Vitacca M, Olivares A, Borri R
… +12 more, Torlaschi V, Gazzi L, Portolani DM, Lastoria C, Aggiato S, Candia C, Maniscalco M, Cassetti G, Vigorè M, Merla S, Steinhilber G, Moretta P
Eur J Intern Med
· 2026 Jun · PMID 42248735
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BACKGROUND: Chronic respiratory diseases are associated with psychiatric/neurocognitive comorbidities; prevalence, clinical impact and responsiveness to in-patient pulmonary rehabilitation (PR) remain poorly characterize...BACKGROUND: Chronic respiratory diseases are associated with psychiatric/neurocognitive comorbidities; prevalence, clinical impact and responsiveness to in-patient pulmonary rehabilitation (PR) remain poorly characterized. AIMS: To assess prevalence of psychiatric and neurocognitive comorbidities in patients admitted to a PR programme, their associations with clinical and rehabilitation outcomes, and to explore sex- and age-related differences. METHODS: In this multicentre-observational-prospective-cohort study, consecutive admitted to in-patient PR programmes over 12 months were classified into six groups: diagnosed psychiatric disorders, psychotropic drug use without diagnosis, respiratory disease only, diagnosed neurocognitive disorders, psychiatric/cognitive impairment detected during hospitalisation and referral for diagnostic assessment. Clinical, functional and psychological data were collected at admission and discharge. Outcomes included changes in and achievement of minimal clinically important differences (MCIDs) for CAT, MRC dyspnea scale, Barthel Dyspnea Index and Six-Minute Walki Test. A composite responder outcome required achievement of all MCIDs. Multivariable logistic regression identified predictors of response. RESULTS: Among 975 patients (59% males, 70.2 years old), 49% had psychiatric (N = 245) and/or neurocognitive comorbidities (N = 45). Psychiatric disorders were more frequent in women, while cognitive impairment increased with age. PR significantly improved outcomes across all groups; however, patients with cognitive impairment showed the poorest multidimensional response, with none achieving the composite endpoint. In a relatively small group (N = 395) a formal psychiatric diagnosis independently predicted a lower probability of response. CONCLUSION: Psychiatric and neurocognitive comorbidities are highly prevalent in inpatient PR. Although PR is effective overall, cognitive impairment markedly limits multidimensional benefit, highlighting need for routine mental health, cognitive screening and multidisciplinary care.
Desgorces FD, Gouelle A, Moss SJ
… +1 more, Noirez P
Eur J Intern Med
· 2026 Jun · PMID 42242955
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Sustained independence during aging reduces morbidity and mortality. Optimal physical activity (PA) is essential for independent living in older adults by preventing sarcopenia, the loss of muscle mass, strength and phys...Sustained independence during aging reduces morbidity and mortality. Optimal physical activity (PA) is essential for independent living in older adults by preventing sarcopenia, the loss of muscle mass, strength and physical performance - the road to frailty. The aim of this narrative review is to establish a theoretical foundation for the development of PA programs in older adults. PA and exercise interventions are considered due to the established dose-response relationship with performance capacity, whereby the 'dose' refers to the combination of exercise frequency, intensity, time and type. Initially, improvements may be observed with minimal PA, but further improvements in functional capacity require increased exercise dose to reach optimal levels. In older adults, and even more so in frail individuals, increasing the dose beyond the individualized optimal level can result in adverse effects. The exercise dose should therefore be carefully adjusted, specifically in older adults with frailty. Multidimensional and/or clinical assessments are applied to identify older adults in a state of pre-frailty or frailty. While such assessments are necessary, they are insufficient for controlling the exercises dose. Rating of perceived exertion and delayed onset of muscle soreness in association with objective testing of physical capabilities, are recognized as appropriate, albeit subjective, assessments of the optimal exercise dose and sufficient recovery time between exercise sessions for older and frail adults. Regular monitoring of objective and subjective markers of exercise response will assist older and frail adults in tailoring their exercise programs to ensure positive outcomes.
de Miguel-Álava M, López J, Vilacosta I
… +10 more, Olmos C, Sáez C, Cabezón G, Ramírez DG, Landín P, Gómez-Lus VG, Lozano A, Oña A, Gómez-Salvador I, Román JAS
Eur J Intern Med
· 2026 Jun · PMID 42242954
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OBJECTIVE: To describe the clinical profile of a large cohort of patients with left-sided IE (LSIE) and embolic events (EE); to explore differences between those who present with an embolism at admission (EEa) and those...OBJECTIVE: To describe the clinical profile of a large cohort of patients with left-sided IE (LSIE) and embolic events (EE); to explore differences between those who present with an embolism at admission (EEa) and those who develop it during hospitalization (EEh); and to compare patients with and without EEa and patients with and without EEh. METHODS: We conducted a retrospective cohort study including 482 patients with a definite diagnosis of LSIE from a multicenter Spanish registry between 2000 and 2024. All patients underwent transoesophageal echocardiography (TEE) within 72 h of admission. EE were classified as present at admission or developed during hospitalization. Clinical, echocardiographic, and microbiological characteristics, along with in-hospital mortality, were analysed. Multivariate logistic regression was used to identify predictors of EE during hospitalization and mortality. RESULTS: Of the 482 patients, 182 (38 %) experienced EE: 122 (25 %) at admission and 73 (15 %) during hospitalization, with 13 patients having both. EEa were associated with atrial fibrillation (AF), Staphylococcus aureus infection, valvular vegetations, and periannular complications, but not with increased mortality (34 % vs. 27 %; p = 0.130). EEh were linked to Streptococcus gallolyticus infection, constitutional symptoms, persistent infection, and absence of heart failure (HF), and were associated with higher mortality (44 % vs. 27 %; p = 0.003). Vegetation size was not associated with EEh. In multivariate analysis, only EEh independently predicted in-hospital mortality (odds ratio 3.03; 95 % confidence interval, 1.66-5.50; p < 0.001). CONCLUSIONS: Among patients with LSIE, EEh are associated with a worse prognosis than those present at admission. Recognizing their timing may help guide clinical decisions and optimize treatment strategies.
Rossi M, Tartaglia E, Askarinejad A
… +4 more, Serio L, Ferri C, Bucci T, Lip GYH
Eur J Intern Med
· 2026 Jun · PMID 42225501
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BACKGROUND: The association between lipoprotein(a) [Lp(a)] and dementia remains controversial. PURPOSE: To assess the relationship between Lp(a) and dementia in a global federated research network. METHODS: A retrospecti...BACKGROUND: The association between lipoprotein(a) [Lp(a)] and dementia remains controversial. PURPOSE: To assess the relationship between Lp(a) and dementia in a global federated research network. METHODS: A retrospective cohort study using data from the TriNetX network. Adults with at least one Lp(a) measurement from 2010 onward were categorized as having elevated (≥50 mg/dL) or normal (<50 mg/dL) Lp(a). Propensity score matching (1:1) balanced baseline characteristics. The primary outcome was incident all-cause dementia; secondary outcomes included Alzheimer's disease, vascular dementia, and frontotemporal dementia. Follow-up extended up to 10 years from the index Lp(a) measurement. Sensitivity analyses accounted for death as a competing event, a 30-day landmark analysis, and comparison across low, high, and very high Lp(a) levels. Subgroup analyses were performed by age, sex, and history of atherosclerotic cardiovascular disease or stroke. RESULTS: Of 151,117 patients with available Lp(a) data, 54,929 had elevated Lp(a) (mean age 56.5 ± 15.9 years; 53.2% female), while 96,188 had normal Lp(a) (mean age 56.4 ± 16.5 years; 48.4% female). After matching, each cohort included 54,841 patients. Over a maximum follow-up of 10 years, elevated Lp(a) was not associated with an increased risk of all-cause dementia (HR 0.99, 95% CI 0.88-1.10), Alzheimer's disease (HR 1.04, 95% CI 0.85-1.27), vascular dementia (HR 1.05, 95% CI 0.86-1.27), or frontotemporal dementia (HR 0.94, 95% CI 0.48-1.83). Findings were consistent across sensitivity and subgroup analyses. CONCLUSION: In this large real-world cohort, elevated Lp(a) levels were not significantly associated with an increased risk of incident dementia or its major subtypes.
Eur J Intern Med
· 2026 May · PMID 42218046
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BACKGROUND: Real-world uptake of guideline-directed medical therapy (GDMT) at hospital discharge and clinical predictors of complete decongestion in acute heart failure (AHF) populations remain insufficiently described....BACKGROUND: Real-world uptake of guideline-directed medical therapy (GDMT) at hospital discharge and clinical predictors of complete decongestion in acute heart failure (AHF) populations remain insufficiently described. METHODS: The BRING-UP 3 HF study is an observational, prospective, nationwide investigation involving 179 Italian cardiology sites. This report summarizes baseline data from the first enrollment phase hospitalized cohort and assesses the predictors of decongestion via a machine learning model. RESULTS: Among 1373 patients (mean age 71 years; 30% females; 43% de-novo HF), HF with reduced ejection fraction (HFrEF) predominated (70%). Hypertension, atrial fibrillation, diabetes mellitus, and chronic kidney disease were reported in 75%, 43%, 35%, and 33% of patients, respectively. In HFrEF, discharge prescriptions rose markedly with respect to admission, with 57% of patients receiving all four pillars of GDMT. Successful decongestion was achieved in 469/681 evaluable patients (69%). A random-forest model identified higher estimated glomerular filtration rate, younger age, lower urea/creatinine ratio, lower C-reactive protein, and smaller left-atrial volumes as the strongest predictors of a successful decongestion, with good discrimination (AUC 0.80). CONCLUSIONS: Contemporary Italian cardiology practice shows high adherence to discharge GDMT across the spectrum of EF in AHF. Nevertheless, nearly one-third of patients leaves the hospital with residual congestion. The identified machine learning model predictors may provide an objective framework for risk stratification. These variables may help clinicians identify a high-risk patient profile that requires intensified in-hospital decongestive strategies and more aggressive post-discharge transitional care to reduce the risk of early rehospitalization. CLINICALTRIAL:GOV: NCT06279988.
Eur J Intern Med
· 2026 May · PMID 42218045
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BACKGROUND: Severe acquired brain injury (sABI) is a major challenge in post-acute care, affecting disability, quality of life, and healthcare resources. Traditional sequential care from acute units to rehabilitation oft...BACKGROUND: Severe acquired brain injury (sABI) is a major challenge in post-acute care, affecting disability, quality of life, and healthcare resources. Traditional sequential care from acute units to rehabilitation often fails to meet the needs of complex patients. Interdisciplinary co-management between Neuro-ICU and Intensive Neurorehabilitation Unit (INRU) has been proposed to enhance continuity of care and optimize resource utilization. METHODS: we analyzed 173 patients admitted to the INRU over three semesters: T1 (pre-implementation, n = 64), T2 (transition, n = 50), and T3 (co management, n = 59). The model involved joint management by a neurointensivist and an internal medicine specialist with expertise in neurorehabilitation, including a multidisciplinary assessment of clinical stability and the appropriateness of the rehabilitation pathway. RESULTS: Median age was 68.3 years [IQR 19.8], 60% male, with no differences across semesters. Co-management reduced length of stay (LoS) (68 vs 53 days) and urgent Emergency Department (ED) transfers (29.7 vs 18.6%), while stabilizing MDRO colonization despite higher admission prevalence. Transfers to rehabilitation units increased (23.8 vs 59.3%), long-term care admissions decreased (28.6 vs 13.6%), and mortality dropped from 7.9% to 3.4%. Negative outcomes (urgent ED transfers, long-term care admission and death) decreased from 56% to 25% (p = 0.003). CONCLUSIONS: Co-management enhances continuity of care, integrates acute and rehabilitative goals, and improves outcomes in complex patients. Structured interdisciplinary collaboration, coordinated by the internist-rehabilitation specialist, facilitates optimization of care pathways. Limitations include the retrospective, single center design and potential temporal bias. Further prospective and multicenter studies are needed to confirm its clinical and organizational benefits.
Desroche LM, Trimaille A, Lequeux B
… +2 more, Homehr N, Girerd N
Eur J Intern Med
· 2026 May · PMID 42215359
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Artificial intelligence is expanding rapidly in cardiovascular medicine, but its value in internal medicine depends less on raw model performance than on whether it improves triage, risk targeting, and coordination of ca...Artificial intelligence is expanding rapidly in cardiovascular medicine, but its value in internal medicine depends less on raw model performance than on whether it improves triage, risk targeting, and coordination of care within real-world workflows. Rather than cataloguing applications, this review focuses on three use cases with near-term relevance in internal medicine: AI-augmented electrocardiography, risk prediction for targeted prevention, and AI-enabled clinical decision support, including selected applications of large language models. Across these domains, evaluation should extend beyond discrimination to calibration, positive predictive value at action thresholds, net benefit, alert burden, override rates, and downstream testing. Cardiovascular AI should not be judged as an autonomous decision-maker, but as a supervised component of care delivery. Its usefulness depends on predefined confirmation pathways, integration into existing information systems, actionable outputs, user training, and post-deployment monitoring for drift, safety, and equity. We propose a practical implementation lens - Train, Explain, Integrate, Accompany (TEIA) - to structure deployment in routine care, and summarize governance issues relevant to European practice, including intended use, interoperability, traceability, cybersecurity, and lifecycle oversight. The central question is not whether an AI tool can classify or predict, but whether its use in routine care supports better decisions with acceptable workload, safer pathways, and measurable clinical value.
Zornoza-González E, Saz-Lara A, Cavero-Redondo I
… +5 more, Del Saz-Lara A, Valladolid-Ayllón S, Martínez-Cifuentes Ó, González-Collado A, Otero Luis I
Eur J Intern Med
· 2026 May · PMID 42203531
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INTRODUCTION: Traumatic brain injury (TBI) is a major global cause of death and disability. Hyponatremia is a frequent complication in neurocritical patients with TBI and has been associated with adverse clinical outcome...INTRODUCTION: Traumatic brain injury (TBI) is a major global cause of death and disability. Hyponatremia is a frequent complication in neurocritical patients with TBI and has been associated with adverse clinical outcomes. However, the association between hyponatremia and mortality in patients with TBI remains uncertain and inconsistently reported. This systematic review and meta-analysis aimed to evaluate the association between hyponatremia and mortality compared with normonatremia in neurocritical patients with TBI and to estimate the incidence of mortality among patients with hyponatremia. METHODS: PubMed, Scopus, and Web of Science were systematically searched through February 2026, complemented by searches in the Cochrane Central Register of Controlled Trials (CENTRAL), Clinical Trials registers, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). Observational studies evaluating the association between hyponatremia and mortality in adult patients with traumatic brain injury (TBI) were included. Pooled mortality proportions and pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using Der Simonian and Laird random-effects models. Subgroup analyses, sensitivity analyses, meta-regressions, and publication bias assessments were also performed. RESULTS: Eighteen studies were included in the systematic review and fourteen in the meta-analysis, comprising 6439 adult patients with traumatic brain injury. The overall mortality incidence among patients with hyponatremia was 11% (95% CI: 7-15%). Hyponatremia was not associated with increased mortality compared with normonatremia (RR: 1.06; 95% CI: 0.80-1.39). Subgroup analyses according to study design and timing of sodium assessment showed consistent findings without significant differences. Age, sex, and ICU length of stay did not significantly influence these associations. No significant publication bias was detected. CONCLUSION: Hyponatremia was not associated with increased mortality compared with normonatremia. Early monitoring of serum sodium concentrations may be of clinical interest in neurocritical TBI care, although the prognostic significance of hyponatremia should be interpreted with caution given the heterogeneity and observational nature of the available evidence.
Burja B, Boubaya M, Bruni C
… +19 more, Christ L, Ananyeva LP, Atzeni F, Bergmann C, Carreira PE, De Vries-Bouwstra J, Papa ND, Marcoccia A, Masado O, Riemekasten G, Rosato E, Schmeiser T, Sprecher M, Hoffmann-Vold AM, Kollert F, Guler S, Distler O, Elhai M, EUSTAR collaborators
Eur J Intern Med
· 2026 May · PMID 42191555
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BACKGROUND: As precision medicine is needed in systemic sclerosis (SSc) and SSc-associated interstitial lung disease (ILD), SSc non-specific antibodies might improve the risk stratification in this population. RESEARCH Q...BACKGROUND: As precision medicine is needed in systemic sclerosis (SSc) and SSc-associated interstitial lung disease (ILD), SSc non-specific antibodies might improve the risk stratification in this population. RESEARCH QUESTION: To evaluate the prevalence and characterize the disease phenotype of SSc patients positive for anti-Ro/SSA alone or in combination with RF antibodies in the largest cohort of SSc patients, focusing on lung involvement. METHODS: Patients from the EUSTAR database with available data on anti-Ro/SSA and RF antibodies were included. Clinical characteristics of patients with or without anti-Ro/SSA and RF antibodies were compared at baseline. Multivariable logistic regression models were built to identify factors associated with ILD. In patients with ILD at baseline, multivariable mixed-effects models for longitudinal FVC and DLCO were built to assess the impact of anti-Ro/SSA and RF. Prognostic factors for the ILD progression and death during follow-up were tested by multivariable Cox proportional hazards regression. RESULTS: Among the 4,221 patients fulfilling the inclusion criteria, 641 (15.2%) had anti-Ro/SSA antibodies. These patients exhibited a higher prevalence of muscular involvement (p < 0.01), pulmonary hypertension (p = 0.06), and ILD (p < 0.01) at baseline. Over 14,066 follow-up visits, anti-Ro/SSA independently predicted the presence of ILD (OR 1.24 [1.07-1.43], p < 0.01). Among anti-Ro/SSA+/RF+ patients, who represented 4.1% of the cohort, ILD was more prevalent as compared to single positive or negative anti-Ro/SSA and RF patients. Anti-Ro/SSA+/RF+ double-positive patients had a more severe ILD, with lower FVC% (R -4.12 [-7.85;-0.40]; p = 0.03) and lower DLCO% (R -5.4[-9.05;-1.74]; p < 0.01). INTERPRETATION: In the large EUSTAR cohort, anti-Ro/SSA antibodies are detected in 15% of SSc patients and represent an independent risk factor for the presence and severity of ILD, particularly for cases with anti-Ro/SSA+/RF+ double positivity. These data support the inclusion of anti-Ro/SSA and RF antibodies in routine clinical practice to improve the risk stratification of SSc patients.
Durante-Mangoni E, Cafarella I, Mercadante S
… +2 more, Scarpulla N, European Federation of Internal Medicine (EFIM) Infectious Diseases in Internal Medicine Working Group
Orthohantaviruses are zoonotic RNA-viruses transmitted to humans through inhalation of aerosols contaminated by infected rodent excreta. Among hantavirus species, Andes virus (ANDV) owns unique capacity for sustained hum...Orthohantaviruses are zoonotic RNA-viruses transmitted to humans through inhalation of aerosols contaminated by infected rodent excreta. Among hantavirus species, Andes virus (ANDV) owns unique capacity for sustained human-to-human transmission, occurring via respiratory droplets and prolonged close contact with symptomatic individuals, with a median reproductive number exceeding 2 and an incubation period ranging from 9 to 40 days. ANDV infection can present with a wide range of clinical manifestations. Of them, the most feared is Hantavirus cardiopulmonary syndrome (HCPS), a severe condition characterised by acute respiratory failure, haemodynamic instability, acute kidney injury, hepatic involvement, and dysregulated cytokine release, with high lethality. Disease severity correlates with the degree of neutrophilia, leukocytosis, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase. No approved antiviral therapy or vaccine currently exists; management remains entirely supportive, centred on oxygen supplementation, haemodynamic stabilisation, and renal replacement therapy when indicated. Case fatality rates reached 32% in a 2018-2019 outbreak, with death occurring a mean of 6.7 days from symptom onset. The April 2026 outbreak aboard the MV Hondius cruise ship - involving passengers of 23 nationalities, with 8 cases (6 confirmed, 2 suspected), and 3 deaths reported as of 11 May 2026 (CFR 38%) - exemplifies how a zoonotic pathogen with limited human-to-human transmissibility can rapidly achieve global reach in the era of mass international travel, underscoring the urgent need for clinician awareness, prompt contact tracing, and internationally coordinated outbreak preparedness.