European Journal of Internal Medicine最新文献

{"title":"Identification of risk factors for permanent visual loss in patients with giant cell arteritis.","authors":"Roser Solans-Laqué, Begoña de Escalante-Yanguela, Eva Fonseca, Guadalupe Fraile, Ferran Martínez-Valle, Luis Caminal, Manuel Monteagudo, Mercedes Pérez-Conesa, Borja Gracia-Tello, Monica Abdilla, Sergio Prieto-González, Aleida Martínez-Zapico, Borja de Miguel-Campo, Jaume Mestre-Torres","doi":"10.1016/j.ejim.2025.06.001","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.001","url":null,"abstract":"<p><strong>Objectives: </strong>permanent visual loss (PVL) is the most frequent ischemic complication of GCA. We aimed to evaluate whether clinical signs, symptoms, and blood test abnormalities at GCA diagnosis can predict PVL.</p><p><strong>Patients and methods: </strong>retrospective, multicenter study of patients with biopsy-proven GCA. The whole cohort was randomly split into a derivation and a validation dataset. Multivariable logistic regression (MVLR) was used to develop a prediction model and a predictive score. The model's performance was determined through the area under the curve (AUC).</p><p><strong>Results: </strong>620 patients were included, 397 in the derivation cohort. PVL occurred in 20.3%. MVLR showed that amaurosis fugax (OR 5.86, 95%CI 3.41-10.07, p<0.001), jaw claudication (OR 2.48, 95%CI 1.51-4.07, p<0.001), and increasing age (OR 1.09, 95%CI 1.05-1.14, p<0.001) were independently associated to PVL. Fever was the only independent protective factor (OR 0.45, 95%CI 0.25-0.84, p=0.01). The optimum cut-off for age as a PVL predictor was 78 years (OR 2.4, 95%CI 1.62-3.59, p<0.001). No laboratory variables were independently associated with PVL. Our model showed an AUC 0.80 (95%CI 0.76-0.85) and good internal validity (AUC 0.82, 95%CI 0.76-0.87). A predictive risk score with a sensitivity of 64.9%, a specificity of 82.0%, and positive and negative predictive values of 46.4% and 90.01% is proposed.</p><p><strong>Conclusions: </strong>The risk of developing PVL at GCA diagnosis may be estimated upon a detailed patient evaluation, including temporal arteries. Amaurosis fugax, jaw claudication, and older age can predict PVL. Fever is a protective factor. Inflammatory markers do not differentiate patients at risk of developing PVL.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and safety of once-daily oral semaglutide in patients with heart failure with preserved ejection fraction, type 2 diabetes and obesity: a real-world study.","authors":"Alicia Trenas, Miguel A Pérez-Velasco, Maria-Rosa Bernal-López, María-Dolores López-Carmona, Juan J Gómez-Doblas, María-Dolores Martínez-Esteban, Oumayma Bouarich, Natalia García-Casares, Diego Fernández-García, María-Dolores García de Lucas, Ricardo Gómez-Huelgas, Luis M Pérez-Belmonte","doi":"10.1016/j.ejim.2025.06.007","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.007","url":null,"abstract":"<p><strong>Background: </strong>There is limited evidence on the role of glucagon-like peptide-1 receptor agonists in heart failure. This work analyzes the efficacy of once-daily oral semaglutide in terms of health status and change in body weight in patients with heart failure with preserved ejection fraction, type 2 diabetes, and obesity.</p><p><strong>Methods: </strong>This prospective, real-world study included patients treated with once-daily semaglutide (O-Sema Group) and without glucagon-like peptide-1 receptor agonists (Control Group). The primary outcome was the heart failure status, defined as the ≥5 point difference in the Kansas City Cardiomyopathy Questionnaire total symptom score, and change in body weight at 18 months.</p><p><strong>Results: </strong>After a 1:1 propensity score matching, 202 patients were included in each group (mean age 77.8 years, mean body mass index 33.5, 59.2 % females). Patients in the O-Sema Group were more likely to have an improvement in heart failure health status from baseline to 18 months (OR:2.92; 95 %CI: 1.45-4.90; p < 0.01). The mean change in body weight was -9.5 ± 3.2 kg in patients with oral semaglutide and -2.0 ± 1.1 kg in control patients (p < 0.01). After treatment, there were negative correlations between the Kansas City Cardiomyopathy Questionnaire total symptom score and the body weight (r=-0.577, p < 0.01) and glycated hemoglobin (r=-0.499, p = 0.011). It had good tolerability and safety.</p><p><strong>Conclusions: </strong>Once-daily oral semaglutide was associated with an improvement in heart failure health status, and weight loss in patients with heart failure with preserved ejection fraction, type 2 diabetes, and obesity. Further research on glucagon-like peptide-1 receptor agonists in heart failure with preserved ejection fraction is needed.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A holistic view of SGLT2 inhibitors: From cardio-renal management to cognitive and andrological aspects.","authors":"Rossella Cannarella, Michele Rubulotta, Vittorio Cannarella, Sandro La Vignera, Aldo E Calogero","doi":"10.1016/j.ejim.2025.06.010","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.010","url":null,"abstract":"<p><p>Type 2 diabetes mellitus (T2DM) is a multifactorial disease associated with complications that significantly affect both survival and quality of life, including cardiovascular, renal, cognitive, sexual, and reproductive dysfunctions. Sodium-glucose cotransporter 2 (SGLT2) inhibitors (SGLT2is) have emerged as a transformative class of drugs, demonstrating benefits that extend beyond glycemic control. Large clinical trials have shown that SGLT2is reduce hospitalization for heart failure by 25-35% and slow progression of chronic kidney disease by 30-45%, with variation based on the specific agent, dose, and patient population. This narrative review examines not only these well-established benefits but also emerging evidence regarding their effects in less-explored domains. SGLT2is have been associated with improved cognitive performance, potentially through reductions in neuroinflammation and oxidative stress. In the sexual and reproductive domains, studies in men with diabetes mellitus suggest potential benefits of SGLT2is in improving erectile function, sperm motility, and testosterone levels, likely mediated by antioxidant and anti-inflammatory mechanisms. By integrating current evidence across multiple systems, this review emphasizes the role of SGLT2is in a holistic, multidisciplinary approach to the management of patients with T2DM.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic markers of inflammation and immune activation in patients with obstructive sleep apnea and paroxysmal atrial fibrillation.","authors":"T E Hunt, G M Traaen, L Aakerøy, B Øverland, C Bendz, A E Michelsen, S Steinshamn, K H Haugaa, O G Anfinsen, P Aukrust, K Broch, H Akre, J P Loennechen, L Gullestad, T Ueland","doi":"10.1016/j.ejim.2025.05.028","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.05.028","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) and obstructive sleep apnea (OSA) frequently coexist, contributing to cardiovascular risk, possibly through shared inflammatory pathways. The specific role of inflammatory markers in patients with AF and OSA is not well established.</p><p><strong>Aim: </strong>This study aimed to determine whether markers of inflammation and immune activation are elevated in patients with paroxysmal AF and OSA, assess the effects of continuous positive airway pressure (CPAP) and pulmonary vein isolation (PVI) on these markers, and evaluate their association with clinical outcomes, such as AF recurrence and thromboembolic risk.</p><p><strong>Methods: </strong>We studied 143 patients with paroxysmal AF and moderate to severe OSA (apnea-hypopnea index ≥15). Of these, 99 were randomised to receive CPAP plus standard care (n = 51) or standard care alone (n = 48). A comparison group of 19 patients with paroxysmal AF and mild/no OSA (AHI <15) and 22 healthy controls were also included. Inflammatory markers related to leukocyte activation, vascular inflammation, and extracellular matrix remodelling were assessed at baseline, 6 months and 12 months follow-up.</p><p><strong>Results: </strong>Patients with OSA and paroxysmal AF had higher levels of NGAL, PTX-3, GDF-15, MMP-9, VCAM1 and ANGP2 than healthy controls. These markers correlated poorly with AF and OSA severity. There was no modifying effect of CPAP on any marker. PTX3 was associated with AF recurrence and a high-risk score for thromboembolic stroke.</p><p><strong>Conclusion: </strong>Moderate to severe OSA and AF are associated with elevated inflammatory markers. However, CPAP therapy did not significantly affect these levels. PTX-3 may hold prognostic value for AF recurrence and thromboembolic risk.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144295253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current epidemiology, risk factors and influence on prognosis of multidrug resistance in Klebsiella spp. bloodstream infection. Insights from a prospective cohort.","authors":"Jorge Calderón-Parra, María Teresa Carretero-Henriquez, Gabriela Escudero, Elena Suances-Martin, Marta Murga de la Fuente, Patricia González-Merino, Ane Andrés-Eisenhofer, Ana Visedo-Colino, Ana Rodríguez, Ana Rojo-Reyes, Itziar Diego-Yagüe, Andrea Gutiérrez-Villanueva, Isabel Sánchez-Romero, Antonio Ramos-Martinez","doi":"10.1016/j.ejim.2025.05.034","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.05.034","url":null,"abstract":"<p><strong>Introduction: </strong>We aimed to describe clinical characteristics, risk factors and prognosis in patients with Klebsiella spp. bacteremia according to their beta-lactam resistance profile.</p><p><strong>Material and methods: </strong>Single-centre prospective cohort, including all adults patients with a first episode of Klebsiella spp. bacteriemia from January 2021 to December 2023. Patients were divided into 2 groups: Klebsiella spp. susceptible to carbapenems (CS-K)); and carbapenem-resistant Klebsiella spp. (CR-K). The primary endpoint for prognosis was 30-day mortality.</p><p><strong>Results: </strong>Of the 186 patients included, 156 (83.9 %) were CS-K, and 30 (16.1 %) CR-K. The only factor independently associated with CR-K was previous known colonization (aOR 353.7, 95 %CI 39.8-3142.5). Thirty-day mortality was higher for CR-K than CS-K (40.0 % vs 10.9 %, p < 0.001). An adequate initial antibiotic was used more frequently in CS-K vs CR-K (75.6 % vs 36.7 %, p < 0.001). After adjusting for possible cofounding factors, CR-K was associated with higher mortality (aOR 3.97, 95 % CI 1.40-9.12). Among CR-K, receiving new beta-lactams/betalactamase inhibitors was independently associated with lower 30-day mortality (aOR 0.10, 95 % CI 0.01-0.91). Those patients had similar mortality than those with carbapenem-susceptible Klebsiella spp. bacteremia (10.9 % vs 16.7 %, p = 0.680) CONCLUSIONS: CR-K bacteremia was associated with worse outcomes. Prior colonization was the most important factor associated with this infection. The use of active new betalactam/betalactamase inhibitor antibiotic in patients with CR-K bacteremia was associated with a better prognosis, matching the 30-day mortality observed in carbapenem-susceptible Klebsiella spp. strains.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The approach to triglyceride levels in patients with coronary heart disease.","authors":"Ilay Shani, Avishay Elis","doi":"10.1016/j.ejim.2025.06.004","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.004","url":null,"abstract":"<p><strong>Background: </strong>Clinical trials demonstrate residual risk despite aggressive LDL-C lowering, partialy realated to high TG levels. CHD patients in Israel do not reach the recommended LDL-C target levels, even after hospitalization. Our impression is that it is the same regarding TG levels.</p><p><strong>Objectives: </strong>Exploring the TG levels among CHD patients and adressing specific therapeutic regimens needed.</p><p><strong>Design and methods: </strong>A sub-analysis of a retrospective cohort study of CHD patients who were admitted to internal medicine wards because of anginal syndrome during 2020-2022. The data was evaluated for demographic and clinical characteristics, TG levels and lipid lowering treatment at admission, 6 months previously, 3 months and 6-9 months after discharge. The factors that affect TG levels, with attention given to very high levels, were also evaluated.</p><p><strong>Results: </strong>The cohort included 10,540 patients. Two-thirds had TG levels < 150 mg/dL. Among the subjects with levels ≥ 150 mg/dL, 4-6 % had severe hypertriglyceridemia (≥ 500 mg/dl). In two-thirds of the patients with TG levels ≥ 150 mg/dL, the HbA1c levels were > 6.4 %. Patient with severe hypertriglyceridemia had higher rates of uncontrolled diabetes mellitus. The majority of subjects received statin treatment, regardless of their TG levels. The use of fibrates was very low, but was significantly higher among patients with severe hypertriglyceridemia. Hospitalization did not have a clinically-significant effect on short-term treatment nor on TG levels.</p><p><strong>Conclusions: </strong>Most CHD patients have controlled TG levels. However, additional attention should be given to the diabetic ones. Further education and strict policy are needed.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gamma-glutamyltransferase independently predicts mortality and heart failure hospitalization in cardiac transthyretin amyloidosis.","authors":"Alberto Aimo, Vincenzo Castiglione, Daniela Tomasoni, Giovanni Battista Bonfioli, Giorgia Panichella, Giulio Sinigiani, Alessandro Lupi, Aldostefano Porcari, Navneet Kaur, Marco Merlo, Alberto Cipriani, Gianfranco Sinagra, Maria Franzini, Giuseppe Vergaro, Michele Emdin","doi":"10.1016/j.ejim.2025.06.009","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.009","url":null,"abstract":"<p><strong>Background: </strong>Transthyretin cardiac amyloidosis (ATTR-CA) is a leading cause of heart failure (HF). Although transthyretin is synthesized in the liver, overt liver disease is uncommon in ATTR-CA. We characterised hepatic involvement in patients with ATTR-CA, and identified the correlates and prognostic value of elevated gamma-glutamyl transferase (GGT), the most prominently deranged biomarker.</p><p><strong>Methods: </strong>We examined 528 patients from four centers, using scintigraphy, cardiovascular magnetic resonance, and circulating biomarkers to assess liver function. The primary endpoint was all-cause mortality; secondary endpoints included HF hospitalization alone or combined with all-cause mortality.</p><p><strong>Results: </strong>The cohort comprised predominantly older men (86 % male; median age 81 years). Scintigraphy showed no abnormal hepatic uptake, but liver extracellular volume was elevated (median 0.69; clinically significant cutoff 0.40). Median GGT was 49 U/L, with 48 % exceeding sex-specific upper reference limits. By comparison, elevated aspartate and alanine transaminases, total bilirubin, and alkaline phosphatase were observed in 26 %, 9 %, 33 %, and 1 % of patients, respectively. Patients with GGT ≥82 U/L displayed indicators of more advanced cardiac disease, hepatic injury, and venous congestion. During a median follow-up of 2.6 years, 39 % died and 33 % were hospitalized for HF. In multivariable analysis, GGT remained predictive of all-cause mortality and HF hospitalization beyond the National Amyloidosis Centre score (hazard ratio [HR] 1.15, 95 % confidence interval [CI] 1.01-1.31; p = 0.045, and HR 1.17, 95 % CI 1.03-1.32; p = 0.016, respectively).</p><p><strong>Conclusions: </strong>Elevated GGT is associated with greater disease severity and predicts worse outcomes in ATTR-CA. GGT measurement may improve risk stratification and guide treatment decision-making.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypochloremia in chronic and acute heart failure scenarios: Prevalence and risk factors.","authors":"Pau Llàcer, Marta Cobo Marcos, François Croset, Isabel Zegrí-Reiriz, Rafael de la Espriella, Jara Gayán Ordás, Aleix Fort, Jorge Rubio-Gracia, Zorba Blázquez-Bermejo, Ana Méndez, Adriana Rodríguez, Pedro Caravaca-Pérez, Josep Comín-Colet, Jose Luis Morales-Rull, Luis Manzano, Julio Núñez","doi":"10.1016/j.ejim.2025.05.022","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.05.022","url":null,"abstract":"<p><strong>Aims: </strong>Chloride plays a key role in maintaining volume homeostasis. Low plasmatic chloride levels are associated with diuretic resistance and worse outcomes in patients with heart failure (HF). This study focused on determining the prevalence and factors related to hypochloremia in patients with heart failure (HF) in chronic and acute settings.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of three cohorts: chronic HF patients from the Spanish Cardiorenal Registry, ambulatory patients with worsening heart failure (WHF) from the SALT-HF trial, and inpatient WHF admitted in a teaching-level center in Spain. Multivariate linear regression analyses were employed to identify factors associated with chloremia.</p><p><strong>Results: </strong>The chronic HF cohort included 845 patients [median age 75 years, 38 % female, 62.7 % presenting with a left ventricular ejection fraction (LVEF)≤40 %]. The prevalence of hypochloremia was 5.5 %. The second cohort (ambulatory WHF) comprised 148 participants (median age 80 years, 30 % female, 50 % displaying LVEF ≥ 50 %). Here, hypochloremia was observed in 11 % of the sample. The third cohort (inpatient WHF) enrolled 427 patients (median age 87 years, 64 % female, 82 % with LVEF≥50 %). This group showed a hypochloremia prevalence of 24 %. Multivariate analysis identified lower plasma sodium, loop diuretic treatment, and higher CA125 as common factors independently related to lower chloride levels in the three cohorts.</p><p><strong>Conclusions: </strong>Prevalence of hypochloremia in HF differ across clinical status. Lower chloride is associated with lower sodium levels, prior loop diuretic and thiazide treatment, and higher CA125 values.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inverted V sign.","authors":"Satoshi Hayano, Yuki Toyama, Masayuki Kashima","doi":"10.1016/j.ejim.2025.05.031","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.05.031","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144267802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of 12-lead electrocardiogram for identifying very low mortality risk patients with non-hypotensive acute pulmonary embolism.","authors":"Crhistian-Mario Oblitas, Francisco Galeano-Valle, Luis-Antonio Alvarez-Sala Walther, Pablo Demelo-Rodríguez","doi":"10.1016/j.ejim.2025.06.002","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.002","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}