Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People
To estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Diana G. Redwood, Tuan A. Dinh, John B. Kisiel, Bijan J. Borah, James P. Moriarty, Ellen M. Provost, Frank D. Sacco, James J. Tiesinga, David A. Ahlquist Tags: Original article Source Type: research

Excessive Daytime Sleepiness
Excessive daytime sleepiness (EDS) is a highly prevalent condition that is associated with significant morbidity. The causes of EDS are varied, and include inadequate sleep, sleep disordered breathing, circadian rhythm sleep-wake disorders, and central disorders of hypersomnolence (narcolepsy, idiopathic hypersomnia, and Kleine-Levin syndrome). Additionally, EDS could represent a symptom of an underlying medical or psychiatric disorder. Assessment of EDS includes a thorough sleep, medical, and psychiatric history, targeted clinical examination, and appropriate use of actigraphy to measure sleep duration and sleep-wake patt...
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Kriti D. Gandhi, Meghna P. Mansukhani, Michael H. Silber, Bhanu Prakash Kolla Tags: Solicited review Source Type: research

Geographic Inequalities in Cardiovascular Mortality in the United States: 1999 to 2018
To evaluate the trends in cardiovascular, ischemic heart disease (IHD), stroke, and heart failure mortality in the stroke belt in comparison with the rest of the United States. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Vibhu Parcha, Rajat Kalra, Ana F. Best, Nirav Patel, Sarabjeet S. Suri, Thomas J. Wang, Garima Arora, Pankaj Arora Tags: Original article Source Type: research

Challenges and Solutions for Physician Mothers: A Critical Review of the Literature
Physician mothers face unique challenges related to family planning, pregnancy, childcare, work-life integration, inequities, and biases that may have serious widespread implications. There is a paucity of available information on the extent and ramifications of such challenges and related solutions. The purpose of this critical review of the literature was to identify and summarize challenges and solutions pertaining to physician mothers. A comprehensive literature search of databases (PubMed, CINAHL, EBSCO MegaFILE, and APA PsycInfo on Ovid) from January 1, 2008, to December 31, 2018, identified empirical articles that a...
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Sherry S. Chesak, Kaia C. Yngve, Julie M. Taylor, Elida R. Voth, Anjali Bhagra Tags: Review Source Type: research

Relative Predictive Value of Circulating Immune Markers in US Adults Without Cardiovascular Disease: Implications for Risk Reclassification
To investigate the relative predictive value of circulating immune cell markers for cardiovascular mortality in ambulatory adults without cardiovascular disease. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Kartik Gupta, Rajat Kalra, Mike Pate, Shivaraj Nagalli, Sameer Ather, Indranee Rajapreyar, Pankaj Arora, Ankur Gupta, Wunan Zhou, Raul San Jose Estepar, Marcelo Di Carli, Sumanth D. Prabhu, Navkaranbir S. Bajaj Tags: Original article Source Type: research

The Clinical Impact of Proteomics in Amyloid Typing
Systemic amyloidosis, a serious and often life-threatening disease, is characterized by extracellular deposition of abnormal protein aggregates in blood-vessel walls and tissues, often leading to organ failure. Presenting symptoms are frequently vague, and pathognomonic findings are uncommon, which can result in a delay in diagnosis. However, once the possibility of amyloidosis is raised, the diagnosis can usually be established by tissue biopsy. Typically, biopsy is performed on a clinically involved organ, although sometimes tissue from a more easily accessible site, such as fat pad or bone-marrow biopsy, is sufficient. ...
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Michelle M. Hill, Surendra Dasari, Peter Mollee, Giampaolo Merlini, Catherine E. Costello, Bouke P.C. Hazenberg, Martha Grogan, Angela Dispenzieri, Morie A. Gertz, Taxiarchis Kourelis, Ellen D. McPhail Tags: Commentary Source Type: research

Janus Kinase Inhibitors and Risk of Venous Thromboembolism: A Systematic Review and Meta-analysis
To assess the risk of venous thromboembolism (VTE) in patients treated with Janus kinase (JAK) inhibitors in clinical trials. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Jawad Bilal, Irbaz Bin Riaz, Syed Arsalan Ahmed Naqvi, Sandipan Bhattacharjee, Michelle R. Obert, Maryam Sadiq, Mohammad A. Abd El Aziz, Yahya Nooman, Lary J. Prokop, Long Ge, Mohammad H. Murad, Alan H. Bryce, Robert D. McBane, C. Kent Kwoh Tags: Original article Source Type: research

Calf Vein Thrombosis Outcomes Comparing Anticoagulation and Serial Ultrasound Imaging Management Strategies
To compare outcomes among patients with calf deep vein thrombosis (DVT) stratified by management strategy because distal or calf DVT is said to have low rates of propagation, embolization, and recurrence and, as such, guideline recommendations include provisions for serial imaging without treatment. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Wiktoria Kuczmik, Waldemar E. Wysokinski, Thanila Macedo, David Froehling, Paul Daniels, Ana Casanegra, Damon Houghton, Danielle Vlazny, Ryan Meverden, Teresa Lang, Launia White, David Hodge, Robert D. McBane Tags: Original article Source Type: research

Frequent Premature Atrial Contractions Are Associated With Poorer Cognitive Function in the Atherosclerosis Risk in Communities (ARIC) Study
To evaluate the association of premature atrial contraction (PAC) frequency with cognitive test scores and prevalence of dementia or mild cognitive impairment (MCI). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Mary R. Rooney, Faye L. Norby, Ankit Maheshwari, Pamela L. Lutsey, Samuel C. Dudley, Elsayed Z. Soliman, Laura R. Loehr, Thomas H. Mosley, Josef Coresh, Alvaro Alonso, Lin Y. Chen Tags: Original article Source Type: research

Silence in the Noise: Journey With Hearing Loss Across 2 Worlds
“You do not have middle ears!” exclaimed my middle schooler as our conversation evolved into chatting about the special sense of hearing and balance while discussing the letters of Helen Keller. The following narration describes the reminiscences during conversations that ensued over the next we ek or so at the dinner table with my wife and our 8- and 12-year-old daughters. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 8, 2021 Category: Internal Medicine Authors: Taimur Sher Tags: PERSPECTIVE AND CONTROVERSY Source Type: research

Omega-3 Benefits Remain Strong Post-STRENGTH
Eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, the 2 main omega-3 long-chain polyunsaturated fatty acids of marine origin, have shown promise for the prevention of cardiovascular disease (CVD) outcomes in animal studies and epidemiologic studies.1 Although several recent trials have shown benefits, as summarized in Mayo Clinic Proceedings in 2019,2 2 randomized control trials published in late 2020 showed neutral results. The situation is summarized thoughtfully in a recent editorial by Farukhi et  al, published in Mayo Clinic Proceedings,3 which cited our recent meta-analysis6 on the subject. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 7, 2021 Category: Internal Medicine Authors: Aldo A. Bernasconi, Carl J. Lavie, Richard V. Milani, Jari A. Laukkanen Tags: Letter to the editor Source Type: research

Chronic Coronary Syndromes in Women
Sex matters in science. This particularly applies to ischemic heart disease, which displays key differences in pathophysiology, presentation, and effectiveness in diagnostic strategies and management between women and men. However, underrepresentation of women in randomized trials has led to an evidence gap in clinical practice. Nevertheless, it has become clear that women present with a higher burden of symptoms and comorbidities, experience worse outcomes, but are less likely to have flow-limiting stenosis in epicardial coronary arteries than men. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Matthias R. Meyer Tags: Thematic review on women's health Source Type: research

Sex- and Gender-Related Differences in Common Functional Gastroenterologic Disorders
This article reviews sex- and gender-based differences in the prevalence, pathophysiologic factors, clinical characteristics, and management of functional dyspepsia (FD) and irritable bowel syndrome (IBS) that together affect approximately 1 in 4 people in the United States. These conditions are more common in women. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Susrutha Puthanmadhom Narayanan, Bradley Anderson, Adil E. Bharucha Tags: Thematic review on women's health Source Type: research

Disseminated Nocardia in an Immunocompetent Host
A 44-year-old man with no medical comorbidities presented with recurrent inferior vena cava thrombosis and several months of fever, headache, and  weight loss. Positron emission tomography–computed tomography was performed, which revealed a 1.5-cm fluorodeoxyglucose avid left lung mass and hypermetabolic soft tissue masses in bilateral inguinal regions (Figure 1). He underwent computed tomography–guided biopsy of the lung and left ingui nal masses. Histopathology found clumps of filamentous branching bacilli, consistent with Nocardia (Supplemental Figure, available online at http://www.mayoclinicproce...
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Grant A. Wintheiser, Elise R. Venable, Zelalem Temesgen Tags: Medical image Source Type: research

Acoustic Properties of Axial and Centrifugal Flow Left Ventricular Assist Devices and Prediction of Pump Thrombosis
To characterize the properties of the audible tones produced by current left ventricular assist device (LVAD) pumps approved for use, and to ascertain if changes in those may be present in the setting of pump thrombosis. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Barry A. Boilson, Elizabeth L. Bechtum, Amy L. Behnken, Laura A. Loga, Angela J. Luckhardt, Sarah D. Schettle, Alfredo L. Clavell, Dan Dragomir-Daescu, John M. Stulak Tags: Original article Source Type: research

Scalp Necrosis in Giant Cell Arteritis
A 67-year-old woman presented with a 2-month history of headache; jaw claudication, weight loss of 6 kg; right-hand ischemia; and scalp necrosis (Figure  1A and B), which developed at the same time as her other symptoms. She had no visual symptoms and ophthalmic examination results were normal, with no occult visual arterial abnormalities suggestive of subclinical ischemia. Both temporal arteries were indurated on physical examination. Her C-reacti ve protein (CRP) level was at 92 mg/L. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Olivier Espitia, Christian Agard Tags: Medical image Source Type: research

A Unique Case of Chronic Cough
A 49-year-old man with a history of coronary artery disease presented to pulmonary clinic with a progressive chronic cough that started 1 year previously, associated with scant hemoptysis and recent onset dyspnea on exertion. He denied smoking, fevers, night sweats, and weight loss. Results of the physical examination were unremarkable. Chest computed tomography (Figure  1) showed a large longitudinal filling tracheal defect. Follow-up bronchoscopy revealed several large wart-like nodular lesions on the vocal cords and in the trachea (Figure 2), causing severe tracheal narrowing. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Gregory Wigger, Munish Luthra Tags: Medical image Source Type: research

77-Year-Old Man With Nausea and Abdominal Pain
A 77-year-old man presented with acute onset of right upper-quadrant and epigastric abdominal pain over the past 10 hours. He described this as “aching,” with radiation to the back. Associated symptoms included chills, nausea, and several episodes of nonbloody, nonbilious emesis. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Chansong Choi, Amrit K. Kamboj, Randall K. Pearson Tags: Residents ’ clinic Source Type: research

Brevibacterium Species: An Emerging Opportunistic Cause of Bloodstream Infections
Brevibacterium species (spp) are nonmotile, catalase-positive, obligate aerobic Gram-positive bacilli.1 A case of Brevibacterium fermentans meningitis was first described in 1969 in an infant who underwent placement of a ventriculocardiac shunt.2 Clinical reports of Brevibacterium spp –associated bloodstream infections and endocarditis3,4 are increasing. Yet, the organism continues to be listed as a common commensal by the National Healthcare Safety Network database of the Centers for Disease Control and Prevention. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: FNU Shweta, Pooja R. Gurram, John C. O ’Horo, Sarwat Khalil Tags: Letter to the editor Source Type: research

Risk Prediction Models
This excellent paper by Bierle et  al1 gives great information regarding risk assesssment before non-cardiac surgery. The authors mention that “…surgical urgency, surgical risk, and patients-specific risk factors are necessary inputs for clinical decision algorithms and society guidelines.” (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Guillermo Lema Tags: Letter to the editor Source Type: research

In Reply — Risk Prediction Models: Can They Be Applied in All Situations?
I thank Dr Lema for his excellent insights. I agree that the best practices in an individual health care system should reflect local factors that influence the generalizability of guidelines and published studies. The use of Bayesian techniques can help overcome some of these differences, but no score is a substitute for comprehensive clinical decision making. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Dennis M. Bierle Tags: Letter to the editor Source Type: research

Preventing Breast Cancer Through Identification and Pharmacologic Management of High-Risk Patients
Breast cancer remains the most common cancer in women in the United States. For certain women at high risk for breast cancer, endocrine therapy (ET) can greatly decrease the risk. Tools such as the Breast Cancer Risk Assessment Tool (or Gail Model) and the International Breast Cancer Intervention Study risk calculator are available to help identify women at increased risk for breast cancer. Physician awareness of family history, reproductive and lifestyle factors, dense breast tissue, and history of benign proliferative breast disease are important when identifying high-risk women. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Elizabeth A. Gilman, Sandhya Pruthi, Erin W. Hofstatter, Dawn M. Mussallem Tags: Concise review for clinicians Source Type: research

Physical Activity
The higher cardiovascular disease (CVD) morbidity and mortality in African Americans (AAs) is caused by numerous physiological, environmental, and socioeconomic factors. In addition, physical activity (PA) has been demonstrated to have significant cardiovascular health benefits.1 However, the impact of physical inactivity on diverse CVD in AAs must be contextualized within other risk factors and the social determinants of health (SDoH). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Keith C. Ferdinand, Saihariharan Nedunchezhian Tags: Editorial Source Type: research

Mosaic Tesserae (Stones) and Concrete Mortar
Recognizing the contribution art has had in the Mayo Clinic environment since the original Mayo Clinic Building was finished in 1914, Mayo Clinic Proceedings features some of the numerous works of art displayed throughout the buildings and grounds on Mayo Clinic campuses as interpreted by the author. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Margaret R. Wentz Tags: Art at mayo clinic Source Type: research

Juvenile Papillomatosis of Breast
A palpable breast mass was excised and diagnosed as juvenile papillomatosis in a young woman. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Beiyun Chen, Lori A. Erickson Tags: Path to patient image quiz Source Type: research

In the Limelight: April 2021
This month ’s feature highlights five articles, four of which focus on COVID-19, that appear in the current issue of Mayo Clinic Proceedings. These articles are also featured on the Mayo Clinic Proceedings’ YouTube Channel (https://youtu.be/mt3zfdaokyu). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Karl A. Nath Tags: In the limelight Source Type: research

Listening for Thrombosis
The introduction of the left-ventricular assist device (LVAD) has fundamentally advanced the management of heart failure (HF), as LVADs provide either a destination form of treatment or a bridge to eventual heart transplantation or the recovery from HF. A disastrous complication that can profoundly compromise the functionality of the LVAD, as for any extracorporeal device, is thrombosis. In the current issue of Mayo Clinic Proceedings, Boilson et  al describe a noninvasive approach for early detection of such events in the LVAD population. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Michael S. Sabbah, Andrew N. Rosenbaum, Atta Behfar Tags: Editorial Source Type: research

Erratum
Correction to ‘The Pandemic of Publications: Are We Sacrificing Quality for Quantity?’ [Mayo Clinic Proceedings 95 (2020) 2288–2290/3037] (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Tags: Correction Source Type: research

Editorial Board
(Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Source Type: research

Table of Contents
(Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Source Type: research

General Information
(Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Source Type: research

Highlights From the Current Issue – Audiovisual Summary
Karl A. Nath, MBChB, Editor-in-Chief of Mayo Clinic Proceedings, discusses the Editor ’s Choice and Highlights articles appearing in the April 2021 issue. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - April 1, 2021 Category: Internal Medicine Authors: Karl A. Nath Tags: Issue summary Source Type: research

A Blueprint to Control the SARS-CoV-2 Pandemic
(Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 26, 2021 Category: Internal Medicine Authors: John C. O ’Horo, Amy W. Williams, Andrew D. Badley Source Type: research

Prevalence of SARS-CoV-2 Antibodies in a Multistate Academic Medical Center
To estimate the seroprevalence of SARS-CoV-2 antibodies in healthcare personnel. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 26, 2021 Category: Internal Medicine Authors: Rickey E. Carter, Elitza S. Theel, Laura E. Breeher, Melanie D. Swift, Nathan A. Van Brunt, Windell R. Smith, Lorrie L. Blanchfield, Elizabeth A. Daugherty, Alyssa B. Chapital, Kathleen M. Matson, Katherine A. Bews, Patrick W. Johnson, Robert A. Domnick, Tags: Original Article Source Type: research

Atrial Fibrillation and Endothelial Dysfunction
Atrial fibrillation (AF) is the most common cardiac arrhythmia, and coronary atherosclerosis is the leading cause of death in the United States and worldwide. Endothelial dysfunction is the earliest clinically detectable form of atherosclerosis. Control of shared AF and coronary atherosclerosis risk factors improves both AF-free survival and vascular endothelial function. Decades of AF research have yielded fundamental insight into AF pathophysiology, but current pharmacological and catheter-based invasive AF therapies have limited long-term efficacy and substantial side effects, possibly because of incomplete understandin...
Source: Mayo Clinic Proceedings - March 25, 2021 Category: Internal Medicine Authors: Michel T. Corban, Takumi Toya, Ali Ahmad, Lilach O. Lerman, Hon-Chi Lee, Amir Lerman Tags: Review Source Type: research

Inverse Association of Handgrip Strength With Risk of Heart Failure
To evaluate the nature, magnitude, and specificity of the association between handgrip strength (HGS) and heart failure (HF) risk. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 25, 2021 Category: Internal Medicine Authors: Jari A. Laukkanen, Hassan Khan, Carl J. Lavie, Ari Voutilainen, Sudhir Kurl, Sae Young Jae, Setor K. Kunutsor Tags: Original article Source Type: research

Geographic Variation in Cardiovascular Health Among American Adults
To evaluate the contemporary geographic trends in cardiovascular health in the United States and its relationship with geographic distribution of cardiovascular mortality. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 25, 2021 Category: Internal Medicine Authors: Vibhu Parcha, Rajat Kalra, Sarabjeet S. Suri, Gargya Malla, Thomas J. Wang, Garima Arora, Pankaj Arora Tags: Original article Source Type: research

Inability of Radioiodine Remnant Ablation to Improve Postoperative Outcome in Adult Patients with Low-Risk Papillary Thyroid Carcinoma
To determine whether radioiodine remnant ablation (RRA) reduces cause-specific mortality (CSM) or tumor recurrence (TR) rate after bilateral lobar resection (BLR). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 17, 2021 Category: Internal Medicine Authors: Ian D. Hay, Suneetha Kaggal, Nicole M. Iniguez-Ariza, Megan S. Reinalda, Gregory A. Wiseman, Geoffrey B. Thompson Tags: Original article Source Type: research

Preoperative Management of Surgical Patients Using Dietary Supplements
The widespread use of complementary products poses a challenge to clinicians in the perioperative period and may increase perioperative risk. Because dietary supplements are regulated differently from traditional pharmaceuticals and guidance is often lacking, the Society for Perioperative Assessment and Quality Improvement convened a group of experts to review available literature and create a set of consensus recommendations for the perioperative management of these supplements. Using a modified Delphi method, the authors developed recommendations for perioperative management of 83 dietary supplements. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 16, 2021 Category: Internal Medicine Authors: Kenneth C. Cummings, Maureen Keshock, Ravindra Ganesh, Alana Sigmund, Deanne Kashiwagi, Jagan Devarajan, Paul J. Grant, Richard D. Urman, Karen F. Mauck Tags: Thematic Review on Perioperative Medicine Source Type: research

Adherence to Chronic Kidney Disease Screening Guidelines Among Patients With Type 2 Diabetes in a US Administrative Claims Database
To examine the screening rates for kidney damage and function among patients with type 2 diabetes (T2D) and chronic kidney disease stage at diabetes diagnosis using a US administrative claims database. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 12, 2021 Category: Internal Medicine Authors: Kerstin Folkerts, Natalia Petruski-Ivleva, Erin Comerford, Michael Blankenburg, Thomas Evers, Alain Gay, Linda Fried, Csaba P. Kovesdy Tags: Original article Source Type: research

Getting Primary Care — A Life-Saving Intervention — Off Life Support
Valerie is in her mid-70s, and I have had the privilege of being her primary care physician (PCP) for 18 years. She is the rare patient whose recommended preventive care is always up-to-date and whose medication list includes only vitamins. She sees me annually to get her flu shot and to receive other recommended preventive care. Over the years, I have learned that she takes great pride in swimming 2 miles every day. She helps to care for several elderly neighbors, running occasional errands and ensuring they have enough food and other household items. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 12, 2021 Category: Internal Medicine Authors: Jennifer E. DeVoe Tags: PERSPECTIVE AND CONTROVERSY Source Type: research

The Oxygen Cascade During Exercise in Health and Disease
The oxygen transport cascade describes the physiological steps that bring atmospheric oxygen into the body where it is delivered and consumed by metabolically active tissue. As such, the oxygen cascade is fundamental to our understanding of exercise in health and disease. Our narrative review will highlight each step of the oxygen transport cascade from inspiration of atmospheric oxygen down to mitochondrial consumption in both healthy active males and females along with clinical conditions. We will focus on how different steps interact along with principles of homeostasis, physiological redundancies, and adaptation. (Sour...
Source: Mayo Clinic Proceedings - March 10, 2021 Category: Internal Medicine Authors: Paolo B. Dominelli, Chad C. Wiggins, Tuhin K. Roy, Timothy W. Secomb, Timothy B. Curry, Michael J. Joyner Tags: Solicited review Source Type: research

Sex Differences in Alcohol Consumption and Alcohol-Associated Liver Disease
Alcohol-associated liver disease is becoming increasingly prevalent throughout the United States. Previously alcohol-associated liver disease was known to affect men more often than women; however, this gap between the sexes is narrowing. Studies show that women develop liver disease with lesser alcohol exposure and suffer worse disease as compared with men. This review article explores the increasing prevalence of alcohol-associated liver disease in women, reasons for changing patterns in alcohol consumption and liver disease development including obesity and bariatric surgery, proposed mechanisms of sex-specific differen...
Source: Mayo Clinic Proceedings - March 10, 2021 Category: Internal Medicine Authors: Camille A. Kezer, Douglas A. Simonetto, Vijay H. Shah Tags: Review Source Type: research

Time Is Brain: Prehospital Emergency Medical Services Response Times for Suspected Stroke and Effects of Prehospital Interventions
To compare prehospital time for patients with suspected stroke in Florida with the American Stroke Association (ASA) time benchmarks, and to investigate the effects of dispatch notification and stroke assessment scales on prehospital time. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 10, 2021 Category: Internal Medicine Authors: Johan L. Heemskerk, Ricardo A. Domingo, Rabih G. Tawk, Tito G. Vivas-Buitrago, Josephine F. Huang, Ashley Rogers, Alfredo Quinones-Hinojosa, Kingsley Abode-Iyamah, William D. Freeman Tags: Original article Source Type: research

Misconceptions About Sexual Health in Older Women
Sexual satisfaction has been linked to quality of life throughout a person ’s life, and distress related to sexual dysfunction impacts the health of the individual and their relationship.1 A common misconception is that aging women are not sexually active. National representative data indicate that, while sexual activity declines with age, both men and women continue to engage in in vaginal intercourse, oral sex, and masturbation even in the eighth and ninth decades of life.1 However, patients and medical providers lack understanding about female sexual function, particularly in older women. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 10, 2021 Category: Internal Medicine Authors: Carol L. Kuhle, Xin Zhang, Ekta Kapoor Tags: Perspective and Controversy Source Type: research

Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement
Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources utilize the recommendations derived from individual studies and do not include a multidisciplinary focus or formal consensus. The Society for Perioperative Assessment and Quality Improvement (SPAQI) identified a lack of authoritative clinical guidance as an opportunity to utilize its multidisciplina...
Source: Mayo Clinic Proceedings - March 10, 2021 Category: Internal Medicine Authors: Kurt J. Pfeifer, Angela Selzer, Carlos E. Mendez, Christopher M. Whinney, Barbara Rogers, Vinaya Simha, Dennis Regan, Richard D. Urman, Karen Mauck Tags: Thematic Review on Perioperative Medicine Source Type: research

Physical Activity, Inflammation, Coronary Artery Calcification, and Incident Coronary Heart Disease in African Americans: Insights From the Jackson Heart Study
To examine associations between physical activity (PA), inflammation, coronary artery calcification (CAC), and incident coronary heart disease (CHD) in African Americans. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 10, 2021 Category: Internal Medicine Authors: Daisuke Kamimura, Loretta R. Cain-Shields, Donald Clark, Adebamike A. Oshunbade, Kellan E. Ashley, Cameron S. Guild, Paul D. Loprinzi, Robert Newton, Michael J. Blaha, Takeki Suzuki, Javed Butler, John E. Hall, Adolfo Correa, Michael E. Hall Tags: Original article Source Type: research

28-Year-Old Man With an Enlarged Left Testicle
A 28-year-old man with no significant medical history presented to his primary care provider with 4 months of progressive left-testicular enlargement. His symptoms were not associated with pain, dysuria, fever, weight loss, or recent trauma. He was sexually active only with his wife. He endorsed using condoms for contraception and denied unsafe sexual practices. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 10, 2021 Category: Internal Medicine Authors: Mason J. Webb, Antonious Z. Hazim, Tony Y. Chon Tags: Residents ’ Clinic Source Type: research

48-Year-Old Woman With Dyspnea and Chest Pain
A 48-year-old woman presented for evaluation of a 1-week history of progressive dyspnea and chest pain. She had a history of Burkitt lymphoma, treated with chemoradiation therapy, at the age of 6. She was a never smoker. She was not on any prescription medications until 3 weeks before this presentation, when she was diagnosed with unprovoked bilateral pulmonary emboli and was initiated on apixaban. The computed tomography (CT) angiogram of the chest also noted new bilateral subcentimeter pulmonary nodules. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 10, 2021 Category: Internal Medicine Authors: Steven R. Hwang, Adam P. Sawatsky Tags: Residents ’ Clinic Source Type: research

A Framework for Outpatient Infusion of Anti-Spike Monoclonal Antibodies to High-Risk Patients with Mild to Moderate Coronavirus Disease-19: The Mayo Clinic Model
This article summarizes essential components and processes in establishing an effective spike monoclonal antibody infusion program. Rapid identification of a dedicated physical infrastructure was essential to circumvent the logistical challenges of caring for infectious patients, while maintaining compliance with regulations and ensuring the safety of our personnel and other patients. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - March 9, 2021 Category: Internal Medicine Authors: Raymund R. Razonable, Nicole C.E. Aloia, Ryan J. Anderson, Gokhan Anil, Lori L. Arndt, Richard F. Arndt, Sara E. Ausman, Sarah J. Bell, Dennis M. Bierle, Marcie L. Billings, Rachel K. Bishop, Carl H. Cramer, Tracy L. Culbertson, Ala S. Dababneh, Amber N. Source Type: research