February 15, 2024

Metabolically healthy obesity (MHO)

Jan Willem Elte, The Netherlands Obesity is one of the most devastating disorders of the present time and its preavalence is rapidly rising. Obesity is a heterogenous condition with multiple different phenotypes. Metabolically unhealthy obesity (MUO) carries a large number of adverse metabolic changes , but metabolically healthy obesity (MHO) is considered to display a relatively favorable metabolic profile. A recent comprehensive review article in the European Journal of Internal Medicine (Tanriover et al Eur J Int Med 111 (2023), 5-20) provides a good overview of the problem and will be summarized in this newsletter. The format of the article will be followed. Although MHO is considered to display a relatively favorable metabolic profile, it is still associated with a number of chronic diseases and has the potential risk of progression into the unhealthy phenotype. Therefore, it should not be considered as an entirely benign or “healthy” condition. Definition A first problem is the definition, as there are more than 30 different definitions of  MHO available. The most commonly used definitions of MHO define it as the absence of any metabolic as well as cardiovascular (cv) disorder in an obese individual (BMI ≥ 30 kg/m²), including hypertension, type 2 diabetes, […]
December 20, 2023


From: Salud (About Health) PABLO PÉREZ MARTÍNEZ, JOSÉ MANUEL RAMOS RINCÓN, ANA MAESTRE PEIRÓ Sepsis is a reaction of the body to an infection caused by microorganisms such as bacteria, viruses and even fungi. When our defenses are not able to eliminate the infection by microorganisms or their toxins, we react by producing substances such as interleukins, which spread through the bloodstream, causing a generalized inflammatory reaction in the body to the infection. Sepsis is a medical emergency and if not diagnosed and treated early, it can be life-threatening, leading to irreversible tissue damage, septic shock, and multiple organ failure. This extreme reaction of the body to an infection especially affects vital organs such as the brain, lungs, liver, kidneys, etc., which are damaged; this is what we know as sepsis. Therefore, sepsis is not a disease in itself, but arises when there is a poorly regulated response of the body to an infection that damages the person’s own tissues and organs and threatens the person’s life. If there is no timely intervention and there is significant damage to multiple organs so that they stop functioning, the patient’s life is in danger. We call this critical phase septic shock. The […]
November 29, 2023
Nurse injects patient with Covid-19 vaccine

Should we take a covid-19 vaccine and a flu vaccine and if so can we take them together? Yes!

Jan Willem Elte The Netherlands and Daniel Sereni France Covid 19 new vaccine is indicated for all people at risk of getting severely ill from a covid infection. The vaccines proposed this fall are active against currently circulating variants of covid.  Vaccination is important for you and others. Side effects may occur but are mild in vast majority of people as shown by reports from tens of millions of doses given so far. European national health agencies (European Centre for Disease Prevention and Control = ECDC and Eropean Medicines Agency = EMA) as well as NHS in the UK advice to take both vaccinations for covid-19 and flu well before the winter. The current covid-19 vaccine is the one directed to the new BA.286. There are generally three vaccines available: from Pfizer, Moderna and Novavax. The flu vaccine is one of those developed  this year based on the flu viruses of last year. It appears that both vaccines indeed can be taken at the same time without problems. Coadministration was not associated with substantially inferior immune response or to more frequent adverse events compared with covid-19  vaccine administration alone. It is recommanded to have each vaccine injected in a different […]
August 28, 2023
Plastic in ocean

The success story of plastic – but what is the price?

Verena Briner, Switzerland Plastics are synthetic products that consist of organic polymers and additives such as bisphenol, ophthalates and flame retardants. Plastic is produced from coal, crude oil and natural gas, and it’s most useful properties are: it is easy to produce, hydrophobic, light, cheap and indestructible. Plastic has been widely used in toys, kitchenware, packaging, construction, electrical industry, machinery and other industries. Due to its properties, the annual production of plastic has increased exponentially worldwide since the 1950s, and reached ca. 400 million tons per year worldwide in 2020. The 7 most used plastics are: polyethylene tetraphthalate (PET), high density polyethylene (PE), polyvinyl chloride (PVC), low density polyethylene (LDPE), polypropylene (PP), polystyrene (PS) and bisphenol (BP). This durability is -on the other hand- the biggest disadvantage of plastic. Littering of single use- plastic products such as PET bottles, coffee cups, plates, bags, etc. results in enormous pollution. Worldwide only 9% of the plastic waste is recycled. Every year more than 2 million tons of plastic reach the sea and the world oceans. Up to 2020 more than 30 million tons of plastic accumulated in the oceans and up to 110 million tons in rivers. The major part of plastic […]
June 30, 2023
Vitamins supplementation in healthy people

Vitamins supplementation in healthy people

Daniel Sereni, France A large proportion of adults in western countries regularly take vitamins supplements. This represents a huge market. But is it useful? It is well established that vitamins are essential for our health. Vitamin deficiencies provoke diseases and foetal and developmental abnormalities. Children are receiving vitamin D supplements for Ricketts prevention and some elderly people need vitamin D because of proven deficiency. There are indications for folic acid (a group B vitamin) supplementation during pregnancy in defined situations. Vitamin deficiency may result from insufficient intake or absorption, and this can lead to serious complications. Deficiency has also to be prevented or corrected in some diseases (for example intestinal or liver disease) or when people are given certain treatments that interfere with the absorption or the metabolism of vitamins. But millions of people without any recognised or suspected deficiency take vitamins every day (usually “multivitamins“). They do so because some medical publications have suggested that vitamin supplements can prevent major and frequent illnesses like cardio-vascular disease and cancer. Most of these assumptions were based on observational studies. There have been also a few randomised clinical trials comparing the outcome of people receiving a vitamin supplement compared to a group receiving […]
May 19, 2023
Anemia is a major but treatable global health problem

Anemia is a major but treatable global health problem

Stefan Lindgren, Sweden and Maria Cappellini, Italy Anemia is the result of a decrease in the level of hemoglobin and too few circulating red blood cells, resulting in poor oxygen delivery to tissues and organs in the body. Anemia may therefore lead to lack of physical and mental capacity, tiredness, loss of breath during physical effort and several other symptoms. In addition, the reason behind anemia may cause additional symptoms from various organ systems. Anemia is a major global health problem with severe consequences for millions of people, particularly young and pregnant women. Moreover, anemia in the elderly though often mild, is quite common and independently associated with important clinical outcomes including decreased quality of life, risk of falls and fractures, cognitive decline, increased length of hospital stay and even mortality. It is often difficult to dissect the cause(s) of anemia in the elderly which is typically multifactorial and a limited diagnostic approach often leads to categorization of the anemia as “unexplained”. The principal mechanisms behind anemia are failure to produce red blood cells due to diseases in the bone marrow, lack of essential components of hemoglobin such as iron, folic acid and vitamin B 12, shorter survival of red […]
April 19, 2023
What are endocrine disruptors and why you should know

What are endocrine disruptors and why you should know

Aart Jan van der Lely, The Netherlands Endocrine disruptors are chemical substances that can interfere with the normal functioning of the endocrine system, which is responsible for producing hormones that regulate various body functions. These chemicals can mimic or block the action of hormones, leading to an imbalance in the body’s hormonal system. There are many sources of endocrine disruptors, including pesticides, herbicides, and industrial chemicals. They can also be found in certain plastics, personal care products, and food packaging. The most well-known endocrine disruptor is probably bisphenol A (BPA), which is found in many plastics and has been linked to a number of health problems, including fertility issues and cancer. Endocrine disruptors can have a range of harmful effects on human health, depending on the specific chemical and the amount of exposure. Some of the potential health impacts include: Reproductive problems: Endocrine disruptors can affect the normal functioning of the reproductive system, leading to infertility, birth defects, and other reproductive problems. Cancer: Some endocrine disruptors have been linked to an increased risk of certain types of cancer, such as breast, ovarian, and prostate cancer. Developmental problems: Exposure to endocrine disruptors during fetal development and early childhood can lead to […]
April 6, 2023

FDIME activities during ECIM 2023, 15 -18 March in Athens

FDIME activities during ECIM 2023 15 -18 March in Athens During the EUROPEAN CONGRESS of INTERNAL MEDICINE in Athens the Foundation for the Development of Internal Medicine in Europe (FDIME) was involved in a variety of activities. Previous Next The most important activity probably was the combined FDIME/EFIM patient session on Friday March 17, mainly organized by members of the FDIME Management Team and chaired by Ramon Pujol and Dror Dicker. After a short introduction about the recent activities of FDIME entitled “Internists, patients and FDIME” and presented by Jan Willem Elte, three patients gave their view after being introduced briefly by three internists, respectively on diabetes developments (Nikolaos Tentolouris), obesity (Dror Dicker) and rare diseases (Ramon Pujol, taking over from Daniel Sereni). The patients were Efstathios Chatzopouloson, who talked about diabetes, Vicki Mooney about obesity and metabolic disease and Eustratios Chatziharalambous about rare diseases/general aspects, followed by a Round Table discussion with all speakers and a general discussion. “Patients address European Internists”. The session was well received with ample discussions and more audience than expected. During the closing ceremony on Saturday March 18 traditionally the two Grant Award winners of 2021 gave a short presentation of their research. Leonardo […]
March 9, 2023


Verena Briner, Switzerland Paracelsus, a famous physician of the 16th century, wrote ‘everything is poison and nothing is poison. It is a question of the dose’. It is true in alcohol consumption. Factors such as gender, cultural reasons, comorbidities and genetics may contribute to alcohol toxicity. The danger of alcohol consumption lies primarily in alcohol addiction, leading to chronic abuse and organ damage. This results in impaired function of the brain and nerves, the heart, the liver, the pancreas, gastro-intestinal tract, immune system and metabolism. In addition, chronic heavy drinking affects family life, work and causes often economic problems. Alcohol is absorbed fast and about 15 minutes after consumption reaches all organs of the body. Alcohol is mainly metabolized in the liver. However, in the stomach and intestine, alcohol results in the production of acetaldehyde (ACD). The ACD formed is an important factor in alcohol dependence. ACD also increases the release of mediators (histamine and bradykinin) to cause flushing. The of ACD is most severe in the brain and the heart. Abstinence from alcoholcauses increase in calcium uptake in  the cells, causing arrythmia, tremor and even seizures. ACD does not pass the blood-brain barrier. In heart muscle, alcohol causes inflammation […]