50-Year-Old Man With Fevers, Cough, and Night Sweats
A 50-year-old man presented to the emergency department in August with a 1-month history of progressive nonproductive cough, daily fevers, and drenching night sweats. His medical comorbidities included rheumatoid arthritis. Medications at the time of presentation included adalimumab and occasional acetaminophen as needed. He reported social alcohol use and no tobacco or recreational drug use. He endorsed intermittent headaches, mild dyspnea on exertion, several episodes of feeling off balance, and mild difficulties with short-term memory. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 27, 2024 Category: Internal Medicine Authors: Joelle N. Friesen, Alexandra Allman, Omar Abu Saleh Tags: Residents ’ clinic Source Type: research

Laryngeal Amyloidosis
Amyloidosis is a disease characterized by abnormal extracellular deposition of fibrillar proteins in tissues that creates a chronic inflammatory response leading to local tissue injury. The larynx is estimated to be involved in up to 15% of all amyloidosis cases.1 Symptoms of amyloidosis are nonspecific, and the diagnosis is determined by the severity and laryngeal site involved. It typically presents with dysphonia, but patients can also have dyspnea, stridor, odynophagia, cough, and hemoptysis. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 27, 2024 Category: Internal Medicine Authors: Renata M. Knoll, Peter M. Sadow, Matthew R. Naunheim Tags: Medical image Source Type: research

Efficacy of Sacubitril-Valsartan on Survival and Cardiac Remodeling in Hypotensive Heart Failure With Reduced Ejection Fraction: A Multicenter Study
To investigate whether hypotensive patients diagnosed with heart failure and reduced ejection fraction (HFrEF) might benefit from angiotensin receptor –neprilysin inhibitors (ARNis) in real-world practice because patients with baseline systolic blood pressure (SBP) of less than 100 mm Hg have been excluded from landmark trials. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 26, 2024 Category: Internal Medicine Authors: Chien-Yi Hsu, Fa-Po Chung, Chieh-Ju Chao, Ying-Ju Chen, Cho-Kai Wu, Yen-Wen Wu, Jin-Long Huang, Pao-Hsien Chu, Charles Jia-Yin Hou, Hung-Yu Chang, Chung-Lieh Hung Tags: Original Article Source Type: research

75-Year-Old Woman With Abdominal Distention
A 75-year-old woman presented to the emergency department with progressive abdominal distention and pain. Her medical history includes colorectal cancer requiring left hemicolectomy and subsequent colostomy takedown 6 years before presentation at our center. She underwent open reduction with internal fixation of a right hip fracture 5 days before seeking emergency care and subsequently experienced gradual, progressive abdominal distention starting on postoperative day 1. She was passing gas and had a single small bowel movement on the day of discharge to inpatient rehabilitation. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 24, 2024 Category: Internal Medicine Authors: Thomas Smith, James F. Howick V, Seth Sweetser Tags: Residents ’ clinic Source Type: research

49-Year-Old Man With Melena and Abdominal Pain
A 49-year-old man presented with a 6-day history of melena. During this time, he also experienced progressive fatigue, light-headedness and dyspnea on exertion, nausea, and a constant epigastric abdominal pain described as a cramping sensation that was unrelated to meals. He had experienced similar symptoms 6 years previously as well as 1 month prior to the current presentation. For the latter episode, he was evaluated at a local hospital where his hemoglobin level was determined to be 4.6 g/dL (reference range, 13.2 to 16.6 g/dL) and he underwent a blood transfusion. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 24, 2024 Category: Internal Medicine Authors: Bibek Saha, Alex P. Danielson, William C. Mundell Tags: Residents ’ clinic Source Type: research

51-Year-Old Woman With Bloody Diarrhea
A 51-year-old woman presented to the emergency department with bloody diarrhea and abdominal cramping. Symptoms began 5 days before presentation with initially nonbloody diarrhea. She had used over-the-counter loperamide with improvement of stool frequency; however, abdominal cramping persisted. Subsequently, diarrhea became more profuse and became bloody 2 days before presentation. She denied fever or rigor. Her medical history was notable for remote deep venous thrombosis, heterozygous factor V Leiden mutation, and class II obesity with distant history of gastric bypass. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 23, 2024 Category: Internal Medicine Authors: Samantha E. Mannion, Clifford M. Csizmar, Sean R. Legler Tags: Residents ’ clinic Source Type: research

19-Year-Old Man With Abdominal Pain, Vomiting, Bloody Diarrhea, and Rash
A 19-year-old man presented to the emergency department with abdominal pain, bloody diarrhea, vomiting, and rash. His symptoms began 1 week prior with nausea, vomiting, and watery diarrhea. Over the next few days, he developed crampy lower abdominal pain and began noting blood in his stools. His diarrhea progressively worsened and by the time of presentation he was having 10 to 12 episodes daily, most of which were bloody. Throughout this period, he noted the appearance of scattered “bumps” over his trunk, arms, and legs. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 23, 2024 Category: Internal Medicine Authors: David L. Farrier, David Chiang, Amindra S. Arora Tags: Residents ’ clinic Source Type: research

66-Year-Old Woman With Fatigue and Hypotension
A 66-year-old woman presented to the emergency department with progressive fatigue, weakness, diarrhea, and hypotension of 3 weeks ’ duration. Her symptoms had been gradually worsening without any clear inciting event. Her medical history was notable for ileocolonic stricturing Crohn disease treated with ileocecectomy 21 years previously, Charcot-Marie-Tooth disease (CMT), obesity, osteoporosis, depression, and dyslipidemia. Her medications had included alendronate, azathioprine for her Crohn disease, and paroxetine for depression, but she had stopped taking the latter 2 medications when her current symptoms started. (So...
Source: Mayo Clinic Proceedings - March 23, 2024 Category: Internal Medicine Authors: Thomas W. Fredrick, Ruth E. DeFoster Tags: Residents ’ clinic Source Type: research

Circulating Docosahexaenoic Acid and Risk of All-Cause and Cause-Specific Mortality
To assess the associations of docosahexaenoic acid (DHA), a marine omega-3 fatty acid, with long-term all-cause mortality, cardiovascular (CV) mortality, and cancer mortality. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 20, 2024 Category: Internal Medicine Authors: Evan L. O ’Keefe, James H. O’Keefe, Nathan L. Tintle, Jason Westra, Luc Albuisson, William S. Harris Tags: Original article Source Type: research

County Rurality and Incidence and Prevalence of Diagnosed Diabetes in the United States
To examine differences in the incidence and prevalence of diagnosed diabetes by county rurality. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 19, 2024 Category: Internal Medicine Authors: Sagar B. Dugani, Brian D. Lahr, Hui Xie, Michelle M. Mielke, Kent R. Bailey, Adrian Vella Tags: Original article Source Type: research

High Baseline High-Sensitivity Cardiac Troponin T Concentrations and Risk of Index Acute Myocardial Infarction
To evaluate the diagnostic performance of the previously recommended baseline high-sensitivity cardiac troponin T (hs-cTnT) thresholds of 52 and 100 ng/L in identifying patients at high risk of acute myocardial infarction (AMI). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 16, 2024 Category: Internal Medicine Authors: Jonathan D. Knott, Olatunde Ola, Laura De Michieli, Ashok Akula, Eric H. Yang, S. Michael Gharacholou, Josh Slusser, Bradley Lewis, Ramila A. Mehta, Rajiv Gulati, Yader Sandoval, Allan S. Jaffe Tags: Original article Source Type: research

Outcomes of Acute Respiratory Failure in Patients With Cancer in the United States
To determine the epidemiological effect-magnitude and outcomes of patients with cancer vs those without cancer who are hospitalized with acute respiratory failure (ARF). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 7, 2024 Category: Internal Medicine Authors: Kiyan Heybati, Jiawen Deng, Archis Bhandarkar, Fangwen Zhou, Cameron Zamanian, Namrata Arya, Mohamad Bydon, Philippe R. Bauer, Ognjen Gajic, Allan J. Walkey, Hemang Yadav Tags: Original Article Source Type: research

Congenital Absence of Right Coronary Artery
A White male in his 20s with no past medical history presented with sudden symptoms of shortness of breath, nausea, and vomiting while at work. He also had a fever, cough, and tested positive for cannabis and tetrahydrocannabinol. On admission, he showed sinus tachycardia at 150 beats/min and low blood pressure (112/52 mm Hg). Laboratory tests revealed abnormal results, including elevated white blood cell count (24 ×109/L [reference range, (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 7, 2024 Category: Internal Medicine Authors: Shriya Sharma, Elizabeth Johnson, Rohan Goswami Tags: Medical image Source Type: research

Circle of Willis
A man in his 50s with a history of squamous cell carcinoma of the tongue with cervical lymph node involvement after radiotherapy presented to an ophthalmologist with intermittent visual changes. His neurologic examination yielded normal results. Fundoscopy revealed cotton wool spots bilaterally, concerning for ischemic retinopathy. Computed tomographic angiography of the neck revealed chronic complete occlusions of the bilateral common carotid arteries and the left vertebral artery. Magnetic resonance imaging of the brain showed multiple bihemispheric watershed infarcts. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 7, 2024 Category: Internal Medicine Authors: Nitesh P. Patel, Lorenzo Rinaldo, Giuseppe Lanzino Tags: Medical image Source Type: research

Emulated Trial for Discharge Prescription of Guideline-Directed Medical Therapy and 15-Year Survival After Coronary Artery Bypass Graft Surgery
To explore admission and discharge prescription rates of guideline-directed medical therapy (GDMT), defined as aggregate antiplatelet agents, statins, and β-blockers, after coronary artery bypass graft (CABG) surgery and to reveal its association with long-term survival. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 6, 2024 Category: Internal Medicine Authors: Yaron Moshkovitz, Liat Orenstein, Liraz Olmer, Keren Laufer, Arnona Ziv, Rachel Dankner Tags: Original article Source Type: research