Decline of Influenza and Respiratory Viruses With COVID-19 Public Health Measures: Alberta, Canada
We evaluated the incidence of influenza and non-influenza respiratory viruses (NIRVs) pre-/post-implementation of public health (PH) measures aimed to decrease COVID-19 transmission using population-based surveillance data. We hypothesized that such measures could reduce the burden of respiratory viruses (RVs) transmitting via the same routes. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 19, 2021 Category: Internal Medicine Authors: Alexander Doroshenko, Nelson Lee, Clayton MacDonald, Nathan Zelyas, Leyla Asadi, Jamil N. Kanji Tags: Original Article Source Type: research

Development and validation of a multivariable risk prediction model for COVID-19 mortality in the Southern United States
To evaluate clinical characteristics of COVID-19 admitted patients in Southern United States and development as well as validation of a mortality risk prediction model. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 16, 2021 Category: Internal Medicine Authors: Aashish Gupta, Sergey M. Kachur, Jose D. Tafur, Harsh K. Patel, Divina O. Timme, Farnoosh Shariati, Kristen D. Rogers, Daniel P. Morin, Carl J. Lavie Tags: Original Article Source Type: research

Physicians ’ Ratings of their Supervisor’s Leadership Behaviors and Their Subsequent Burnout and Satisfaction: A Longitudinal Study
To evaluate the relationships between immediate supervisors ’ leadership qualities and the subsequent levels and changes in burnout and satisfaction of supervised physicians 2 years later. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 15, 2021 Category: Internal Medicine Authors: Liselotte N. Dyrbye, Brittny Major-Elechi, J. Taylor Hays, Cathryn H. Fraser, Steven J. Buskirk, Colin P. West Tags: Original article Source Type: research

Eosinophils in Health and Disease: A State-of-the-Art Review
Eosinophils play a homeostatic role in the body ’s immune responses. These cells are involved in combating some parasitic, bacterial, and viral infections and certain cancers and have pathologic roles in diseases including asthma, chronic rhinosinusitis with nasal polyps, eosinophilic gastrointestinal disorders, and hypereosinophilic syndromes. Treatment of eosinophilic diseases has traditionally been through nonspecific eosinophil attenuation by use of glucocorticoids. However, several novel biologic therapies targeting eosinophil maturation factors, such as interleukin (IL)-5 and the IL-5 receptor or IL-4/IL-13, ha...
Source: Mayo Clinic Proceedings - September 15, 2021 Category: Internal Medicine Authors: Michael E. Wechsler, Ariel Munitz, Steven J. Ackerman, Matthew G. Drake, David J. Jackson, Andrew J. Wardlaw, Stephanie K. Dougan, Sergejs Berdnikovs, Florence Schleich, Andrea Matucci, Pascal Chanez, Charlene M. Prazma, Peter Howarth, Peter F. Weller, Pe Tags: Review Source Type: research

High-Intensity Statins Benefit High-Risk Patients: Why and How to Do Better
Review of the US and European literature indicates that most patients at high risk for atherosclerotic cardiovascular disease (ASCVD are not treated with high-intensity statins, despite strong clinical-trial evidence of maximal statin benefit. High-intensity statins are recommended for 2 categories of patients: those with ASCVD (secondary prevention) and high-risk patients without clinical ASCVD. Most patients with ASCVD are candidates for high-intensity statins, with a goal for low-density lipoprotein cholesterol reduction of 50% or greater. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 14, 2021 Category: Internal Medicine Authors: Scott M. Grundy, Neil J. Stone, Roger S. Blumenthal, Lynne T. Braun, Paul A. Heidenreich, Donald Lloyd-Jones, Carl E. Orringer, Joseph J. Saseen, Sidney C. Smith, Laurence S. Sperling, Salim S. Virani Tags: Consensus recommendation Source Type: research

Bexarotene
Specialty drugs are used to treat rare complex conditions and are often marked by their high costs. In fact, the Center for Medicare and Medicaid Services (CMS) defines specialty drugs as those with monthly costs exceeding $670.1 These drugs have accounted for a disproportionate share of recent drug-spending growth for both patients and health plans. A recent analysis found that Medicare Part D spending on specialty drugs increased from $11.3 billion in 2011, to $35.4 billion in 2017.2 (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 14, 2021 Category: Internal Medicine Authors: Pranav Puri, S. Vincent Rajkumar, Nilay D. Shah, Mark R. Pittelkow, Aaron R. Mangold Tags: Commentary Source Type: research

44-Year-Old Woman With Fever, Sore Throat, and Polyarthralgia
In early 2019, a 44-year-old woman with no pertinent comorbidities presented to the clinic with a 4-day history of fever, chills, sore throat, joint and muscle pain, swelling on the right side of her neck, and odynophagia. She denied symptoms of hoarseness, conjunctivitis, coryza, cough, and urethritis. She denied smoking, alcohol use, and illicit drug use, was in a monogamous relationship, and took no medications. On physical examination, the patient was febrile to 38.1 °C, with a heart rate of 100 beats/min and regular rhythm, a blood pressure of 108/68 mm Hg in the right arm sitting, a respiratory rate of 18 breaths...
Source: Mayo Clinic Proceedings - September 14, 2021 Category: Internal Medicine Authors: Denise A. Gococo-Benore, Amanda L. McKenna, Dana M. Harris Tags: Residents ’ clinic Source Type: research

51-Year-Old Man With Ascites and Abdominal Pain
A 51-year-old man presented to the emergency department with 2 days of abdominal pain. He was in his usual state of health when he experienced progressive epigastric abdominal pain radiating to the back, which was worsened while lying supine. Nausea, emesis, and anorexia accompanied the pain. Symptoms did not improve with acetaminophen or omeprazole. He denied any fever, hematemesis, melena, or hematochezia. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 14, 2021 Category: Internal Medicine Authors: Anthony Robateau, Chineze Akusoba, Laura Greenlund Tags: Residents ’ clinic Source Type: research

37-Year-Old Man With an Altered Level of Consciousness
A 37-year-old Black man was found by friends to be confused at home. Medical comorbidities were remarkable only for morbid obesity (body mass index, 40.4 kg/m2) and recently diagnosed type 2 diabetes mellitus and hypertension; although he was prescribed metformin and lisinopril, he was nonadherent to all therapies and took no regular medication. He lived alone, and no collateral information on symptoms over the preceding days could be obtained. Upon arrival of emergency medical services, the patient was combative with a Glasgow Coma Scale of 8. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 14, 2021 Category: Internal Medicine Authors: Hadiyah Y. Audil, Tucker W. Coston, Craig E. Daniels Tags: Residents ’ Clinic Source Type: research

Medical Marijuana Regulations: You Can ’t Make Sense of Nonsense
If the reader finds the content of this month ’s Proceedings article about medical marijuana’s legal status in the United States confusing, illogical, even somewhat incoherent, don’t blame the messengers.1 As some Americans turn to marijuana for treatment of a variety of symptoms, with or without their doctors’ advice, health care insti tutions struggle with how to respond. Perlman and colleagues have accurately captured the essence of a national scene in which (1) the federal and state laws are in conflict, (2) the scientific method is rejected, and (3) the Food and Drug Administration (FDA) proces...
Source: Mayo Clinic Proceedings - September 14, 2021 Category: Internal Medicine Authors: J. Michael Bostwick Tags: Editorial Source Type: research

Clinical Heterogeneity of the VEXAS Syndrome
The objective of this study is to describe the clinical features and outcomes of patients with the newly defined vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome. Nine men with somatic mutations in the UBA1 gene were identified; the most frequent variant was p.Met41Thr (7 of 9, 78%). The median age at VEXAS diagnosis was 74 (67, 76.5) years, and patients had a median duration of symptoms for 4 years before diagnosis. Refractory constitutional symptoms (88%), ear and nose chondritis (55%), and inflammatory arthritis (55%) were common clinical features. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 3, 2021 Category: Internal Medicine Authors: Matthew J. Koster, Taxiarchis Kourelis, Kaaren K. Reichard, Tanaz A. Kermani, David B. Beck, Daniela Ospina Cardona, Matthew J. Samec, Abhishek A. Mangaonkar, Kebede H. Begna, C. Christopher Hook, Jennifer L. Oliveira, Samih H. Nasr, Benedict K. Tiong, Mr Tags: Brief report Source Type: research

SARS-CoV-2 Testing Prior to International Airline Travel, December 2020-May 2021
While there have been several case reports and simulation models of SARS-CoV-2 transmission associated with air travel, there are limited data to guide testing strategy to minimize the risk of SARS-CoV-2 exposure and transmission onboard commercial aircraft. Among 9,853 passengers with a negative SARS-CoV-2 PCR performed within 72 hours of departure from December 2020 through May 2021, five (0.05%) passengers with active SARS-CoV-2 infection were identified with rapid antigen tests and confirmed with rapid molecular test performed before and after an international flight from the United States to Italy. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Aaron J. Tande, Matthew J. Binnicker, Henry H. Ting, Carlos Del Rio, Lindsey Jalil, Matthew Brawner, Peter W. Carter, Kathleen Toomey, Nilay D. Shah, Elie F. Berbari Tags: Brief Report Source Type: research

Synopsis of the 2020 US Department of Veterans Affairs/US Department of Defense Clinical Practice Guideline: The Non-Surgical Management of Hip and Knee Osteoarthritis
In July 2020, the US Department of Veterans Affairs (VA) and US Department of Defense (DoD) approved a new joint clinical practice guideline for the non-surgical management of hip and knee osteoarthritis. This synopsis highlights some of the recommendations. In February 2019, the VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included clinical stakeholders and conformed to the National Academy of Medicine ’s tenets for trustworthy clinical practice guidelines. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Anil Krishnamurthy, Adam Edward Lang, Sanjog Pangarkar, Jess Edison, John Cody, James Sall Tags: Clinical practice guideline Source Type: research

Brachydactyly in Pseudopseudohypoparathyroidism
A 26-year-old woman was seen for a longstanding mild elevation of parathyroid hormone (PTH), with otherwise normal serum mineral levels. Repeat testing confirmed elevated PTH 75 pg/mL (15 to 65 pg/mL) with normal calcium 9.1 mg/dL (8.6 to 10.0 mg/dL), phosphorus 3.7 mg/dL (2.5 to 4.5 mg/dL), and creatinine 0.67 mg/dL (0.59 to 1.04 mg/dL). The results of 24-hour urine calcium excretion, thyroid stimulating hormone, and free thyroxine tests were normal. Total 25-hydroxy-vitamin D level was 18 ng/mL, indicating mild deficiency. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Clifford M. Csizmar, Meera Shah Tags: Medical image Source Type: research

Necrobiotic Xanthogranuloma
A 75-year-old woman was referred to the hematology clinic for a 2-year history of erythematous skin lesions. One year after the initial lesions erupted, physical examination showed extensive xanthomatous plaques with erythematous borders on the neck, chest, breasts, abdomen, arms, thighs, and eyelids (Figure  1A). She had no associated systemic or focal symptoms. Initial biopsy at this time was interpreted as consistent with atypical granuloma annulare. However, lesions were not responsive to topical or intralesional corticosteroids or ultraviolet B phototherapy. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Andrew J. Portuguese, Thomas H. Long, Michael Linenberger Tags: Medical image Source Type: research

Dr John H. Watson: Sherlock Holmes ’ Companion and Biographer
Few fictional characters are as well recognized around the world as the London-based crime-solving duo of “consulting detective” Sherlock Holmes and his loyal confidant Dr John Watson, created in 1887 by British writer Arthur Conan Doyle (1859-1930). Watson and Holmes’ literary association spanned 40 years, from their first appearance in A Study in Scarlet: Being a Reprint from the Reminiscences o f John H. Watson, M.D., Late of the Army Medical Department to The Adventure of Shoscombe Old Place, published in The Strand Magazine in 1927. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: David P. Steensma, Robert A. Kyle Tags: Stamp vignette on medical science Source Type: research

The implications of Industry-Funded Disease Awareness Campaigns in the Rare Disease Setting
In 1983, the US Congress enacted the Orphan Drug Act to incentivize pharmaceutical companies to develop drugs, vaccines, and diagnostic agents for rare diseases.1 The Act offers 7 years of marketing exclusivity, a 25% tax credit (50% before 2017) on qualified research and development costs, and research subsidies for orphan diseases, defined as conditions that affect less than 200,000 people in the United States. Since its passage, the number of orphan drugs has risen dramatically. In 2018, 58% of all new drug approvals had a rare disease indication. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Jennifer Gill, Ameet Sarpatwari, Vinay Prasad Tags: Commentary Source Type: research

Heparin Skin Necrosis in Heparin-Induced Thrombocytopenia
A 66-year-old woman presented with painful abdominal skin necrosis where she had been injecting subcutaneous enoxaparin 1 week following elective knee arthroplasty (Figure). Her complete blood cell count and basic metabolic panel yielded unremarkable findings. Enoxaparin was discontinued, and a direct thrombin inhibitor was started. Heparin platelet factor 4 IgG antibody was strongly positive (2.065 OD), as was the serotonin release assay —findings consistent with the diagnosis of heparin skin necrosis and heparin-induced thrombocytopenia. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Ahmed K. Pasha, Robert D. McBane II Tags: Medical image Source Type: research

21-Year-Old Man With Fever, Night Sweats, Productive Cough, and Diarrhea
A 21-year-old White man with Gilbert syndrome presented to the emergency department of Mayo Clinic in Arizona in August 2019 with approximately 10 days of cough and 5 days of progressively severe fever, night sweats, vomiting, and diarrhea. He also noted antecedent intermittent nausea, vomiting, diarrhea, and abdominal cramping over the previous 6 months that improved with dietary modification. Review of systems was also positive for right-sided pain in the lower thorax and upper abdomen. The patient had no notable medical or surgical history besides cochlear implant placement for congenital deafness. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: John S. Trickett, Preston H. Seaberg Tags: Residents ’ clinic Source Type: research

37-Year-Old Woman With Shortness of Breath
A 37-year-old woman presented to the emergency department with the chief complaint of shortness of breath of 5-hours duration. The onset was abrupt without additional associated symptoms. Her medical history includes ruptured intracranial aneurysm treated with surgical clipping 1 year previously with no neurological sequelae. Three weeks ago, she underwent open reduction internal fixation of a left ankle fracture. She has no other comorbidities, and her only medication is an oral combined estrogen-progestin contraceptive. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Mary T. Sessums, Charles Ritchie Tags: Residents' clinic Source Type: research

34-Year-Old Woman With Human Immunodeficiency Virus and Chronic Diarrhea
A 34-year-old woman with a history of human immunodeficiency virus (HIV) treated with antiretroviral therapy (ART) for 1 year, chronic hepatitis B, latent tuberculosis, and treated Helicobacter pylori infection was transferred to our institution for the evaluation of refractory abdominal pain, nausea, vomiting, and diarrhea. She experienced about 10 to 12 daily episodes of Bristol type 7 stool associated with abdominal bloating and cramping for a year with intermittent episodes requiring hospital admission for failure to thrive. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Blake H. Fortes, Saam Dilmaghani, Samantha M. Ryan Tags: Residents ’ clinic Source Type: research

Racial Differences in the Prevalence of Diagnosed Atrial Fibrillation Among Hospitalized Patients
Atrial fibrillation (AF) will affect at least 12 million people in the United States by 2030. Atrial fibrillation is associated with an increased risk for stroke and death and contributes to substantial costs and resource use.1 Considerable efforts are devoted to optimize AF management and mitigate its negative sequalae. However, the literature suggests the presence of racial disparities in the management of AF in the United States. Recent studies showed that direct oral anticoagulant, pulmonary vein isolation, and left atrial appendage closure are less commonly used among patients of non-White race. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Mohammed Osman, Abhishek J. Deshmukh, David R. Holmes, Mohamad Alkhouli Tags: Letter to the editor Source Type: research

Metaplastic Breast Cancer
A 5-cm breast mass was excised from an adult female and diagnosed by pathology as a matrix producing metaplastic breast carcinoma. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Beiyun Chen, Lori A. Erickson Tags: Path to patient image quiz Source Type: research

Changing the Culture of Tobacco Dependence Treatment Among Not Only Patients, But Also Prescribers
The article by Ebbert et  al1 is a crucial addition to the literature emphasizing the safety of medications for tobacco and nicotine dependence. The implications of such research are extremely important because these medications have a significant impact on the tobacco or nicotine user’s chances of quitting and are recom mended as standard of care.2,3 The article discusses that many patients have misperceptions about the side effects of these treatments that lead them to avoid them.1 However, potentially more important is the general misperceptions held by prescribers. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Adam Edward Lang Tags: Letter to the editor Source Type: research

Formulation: Articulation by Joseph Albers
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 - September 1, 2021 Category: Internal Medicine Authors: Margaret R. Wentz Tags: Art at mayo clinic Source Type: research

In Reply: Changing the Culture of Tobacco Dependence Treatment Among Not Only Patients, But Also Prescribers
We completely agree with Dr Lang.1 Lingering misperceptions held by patients, physicians, and advanced practice providers continue to inhibit them from using safe and effective pharmacotherapy for tobacco dependence. There is also a misperception that we have conquered the tobacco epidemic. This is also not true, although we have made great progress. In the United States, we continue to have 30 to 35 million adults who use tobacco regularly and tobacco causes tremendous excess mortality beyond the diseases commonly associated with tobacco use such as cancer, cardiovascular disease, and chronic lung disease. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Jon O. Ebbert, Carlos Jimenez-Ruiz, Michael P. Dutro, Matt Fisher, Jing Li, J. Taylor Hays Tags: Letter to the editor Source Type: research

Lessons From India ’s Second Wave
Until the middle of March 2021, there was a sense that India had somehow miraculously averted the coronavirus disease 2019 (COVID-19) pandemic. The first wave had almost fully abated by the end of 2020, and life was returning to normal. Then came the ferocious second wave, which at its peak in early May was marked by 400,000 confirmed daily new cases, and more than 400 daily deaths by official counts.1 India ’s deadly second wave had many lessons for the world. First, it demonstrated that abandoning protective measures like masks and distancing before achieving herd immunity can have devastating consequences. (Source...
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Priya Sampathkumar Tags: Editorial Source Type: research

Reducing Community Exposure to Protect Health Care Personnel in a Pandemic Environment
Health care practices typically have an abundance of evidence-based medicine literature and best practice guidelines on which to base policies and procedures designed to prevent transmission of communicable disease. However, with the coronavirus disease 2019 (COVID-19) pandemic, things were much different. Physicians and their teams practicing in public health, employee occupational health, and infection prevention quickly found themselves asked to make recommendations and decisions to support safety in health care institutions with limited and sometimes conflicting information about severe acute respiratory syndrome coron...
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Laura E. Breeher Tags: Editorial Source Type: research

Sleep Apnea, Septal Myectomy, and the Valsalva/Mueller Maneuvers: Who Can Resist Loving Hemodynamic Physiology?
Patients with hypertrophic cardiomyopathy (HCM) represent a unique group of cardiovascular patients because common indicators of cardiomyopathy progression may be of limited utility in HCM (left ventricular ejection fraction), while other individualized measures have been identified to predict adverse outcomes (left atrial size, atrial and ventricular arrhythmias, septal thickness, peak oxygen consumption). The distinctive aspects of obstructive HCM pathophysiology can test the clinician ’s skills during auscultation maneuvers as well as during unique management decisions (restrictions in the use of afterload reducin...
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Jan Konecny, Thomas Konecny Tags: Editorial Source Type: research

In the Limelight: September 2021
This month ’s feature highlights three articles 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/H79AfL9gByE). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Karl A. Nath Tags: In the limelight Source Type: research

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

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

General Information
(Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 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 September 2021 issue. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - September 1, 2021 Category: Internal Medicine Authors: Karl A. Nath Tags: Issue summary Source Type: research

Cone Reconstruction for Ebstein Anomaly
To define the impact of tricuspid valve cone reconstruction (CR) on ventricular performance in Ebstein anomaly, both independently and after stem cell therapy. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 31, 2021 Category: Internal Medicine Authors: Patrick W. O ’Leary, M. Yasir Qureshi, Frank Cetta, Timothy J. Nelson, Kimberly A. Holst, Joseph A. Dearani, Wanek Program Clinical Pipeline Group Tags: Original article Source Type: research

How Feedback Is Given Matters: A Cross-Sectional Survey of Patient Satisfaction Feedback Delivery and Physician Well-being
To evaluate how variation in the way patient satisfaction feedback is delivered relates to physician well-being and perceptions of its impact on patient care, job satisfaction, and clinical decision making. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 31, 2021 Category: Internal Medicine Authors: Stacie M. Vilendrer, Samantha M.R. Kling, Hanhan Wang, Cati Brown-Johnson, Tanvi Jayaraman, Mickey Trockel, Steven M. Asch, Tait D. Shanafelt Tags: Original article Source Type: research

Ethnicity-Based Disparities in Immune-Mediated Diseases —Time for Action!
Immune-mediated conditions, particularly allergic diseases (ADs) including allergic rhinitis, asthma, food allergy, and atopic dermatitis, are among the most common noncommunicable diseases in high-income countries (HICs) with racially, ethnically, and culturally diverse populations such as the United Kingdom, the United States, and Australia. Disease burden within HICs varies significantly by race and ethnicity, and this variability has prompted global attention toward disparities in health outcomes and management. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 31, 2021 Category: Internal Medicine Authors: Mamidipudi Thirumala Krishna, Christopher M. Warren, Jialing Jiang, Ruchi S. Gupta Tags: Perspective and Controversy Source Type: research

Topic-Based, Recent Literature Review on Pulmonary Hypertension
Pulmonary hypertension is a complex condition but a relatively common manifestation of severe cardiopulmonary disease. By contrast, pulmonary arterial hypertension is uncommon and is more prevalent in young women. To better categorize patients and to guide clinical decision-making, 5 diagnostic groups and associated subgroups characterize the spectrum of disease. A multidisciplinary approach to evaluation and treatment is recommended by published guidelines and often entails referral to a designated pulmonary hypertension center. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 31, 2021 Category: Internal Medicine Authors: Charles D. Burger, Hilary M. DuBrock, Rodrigo Cartin-Ceba, John E. Moss, Brian P. Shapiro, Robert P. Frantz Tags: Review Source Type: research

DXA Versus Clinical Measures of Adiposity as Predictors of Cardiometabolic Diseases and All-Cause Mortality in Postmenopausal Women
To investigate whether dual-energy x-ray absorptiometry (DXA) estimates of adiposity improve risk prediction for cardiometabolic diseases over traditional surrogates, body mass index (BMI), waist circumference (WC), and waist-to-hip ratio (WHR) in older women. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 31, 2021 Category: Internal Medicine Authors: Deepika R. Laddu, FeiFei Qin, Haley Hedlin, Marcia L. Stefanick, JoAnn E. Manson, Oleg Zaslavsky, Charles Eaton, Lisa Warsinger Martin, Thomas Rohan, Themistocles L. Assimes Tags: Original article Source Type: research

ChAdOx1 n-COV 19 Vaccine Protected Health Care Workers From Severe Infection Caused by the Variants
India has recently witnessed the “tsunami” of the second coronavirus disease 2019 wave, which resulted in more than 400,000 new cases at its peak in mid-May 2021.1 The infections occurring after 2 weeks of the complete vaccination are termed breakthrough infections (BTIs).2 These BTIs occur in a small percentage of vaccinated p ersons.3 (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 31, 2021 Category: Internal Medicine Authors: Raju Vaishya, Arpita Malani, Leena Mendiratta, Hena Butta, Anupam Sibal, Sujeet Kumar Singh, Hari Prasad K Tags: Letter to the editor Source Type: research

Antibody response to BNT162b vaccine is almost universal in health care workers. Results from the RENAISSANCE study: REsponse to BNT162b2 COVID-19 vacciNe - short And long term Immune reSponSe evAluatioN in healthCare workErs
To evaluate the SARS-CoV-2 anti-spike IgG antibodies production after the vaccination with BNT162b2 and the protection from symptomatic breakthrough infections in healthcare workers. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 29, 2021 Category: Internal Medicine Authors: Arianna Pani, Valeria Cento, Chiara Vismara, Daniela Campisi, Federica Di Ruscio, Alessandra Romandini, Michele Senatore, Paolo Andrea Schenardi, Oscar Matteo Gagliardi, Simona Giroldi, Laura Zoppini, Mauro Moreno, Matteo Corradin, Oscar Massimiliano Epis Tags: Original Article Source Type: research

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Essentials of Diagnosis and Management
Despite myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) affecting millions of people worldwide, many clinicians lack the knowledge to appropriately diagnose or manage ME/CFS. Unfortunately, clinical guidance has been scarce, obsolete, or potentially harmful. Consequently, up to 91% of patients in the United States remain undiagnosed, and those diagnosed often receive inappropriate treatment. These problems are of increasing importance because after acute COVID-19, a significant percentage of people remain ill for many months with an illness similar to ME/CFS. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 25, 2021 Category: Internal Medicine Authors: Lucinda Bateman, Alison C. Bested, Hector F. Bonilla, Bela V. Chheda, Lily Chu, Jennifer M. Curtin, Tania T. Dempsey, Mary E. Dimmock, Theresa G. Dowell, Donna Felsenstein, David L. Kaufman, Nancy G. Klimas, Anthony L. Komaroff, Charles W. Lapp, Susan M. Tags: Consensus recommendations Source Type: research

Academic Physician Specialists ’ Approaches to Counseling Patients Interested in Unproven Stem Cell and Regenerative Therapies—A Qualitative Analysis
To explore the experiences, approaches, and challenges of physicians consulting patients about experimental stem cell and regenerative medicine interventions (SCRIs). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 25, 2021 Category: Internal Medicine Authors: Cambray Smith, Aidan Crowley, Megan Munsie, Atta Behfar, Erin S. DeMartino, Nathan P. Staff, Shane A. Shapiro, Zubin Master Tags: Original article Source Type: research

A Population-Based Study of the Incidence and Natural History of Degenerative Thoracic Aortic Aneurysms
To investigate the incidence and natural history of degenerative thoracic aortic aneurysms (TAAs) and compare results between ascending (aTAAs) and descending TAAs (dTAAs). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 20, 2021 Category: Internal Medicine Authors: Ying Huang, Hartzell V. Schaff, Joseph A. Dearani, Gustavo S. Oderich, Thomas C. Bower, Manju Kalra, Kevin L. Greason, Alberto Pochettino, Jason K. Viehman, William S. Harmsen, Peter Gloviczki, Randall R. DeMartino Tags: Original article Source Type: research

Bleeding in Patients With Gastrointestinal Cancer Compared With Nongastrointestinal Cancer Treated With Apixaban, Rivaroxaban, or Enoxaparin for Acute Venous Thromboembolism
To compare the bleeding risk in patients with gastrointestinal (GI) cancer with that in patients with non-GI cancer treated with anticoagulation for acute cancer-associated venous thromboembolism (Ca-VTE). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 20, 2021 Category: Internal Medicine Authors: Damon E. Houghton, Danielle T. Vlazny, Ana I. Casanegra, Nichole Brunton, David A. Froehling, Ryan A. Meverden, David O. Hodge, Lisa G. Peterson, Robert D. McBane, Waldemar E. Wysokinski Tags: Original article Source Type: research

Diffuse Soft-Tissue Swelling in Antinuclear Matrix Protein-2 Antibody-Associated Dermatomyositis Sine Dermatitis
A 66-year-old man presented with progressive weakness and myalgia for 3 months, followed by anasarca and dysphagia. Physical examination showed symmetric limb-girdle weakness and generalized edema without skin rashes. Creatine kinase was 1584 U/L (normal: (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 20, 2021 Category: Internal Medicine Authors: Pitcha Chompoopong, Teerin Liewluck, Brendan P. McMenomy, Charles M. Harper Tags: Medical image Source Type: research

HLA Antibody Rates Are Not Increased In A Regional Group Of Male COVID-19 Convalescent Plasma Donors
(Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 19, 2021 Category: Internal Medicine Authors: Justin E. Juskewitch, Jonathon W. Senefeld, Patrick W. Johnson, John R. Mills, Michael J. Joyner, Manish J. Gandhi Tags: Letter to the Editor Source Type: research

Viral Endothelial Dysfunction: A Unifying Mechanism for COVID-19
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible virus with significant global impact, morbidity and mortality. The SARS-CoV-2 virus may result in widespread organ manifestations including acute respiratory distress syndrome, acute renal failure, thromboembolism, and myocarditis. Virus-induced endothelial injury may cause endothelial activation, increased permeability, inflammation, and immune response and cytokine storm. Endothelial dysfunction is a systemic disorder that is a precursor of atherosclerotic vascular disease that is associated with cardiovascular risk factors, and hi...
Source: Mayo Clinic Proceedings - August 18, 2021 Category: Internal Medicine Authors: Megha Prasad, Martin Leon, Lilach O. Lerman, Amir Lerman Source Type: research

U-Shaped Association Between Duration of Sports Activities and Mortality: Copenhagen City Heart Study
To investigate the association between the duration of weekly leisure-time sports activity and all-cause mortality. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 17, 2021 Category: Internal Medicine Authors: Peter Schnohr, James H. O ’Keefe, Carl J. Lavie, Andreas Holtermann, Peter Lange, Gorm Boje Jensen, Jacob Louis Marott Tags: Original article Source Type: research

Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for  Complications
To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF) undergoing cardiac surgery and to identify patient factors associated with complications. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - August 16, 2021 Category: Internal Medicine Authors: Jessie J. Hu, Crystal R. Bonnichsen, Joseph A. Dearani, William R. Miranda, Jonathan N. Johnson, Frank Cetta, Elizabeth H. Stephens, Devon O. Aganga, Charlotte S. Van Dorn Tags: Original article Source Type: research