, 24% of patients being discharged home from the ED). AHF may present de novo, that is, as... more
Impact of pre-hospital renal function on the detection of acute kidney injury in acute decompensated heart failure
Heart failure (HF), a chronic heterogeneous syndrome with increasing prevalence and incidence, is associated with high mortality and morbidity [1,2]. In ambulatory patients, the occurrence of an... more
Predictors of infection after “de novo” cardiac electronic device implantation
Over the past few decades, a rapid and stable increase in cardiovascular implantable electronic devices (CIEDs) rates has been observed. Continuous aging of the population and a wider spectrum of... more
A new simplified model for predicting 30-day mortality in older medical emergency department patients: The rise up score
Early identification of high risk patients who visit an emergency department (ED) is important to optimise the diagnostic approach, care and outcome. In particular, older patients are at high risk of... more
Antithrombotic treatment in patients with atrial fibrillation undergoing coronary angioplasty: rational convincement and supporting evidence
The choice of optimal antithrombotic therapy for patients undergoing percutaneous coronary interventions (PCI) with an indication for long-term oral anticoagulation (OAT) is challenging. Atrial... more
Review Article
Hepatic consequences of COVID-19 infection. Lapping or biting?
The outbreak of coronavirus disease 2019 (COVID-19) starting last December in China placed emphasis on liver involvement during infection. This review discusses the underlying mechanisms linking... more
Therapeutic strategies for virus-negative myocarditis: a comprehensive review
Myocarditis is defined by World Health Organization as an inflammatory disease affecting the myocardium, diagnosed by endomyocardial biopsy (EMB) using established histological, immunological, and... more