73-Year-Old Woman With Fatigue
A 73-year-old woman presented to the emergency department with worsening fatigue, dizziness, and generalized weakness of 2 weeks ’ duration. Her medical comorbidities included heart failure with preserved ejection fraction, prior rheumatic fever complicated by severe mitral valve regurgitation after prosthetic mitral valve replacement, acute ischemic stroke, and a history of gastrointestinal (GI) bleeding. Her medications i ncluded rivaroxaban, iron supplementation tablet, metoprolol tartrate, and torsemide. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 17, 2024 Category: Internal Medicine Authors: Joon Korleski, Santiago Martinez-Sosa, Aditya Shah Tags: Residents ’ clinic Source Type: research
A Focal Chronic Myopathic Form of Muscular Sarcoidosis
A woman in her 70s with sarcoidosis presented with a 9-month history of slowly progressive gait disturbance. Laboratory findings revealed elevated levels of creatine kinase (CK) (1595 U/L; normal, 41 to 153 U/L) and aldolase (9.6 U/L; normal, 2.1 to 6.1 U/L). Neurologic examination revealed moderate weakness and mild diffuse swelling of the right gastrocnemius muscle. Lower-leg magnetic resonance imaging (MRI) revealed hyperintensity of the right gastrocnemius on short-tau inversion recovery imaging (arrows in Figures 1A and 1B). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 17, 2024 Category: Internal Medicine Authors: Daisuke Suzuki, Fumiaki Uchimura, Akiko Nishida Tags: Medical image Source Type: research
Discordance Between Mucosal Appearances and Pathologic Findings in Intestinal Mycobacterial Infection in an Immunocompromised Patient
A man in his early 50s with dermatomyositis, interstitial pneumonia, and lower limb venous thrombosis was admitted to our hospital with intermittent intestinal bleeding of 1 month ’s duration. He was being treated with prednisolone (18 mg/d), tacrolimus (7 mg/d), azathioprine (50 mg/d), iguratimod (25 mg/d), and edoxaban (30 mg/d). On admission, he had no abdominal pain. Laboratory findings included a hemoglobin level of 5.4 g/dL and negative results for HIV antibody. Esoph agogastroduodenoscopy revealed a normal duodenal mucosal surface; however, it bled with irrigation alone (Figure 1). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 17, 2024 Category: Internal Medicine Authors: Daisuke Tsukui, Toshihiro Haga, Koichiro Abe Tags: Medical image Source Type: research
Cowden Syndrome —Oral Finding
Cowden syndrome is a rare autosomal dominant disease known to affect multiple organs, with a higher risk of malignancy and benign hamartomatous growths throughout the body. The syndrome is caused by a genetic mutation in the PTEN gene that is responsible for tumor suppression through suppression of cellular growth velocity and accurate division of cells throughout the body.1 (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 17, 2024 Category: Internal Medicine Authors: Ashley M. Stantz, Jamie S. Newman Tags: Medical image Source Type: research
Oxalate Metabolism: From Kidney Stones to Cardiovascular Disease
Oxalate kidney stones are common and exert a huge burden of morbidity worldwide. However, circulating or excreted concentrations of oxalate are rarely measured. We argue that oxalate and its metabolism are important above and beyond kidney stone formation. There is emerging evidence that increased concentrations of oxalate could be a driver of chronic kidney disease progression. Furthermore, oxalate has been implicated in cardiovascular disease. Thus, the reduction of elevated plasma oxalate concentrations may represent a novel cardioprotective and nephroprotective strategy. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 16, 2024 Category: Internal Medicine Authors: Gerlineke Hawkins-van der Cingel, Stephen B. Walsh, Kai-Uwe Eckardt, Felix Knauf Tags: Understanding Disease Source Type: research
Proton Pump Inhibitor Use and Bone Health in Patients With Rheumatic Diseases: A Cross-Sectional Study
To assess the effect of proton pump inhibitor (PPI) use on bone mineral density (BMD) and bone microarchitecture as measured by the trabecular bone score (TBS) in patients with inflammatory rheumatic and musculoskeletal diseases (iRMDs). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 16, 2024 Category: Internal Medicine Authors: Andriko Palmowski, Gabriela Schmajuk, Jinoos Yazdany, Patricia Katz, Jing Li, Rachael Stovall, Emma Kersey, Sabrina M. Nielsen, Robin Christensen, Henning Bliddal, Zhivana Boyadzhieva, Udo Schneider, Tobias Alexander, Burkhard Muche, Sandra Hermann, Edgar Tags: Original article Source Type: research
Trends in California Cardiovascular Disease Mortality: Sex –Race/Ethnicity Disparity and Income Inequality
To examine the cardiovascular disease (CVD) –related death trends and the relationship between CVD deaths and sex, race/ethnicity, and income in California from January 1, 1999, to December 31, 2021. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 13, 2024 Category: Internal Medicine Authors: Dharma N. Bhatta, William Bommer Tags: Original article Source Type: research
Blue Rubber Bleb Nevus Syndrome
A man in his mid-20s presented with papules and nodules over his body that had been present for about 20 years. His family history was unremarkable. Physical examination revealed many bluish-violet papules and nodules of various sizes on his face, trunk (Figures 1 and 2; Supplemental Figures 1 and 2, available online at http://www.mayoclinicproceedings.org), limbs, and feet (Supplemental Figures 3 and 4, available online at http://www.mayoclinicproceedings.org). The lesions were soft with a rubbery consistency and nontender. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 7, 2024 Category: Internal Medicine Authors: Zheng Gu, Dong-Lai Ma Tags: Medical image Source Type: research
41-Year-Old Woman With Ascites
A 41-year-old woman presented to the emergency department with 2 weeks of worsening dyspnea on exertion and abdominal swelling. She was becoming short of breath walking to her bathroom. She noticed a yellowish discoloration in her eyes over the past week. The patient was a Mexican immigrant with limited medical records. Reported medical history included atrial flutter, congestive heart failure, cirrhosis, and hypothyroidism. Home medications included furosemide, levothyroxine, propranolol, and spironolactone. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 5, 2024 Category: Internal Medicine Authors: Alex P. Danielson, Bibek Saha, Michael W. Cullen Tags: Residents ’ clinic Source Type: research
Change in Body Mass Index and Cardiovascular Outcomes in Patients With Cancer
To investigate the association between body mass index (BMI) changes and the risk of cardiovascular disease (CVD) in patients with cancer. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 4, 2024 Category: Internal Medicine Authors: Kensuke Ueno, Hidehiro Kaneko, Yuta Suzuki, Akira Okada, Katsuhito Fujiu, Taisuke Jo, Norifumi Takeda, Kentaro Kamiya, Junya Ako, Hiroyuki Morita, Koichi Node, Hideo Yasunaga, Issei Komuro Tags: Original article Source Type: research
Physician Health Series Part One: Characteristics of Physicians as Patients
This is the first article of a 3-part series about physician health. In this installment, we outline the unique characteristics of physicians as patients, challenges and opportunities presented by physician-patients, and recommendations for treating physicians. Future articles will delve into role clarity, occupational considerations, mental health, and interactions with third parties such as the physician ’s employer or licensing board. Ultimately, this series will help treating clinicians provide the best care to their physician-patients and successfully navigate the unique challenges that may arise, especially when th...
Source: Mayo Clinic Proceedings - May 1, 2024 Category: Internal Medicine Authors: Greg P. Couser, Philip T. Hagen, Melanie D. Swift, Richard D. Newcomb, Clayton T. Cowl Tags: Thematic Review on Physician Health Source Type: research
Capillary Telangiectasia
A female in her late 40s presented for a second opinion regarding a pontine lesion concerning for a possible glial neoplasm that has been present for at least 10 years by imaging. Prior magnetic resonance imaging scans showed a solitary well-circumscribed T1-hypointense and subtle T2/T2-fluid-attenuated inversion recovery hyperintense lesion in the lower pons with homogenous gadolinium enhancement but no overt hemosiderin deposition on gradient echo sequence and no evidence of any other suspicious lesions in the brain or spinal cord. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 1, 2024 Category: Internal Medicine Authors: Ehab Harahsheh, Justin Cramer Tags: Medical image Source Type: research
Focused Monitoring After Heart Failure Trials
Cardiovascular death and hospitalization for heart failure (HF) are prevailing end points in randomized controlled trials (RCTs) in patients who have HF with reduced ejection fraction (HFrEF). The low incidence of cardiovascular death and hospitalization in recent RCTs contrasts with the 5-year mortality rate of 75.5% and readmission risk of 48.5% among hospitalized HFrEF patients, indicating enrollment of stable New York Heart Association (NYHA) class II-III patients.1,2 However, inclusive enrollment in RCTs may yield incomplete therapeutic information. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 1, 2024 Category: Internal Medicine Authors: Thierry H. Le Jemtel, Rohan Samson Tags: Perspective and controversy Source Type: research
Competencies for Those Who Coach Physicians: A Modified Delphi Study
The rapidly evolving coaching profession has permeated the health care industry and is gaining ground as a viable solution for addressing physician burnout, turnover, and leadership crises that plague the industry. Although various coach credentialing bodies are established, the profession has no standardized competencies for physician coaching as a specialty practice area, creating a market of aspiring coaches with varying degrees of expertise. To address this gap, we employed a modified Delphi approach to arrive at expert consensus on competencies necessary for coaching physicians and physician leaders. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - May 1, 2024 Category: Internal Medicine Authors: Angela M. Passarelli, Gail Gazelle, Leslie E. Schwab, Robert F. Kramer, Margaret A. Moore, Raja G. Subhiyah, Nicole M. Deiorio, Mamta Gautam, Priscilla Gill, Sharon K. Hull, Cara R. King, Andrea Sikon Tags: Special article Source Type: research
Acute and Complicated Inflammatory Pericarditis
Inflammatory disease of the pericardium represents a relatively common presentation, especially among the young. For the most part, inflammatory pericardial disease can be expeditiously and effectively managed without significant sequelae. However, some individuals present with severe and recurrent illness, representing significant therapeutic challenges. During the past decade, there have been great strides made in developing an evidence-based approach to management of inflammatory pericardial disease, the result of which has been the development of (1) a systematic, protocoled approach to initial care; (2) targeted thera...
Source: Mayo Clinic Proceedings - May 1, 2024 Category: Internal Medicine Authors: Awais A. Malik, James W. Lloyd, Nandan S. Anavekar, Sushil Allen Luis Tags: Review Source Type: research
