Combined Pulmonary Fibrosis and Emphysema
Combined pulmonary fibrosis and emphysema (CPFE) syndrome refers to co-occurrence of two disease processes in the lung that can be difficult to diagnose but is associated with high morbidity and mortality burden. Diagnosis of CPFE is challenging because the two diseases can counterbalance respective impairments resulting in deceivingly normal-appearing chest radiography and spirometry in a dyspneic patient. Although an international committee published the terminology and definitions of CPFE in 2022, consensus on exact diagnostic criteria and optimal management strategy is yet to be determined. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Masahiro Nemoto, Chi Wan Koo, Paul D. Scanlon, Jay H. Ryu Tags: Review Source Type: research

27-Year-Old Woman With Hypoxemia
A 27-year-old woman presented to the clinic for home pulse oximetry readings persistently below 90% with associated dyspnea for several months. She denied additional complaints. Her medical history was notable for bipolar disorder, type I diabetes, hypertension, obesity, hypothyroidism, gastroesophageal reflux disease, prior cholecystectomy, and episodic jaundice. Medications on presentation were lamotrigine, insulin, hydrochlorothiazide, levothyroxine, and omeprazole. Episodic jaundice had been attributed to glucose-6-phosphate dehydrogenase (G6PD) deficiency diagnosed at 2 years of age when the patient developed acute an...
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Holly M. Thomson, Surbhi Shah Tags: Residents ’ clinic Source Type: research

53-Year-Old Man With Dyspnea
A 53-year-old man with type 2 diabetes mellitus treated with metformin, pioglitazone, and empagliflozin presented to the emergency department with acutely worsening dyspnea for 1 day. Five days before onset of dyspnea, he developed chills followed by a nonproductive cough. He had not had any recent known sick contacts, recent travel, or medication changes. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Benjamin R. Stultz, Matthew W. Ewy, Sarah J. Chalmers Tags: Residents ’ clinic Source Type: research

62-Year-Old Woman With Dysphagia
A 62-year-old female with a medical history significant for cerebrovascular accident and iron deficiency anemia presented for evaluation of dysphagia. She reported a transient ischemic attack/stroke-like episode which occurred 2 years before presentation. Her initial symptoms were dysphagia with liquids only without oropharyngeal transfer difficulties such as choking, gagging, coughing, or nasopharyngeal regurgitation. These symptoms, plus lower-extremity weakness, began around the time of her stroke-like episode. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Paul M. Travers, R. Christopher Chase, Maoyin Pang Tags: Residents ’ clinic Source Type: research

Invasive Central Nervous System Aspergillosis in a Patient Receiving Long-term Acalabrutinib Therapy
A patient in their 80s with a history of chronic lymphocytic leukemia (CLL) in remission taking acalabrutinib was admitted for acute kidney injury, confusion, and 1-month history of progressive left ocular symptoms. The patient was hemodynamically stable but noted to have anisocoria, slow left pupillary response, and reduced visual acuity involving the left upper visual field. The ophthalmologic evaluation noted left anterior uveitis with a large choroidal lesion along the inferior arcade. Patients with CLL treated with Bruton tyrosine kinase inhibitors, particularly ibrutinib, are at increased risk for an invasive fungal ...
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Reema K. Tawfiq, Nischal Ranganath, Vance T. Lehman Tags: Medical image Source Type: research

Laryngopharyngeal Herpes Zoster Without Skin Vesicles Preceded by Intractable Hiccups
A man in his late 40s presented with a 7-day history of persistent hiccups. He had experienced a short-lived sore throat 10 days prior. Three days after symptom onset, hiccups appeared and persisted. On admission, his vital signs were normal. Physical examination revealed several mucosal vesicles in the left oropharynx (Figure A). No vesicular rashes were observed on the face, trunk, or limbs. Laryngoscopy revealed white mucosal discharge on the left side of the oropharynx, posterior pharyngeal wall, and epiglottis (Figures B and C). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Kana Sakai, Daisuke Miyamori, Masao Horiuchi Tags: Medical image Source Type: research

Multiple Beau Lines and Onychomadesis
A man in his late 60s was referred to the dermatology department with asymptomatic nail changes on his fingers and toes. These lesions had developed after a 6-month course of chemotherapy with cetuximab and afatinib for metastatic lung adenocarcinoma (Figure  1). No systemic symptoms nor history of nail trauma were noted. Physical examination revealed proximal nail gaps (onychomadesis) on multiple fingernails and toenails (Figure 1A). Moreover, multiple transverse white lines (Beau lines) were also noted on the nail plate of the left big toe (Figure  1B). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Tai-Li Chen, Chih-Chiang Chen Tags: Medical image Source Type: research

Ticagrelor vs Clopidogrel in Acute Myocardial Infarction Patients With a History of Ischemic Stroke
To investigate whether use of ticagrelor compared to clopidogrel is associated with different risks for thrombotic events or major bleeding among acute myocardial infarction (AMI) patients with a prior history of acute ischemic stroke. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Hsin-Yi Huang, Chi-Chuan Wang, Aaron J. Katz, Shin-Yi Lin, Fang-Ju Lin, Chung-Hsuen Wu Tags: Original article Source Type: research

Career Plans of US Physicians After the First 2 Years of the COVID-19 Pandemic
To assess the career plans of US physicians at the end of 2021 relative to 2011 and  2014. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Tait D. Shanafelt, Liselotte N. Dyrbye, Colin P. West, Mickey Trockel, Michael Tutty, Hanhan Wang, Lindsey E. Carlasare, Christine A. Sinsky Tags: Original article Source Type: research

Politicization of Medical Care, Burnout, and Professionally Conflicting Emotions Among Physicians During COVID-19
To evaluate the association of politicization of medical care with burnout, professional fulfillment, and professionally conflicting emotions (eg, less empathy, compassion; more anger, frustration, resentment). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Christine A. Sinsky, Mickey Trockel, Lindsey E. Carlasare, Colin P. West, Hanhan Wang, Michael Tutty, Liselotte N. Dyrbye, Tait D. Shanafelt Tags: Original article Source Type: research

Adrenal Gland Solitary Fibrous Tumor
A man in his 70s was found to have an adrenal mass, for which he underwent adrenalectomy. Histopathologic examination revealed a solitary fibrous tumor within the adrenal gland (Figure  1). (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Rumeal D. Whaley, Jeremy Molligan, Lori A. Erickson Tags: Path to patient image quiz Source Type: research

Clinical Significance of Viral Sociology Emerges as Influenza Season Collides With COVID-19 Pandemic
Recently, public concerns have been growing about the new reality that COVID-19 will complicate the seasonal influenza epidemics, causing the overlapping flu –COVID-19 pandemic (Figure). The overlapping flu–COVID-19 pandemic may increase the risk of flu–COVID-19 coinfection that leads to the critical illness of COVID-19.1,2 Understanding this issue will improve the preparedness for influenza season and reduce the overall burden of the COVID-19 pand emic. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Ming Zheng Tags: Letter to the editor Source Type: research

Regarding Racial and Gender Differences in Medical Student Burnout: A 2021 National Survey
We read the recent report of Briggs et  al1 on medical student burnout with great interest. Supporting medical students by creating and sustaining learning environments within which they can thrive should be an imperative in medical education. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Colin P. West, Liselotte N. Dyrbye, Tait D. Shanafelt Tags: Letter to the editor Source Type: research

In Reply: Regarding Racial and Gender Differences in Medical Student Burnout: A 2021 National Survey
We thank West et  al for their letter to the Editor in response to our previously published report on medical student burnout in the United States.1 They raised the well-appreciated point about the many definitions and metrics for physician burnout and consequently how care must be taken in comparing results across studies. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: Logan G. Briggs, Grant J. Riew, Michael W. Seward, Jack F. Donaghue, Jae Ermer, Bruno T. Scodari, Kerri Palamara Tags: Letters to the editor Source Type: research

Six Decades of Philatelic Vignettes: In Honor of Dr Robert A. Kyle ’s Contributions to Medicine and Stamps
In philately, the “vignette” is the central design or picture of a postage stamp—distinct from the lettering and from any framing. This term was first used by book publishers. It is a diminutive of the French word vigne (vine), since foliage motifs including grapes and vines were once the most common printed de signs used to fill in blank spaces in books, and to denote the beginning and end of chapters. “Vignette” acquired a variety of other meanings in different fields from theater to graphic design. (Source: Mayo Clinic Proceedings)
Source: Mayo Clinic Proceedings - November 1, 2023 Category: Internal Medicine Authors: David P. Steensma, Thomas E. Witzig Tags: Stamp vignette on medical science Source Type: research