Medicine and Music – Is There a Connection?
What if any connection exists between medicine and music? Of course, there are differences, with medicine being part science and part humanities, while music is almost entirely an art form. What possible relationship could exist between these two entities? (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 28, 2021 Category: General Medicine Authors: Joseph Alpert Source Type: research

A Cautionary Tale of Replenishing Fluids in Post-Obstructive Diuresis
Post-obstructive diuresis is a response initiated by the kidneys after relief of a ureteral obstruction to eliminate accumulated salt and fluid. Studies suggest that 0.5% to 52% of patients experience post-obstructive diuresis after relief of an obstruction1. Urine output of 200 mL/hour for two consecutive hours or 3L/24 hours after relief of an obstruction is diagnostic2. In most patients the diuresis resolves on its own once the kidneys normalize the volume and solute status. However, diuresis will continue in some patients after homeostasis is reached, leading to pathologic post-obstructive diuresis, which puts patients...
Source: The American Journal of Medicine - November 23, 2021 Category: General Medicine Authors: Emma D. Klein, Amit Narayan Source Type: research

Fitz-Hugh-Curtis Syndrome in the Absence of Pelvic Inflammatory Disease
A 34-year-old naturopathic woman presented to our emergency department with an abrupt right upper quadrant abdominal pain and elevated inflammatory markers. She lives a monogamous life and is sexually active with her life partner. Her past medical history included undergoing conization due to cervical intraepithelial neoplasia five years prior. The patient did not complain of any current or recent vaginal discharge, urinary symptoms, or discomfort during intercourse. She noticed a low-grade fever (a temperature of 37.5 Celcius per mouth was noted on admission). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 23, 2021 Category: General Medicine Authors: Roy Rafael Dayan, Dana Braiman, Israel Shenkman, Lisa Saidel-Odes, Nimrod Maimon Source Type: research

Cerebral sinus vein thrombosis as presenting feature of adenocarcinoma of the lung
A 64-year-old woman presented with sudden face asymmetry and constant headache over two weeks and was admitted. She had a history of diabetes, hypertension, and smoking, but no prior admissions. Trace peripheral right facial nerve palsy was the only abnormality discovered on examination, laboratory tests, ECG, and chest X-ray. Cerebral CT angiography revealed right-sided sinus vein thrombosis and a suspected lesion at the right lung apex (Fig. 1). A>70% stenosis of the proximal left internal carotid artery was also seen. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 23, 2021 Category: General Medicine Authors: Ami Schattner, Ina Dubin, Yair Glick Tags: Clinical Communication to the Editor Source Type: research

Utility of a Diagnostic Time-out to Evaluate an Atypical Pneumonia
A 48-year-old woman with no significant medical history presented to the emergency department with fever, non-productive cough, and shortness of breath for four days. She reported ongoing dyspnea on exertion over one month which rapidly progressed in the days leading up to her presentation. In the past month, she reported experiencing watery, non-bloody diarrhea, night sweats, and ageusia. Review of system was negative for weight loss, headache/neck pain, chest pain, rash, lymphadenopathy, arthralgia, dysuria and change in urinary frequency. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 20, 2021 Category: General Medicine Authors: Zaw Hlyan Phyo, Che Matthew Harris, Amteshwar Singh, Susrutha Kotwal Source Type: research

A Quality Improvement Initiative for Increasing Cardiac Rehabilitation Referrals Using Plan-Do-Study-Act (PDSA) Methodology
Cardiovascular diseases, namely coronary artery disease and heart failure, continue to be the leading cause of morbidity, mortality, and hospitalizations in the United States (US) as well as worldwide.1,2 The prevalence of these illnesses has increased over the decades as has the overall economic burden faced by the healthcare system.2,3 This cost not only includes the direct monetary costs of hospitalizations, re-admissions, procedures, and medications, but also indirect costs in the form of health-related quality of life and lost productivity. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 20, 2021 Category: General Medicine Authors: Deep Sangani, Vinay Krupadev, Michael Crawford, Brad Deere, Robert Hendel Source Type: research

Non-invasive versus invasive treatment options for challenging and progressive infundibulitis
A 39-year-old Caucasian male with no prior history of chronic disease presented with a chief complaint of pronounced fatigue, xerostomia, polydipsia and polyuria, which woke him up five times per night, and loss of libido. The symptoms had developed over the past six months. The patient had no personal medical history of head trauma or previous neurosurgery and his family history was unremarkable. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 20, 2021 Category: General Medicine Authors: Jan P. Nieke, Maria I. Vargas, Patrick Meyer, J örg D. Seebach, Peter Jandus Tags: Diagnostic Dilemma Source Type: research

New Precordial T wave Inversions in Hospitalized Patients
The incidence of precordial T changes has been described in athletes and in specific populations, while the etiology in a large patient population admitted to the hospital has not previously been reported. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 19, 2021 Category: General Medicine Authors: Nitin Thinda, John A. Ambrose, Amarbir Bhullar, Siyi Huang, Miro Asadourian, Ashwini Sadhale, Rochelle Anne Chua, Ralph Wessel Source Type: research

A Left Atrial Mass in the Time of COVID
A 60-year-old woman presented to the emergency department with chest pain and worsening dyspnea. On initial vital signs, she was afebrile with a blood pressure of 160/107 mmHg, a heart rate of 89 beats/min, a respiratory rate of 30 breaths/min, and an oxygen saturation of 95% on 4 liters oxygen via nasal cannula (an increase from her home requirement of 2 liters oxygen via nasal cannula). Her weight on presentation was 24 lbs above her baseline. Her exam was notable for elevated jugular venous pressure to 14 cm of water, rales in bilateral lung bases without wheezes, and significant bilateral lower extremity edema to her t...
Source: The American Journal of Medicine - November 19, 2021 Category: General Medicine Authors: Seulgi E. Kim, Stephanie Koh, Ihab Hamzeh Source Type: research

An old ally to address the “triple threat”
The patient is a 32 year old female with obesity complicated by Type 2 Diabetes Mellitus and hyperlipidemia. Diabetes mellitus was first diagnosed at the age of 26 – insulin autoantibodies were negative and endogenous insulin production was adequate. However, glycemic control remained persistently poor (HbA1c 9.4 – 11.9%) despite large doses of basal and prandial insulin (total insulin dose of 1.7 units/kg/day). Of significance, the patient had multiple ps ychiatric comorbidities, including psychotic depression, anxiety neuroses with somatisation and borderline personality disorder. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 19, 2021 Category: General Medicine Authors: Marvin Wei Jie Chua Tags: Commentary Source Type: research

First trimester anticoagulant exposure and adverse pregnancy outcomes in women with preconception venous thromboembolism: a nationwide cohort study
Venous thromboembolism, which refers to deep venous thrombosis plus pulmonary embolism, is a concern in women of childbearing age. Pregnancy is associated with a hypercoagulable state, such that pregnant women carry a 4- to 5-fold higher risk of venous thromboembolism compared to the general female population of reproductive age1. Venous thromboembolism incidence during pregnancy ranges from 0.6-2.0 events per 1000 deliveries1,2 with higher incidence in patients at high baseline risk such as thrombophilia or previous venous thromboembolism. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 16, 2021 Category: General Medicine Authors: Mette S øgaard, Flemming Skjøth, Peter Brønnum Nielsen, Jan Beyer-Westendorf, Torben Bjerregaard Larsen Tags: Clinical Research Study Source Type: research

Impact of Medication Adherence and Glycemic Control on the Risk of Micro/Macrovascular Diseases in Patients with Diabetes
To clarify the impact of medication adherence to oral hypoglycemic agents (OHAs) during a one-year period and subsequent glycemic control on the risk of micro/macrovascular diseases. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 16, 2021 Category: General Medicine Authors: Yuta Yaguchi, Kazuya Fujihara, Mayuko Harada Yamada, Yasuhiro Matsubayashi, Takaho Yamada, Midori Iwanaga, Masaru Kitazawa, Masahiko Yamamoto, Hiroyasu Seida, Satoru Kodama, Hirohito Sone Tags: Clinical Research Study Source Type: research

Differences in Inflammation, Treatment and Outcomes between Black and non-Black Patients Hospitalized for COVID-19: A Prospective Cohort Study
The Coronavirus 19 Disease (COVID-19) pandemic has disproportionately affected minorities in the United States1,2. The prevalence of COVID-19 is higher in Black patients relative to other racial groups3, and Black patients have a higher prevalence of risk factors for severe COVID-19, including obesity, hypertension, diabetes mellitus and kidney disease compared to non-Black patients.4,5,6,7 However, reports on the association between Black race and worse COVID-19 outcomes have been discrepant. Nationwide data suggest Black patients account for a higher percentage of deaths relative to their representation in the general po...
Source: The American Journal of Medicine - November 15, 2021 Category: General Medicine Authors: Tariq U. Azam, Hanna Berlin, Elizabeth Anderson, Michael Pan, Husam R. Shadid, Kishan Padalia, Patrick O'Hayer, Chelsea Meloche, Rafey Feroze, Erinleigh Michaud, Christopher Launius, Penelope Blakely, Abbas Bitar, Cristen Willer, Rodica Pop-Busui, John M. Tags: Clinical Research Study Source Type: research

An Enigmatic Case of Hashimoto's Thyroiditis and Apparent Hypothyroidism
A 60-year old male state worker was seen at our facility for the first time in 2017 for thyroid evaluation with a diagnosis of Hashimoto's thyroiditis and hypothyroidism who had been treated with varying doses of 50-200 ugm of levothyroxine for several years. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 15, 2021 Category: General Medicine Authors: Joseph R. Tucci Tags: Diagnostic Dilemma Source Type: research

Prior Exposure to Non-Steroidal Anti-inflammatory Drugs Reduces the Rate of Organ Failure and In-Hospital Mortality in Acute Pancreatitis. A Retrospective Cohort Study.
Acute pancreatitis remains a public health concern worldwide. In the US alone it accounts for>290,000 admissions annually with a cost of $2.5 billion 1. During severe acute pancreatitis, pro-inflammatory cytokines set in motion the systemic inflammatory response syndrome (SIRS) which is responsible for the development of organ failure in the early phases of the disease 2. Development of organ failure defined as the presence of acute kidney injury, cardiovascular failure or respiratory failure; either alone or in combination is the main factor driving the high mortality rate of severe cases 2, 3. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 15, 2021 Category: General Medicine Authors: Antonio Mendoza Ladd, Darwin Conwell, Thomas E Burroughs, Munigala Satish Tags: Clinical Research Study Source Type: research

The impact of atrial fibrillation on outcomes of peripheral arterial disease: analysis of routinely collected primary care data
Peripheral arterial disease is a major health problem associated with functional decline1 and more than double risk of overall mortality, cardiovascular mortality, major coronary events and cerebrovascular events.2,3 Proactive surveillance of peripheral arterial disease patients and recognition of potential risk factors for these adverse outcomes is of paramount importance. The prevalence of atrial fibrillation in peripheral arterial disease patients is high, ranging from 8% to 17.9% in different cohorts. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 15, 2021 Category: General Medicine Authors: Antonios Vitalis, Krishnarajah Nirantharakumar, Rasiah Thayakaran, Rajiv K. Vohra, MarK. Kay, Alena Shantsila, Gregory Y.H. Lip Tags: Clinical Research Study Source Type: research

Erythema ab igne in a caregiver
To the Editor: (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 15, 2021 Category: General Medicine Authors: Yasuhiro Kano, Miyuki Kato Tags: Clinical Communications to the Editor Source Type: research

Recurrent Neurogenic Pulmonary Edema
To the Editor: (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 14, 2021 Category: General Medicine Authors: Yusuke Yasumoto, Koji Uhara, Yoshitaka Tomoda, Ryotaro Kato Tags: Clinical Communication to the Editor Source Type: research

Virtual Recruitment: Experiences and Perspectives of Internal Medicine Program Directors
Due to the COVID-19 pandemic, internal medicine residency recruitment in fall 2021 was exclusively conducted virtually.1 This change represented a major shift in recruitment strategies and operations for US training programs, with limited data on best practices for virtual interviews.2, 3 Prior to COVID-19, applicants routinely traveled for in-person interviews with program faculty, met with program leadership and current residents, and visited the location and health care facilities. The in-person interview process provided applicants the benefit of learning about the culture and multiple aspects of the program and its lo...
Source: The American Journal of Medicine - November 6, 2021 Category: General Medicine Authors: Rachel P. Simmons, Jordan Ortiz, Michael Kisielewski, Aimee Zaas, Kathleen Finn Source Type: research

Consider the Early Diagnosis of Melanoma in Foot Examinations of Older Adults
The excellent paper by James et al1 describing foot examinations of older adults emphasizes the importance of this physical inspection; however, it does not mention the importance of an early diagnosis of melanoma at this particular site. Foot and subungual melanomas have an average 5.03 mm in thickness (the most important index for the prognosis of melanoma) at diagnosis, but at other cutaneous sites, melanomas average is about 0.8 mm in thickness. As a result, both overall and disease-free survival rates are worse for those with melanomas in the foot. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 1, 2021 Category: General Medicine Authors: Vincenzo De Giorgi, Flavia Silvestri, Federico Venturi, Federica Scarf ì, Luciana Trane, Piero Covarelli Tags: Letter Source Type: research

Body Weight and Future Risk of Pneumonia
Bae et al1 demonstrated the association between high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG) relating to higher risk of long-term pneumonia hospitalization in their recent article. Their study is remarkable in terms of the large sample size, long-term follow-up, and uniformity of lipid profiles measurement in fasting condition. Because the link between lipid metabolism and the immune system is not completely understood, their findings will be of help to clarify those mechanisms, possibly leading to better clinical practices. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 1, 2021 Category: General Medicine Authors: Atsuyuki Watanabe Tags: Letter Source Type: research

Gallbladder Cryoablation: Other Endoscopic Options for High-Risk Patients with Cholecystitis
We read with great interest the review on novel cryoablation therapy for cholecystitis by McNiel et al.1 Surgical cholecystectomy is the gold standard of treatment for acute cholecystitis according to recently updated Tokyo guidelines.2 We agree with McNiel et al that a definitive management of  cholecystitis in patients who are not surgical candidates remains a significant clinical need. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 1, 2021 Category: General Medicine Authors: Jason Jones, Harry R. Aslanian, Thiruvengadam Muniraj Tags: Letter Source Type: research

The Reply
We greatly appreciate the letter by Dr. De Giorgi et al, urging clinicians to “Consider the early diagnosis of melanoma in foot examinations of older adults” in response to our manuscript, “Foot Examination for Older Adults.”1 We agree that the skin examination of older adults is a critical part of the foot examination, and appreciate the importance of considering mel anoma when examining the feet. Many older adults may have mobility limitations that make it difficult to examine the skin on their feet thoroughly and detect abnormalities,2 and as the authors point out, this delay in diagnosis of a me...
Source: The American Journal of Medicine - November 1, 2021 Category: General Medicine Authors: Andrea Wershof Schwartz, Kirstyn James, Ariela R. Orkaby Tags: Letter Source Type: research

The Reply
We thank Jones et al for their comments on our recent article1 and for sharing their perspective on endoscopic techniques to treat cholecystitis. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 1, 2021 Category: General Medicine Authors: David McNiel, Charles Hennemeyer, Greg Woodhead, Hugh McGregor Tags: LETTER Source Type: research

Table of Contents
(Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 1, 2021 Category: General Medicine Source Type: research

Physician Burnout: Fix the Doctor or Fix the System?
Burnout-emotional exhaustion and depersonalization (i.e. treating patients like objects)-affects almost half of American physicians, even before the COVID-19 pandemic1. Burnout diminishes the quality of physician's lives2 and undermines patient care by leading to more medical errors and physicians leaving practice3. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 1, 2021 Category: General Medicine Authors: Nancy C. Greep, Steffie Woolhandler, David Himmelstein Tags: Commentary Source Type: research

Empathy – now more than ever
Empathy has varied definitions but we suggest that effective empathy can be defined as a continuum of three obligatory stages: first, Comprehension of the patient's predicament - a cognitive process based on listening and understanding the patient's narrative1; then, Compassion - an emotional, affective response that involves identification and benevolence; and subsequently, a Commitment to do the best for this patient – an active stage that may include search for the very best patient-tailored solutions, smoothing the path to necessary tests and consultations, and providing ongoing support. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Ami Schattner Source Type: research

Eruptive xanthomas: importance of recognition to reduce delay of effective triglyceride reduction
We present three cases of patients with eruptive xanthomas and severe hypertriglyceridemia who underwent skin biopsy and waited weeks to years before receiving effective treatment. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Emily P. Marogi, Ramael O. Ohiomoba, Neil J. Stone Tags: Review Source Type: research

Management of Atherosclerotic Carotid Artery Disease. A Brief Overview and Update
The objective of this review is to outline the clin ical presentation of symptomatic carotid artery stenosis and the risk factors associated with development of carotid artery stenosis, and then summarize the current evidence-based medical treatment modalities, along with available surgical and endovascular therapies. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Sara Hassani, Marc Fisher Tags: Review Source Type: research

An Overdue Thank You to My Role Models
Dr. Joseph Alpert said in his AJM Editorial, Role Modeling: A Personal Anecdote1 in 2011, “The term ‘role model’ refers to someone who is a colleague, often an older and more experienced individual, commonly imitated by younger colleagues.” In speaking about Sir William Osler in his book, Osler, Inspirations from a Great Physician2, Charles Bryan wrote “In speaking about those he thought highly of, Osler said they ‘have influenced the profession less by their special work than by exemplifying those graces of life and refinements of heart which make up character.’ He went on to say ...
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Daniel M. Lichtstein Tags: Commentary Source Type: research

Antiviral Therapeutics: Key to Curbing the COVID-19 Pandemic
Well-nigh two years into the SARS-CoV-2 pandemic, the successful abrogation of this global scourge appears increasingly uncertain. Confronted with a fourth wave of infections fueled by the highly transmissible delta variant, an exhausted planet stands bereft of a clear path forward. Left to ponder waning vaccine-mediated protection, attendant breakthrough infections, and vaccine boosters, governments the world over are in desperate search for solutions. Non-adherence to mitigation measures, anti-vaccination and masking sentiments, as well as growing pandemic fatigue, further compromise what is rapidly becoming an increasin...
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Eli Y. Adashi, I. Glenn Cohen Tags: Commentary Source Type: research

Two Hearts Living in One Mind: What is the Rhythm?
A 59-year-old patient who underwent orthotropic heart transplantation (OHT) for end-stage non-ischemic cardiomyopathy presented 2-months later with palpitations and fatigue. He has a history of hypertension, diabetes mellitus, and well-controlled human immunodeficiency virus. Of note, pre-transplant imaging had demonstrated a persistent left-sided superior vena cava draining into a large coronary sinus. Therefore, a bi-atrial anastomosis surgical technique (involving suturing the donor right atrium to a portion of the native right atrium with preservation of the native and donor coronary sinuses) was used at the time of tr...
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Tarek Zghaib, Gustavo Guandalini, Robert D. Schaller Tags: ECG image of the month Source Type: research

Just another case of acute stroke?
To: The Editor (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Marvin Wei Jie Chua Tags: Clinical Communication to the Editor Source Type: research

Checkmate with Dignity
Mr. John Williams (as I'll call him) was well-known to our Coronary Intensive Care Unit (CICU) staff. On this admission, he suffered from multi-organ failure and a rapidly dropping platelet level. During a brief respite, when he seemed to improve, we moved him from the CICU to the step-down Progressive Care Unit (PCU). One morning, after our team had rounded on Mr. Williams, he turned to us and said: “You all go on, I want to talk to the Doc.” (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 29, 2021 Category: General Medicine Authors: Sheldon H. Gottlieb Source Type: research

Association of Social Gaming with Well-being (Escape COVID-19): A Sentiment Analysis
: During the 2020-2021 COVID-19 lockdown, social activities were limited by the government-recommended social distancing guidelines leading to an abundance of mental health issues. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 28, 2021 Category: General Medicine Authors: Chayakrit Krittanawong, Hafeez Ul Hassan Virk, Craig L. Katz, Scott Kaplin, Zhen Wang, Joseph Gonzalez-Heydrich, Eric A Storch, Carl J Lavie Source Type: research

Statin Intolerance and Non-Compliance: An Empiric Approach
Over the long-term, at least half of patients started on statins will discontinue them. Statin noncompliance can be defined as discontinuing therapy for whatever reason. This results from four causes: dysfunction of the health care system; fear of side effects (nocebo effect); disorders of the musculoskeletal system or other organs misconstrued as statin related; and true statin myotoxicity. Statin intolerance here represents discontinuation due to perceived side effects. For statin intolerance in patients with clinical atherosclerotic cardiovascular disease, the goal is an LDL level (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 27, 2021 Category: General Medicine Authors: Scott M. Grundy, Gloria L. Vega Tags: Advancing High Value Health Care Source Type: research

Artificial Sepsis - Think Twice Before Pausing Therapy
We describe the case of a 58-year-old female patient presenting with a differentiated neuroendocrine tumor of the pancreas (PanNET) and hepatic metastases that was initially diagnosed in 09/2020. In 10/2020, chemotherapy with streptozocin/5-fluorouracil was started. At the request of the patient, a port was implanted before starting the 2nd chemotherapy cycle. Postinterventional routine laboratory testing showed increased C-reactive protein (CRP) levels of 1.6 mg/dl (reference range: (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 27, 2021 Category: General Medicine Authors: Annie Mathew, Dagmar F ührer, Harald Lahner Tags: Clinical Communication to the Editor Source Type: research

Don't give up now: the tide is about to turn
The tide is about to turn (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 27, 2021 Category: General Medicine Authors: Marvin Wei Jie Chua Tags: Clinical Communication to the Editor Source Type: research

The impact of an inpatient pancreatitis service and educational intervention program on the outcome of acute pancreatitis
: We introduced an inpatient pancreatitis consultative service aimed to (1) provide guideline-based recommendations to acute pancreatitis inpatients and (2) educate inpatient teams on best practices for acute pancreatitis management. We assessed the impact of pancreatitis service on acute pancreatitis outcomes. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 27, 2021 Category: General Medicine Authors: Cinthana Kandasamy, Ishani Shah, William Yakah, Awais Ahmed, Supisara Tintara, Cristina Sorrento, Steven D. Freedman, Darshan J. Kothari, Sunil G. Sheth Tags: Clinical Research Study Source Type: research

Reducing ICU Utilization, Length of Stay, and Cost by Optimizing the Clinical Use of Continuous Monitoring System Technology in the Hospital
Routine vital sign monitoring on inpatient general care units is carried out intermittently. The periods between these measurements —when clinicians are not actively monitoring patients, either in the room with another patient or performing any of their other responsibilities—create opportunities for patients to deteriorate. Delays in recognizing decompensation place patients at risk for complications, deterioration, and adv erse events. Failure to rescue occurs when unexpected but preventable complications occur, are not treated in a timely fashion, and result in death. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 26, 2021 Category: General Medicine Authors: Patricia C. Dykes, Graham Lowenthal, Stuart Lipsitz, Suzanne M. Salvucci, Catherine Yoon, David W. Bates, Perry G. An Tags: Clinical Research Study Source Type: research

Into the duct: an unusual source of bacteremia
A 52-year-old male presented to the hospital with a three-day history of high-grade fever (over 39.0 °C), arthralgia, and headache. He was diagnosed with acute pancreatitis for the first time when he was 28. Since then, he had been admitted several times due to chronic pancreatitis. The cause of chronic pancreatitis had been assumed to be alcohol consumption. Three months prior, he received an end oscopic ultrasound-fine needle aspiration to evaluate a mass in the pancreatic head, which yielded no evidence of malignancy. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 26, 2021 Category: General Medicine Authors: Wataru Komaba, Yukinori Harada, Yuki Ishida, Atsuko Tamashiro, Akihiko Tomita Tags: Diagnostic dilemma Source Type: research

Older Age as a Predictive Risk Factor for Acute Mountain Sickness
The population and proportion of older persons is increasing worldwide,1 a demographic representing up to 48% of high altitude trekkers,2 and 60 – 70% of hikers and tourists.3, 4 With older age comes an increased risk of more severe medical and traumatic illness and worse outcomes,5, 6 however the concern for increasing age as a risk factor for altitude illness is unclear. Acute mountain sickness is a constellation of distressing and often debilitating symptoms encountered in 40 – 80% of those ascending rapidly to high altitude. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 26, 2021 Category: General Medicine Authors: Elan Small, Caleb Phillips, James Marvel, Grant Lipman Tags: Clinical Research Study Source Type: research

Oral Is the New IV –Challenging Decades of Blood and Bone Infection Dogma: A Systematic Review
For many years, clinicians have assumed that intravenous (IV) antibiotics are necessary to successfully treat osteomyelitis, bacteremia, and endocarditis. This presumption stems from uncontrolled case series from the 1940s and 1950s, and the limited bioavailability of the few oral antibiotics available at that time (sulfanilamide, erythromycin, tetracycline).1-3 More modern drugs were not subjected to rigorous testing until the 1980s, by which time the culture of medicine had already established a deep, more than 30 years ’ old belief in IV-only therapy. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 26, 2021 Category: General Medicine Authors: Noah Wald-Dickler, Paul D. Holtom, Matthew C. Phillips, Robert M. Centor, Rachael. A. Lee, Rachel Baden, Brad Spellberg Tags: Clinical Research Study Source Type: research

Atypical Herpetic Rash: ‘Knife-cut’ Sign
A 73 year old lady initially presented to her primary care physician's office with complaints of a linear rash in the right groin and lower abdominal region. Her past medical history included systemic lupus erythematosus (SLE), rheumatoid arthritis, hypertension, depression, and chronic kidney disease (baseline serum creatinine around 1.8 mg/dl).There was concern for herpes zoster and a coexisting cutaneous fungal infection. Oral valacyclovir and topical betamethasone with clotrimazole were prescribed. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 26, 2021 Category: General Medicine Authors: Abraham Attah, Jeffrey Uchin, Charles Mount, Zaw Min, Nitin Bhanot Tags: Images in Dermatology Source Type: research

A Treacherous Twist on ECG
The patient is a 61-year-old female with a history of well-controlled hypothyroidism on levothyroxine supplementation and prior suspected cardioembolic stroke on chronic anticoagulation who previously underwent surgical mitral valve repair 1 year previously due to symptoms of severe fatigue with a baseline left ventricular ejection fraction of 55-60% and non-obstructive coronary artery disease. Immediately following surgery, her left ventricular ejection fraction declined to 40%. Postoperatively, she continued to experience fatigue with gradual worsening of her left ventricular ejection fraction to 30%. (Source: The Americ...
Source: The American Journal of Medicine - October 26, 2021 Category: General Medicine Authors: Tyler J. Bonkowski, Christopher M. Madison, Sanjay Dandamudi, David A. McNamara Tags: ECG Image of the Month Source Type: research

Sex Differences in Symptom Phenotypes Among Older Patients with Acute Myocardial Infarction
Making a diagnosis for an individual patient typically starts with a clinician using pattern recognition to generate a list of diagnostic possibilities.1-4 Novice students, lacking clinical experience, use causal knowledge of diseases to recognize diagnostic possibilities, whereas expert diagnosticians rely more on clinical experience including memories of specific clinical instances. 5,6 When an instance such as a diagnostic encounter is stored in long-term memory, it is remembered using a knowledge structure called an exemplar. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 26, 2021 Category: General Medicine Authors: John E. Brush, Alexandra M. Hajduk, Erich J. Greene, Rachel P. Dreyer, Harlan M. Krumholz, Sarwat I. Chaudhry Tags: Clinical Research Study Source Type: research

An Empirical Analysis of Precision Previvorship: Are Familial and High-Risk Cancer Preventive Programs Evidence-Based?
Over the last decade, some academic medical centers have launched new cancer screening or preventive programs, often appealing to individuals with family history or known elevated genetic risk. Preventive and screening services are offered for a breadth of tumor types, including pancreatic, hematologic, breast, and lung cancers. Standard services available are cancer prevention counseling, prophylactic surgery, personalized genomic risk profiling, removal of precancerous growths, ongoing surveillance, access to clinical trials, and exercise and nutrition plans. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 19, 2021 Category: General Medicine Authors: Kerrington Powell, Alyson Haslam, Vinay Prasad Tags: Advancing High Value Health Care Source Type: research

Digenic inheritance of a FOXC2 mutation and two PIEZO1 mutations underlies congenital lymphedema in a multigeneration family
The lymphatic system is essential for maintaining the balance of interstitial fluid in tissues and for returning protein rich fluids (lymph) to the bloodstream. Congenital lymphatic defects lead to accumulation of lymph in peripheral tissues and body cavities, termed primary lymphedema. To date, only a limited number of individual genes have been identified in association with primary lymphedema. However, variability of age of onset and severity of lymphatic abnormalities within some families suggests that multiple mutations and/or genes may be responsible, thus hampering efforts to identify individual associated genes. (S...
Source: The American Journal of Medicine - October 14, 2021 Category: General Medicine Authors: DJ Mustacich, LW Lai, MJ Bernas, JA Jones, R Myles, P Kuo, W Williams, C Witte, RP Erickson, MH Witte Tags: CLINICAL RESEARCH ARTICLE Source Type: research

The Reluctant Patient and the Insistent Doctor
Recently, while seeing inpatients on our cardiology consult service, our nurse practitioner and I were faced with a common bioethical problem. The patient was a frail 82 year old man whose command of English was only moderate. He had been admitted from the Emergency Department complaining of diffuse chest and abdominal pain. His ECG revealed non-specific ST-T changes that were not diagnostic for myocardial ischemia, but his blood troponin values were elevated. Despite his atypical symptoms, the admitting diagnosis was non-ST elevation myocardial infarction (NSTEMI). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 14, 2021 Category: General Medicine Authors: Joseph Alpert Tags: Commentary Source Type: research

Desperate Times, Desperate Measures: Same Day Discharge for ST Segment Elevation Myocardial Infarction Patients
When I was a medical student in Pakistan, I lamented the condition of its public health system, symbolized by its inability to eradicate polio or measles despite successes in other countries (1). Admittedly, at that time I had not envisioned a COVID-19 pandemic, nor had I imagined that convincing people for vaccination would be a challenge, especially in the western world (2). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 14, 2021 Category: General Medicine Authors: Haris Riaz Tags: Commentary Source Type: research