European Journal of Internal Medicine最新文献

{"title":"Modern data on blood pressure distribution in European children and adolescents.","authors":"Paolo Verdecchia, Prerna Banati","doi":"10.1016/j.ejim.2025.07.010","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.07.010","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627614","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 characteristics and outcomes of patients with acute myocardial Infarction without standard modifiable risk factors (SMuRFs).","authors":"Dimitrios V Moysidis, Vasileios Anastasiou, Stylianos Daios, Andreas S Papazoglou, Efstratios Karagiannidis, Barbara Fyntanidou, Vasileios Kamperidis, Matthaios Didagelos, Sonia Konstantinidou, Christos Savopoulos, Kali Makedou, Panagiotis Kyriakidis, George Giannakoulas, Antonios Ziakas, Georgios Giannopoulos, Vassilios Vassilikos","doi":"10.1016/j.ejim.2025.07.007","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.07.007","url":null,"abstract":"<p><strong>Background: </strong>The etiology as well as the prevalence of acute myocardial infarction (AMI) in patients without history of standard modifiable risk factors (SMuRFs) remains unclear, especially in European populations. Simultaneously, evidence suggests that SMuRF-less patients may experience worse short-term outcomes after AMI.</p><p><strong>Methods: </strong>The \"Beyond-SMuRFs\" prospective observational study (NCT05535582) included 1011 consecutive patients with AMI in Greece, who underwent coronary angiography and had available data on clinical, laboratory and imaging parameters. SMuRF-less patients were defined as those who have no history of diabetes mellitus, dyslipidemia, hypertension or smoking. Multivariable logistic-regression and receiver operating characteristic (ROC) analyses were implemented to investigate potential predictors of SMuRF-less AMIs and their predictive ability. Kaplan-Meier curves and Cox-regresion analyses were used to compare all-cause mortality and the composite outcome of cardiovascular death or/and AMI/heart-failure (HF) re-hospitalization or/and stroke among patients with and without SMuRFs.</p><p><strong>Results: </strong>Of 1011 patients with AMI (mean age 62.0 ± 11.8 years), 842 (83.2 %) had at least on SMuRF and 169 (16.7 %, 95 % CI: 14.5 %-19.1 %) were SMuRF-less patients. When patients with obesity or former smoking status were excluded from the SMuRF-less group, this number decreased to 140 (13.8 %, 95 % CI: 11.7 %-16.1 %). The multivariable logistic regression model showed that positive family history of AMI [adjusted Odds Ratios (aOR): 1.88 [1.26-2.80], p = 0.002), history of rheumatic/inflammatory disorders (3.31 [1.38-7.93], p = 0.007), major psychiatric disease (2.77 [1.24-6.19], p = 0.013) and drugs/alcohol abuse (4.45 [2.24-8.82], p < 0.001) were independently associated with the occurence of SMuRF-less AMI. The ROC area under the curve for this model was 0.64 ([0.58-0.69], p = 0.001) but was increased to 0.78 [0.73-0.83], p = 0.001), when patients with former smoking and obesity were not considered as SMuRF-less. Regarding the short-term (in-hospital and 30-day) outcomes, SMuRF-less patients exhibited higher rates of all-cause death [adjusted Hazard Ratio (aHR): 2.45 [1.36-4.41], p = 0.003 and 2.38 [1.32-4.31], p = 0.003, respectively] and the secondary composite outcome (aHR: 2.99 [1.65-5.09]; p = 0.001 and 2.75 [1.60-4.70]; p = 0.001, respectively). However, at long-term follow-up non-significant differences were observed.</p><p><strong>Conclusions: </strong>Positive family history, history of inflammatory or major psychiatric diseases, along with drug or alcohol abuse, were independently associated with SMuRF-less AMIs. SMuRF-less patients experienced worse short-term outcomes than patients with SMuRFs, which was not maintained at the long-term follow-up.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621080","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' reply.","authors":"B Mannheimer, J D Lindh, H Falhammar, J Skov","doi":"10.1016/j.ejim.2025.07.002","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.07.002","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144610245","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":"Deterioration of renal function is delayed in patients with atrial fibrillation treated with direct oral anticoagulants compared to vitamin K antagonists: systematic review and meta-analysis.","authors":"Anastasia Adamou, Ioannis Kyriakoulis, Polyxeni Botou, Ioannis Belios, Iliana Stamatiou, David Dimitris Chlorogiannis, Theodoros Mavridis, George Ntaios","doi":"10.1016/j.ejim.2025.07.003","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.07.003","url":null,"abstract":"<p><strong>Background: </strong>The use of anticoagulants has been linked to anticoagulant-related nephropathy, a condition initially reported in patients treated with warfarin. However, cases have also been documented in patients receiving direct oral anticoagulants (DOACs). We conducted a systematic review and meta-analysis to assess the comparative effect of DOACs versus Vitamin K antagonists (VKAs) in renal function deterioration in atrial fibrillation (AF) population.</p><p><strong>Methods: </strong>According to the PRISMA reporting guidelines for systematic reviews and meta-analyses, we performed a comprehensive search in PubMed/MEDLINE and EMBASE (via Scopus), focusing on studies in AF patients treated with DOACs or VKAs and assessing their renal function over time. The studied outcomes were ≥30 % eGFR decline, progression to stage five chronic kidney disease (CKD) and doubling of serum creatinine.</p><p><strong>Results: </strong>Among 4566 records, 13 studies with 302,071 patients were included with an overall follow-up period of 701,421.5 patient-years (mean:2.3 years per patient). DOACs were associated with a lower risk of ≥30 % eGFR decline (HR:0.72, 95 %CI:0.59-0.88), progression to stage five CKD (HR:0.49,95 %CI:0.37-0.64) and doubling of serum creatinine (HR:0.50, 95 %CI:0.42-0.61). ≥30 % eGFR decline was also lower when apixaban, dabigatran and rivaroxaban were compared separately to VKAs, (HR:0.81, 95 %CI:0.69-0.95), (HR:0.61, 95 %CI:0.48-0.78) and (HR:0.80, 95 %CI:0.70-0.92) respectively. There was no effect in progression to stage five CKD and doubling of serum creatinine, when apixaban was compared to VKAs.</p><p><strong>Conclusions: </strong>This systematic review and metanalysis of 13 studies and >300,000 patients with AF followed for an overall period of >700,000 patient-years showed that eGFR decline, progression to stage five CKD and doubling of serum creatinine are delayed in patients treated with DOACs compared to VKAs.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602104","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":"Prognostic impact of uric acid levels in heart failure with mildly reduced ejection fraction: Insights from a large retrospective registry.","authors":"Alexander Schmitt, Michael Behnes, Thomas Bertsch, Marielen Reinhardt, Michelle Goertz, Noah Abel, Felix Lau, Kathrin Weidner, Jonas Dudda, Henning Johann Steffen, Mohammad Abumayyaleh, Daniel Duerschmied, Ibrahim Akin, Tobias Schupp","doi":"10.1016/j.ejim.2025.06.033","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.033","url":null,"abstract":"<p><strong>Background: </strong>Elevated uric acid (UA) is a recognized biomarker in patients with cardiovascular disease. However, the prognostic significance of UA levels in patients with heart failure (HF), particularly those with HF with mildly reduced ejection fraction (HFmrEF), remains unexplored.</p><p><strong>Methods: </strong>From 2016 to 2022, consecutive patients hospitalized with HFmrEF at one medical centre were retrospectively included. Patients were stratified by pre-specified UA levels (i.e., normal UA: ≥3.5 - ≤6.0 (females) or ≤7.0 (males); low UA: <3.5 and high UA: >6.0 (females) or >7.0 mg/dL (males)), further stratification was performed by UA quintiles. The primary endpoint was all-cause mortality at 30 months (median follow-up), the key secondary endpoint was HF-related rehospitalization.</p><p><strong>Results: </strong>The study cohort comprised 1419 HFmrEF patients with a median UA of 6.0mg/dL. UA levels above (H) and below (L) the normal range (N) were predictive for the risk of all-cause mortality at 30 months (H: 42 % and L: 43 % vs. N: 27 %), which persisted after multivariable adjustments (H vs N: HR=1.230; 95 % CI 1.003-1.508; p = 0.046; L vs N: HR=1.915; 95 % CI 1.383-2.650; p = 0.001). Furthermore, there was a trend towards a higher risk of long-term HF-related rehospitalization in patients with elevated UA levels (H: 20 % vs. N: 9 % vs. L: 8 %). However, this finding failed to reach statistical significance after multivariable adjustment (H vs. N: HR=1.408; 95 % CI 0.995-1.992; p = 0.053).</p><p><strong>Conclusion: </strong>Both elevated and low UA levels were associated with an increased risk of long-term all-cause mortality in patients with HFmrEF.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602105","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":"Point of care ultrasound (POCUS) applications in the ambulatory internal medicine setting: A scoping review.","authors":"Michael Pratte, Mathilde Gaudreau-Simard, Sydney Ruller, Kordan Harvey, Valentina Ly, Jessica Evans","doi":"10.1016/j.ejim.2025.06.008","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.008","url":null,"abstract":"<p><strong>Introduction: </strong>Point of care ultrasound (POCUS) is an increasingly recognized tool in internal medicine, with evidence supporting its use largely derived in the inpatient setting. We endeavored to provide an overview of outpatient POCUS applications that could be relevant to the practice of internal medicine.</p><p><strong>Methods: </strong>A scoping review was conducted using the JBI Evidence Synthesis framework. Studies of adults who received a POCUS assessment during an outpatient clinic encounter for an indication that was within the scope of practice of an internist were included. Data was extracted on POCUS intervention characteristics, POCUS applications, as well as outcomes such as validation, feasibility, prognostic value, clinical integration, resource utilization, and effect on medical management.</p><p><strong>Results: </strong>A total of 100 studies were included in the final analysis. Most POCUS scans were conducted by cardiologists (n = 21) and family physicians (n = 31). The primary POCUS applications identified were lung (n = 30), cardiac (n = 29), vascular (n = 10), and musculoskeletal (n = 9). Screening applications for cardiac and vascular arterial disease were also uncovered (n = 16). POCUS was found to have prognostic value (n = 16/21, 76.2 %) and be feasible (n = 40/40, 100.0 %) in studies of various outpatient settings. Just over half of the studies reported POCUS interventions that were integrated into clinical care (n = 56), with many of these studies reporting that POCUS was associated with changes in medical management (n = 35/36, 97.2 %) and reduced resource utilization (n = 18/19, 94.7 %).</p><p><strong>Conclusion: </strong>POCUS use in the outpatient internal medicine setting is a promising modality to aid in the screening, early diagnosis, and prognostication of various pathologies.</p>","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592849","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":"\"Limits to medicine\" still needed after 50 years.","authors":"Bjørn Hofmann","doi":"10.1016/j.ejim.2025.06.026","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.026","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144592848","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":"Mapping the clinical trial landscape of gut microbiota modulation in neurodegenerative diseases.","authors":"Hui Chen","doi":"10.1016/j.ejim.2025.06.032","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.032","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565442","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":"Association of serum potassium time in target range with all-cause and cardiovascular mortality in HFrEF patients.","authors":"Wenlong Xu, Yifei Ruan, Zhiwen Xiao, Xiaobo Huang, Yanmei Chen","doi":"10.1016/j.ejim.2025.06.019","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.019","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565441","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":"Constrictive pericarditis and tuberculosis: A second look.","authors":"Abraham J Beun, Maria Gabrovska, Rakan Nasreddine","doi":"10.1016/j.ejim.2025.06.031","DOIUrl":"https://doi.org/10.1016/j.ejim.2025.06.031","url":null,"abstract":"","PeriodicalId":50485,"journal":{"name":"European Journal of Internal Medicine","volume":" ","pages":""},"PeriodicalIF":5.9,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561834","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}