Artificial intelligence (AI) applications bear a great promise for healthcare. If successfully implemented, AI could reduce the workload for healthcare professionals and enhance the quality of work produced by reducing e...Artificial intelligence (AI) applications bear a great promise for healthcare. If successfully implemented, AI could reduce the workload for healthcare professionals and enhance the quality of work produced by reducing error and increasing precision. It could also extend medical knowledge and ameliorate clinical management. In addition, it has the potential to empower patients to participate more in medical decision making and taking more responsibility in their health management. However, robust and tangibly helpful decision support for medical advice is still in its infancy. Examples where AI can really have added value in guiding physicians in their expert opinion is currently scarce. Similarly, real progress based on big data analysis is also limited so far, for a large part due to qualitatively insufficient data input. However, in the area of medical diagnostics, such as imaging studies, interpretation of lab results or histopathology, major applications based on AI have already been introduced and sometimes implemented and act as serious associate to specialist professionals or can markedly reduce their workload. Currently the challenges associated with AI in healthcare are still significant. Accuracy of AI and will require more study and understanding of the capabilities and limitations of AI. Although AI may have advantages of speed and accuracy, at the moment physicians are still required for the more cognitively complex (or emotional) aspects and tasks.
BACKGROUND: Hyponatremia is the most common electrolytic disturbance among inpatients. It is associated with poor outcomes in frail older patients, even for mild disturbances. Prevalence increases with age, and the commo...BACKGROUND: Hyponatremia is the most common electrolytic disturbance among inpatients. It is associated with poor outcomes in frail older patients, even for mild disturbances. Prevalence increases with age, and the commonest cause is the Syndrome of Inappropriate Antidiuresis. We assessed observationally the practice patterns toward diagnosis and treatment of euvolemic hyponatremia according to severity in a geriatric setting. METHODS: All euvolemic hyponatremic patients admitted to acute geriatric wards in 2023 were retrospectively included. Demographic, biological and clinical characteristics, geriatric syndromes and outcomes were extracted from medical records. Mild (134-130mmol/L), moderate (129-125 mmol/L) and profound (<125 mmol/L) groups were compared. Regression analyses between hyponatremia and clinical outcomes (delirium or falls incidence, 6-month and 1-year mortality and readmission) were realised. RESULTS: The 130 euvolemic hyponatremic patients included had a mean age of 87 years, a mean Cumulative Illness Rating Scale of 17 points and 96.5% had low physical performance. Hyponatremia was mentioned in 32.3% of medical files. Forty-two percent had urine spot tests performed in the first 48h. Fluid restriction was the commonest treatment but was implemented in 26.2% of cases. Significant differences were found across severity groups (p<0.001). One third of patients remained hyponatremic at discharge, especially profound cases (77.8%, p<0.05). We found no independent association between hyponatremia severity and outcomes. CONCLUSION: Hyponatremia is poorly considered and investigated in acute geriatric wards. Mild and moderate hyponatremia are unfrequently treated despite existing guideline-recommended therapies. Clinicians are encouraged to exhaustively investigate hyponatremia in geriatric patients, even in mild cases.
Bartalucci C, Salmanton-García J, Tiseo G
… +14 more, Falcone M, Muccio M, Caldararo L, Giacobbe DR, Bucci L, Guinea J, Mikulska M, Valerio M, Bouza E, Muñoz P, Rello J, Bassetti M, Vena A, ESCMID Fungal Infection Study Group (EFISG) and ESCMID Study Group for Infections in the Elderly (ESGIE)
BACKGROUND: Candida bloodstream infections (BSI) are a major cause of disease in hospitalized patients, with particularly high morbidity and mortality among older adults. However, the impact of biological sex on clinical...BACKGROUND: Candida bloodstream infections (BSI) are a major cause of disease in hospitalized patients, with particularly high morbidity and mortality among older adults. However, the impact of biological sex on clinical presentation and outcomes in this population remains poorly defined. We evaluated sex-based differences in patients aged ≥65 years with Candida BSI. METHODS: We conducted a retrospective multicenter cohort study across three hospitals in Italy and Spain (2018-2022), including all patients aged ≥65 years with Candida BSI. The primary outcome was 30-day all-cause mortality. Cox regression and 1:1 propensity score matching were used to assess the association between biological sex and mortality and to identify independent predictors of outcome. RESULTS: A total of 1132 patients were included (53.4% male; median age 79 years). Men had a higher comorbidity burden and more severe clinical presentation at onset. Overall, 30-day mortality was 46.9%, with no significant difference between sexes (log-rank p = .929). In multivariable analysis, older age, higher Charlson Comorbidity Index, and septic shock were independently associated with mortality, whereas biological sex was not (aHR 1.19, 95% CI 0.95-1.50, p = .136). After propensity score matching, biological sex was not associated with mortality, while adequate source control was protective (aHR 0.62, 95% CI 0.47-0.82, p = .0008). CONCLUSIONS: In older adults with Candida BSI, short-term mortality is driven primarily by disease severity, comorbidity burden, and adequacy of management rather than biological sex. Optimizing timely antifungal therapy and source control appears critical to improving outcomes in this vulnerable population.
Prostate cancer (PCa) is one of the most common malignancies among men worldwide. Advances in systemic therapies, including androgen deprivation therapy (ADT), androgen receptor-targeted agents, chemotherapy, poly(ADP-ri...Prostate cancer (PCa) is one of the most common malignancies among men worldwide. Advances in systemic therapies, including androgen deprivation therapy (ADT), androgen receptor-targeted agents, chemotherapy, poly(ADP-ribose) polymerase (PARP) inhibitors, and immunotherapy, have substantially improved survival outcomes. However, these therapeutic advances have also led to increased recognition of treatment-related cardiovascular toxicity. Cardiovascular disease is highly prevalent among patients with prostate cancer and remains a major cause of morbidity and mortality, underscoring the importance of integrating cardiovascular care into oncologic management. This review summarizes the principal cardiovascular complications associated with contemporary prostate cancer therapies and discusses current strategies for their prevention and management. ADT has been associated with metabolic dysfunction, hypertension, arrhythmias, and increased cardiovascular risk. Androgen receptor-targeted agents and androgen biosynthesis inhibitors may further contribute to hypertension, fluid retention, ischemic heart disease, and cardiac rhythm disturbances. Additional therapies, including taxane-based chemotherapy, PARP inhibitors, and immune checkpoint inhibitors, have also been linked to myocardial dysfunction, hypertension, QT prolongation, and immune-mediated myocarditis, although the incidence and severity vary across therapeutic classes. Given the increasing complexity of prostate cancer treatment, early cardiovascular risk stratification and close monitoring during therapy are essential. Baseline cardiovascular evaluation, regular assessment of blood pressure and metabolic parameters, electrocardiographic surveillance, multimodality cardiovascular imaging, and appropriate management of pre-existing cardiovascular disease are critical components of patient care. A multidisciplinary cardio-oncology approach is essential to minimize cardiovascular toxicity while preserving the therapeutic benefits of modern prostate cancer treatment.
Eur J Intern Med
· 2026 Jun · PMID 42373336
·
Publisher ↗
Testosterone deficiency is highly prevalent in men with chronic kidney disease (CKD), affecting 30-70% of patients depending on disease stage and diagnostic criteria. Despite its frequency and association with adverse ou...Testosterone deficiency is highly prevalent in men with chronic kidney disease (CKD), affecting 30-70% of patients depending on disease stage and diagnostic criteria. Despite its frequency and association with adverse outcomes including anemia, malnutrition, muscle wasting, cardiovascular disease, and impaired quality of life, testosterone replacement therapy (TRT) remains underutilized in this population. This review synthesizes evidence from randomized controlled trials, prospective registries, and observational studies demonstrating that TRT in CKD patients produces clinically meaningful improvements in hematologic parameters, nutritional markers, muscle strength, body composition, sexual function, and quality of life. Emerging observational data suggest potential renoprotective effects, with treated patients showing preserved or improved estimated glomerular filtration rate compared to untreated controls. Cardiovascular safety data from large trials indicate noninferiority to placebo for major adverse cardiac events, though vigilance for atrial fibrillation and acute kidney injury is warranted. Importantly, transdermal testosterone gel formulations offer superior pharmacokinetic profiles compared to intramuscular injections, providing stable physiological testosterone levels without supraphysiological peaks and consequently lower risk of excessive erythrocytosis. Given the substantial burden of hypogonadism in CKD and accumulating evidence of therapeutic benefit, systematic screening and individualized treatment of testosterone deficiency should be integrated into comprehensive CKD management.
Uslar T, Sanfuentes B, Olmos R
… +16 more, Burnier A, Böhm P, Guarda FJ, Huete Á, Mertens N, Besa C, Andía M, Majerson A, Cartes J, Tapia A, Carvajal CA, Fardella CE, Allende F, Solari S, Vaidya A, Baudrand R
Eur J Intern Med
· 2026 Jun · PMID 42364940
·
Publisher ↗
BACKGROUND: Incidental adrenal adenomas are common, yet renin status is infrequently assessed in hypertensive patients. Emerging evidence supports a spectrum of renin-independent aldosterone excess associated with advers...BACKGROUND: Incidental adrenal adenomas are common, yet renin status is infrequently assessed in hypertensive patients. Emerging evidence supports a spectrum of renin-independent aldosterone excess associated with adverse cardiovascular risk. OBJECTIVE AND METHODS: To determine the frequency of a low-renin phenotype in a prospective cohort of hypertensive patients with adrenal adenomas and to evaluate the clinical response to aldosterone-targeted therapy across baseline aldosterone categories. Low-renin phenotype was defined as suppressed renin (PRA <1.0 ng/mL/h or DRC <10 µIU/mL). Among these patients, plasma aldosterone concentration (PAC) was categorized as 5-10 ng/dL (Group 1), 10-15 ng/dL (Group 2), and >15 ng/dL (Group 3). Patients with suppressed renin were treated with MR antagonists or adrenalectomy and followed longitudinally using PAMO/PASO criteria. RESULTS: Low renin was present in 47% (138/290) of hypertensive patients. Increasing aldosterone levels were associated with higher systolic blood pressure (SBP), resistant hypertension, higher antihypertensive treatment burden, lower potassium, and reduced eGFR (p-trend <0.001). After a mean follow-up of 24±18 months (n = 121), aldosterone-targeted therapy (75% medical, 25% surgical) led to significant reductions in SBP (-18, -26, and -30 mmHg across Groups 1-3; all p < 0.001), decreased medication and significant increases in renin (all p < 0.001), irrespective of aldosterone category. CONCLUSIONS: Nearly half of hypertensive patients with adrenal incidentalomas exhibit suppressed renin levels associated with greater blood pressure burden and favorable response to aldosterone-targeted therapy, even in lower aldosterone levels categories. These findings support systematic renin assessment in hypertensive patients with incidental adrenal adenomas and provide a rationale for testing aldosterone-targeted therapy in broader hypertensive populations beyond adrenal adenomas.
Merzou F, Tarantini L, Landau B
… +8 more, Lesmeister M, Martin H, Bertsch T, Mathur S, Groppa S, Winter Y, Fassbender K, Lochner P
Eur J Intern Med
· 2026 Jun · PMID 42364939
·
Publisher ↗
BACKGROUND: Direct oral anticoagulants (DOACs) are increasingly used, but their pharmacokinetic stability compared to vitamin K antagonists during acute illness remains poorly characterized. We aimed to evaluate the impa...BACKGROUND: Direct oral anticoagulants (DOACs) are increasingly used, but their pharmacokinetic stability compared to vitamin K antagonists during acute illness remains poorly characterized. We aimed to evaluate the impact of renal and hepatic dysfunction on anticoagulant levels in patients presenting to the emergency department. METHODS: This multi-center cohort study included 608 patients on established treatment with rivaroxaban, apixaban, dabigatran, edoxaban, or phenprocoumon. Above-threshold anticoagulant levels were determined via drug-specific plasma concentrations, anti-Xa activity, Hemoclot assays, or INR. Multivariable regression was used to assess the impact of renal function and the Model for End-Stage Liver Disease (MELD) score on supratherapeutic levels. RESULTS: Of 608 patients, 457 (75%) received DOACs and 151 (25%) phenprocoumon. Supratherapeutic levels were significantly less frequent with apixaban (14.4%; OR 0.41, 95% CI 0.25-0.69) and edoxaban (10.8%; OR 0.30, 95% CI 0.10-0.90) compared to phenprocoumon (28.5%). Impaired renal function was independently associated with above-threshold levels for DOACs (OR 1.55, 95% CI 1.17-2.05)-particularly apixaban (OR 2.23, 95% CI 1.33-3.75)-but not for phenprocoumon (OR 1.18, 95% CI 0.79-1.76). Conversely, hepatic dysfunction (MELD score) significantly increased the probability of above-threshold levels (OR 3.80, 95% CI 2.78-5.21), with a more pronounced effect on phenprocoumon (OR 5.26, 95% CI 2.86-9.68) than DOACs (OR 3.46, 95% CI 2.44-4.92). CONCLUSIONS: DOACs demonstrate superior pharmacokinetic robustness compared to phenprocoumon in the emergency setting. However, DOAC levels are highly sensitive to renal fluctuations, whereas phenprocoumon is more susceptible to hepatic impairment. These findings suggest that individualized monitoring may be necessary for DOAC patients with acute renal decline.
Neale M, Wong C, Kreuter D
… +2 more, Taylor J, Sivapalaratnam S
Eur J Intern Med
· 2026 Jun · PMID 42364938
·
Publisher ↗
Artificial intelligence (AI) is having a transformational impact on society, yet its adoption in laboratory medicine has proceeded notably slower than in many other industries and even different specialities within medic...Artificial intelligence (AI) is having a transformational impact on society, yet its adoption in laboratory medicine has proceeded notably slower than in many other industries and even different specialities within medicine. This review sets out to examine why, despite such technical progress, meaningful clinical translation beyond rule-based autoverification has remained elusive. We argue that three principal barriers account for this gap. First, modelling approaches have been insufficiently robust for the inherent complexity of laboratory data. Second, the datasets available for model training and validation lack the scale, diversity, and operational representativeness required for genuine generalisation. Third, the regulatory environment constrains both the acquisition of data and the subsequent deployment of trained models. We trace the field's attempts at automation from autoverification systems through classical machine learning and single-modal deep learning approaches to the current generation of foundation and generative models, and we highlight the limitations and constraints of each approach. We then examine existing regulatory frameworks, available large-scale data initiatives and federated learning, a potential means to address these barriers.