European Journal of Internal Medicine最新文献

{"title":"New onset left atrial dilatation in the general population: A quarter-century follow-up.","authors":"Cesare Cuspidi, Rita Facchetti, Fosca Quarti-Trevano, Raffaella Dell'Oro, Andrea Faggiano, Giuseppe Mancia, Guido Grassi","doi":"10.1016/j.ejim.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.05.001","url":null,"abstract":"<p><strong>Background: </strong>Information on the incidence of left atrial enlargement (LAE) and the factors underlying progressive LA remodelling in long-term longitudinal population-based studies is scanty. We investigated the incidence of new onset LAE and its determinants among middle aged adults over a 25-year time period.</p><p><strong>Methods: </strong>A total of 423 participants with measurable echocardiographic parameters at baseline (mean age 41+10 years, 52 % men) and after a 25-year follow-up were included in the analysis. LA diameter (LAD) was measured with 2D-guided M-mode technique. LAE was detected according to sex-specific non-indexed criteria and a sex-independent indexed to body surface area (BSA) criterion recommended by contemporary echocardiographic guidelines.</p><p><strong>Results: </strong>New LAE occurred in 27.4 % (absolute LA diameter, LAD) and 16.5 % (LAD/BSA), respectively. Initial LAD and body mass index (BMI), as well as the 25-year change in BMI and left ventricular mass index (LVMI) were independently correlated to incident non-indexed LAE. Besides age, the independent modifiable predictors of new-onset LAE/BSA were initial LAD/BSA, the 25-year change in BMI and 24-h pulse pressure (PP).</p><p><strong>Conclusions: </strong>The incidence of LAE from mid to late adulthood occurs in a large clinically relevant fraction of participants and is affected by initial LAD, BMI and 25-year change in BMI, LVMI and 24-h PP. The findings provided by the present study support the view that avoid obesity and maintain normal levels of BMI, blood pressure and LVMI during life can contribute to strengthen cardiovascular prevention in the general population through prevention of LA remodelling and its harmful consequences.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030870","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 effects of sleep improving interventions in medical hospital wards: the WEsleep study - A randomized clinical trial.","authors":"C J de Gans, A J G Meewisse, E S van den Ende, M L van Zuylen, P W B Nanayakkara, J Hermanides, D J Stenvers","doi":"10.1016/j.ejim.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.015","url":null,"abstract":"<p><strong>Objective: </strong>Hospitalized patients often experience disturbed sleep, affecting general health. While some randomized studies have assessed individual non-pharmacological interventions, none have evaluated approaches that combine multiple strategies to improve sleep. This study aimed to assess the effects of a multicomponent sleep-enhancing protocol in hospitalized medical patients.</p><p><strong>Methods: </strong>The WEsleep cluster randomized controlled trial was conducted between July 2023 and March 2024 across six medical departments in a large Dutch academic hospital. Adult medical patients who were able to provide informed consent and were expected to stay at least two nights were eligible for inclusion. The multicomponent intervention included delaying early morning nursing rounds, training healthcare professionals, optimizing sleep-disturbing medication timing, offering earplugs and eye masks, and conducting evening sleep rounds. The primary outcome was sleep quality on the second night, assessed with the Richards-Campbell Sleep Questionnaire (RCSQ). Secondary outcomes included sleep quantity, 30-day mortality, delirium incidence, and use of sleep-enhancing tools.</p><p><strong>Results: </strong>Data from 291 patients were analyzed. The intervention group reported better sleep quality, with a median RCSQ score of 66.6 (IQR 44.3-78.9), compared to 55.7 (IQR 38.2-74.3) in the control group (p = 0.033). No significant differences were observed in sleep quantity, 30-day mortality or delirium incidence. Protocol adherence ranged from 42 % to 73 %.</p><p><strong>Conclusions: </strong>This study provides a valuable roadmap for hospitals aiming to enhance patient care through improved sleep management. A multicomponent intervention can lead to significantly better sleep quality in medical wards, highlighting the potential of structured, non-pharmacological strategies in routine hospital care.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993077","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":"Fast versus slow fibrosers: Risk factors for fibrosis progression in eosinophilic oesophagitis.","authors":"Giovanni Santacroce, Antonio Di Sabatino","doi":"10.1016/j.ejim.2025.04.042","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.042","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043936","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":"Difficult-to-treat rheumatoid arthritis among elderly patients from the KOBIO registry.","authors":"Ju-Yang Jung, Eunyoung Lee, Ji-Won Kim, Chang-Hee Suh, Kichul Shin, Jinhyun Kim, Hyoun-Ah Kim","doi":"10.1016/j.ejim.2025.04.040","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.040","url":null,"abstract":"<p><strong>Background: </strong>'Difficult-to-treat (D2T)' rheumatoid arthritis (RA) refers to patients who fail to achieve low disease activity or remission despite multiple biologic or targeted synthetic disease modifying anti-rheumatic drugs (b/tsDMARD) cycles. Elderly RA patients often have higher disease activity and more comorbidities. This study aimed to determine the prevalence of D2T-RA in elderly RA patients treated with b/tsDMARDs and examine their characteristics and treatment outcomes.</p><p><strong>Methods: </strong>Data were extracted from the Korean College of Rheumatology Biologics registry for RA patients receiving b/tsDMARDs.</p><p><strong>Results: </strong>Among 516 elderly RA patients (≥65 years) on b/tsDMARDs, 54 (10.5 %) had D2T-RA. Younger age (OR = 0.905, p = 0.012), higher RAPID3 scores (OR = 1.082, p = 0.044), lack of prior leflunomide use (OR = 0.446, p = 0.009), and lack of prior use of two or more conventional synthetic DMARDs (csDMARDs) (OR = 0.114, p < 0.001) were associated with D2T-RA. Drug survival rates were similar between D2T-RA and non-D2T-RA groups (p = 0.53). Discontinuation and switching rates did not differ, but inefficacy was a more frequent withdrawal reason in D2T-RA (63 % vs. 29.7 %, p = 0.001). Disease activity scores remained higher in D2T-RA patients at 1- and 2-year follow-ups.</p><p><strong>Conclusions: </strong>Among elderly RA patients on b/tsDMARDs, 10.5 % had D2T-RA. Younger age, higher RAPID3, absence of prior leflunomide use, and absence of prior use of two or more csDMARDs were associated with D2T-RA. Despite comparable drug survival, persistent disease activity underscores the need for ongoing efficacy evaluation and tailored treatment strategies for better disease control.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024457","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":"Drug-induced hyponatremia in clinical care.","authors":"Buster Mannheimer, Jonatan D Lindh, Cecilia Bergh Fahlén, Issa Issa, Henrik Falhammar, Jakob Skov","doi":"10.1016/j.ejim.2025.04.034","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.034","url":null,"abstract":"<p><strong>Purpose: </strong>Over the last decades, advances in understanding of previously described associations have important implications for diagnosis and workup of hyponatremia. In addition, new drug groups potentially affecting sodium balance and water homeostasis have evolved. The aim of this review is to summarize current evidence on drug-induced hyponatremia in clinical care.</p><p><strong>Methods: </strong>We searched PubMed using the string \"Inappropriate ADH Syndrome/chemically induced\"[Mesh] OR \"Inappropriate ADH Syndrome/diagnosis\"[Mesh]) OR (\"Hyponatremia/chemically induced\"[Mesh] OR \"Hyponatremia/diagnosis\"[Mesh]), January 1^st, 2008, to September 2^nd 2024. In total 2003 articles were found and reviewed. Relevant articles referenced herein were subsequently traced backwards and also reviewed.</p><p><strong>Results: </strong>Drugs associated with hyponatremia, including selective serotonin reuptake inhibitors, antipsychotics, antiepileptic drugs and proton pump inhibitors, typically cause hyponatremia shortly after initiation of treatment. For thiazide diuretics, the number one culprit in drug-induced hyponatremia, the risk for hyponatremia is highest the first weeks after initiation and then gradually decreases to a stable but still increased level after around 3 months. Several drugs that promote a negative water balance such as loop diuretics, lithium and of sodium-glucose cotransporter-2 inhibitors appear to decrease the risk for hyponatremia. Treatment with immune checkpoint inhibitors is associated with an increased risk of hypophysitis and adrenalitis resulting in hyponatremia due to secondary and primary cortisol deficiency.</p><p><strong>Conclusion: </strong>For most drugs associated with hyponatremia, including thiazides, the cause-effect relationship is tightly linked to newly initiated treatment. Further research is warranted to characterize the association between hyponatremia and newly developed drugs such as sodium-glucose cotransporter-2 inhibitors and immune checkpoint inhibitors.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037523","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":"Chronic kidney disease classification according to different formulas and impact on adverse outcomes in patients with atrial fibrillation: A report from a prospective observational European registry.","authors":"Giuseppe Boriani, Davide Antonio Mei, Niccolò Bonini, Marco Vitolo, Jacopo Francesco Imberti, Giulio Francesco Romiti, Bernadette Corica, Igor Diemberger, Gheorghe Andrei Dan, Tatjana Potpara, Marco Proietti, Gregory Y H Lip","doi":"10.1016/j.ejim.2025.04.038","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.038","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) and atrial fibrillation (AF) often coexist, making accurate renal function estimation crucial, typically through equations calculating estimated glomerular filtration rate (eGFR) or creatinine clearance (CrCl).</p><p><strong>Objective: </strong>To compare the concordance and predictive performance of different renal function estimation equations in a European cohort of AF patients.</p><p><strong>Methods: </strong>We analyzed data from AF patients enrolled in a prospective observational European registry. Renal function was estimated using eight formulas: BIS-1, CG, CG-BSA, CKD-EPI, EKFC, FAS, LMR and MDRD. Concordance between formulas was assessed using weighted Cohen's Kappa, while Cox regression and receiver operating characteristic (ROC) curves evaluated their association with outcomes (composite of all-cause death, any coronary revascularization and any thromboembolism).</p><p><strong>Results: </strong>We included 8,506 patients. CKD-EPI demonstrated good to excellent concordance with other formulas, with the lowest concordance with CG (K = 0.607; 95% CI, 0.595-0.618) and the highest with MDRD (K = 0.880; 95% CI, 0.873-0.887). The risk of adverse outcomes increased sharply when renal function dropped below 60 ml/min across all formulas. CG-BSA and CG formulas showed the best discriminative ability for predicting composite outcomes (AUC 0.660, 95% CI 0.644-0.677, and 0.661, 95% CI 0.644-0.678, respectively). Based on integrated discrimination improvement (IDI) analysis, compared to the CKD-EPI equation, the CG and CG-BSA formulas showed significant improvements in sensitivity of 0.9% and 1.1%, respectively CONCLUSION: Equations for estimating renal function vary in concordance, with potential implications for drug prescription and predicting adverse events. CG and CG-BSA formulas showed superior performance in identifying patients at risk for adverse outcomes.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057517","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":"Tailoring non-invasive respiratory supports in acute hypoxemic respiratory failure: A practical approach for clinicians.","authors":"Maria Laura Vega Pittao, Stefano Nava, Nicholas S Hill, Lara Pisani","doi":"10.1016/j.ejim.2025.04.018","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.018","url":null,"abstract":"<p><p>The use of non-invasive respiratory support (NIRS) for acute respiratory failure (ARF), particularly hypoxemic respiratory failure, has advanced in recent years, especially during the COVID-19 pandemic. NIRS modalities like high-flow nasal cannula (HFNC), continuous positive airway pressure (CPAP), and non-invasive ventilation (NIV) have shown efficacy, though evidence is inconsistent, especially for \"de novo\" acute hypoxemic respiratory failure (AHRF). This review outlines the physiological rationale for NIRS and offers practical guidance on tailoring treatment to individual patients. Successful AHRF management with NIRS requires a personalized approach, guided by clinical expertise. Further research is needed to refine patient selection and optimize NIRS application.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023067","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":"Cost-effectiveness of daily home haemodialysis versus in-centre haemodialysis: A propensity score matching analysis based on real-world data from the French healthcare system.","authors":"Guy Rostoker, Jean-Jacques Dumas, Benoît Thomé, Victor-Alexandre Aragno, Michel Thomas, Bernard Canaud","doi":"10.1016/j.ejim.2025.04.017","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.017","url":null,"abstract":"<p><p>Background Daily home haemodialysis (HD) offers several advantages over conventional 3-times-weekly in-centre HD, with better preservation of quality of life and treatment flexibility, but its costs and potential benefits on mortality are poorly understood. Methods Individual healthcare data from the French National Health Data System for patients with end-stage kidney disease undergoing dialysis cross-referenced with the French National Cost Scale of the health ministry. After exclusion of patients treated < 90 days, and those without a treatment schedule or incomplete data for a social disadvantage score, 42 605 patients were selected (28 317 prevalent and 14 288 incident HD patients). After propensity score matching, 265 incident patients (in-centre HD, n = 212; daily home HD, n = 53) and 765 prevalent patients (in-centre HD, n = 612; daily home HD, n = 153) were analysed. Findings The global cost of daily home HD in incident patients was lower than in-centre HD (€1403/week vs. €1652/week, respectively). In prevalent patients, the cost was also slightly lower for daily home haemodialysis than compared to in-centre haemodialysis (€1360/week vs. €1456/week, respectively). The gross death rate in incident patients treated by in-centre HD after a 2-year follow-up was 10·4 % vs. 1·9 % for patients treated by daily home HD (p = 0·049, at Chi² test; relative risk=5·5). Using a Cox proportional hazard regression model, in-centre HD was associated with a 7-fold higher risk of death (hazard ratio=7·888, p = 0·045). Interpretation Daily home HD is a more cost-effective and patient-centred treatment option than in-centre HD. Funding This research was funded by Physidia Ltd and Ramsay Health Care, France.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030634","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":"Clinical trajectories in liver cirrhosis: An evidence-based reappraisal for the internist.","authors":"Rosa Zampino, Fabian Patauner, Emanuele Durante-Mangoni","doi":"10.1016/j.ejim.2025.04.028","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.04.028","url":null,"abstract":"<p><p>Over the last few years, the approach to clinical recognition and risk stratification of advanced liver disease has changed substantially, and liver cirrhosis has been increasingly conceptualized as a clinical rather than a histopathologic condition. In this Clinical Insight, we summarize the latest developments on recognition and management of 'clinically' advanced chronic liver disease.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006624","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":"Refining the understanding of cardiovascular risk following COPD exacerbations: Opportunities for stratified and multidisciplinary approaches","authors":"Rujian Yu ,&nbsp;Lamei Zou","doi":"10.1016/j.ejim.2024.12.026","DOIUrl":"10.1016/j.ejim.2024.12.026","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":"135 ","pages":"Pages 159-160"},"PeriodicalIF":5.9,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142899680","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}