Hiding Behind Atrial Fibrillation: A Rare Presentation of Atrial Myxoma
We present a case of atrial myxoma that was found incidentally in a patient that presented with atrial fibrillation. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 18, 2020 Category: General Medicine Authors: Usman A. Hasnie, Ammar A. Hasnie Tags: Clinical Communication to the Editor Source Type: research

Peripheral arterial disease in patients with atrial fibrillation: The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study.
Atrial fibrillation and peripheral arterial disease are two conditions associated with high risk of cardiovascular and cerebrovascular complications and mortality.1 –5 There is evidence that coexistence of both these clinical conditions can result to an additive risk of adverse events.6 Indeed, atherosclerotic vascular disease has been linked with stroke, thromboembolism and death in subjects with atrial fibrillation and has been therefore included as one of the components of risk scores, such as the CHA2DS2-VASc score (Congestive Heart failure, Hypertension Age> 75 years, DM, Stroke, Vascular disease) in order to...
Source: The American Journal of Medicine - September 18, 2020 Category: General Medicine Authors: Antonios Vitalis, Alena Shantsila, Marco Proietti, Rajiv K. Vohra, Mark Kay, Brian Olshansky, Gregory Y.H. Lip Source Type: research

The Decline of the Experimental Paradigm During the COVID-19 Pandemic: A Template for the Future
The current COVID-19 pandemic has exerted an unprecedented impact across the globe. As a consequence of this overwhelming catastrophe, long established prevailing medical and scientific paradigms have been disrupted. The response of the scientific community, medical journals, media and some politicians, has been far from ideal. The present manuscript discusses the failure of the scientific enterprise in its initiatives to address the COVID-19 outbreak, as a consequence of the disarray attributable to haste and urgency. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 17, 2020 Category: General Medicine Authors: Jo ão Pedro Ferreira, Murray Epstein, Faiez Zannad Tags: Review Source Type: research

An elusive diagnosis in non-cirrhotic chronic portal vein thrombosis
A 66-year-old man with a history of hypertension, dyslipemia, and pulmonary tuberculosis in adolescence presented to our clinic with melena and 2-point loss of hemoglobin. Additional laboratory values revealed thrombopenia (102,000/ μL) and values within the normal range of liver blood tests. Urgent esophagogastroduodenoscopy evidenced active bleeding from esophageal varices that were treated endoscopically with band ligation and medically with somatostatin and ceftriaxone. An extended liver etiology screen was negative, and a n abdominal computed tomography scan additionally revealed calcified lymph nodes in relation t...
Source: The American Journal of Medicine - September 17, 2020 Category: General Medicine Authors: Jos é Ignacio Fortea, Angela Puente, Antonio Cuadrado, Carmen del Pozo, Inés García, Raul Pellon, Maria Luisa Cagigal, Emilio Fábrega, Javier Crespo Tags: Clinical Communication to the Editor Source Type: research

The diagnostic approach in complex patients: parsimony or plenitude?
The principle of parsimony, known to many as Occam's razor, states that simple explanations are preferred over more complex ones where explanatory power is equivalent. An enduring maxim in science and philosophy, it is also commonly used implicitly when non-scientists reason about everyday problems. In medicine, the principle of diagnostic parsimony favours a unifying diagnosis over multiple ones where both explain the clinical data equally well and is arguably the most widely employed heuristic in medical practice. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 17, 2020 Category: General Medicine Authors: Dr. James Kelly Tags: Commentary Source Type: research

Tai Chi for Chronic Illness Management: Synthesizing Current Evidence from Meta-Analyses of Randomized Controlled Trials
An umbrella review of systematic reviews and meta-analyses of randomized controlled trials (RCTs) was conducted to evaluate the existing evidence of Tai Chi as a mind-body exercise for chronic illness management. MEDLINE/PubMed and Embase databases were searched from inception until 31st March 2019 for meta-analyses of at least two RCTs that investigated health outcomes associated with Tai Chi intervention. Evidence of significant outcomes (P-value (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 15, 2020 Category: General Medicine Authors: Liye Zou, Tao Xiao, Chao Cao, Lee Smith, Kellie Imm, Igor Grabovac, Thomas Waldhoer, Yin Zhang, Albert Yeung, Jacopo Demurtas, Nicola Veronese, Ulf Ekelund, Yikyung Park, Lin Yang Tags: Review Source Type: research

Rethinking Women, Aspirin and Primary Prevention
Aspirin has long been a cornerstone of primary prevention of cardiovascular disease. In 2018, three randomized trials updated the literature on aspirin use in the elderly (ASPREE), diabetics (ASCEND) and intermediate-risk populations (ARRIVE)1. While these trials provided useful insights on contemporary aspirin use, the role of aspirin in primary prevention was contested. As the apparent benefit of aspirin in primary prevention was less convincing, these trials were obliged to be reported as “negative”. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 14, 2020 Category: General Medicine Authors: Osama Dasa, Carl J Pepine Tags: Commentary Source Type: research

A Missionary from Sudan: Brucellosis
Brucellosis is a zoonotic disease caused by a fastidious Gram-negative bacteria. Most commonly, it is transmitted from the consumption of unpasteurized dairy products and rarely from human to human. Endemic areas include Africa, the Mediterranean Basin, the Middle East, and Central and South Americas. Symptoms are often nonspecific including fever, fatigue, and decreased appetite. Brucella poses a real danger to lab personnel if not notified by the suspecting physician. Both the health of the patient and laboratory staff is at risk1. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 14, 2020 Category: General Medicine Authors: Rich Kodama, Siddharth Bhesania, John Gorski, Douglas Sepkowitz Tags: Clinical Communication to the Editor Source Type: research

Foot Torture (Falanga): Ten Victims With Chronic Plantar Hyperpigmentation
Falanga is a widespread form of torture, but details of the chronic skin sequelae on physical examination are unreported. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 14, 2020 Category: General Medicine Authors: George F. Longstreth, Lydia Grypma, Brittney A. Willis, Kathi C. Anderson Tags: Brief Observation Source Type: research

Epiploic appendagitis
A 35-year-old man presented with acute onset of persistent, localized, and nonradiating left-sided lower abdominal pain, 12 hours prior to presentation in October 2018. He denied vomiting, diarrhea, blood-stained stools, or hematuria. Physical examination revealed body temperature of 37.0 °C, blood pressure of 162/118 mmHg, pulse rate of 85 beats/min, respiratory rate of 16 breaths/min, and SpO2 of 98% on room air. Palpation of the left lower abdomen revealed rebound tenderness, and Carnett's sign was negative. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 14, 2020 Category: General Medicine Authors: Yuta Hirose, Kiyoshi Shikino Tags: Clinical communication to the editor Source Type: research

Diet quality and long-term absolute risks for incident cardiovascular disease and mortality
Long-term absolute risks for cardiovascular disease and mortality and cardiovascular disease-free survival according to diet quality at different adult ages are unclear. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 13, 2020 Category: General Medicine Authors: Victor W. Zhong, Hongyan Ning, Linda Van Horn, Mercedes R. Carnethon, John T. Wilkins, Donald M. Lloyd-Jones, Norrina B. Allen Tags: Clinical Research Study Source Type: research

Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial
We evaluated the efficacy of spinal manipulation for the management of non-acute lumbar radiculopathy. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 12, 2020 Category: General Medicine Authors: Seyedezahra Hosseini Ghasabmahaleh, Zahra Rezasoltani, Afsaneh Dadarkhah, Sanaz Hamidipanah, Reza Kazempour Mofrad, Sharif Najafi Tags: Clinical Research Study Source Type: research

Retention of Point-of-care Ultrasound Skills among Practicing Physicians: Findings of the VA National Point-of-care Ultrasound Training Program
Point of Care Ultrasound (POCUS) use continues to increase in many specialties, but lack of POCUS training is a known barrier amongst practicing physicians. Many physicians are obtaining POCUS training through post-graduate courses, but the impact of these courses on skill retention and frequency of POCUS use post-course is unknown. The purpose of this study was to assess the change in POCUS knowledge, skills, and frequency of use after 6-9 months of participating in a brief training course. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 12, 2020 Category: General Medicine Authors: Christopher K. Schott, M. LoPresti, Jeremy S. Boyd, Megan Core, Elizabeth K. Haro, Michael J. Mader, Sergio Pascual, Erin P. Finley, Brian P. Lucas, Angel Colon-Molero, Marcos I. Restrepo, Jacqueline Pugh, Nilam J. Soni Tags: Clinical Research Study Source Type: research

Proton pump inhibitors vs. histamine-2 receptor antagonists likely increase mortality in critical care: an updated meta-analysis
Upper gastrointestinal bleeding is common among the critically ill. Recently, the Proton Pump Inhibitors (PPIs) vs. Histamine-2 Receptor Blockers (H2RAs) for Ulcer Prophylaxis Therapy in the Intensive Care Unit (PEPTIC) trial suggested PPIs might increase mortality. We performed an updated meta-analysis to further inform discussion. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 12, 2020 Category: General Medicine Authors: Todd C. Lee, Marnie Goodwin Wilson, Alexander Lawandi, Emily G. McDonald Tags: Brief Observation Source Type: research

Adherence to stepped care for management of musculoskeletal knee pain leads to lower healthcare utilization, costs, and recurrence
To report compliance with stepped care management of patellofemoral pain, and determine whether adherence to stepped-care results in decreased recurrence and lower health care utilization. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 12, 2020 Category: General Medicine Authors: Alessandra N Garcia, Chad E Cook, Daniel I Rhon Tags: Clinical Research Study Source Type: research

Painful diplopia: Do not forget Thyroid-Associated Ophthalmopathy.
Abrupt onset of painful diplopia has a wide differential diagnosis and should be thoroughly investigated. A 45-year-old male presented to the Emergency Department with 3 days history of acute onset diplopia and right bulbar pain provoked by eye movements. The patient did not have any relevant past medical history. He is a smoker (20 pack-years) and denied any other medication or alcohol abuse. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 12, 2020 Category: General Medicine Authors: Theodoros Mavridis, Georgios Velonakis, Vasiliki Zouvelou Tags: Images in Radiology Source Type: research

The Impact of Non-alcoholic Fatty Liver Disease in Primary Care: A Population Health Perspective
Non-alcoholic Fatty Liver Disease (NAFLD) is the leading cause of liver disease worldwide with rising rates in parallel to those of obesity, type 2 diabetes and metabolic syndrome. NAFLD encompasses a wide spectrum of pathology from simple steatosis to nonalcoholic steatohepatitis (NASH) and cirrhosis, which are linked to poor outcomes. Studies confirm a significant amount of undiagnosed NAFLD and related fibrosis within the community increasing the overall burden of the disease. NAFLD appears to be more prevalent in certain populations such as those with type 2 diabetes and metabolic syndrome. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 12, 2020 Category: General Medicine Authors: Amr Dokmak, Blanca Lizaola-Mayo, Hirsh D. Trivedi Tags: Review Source Type: research

A Case of Thiamine Deficiency Post Roux-n-Y Gastric Bypass Surgery
Thiamine deficiency after Roux-n-Y gastric bypass surgery is well described in the literature, presenting with ataxia, altered mental status, and eye movement disorders2. Most present within the first six months post-surgery2. Female patients often present earlier2 and patients with persistent vomiting post operatively are more susceptible3. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 12, 2020 Category: General Medicine Authors: Rubel Ariella, Kang Angela, Saleem Maryam Tags: Clinical Communication to the Editor Source Type: research

Calcified Umbilical Nodule with Abdominal Pain
A 22-year-old man with no previous medical history presented to clinic with non-radiating, constant mid-abdominal pain that started three days prior and progressively worsened. He reported intermittent, mild abdominal pain for several years but nothing of this severity and was unaware of any umbilical abnormalities. He did report manipulating the umbilicus in an effort to self-treat the current issue. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 12, 2020 Category: General Medicine Authors: Amanda S. Weissman, Viral Sanjay Patel, Loretta S. Davis Tags: Images in Dermatology Source Type: research

Risks of Serious Injury with Testosterone Treatment
Injury causes significant morbidity and mortality that is sometimes attributed to testosterone and violence. We hypothesized that prescribed testosterone might be associated with the subsequent risk of serious injury. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 11, 2020 Category: General Medicine Authors: Christopher J. Yarnell, Deva Thiruchelvam, Donald A. Redelmeier Tags: Clinical Research Study Source Type: research

Hepatic Portal Venous Gas in a Man on Maintenance Hemodialysis
A 66-year-old man who had been on maintenance hemodialysis for 8 consecutive years in our department presented with a 12-hour history of severe abdominal pain, emesis, and inability to pass flatus. His body temperature was 36.5 °C (97.7°F), pulse was 105 beats per minute, blood pressure was 131/70 mm Hg, respiratory rate was 25 breaths per minute, and oxygen saturation was 93% on room air. On examination, diffuse abdominal distension, absent bowel sounds, and mild tenderness were detected. The most severe pain was in the right upper quadrant with the pain intensity at 8 of 10. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - September 10, 2020 Category: General Medicine Authors: Zehua Lin, Xiaopeng Guo, Yingchun Ma Tags: Clinical Communication to the Editor Source Type: research

Risks and Costs of Routine Preventive Coronary Artery Calcium Scans
Schade, Arora, and Eaton make an interesting comparison between routine preventive colonoscopy and coronary artery calcium scanning.1 However, an important distinction between these modalities is that radiological tests invariably lead to incidental findings, which have been a long-standing concern with cardiac imaging.2,3 Investigations of various cardiac imaging modalities have repeatedly shown high rates of incidental findings, few of which are clinically significant, and high costs associated with the cascade workups. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 29, 2020 Category: General Medicine Authors: Taher Modarressi Tags: Letter Source Type: research

Comparing 2 Adapted Maslow's Hierarchy of Needs Frameworks on Physician Wellness
We read with great interest the recent article by Shapiro et al in The American Journal of Medicine.1 The authors propose modifying Maslow's 1943 work on human well-being2 into a cohesive framework to address physician burnout. We share here our previously published work that adapts Maslow's hierarchy of needs to a wellness framework specific to graduate medical education (GME).3 We believe that our 2 manuscripts, published within a year of each other, highlight that a comprehensive view of physician wellness is necessary and that Maslow's framework is an excellent starting point. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 29, 2020 Category: General Medicine Authors: Andrew J. Hale, Daniel N. Ricotta, Jason A. Freed, C. Christopher Smith, Grace C. Huang Tags: Letter Source Type: research

Graduate Medical Education Has Been Threatened
Every year thousands of college graduates embark on the taxing journey of medical school, acquiring hundreds of thousands of dollars in debt along the way, and sacrificing many years of their young adulthood to achieve their dream of becoming a physician. The journey is difficult, with the goal of matching into a residency training program, an educational experience and job that pays much less than minimum wage. Some fear the threat of not matching into a residency program because matching is not a guarantee, while most assume that they will, indeed match, if they came from a decent medical school with a good academic reco...
Source: The American Journal of Medicine - August 29, 2020 Category: General Medicine Authors: Laura Kendall Tags: Commentary Source Type: research

The Reply
Hale et al have drawn our attention to their excellent 2019 paper adapting Maslow's hierarchy1 to resident wellness.2 We were unaware of their work when we started our project in 2017 but found their adaptation and letter a delightful surprise. We suspect that both groups landed on adapting Maslow's work out of a hunger to more systematically address our colleagues ’ and trainees’ wellness. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 29, 2020 Category: General Medicine Authors: Daniel E. Shapiro, Cathy Duquette, Lisa M. Abbott, Timothy Babineau, Amanda Pearl, Paul Haidet Tags: Letter Source Type: research

Gender Representation by Specialty: Is 50:50 Mandatory?
Dr Alpert's commentary in the March 2020 American Journal of Medicine asks the question, “Why are Women Underrepresented in Cardiology?”1 As he stated, only 25% of cardiology trainees are female. He reported that a group of academic cardiologists had met in 2019 to seek answers but was unable to reach a conclusion. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 29, 2020 Category: General Medicine Authors: Mark Buchanan Tags: letter Source Type: research

The Reply
I much appreciate Dr. Buchanan's comments concerning my editorial titled “Why are women underrepresented in cardiology?”1 Dr. Buchanan favors what I believe is a tongue-in-cheek approach to increasing the number of women who train in cardiology (ie, a quota system whereby cardiology would set limits on the number of men accepted and “trade” these men for some of the many women going into pediatrics). This plan would certainly increase the number of women in cardiology, but I am quite sure it is illegal. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 29, 2020 Category: General Medicine Authors: Joseph S. Alpert Tags: Letter Source Type: research

The Reply
We thank Dr. Modarressi for his thoughtful Letter to the Editor commenting on our article.1 We agree with him that a coronary artery calcium (CAC) scan is often accompanied by incidental findings in the chest. Whether this description of additional medical information is beneficial or detrimental depends upon one's viewpoint. Our viewpoint is that the more we know about our patients ’ health, the better we can serve them. We believe that incidental findings are an additional benefit of CAC scanning, which is provided at no additional cost. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 29, 2020 Category: General Medicine Authors: David S. Schade, Sanjeev Arora, R. Philip Eaton Tags: Letter Source Type: research

Table of Contents
(Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 29, 2020 Category: General Medicine Source Type: research

Something to feel good about in these bad times
I am writing this commentary while taking a much-needed one week's vacation following almost 5 continuous months covering various in-patient services. Many of our regular in-patient doctors have been asked to stay away from the medical center because of advanced age or have been urgently shifted to our busy COVID wards. As noted in earlier commentaries, I could not allow myself to be absent from the hospital in these demanding and potentially dangerous times.1,2 During this relaxing week, I have been thinking a lot about current events and following the daily COVID reports on the internet alongside other stories of recurri...
Source: The American Journal of Medicine - August 29, 2020 Category: General Medicine Authors: Joseph S. Alpert Tags: Commentary Source Type: research

Low Prevalence of Clinically Apparent Cardiac Amyloidosis Among Carriers of Transthyretin V122I Variant in a Large Electronic Medical Record
This study sought to determine the prevalence of clinically apparent cardiac amyloidosis among carriers of the TTR V122I variant. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 28, 2020 Category: General Medicine Authors: Brian B. Agbor-Etang, Henry E. Okafor, Eric H. Farber-Eger, Quinn S. Wells Tags: Clinical Research Study Source Type: research

Retinal microvascular signs as screening and prognostic factors for cardiac disease: a systematic review of current evidence
The substantial burden of heart disease promotes an interest in new ways of screening for early disease diagnosis, especially by means of non-invasive imaging. Increasing evidence for association between retinal microvascular signs and heart disease prompted us to systematically investigate the relevant current literature on the subject. We scrutinized the current literature by searching PubMed and Embase databases from 2000 to 2020 for clinical studies of the association between retinal microvascular signs and prevalent or incident heart disease in humans. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 27, 2020 Category: General Medicine Authors: Raviv Allon, Michael Aronov, Michael Belkin, Elad Maor, Michael Shechter, Ido Didi Fabian Tags: Review Source Type: research

Participation in Health Services/Population Health Research in US Departments of Medicine
Health services research, inclusive of population health, is broadly defined as “a multidisciplinary field of inquiry, both basic and applied, that examines access to, and the use, costs, quality, delivery, organization, financing, and outcomes of healthcare services to produce new knowledge about the structure, processes, and effects of health services for individuals and po pulations.”1 These fields help to link together medicine and public health with health care delivery and serving the community. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 25, 2020 Category: General Medicine Authors: Jill S. Barnholtz-Sloan, Robert Salata, Mone Zaidi, Laura A. Petersen, Michael Kisielewski, Kristin Waite, Robert F. Todd Tags: AAIM Perspectives Source Type: research

Shortness of breath while swimming: a case report of a competitive triathlete
We present a case of a triathlete with shortness of breath to illustrate this point. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 25, 2020 Category: General Medicine Authors: Elizabeth H. Dineen, Christina Rodriguez, Robert W. Battle Tags: Clinical communication to the editor Source Type: research

Mixing drugs and genetics: a complex hemorrhagic cocktail
A 83-year old Caucasian woman developed a subarachnoid hemorrhage related to multiple drug-drug interactions and polymorphisms of the ABCB1 gene leading to a reduced activity of the P-glycoprotein (P-gp) and high dabigatran plasma levels. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 25, 2020 Category: General Medicine Authors: Laura Barbolini, Jean Terrier, Christophe Marti, Caroline Samer, Youssef Daali, Pierre Fontana, Jean ‑Luc Reny Tags: Clinical Communication to the editor Source Type: research

Kaolin Pneumoconiosis
Kaolin is a form of clay mostly composed of kaolinite, which is cytotoxic to erythrocytes and macrophages.1 It is found to have pathological effects on the lungs, sometimes leading to radiological lung abnormalities in kaolin mine workers who have inhaled the material, resulting in a tentative diagnosis of kaolin pneumoconiosis. Pneumoconiosis can result in lung inflammation, leading to fibrosis and restricting carbon dioxide and oxygen exchange.2 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 25, 2020 Category: General Medicine Authors: Jeremy R Burt, Sydney A Burt, Namrata Paladugu, Gilberto J Aquino Tags: Clinical Communication to the Editor Source Type: research

Perforated appendicitis presenting as mechanical small bowel obstruction
A previously healthy 57-year-old lady presented with a 3-day history of vomiting, colicky generalized abdominal pain, and fever of 38 to 40 degrees Celsius. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 25, 2020 Category: General Medicine Authors: Alexander Yeo, Nyi Nyi Htun, Yi Ting Lim, Faimee Erwan Muhamat Nor, Asrie Arsad Tags: Clinical Communication to the Editor Source Type: research

Half-and-half nails in a patient with Graves' Disease
A 48-year-old Venezuelan woman, a manicurist, with no diagnosed illnesses, was brought to the emergency room because of acute disorientation. On admission, she was tachycardic, hypotensive, febrile, and dehydrated. Supraventricular tachycardia with narrow QRS and regular RR, leukocytosis with neutrophilia, and acute kidney injury (BUN 53.89 mg/dL reference value [8-23 mg/dL], serum creatinine 1.78 mg/dL [0.51-0.95 mg/dL]) were documented at admission. She was managed with amiodarone, adenosine, and electrical cardioversion before being transferred to the intensive care unit (ICU). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 25, 2020 Category: General Medicine Authors: Jos é S. Cortés, Juan Diego Rivera, Luis Fernando Durán-Gutiérrez Tags: Clinical Communication to the Editor Source Type: research

Participation in Health Services/Population Health Research in U.S. Departments of Medicine
Health services research, inclusive of population health, is broadly defined as “a multidisciplinary field of inquiry, both basic and applied, that examines access to, and the use, costs, quality, delivery, organization, financing, and outcomes of healthcare services to produce new knowledge about the structure, processes, and effects of health services for individuals and po pulations,” (1). These fields help to link together medicine and public health with health care delivery and serving the community. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 25, 2020 Category: General Medicine Authors: Jill S. Barnholtz-Sloan, Robert Salata, Mone Zaidi, Laura A. Petersen, Michael Kisielewski, Kristin Waite, Robert F. Todd Tags: AAIM Perspectives Source Type: research

“Nephrolithiasis from an Unexpected Cause: Phosphaturia”
A 54-year-old woman with a history of Type 2 diabetes mellitus and breast cancer with bilateral mastectomy presented to the nephrology clinic for evaluation of nephrolithiasis. She was first diagnosed with nephrolithiasis 3 years prior to arrival requiring lithotripsy and treated with oral potassium citrate. On physical examination, she was a pleasant, middle aged woman with normal blood pressure, regular pulse and mild costovertebral tenderness bilaterally. Her laboratory studies were remarkable for serum creatinine of 1.29 mg/dl (normal value 0.5-1.2 mg/dl), serum calcium 10.7 mg/dl (normal value 8.8-10.7 mg/dl), serum a...
Source: The American Journal of Medicine - August 25, 2020 Category: General Medicine Authors: Ankit B. Patel, Ashish Verma, Gearoid M. McMahon Tags: Clinical Communication to the Editor Source Type: research

Acute Necrotizing Pneumonia from Herpes Simplex Virus
We describe the unusual case of an ICU patient with no previous history of immunosuppression, who developed acute necrotizing pneumonia from Herpes simplex virus. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 21, 2020 Category: General Medicine Authors: Aaakriti Pandita, Katelyn Dannheim, Nikhil Madhuripan, Afshin Ehsan, Dimitrios Farmakiotis Tags: Clinical Communication to the Editor Source Type: research

Effects of exercise training on vascular markers of disease progression in patients with small abdominal aortic aneurysms
Currently, no medical therapy is effective in limiting progression of small abdominal aortic aneurysms (AAA; ≤ 5.5 cm). Previously, we have demonstrated safety and efficacy of exercise training in patients with AAA. However, the impact of exercise training on vascular markers of AAA progression, such as lipid accumulation product (lipid accumulation product) and matrix metalloproteinase 9 (MMP-9, linked to destruction of aortic matrix) is unknown. The aim of this study was to assess the impact of exercise training on AAA diameter, lipid accumulation product, MMP-9 and other risk markers of vascular disease. (Source...
Source: The American Journal of Medicine - August 21, 2020 Category: General Medicine Authors: Sarah Niebauer, Josef Niebauer, Ronald Dalman, Jonathan Myers Source Type: research

A great athlete with muscular weakness
A 21-year-old Romanian man presented to our clinic for leanness assessment evolving for several years. He had been adopted at the age of 3 years old hence, no familial history was available. His medical history was notable for dyspraxia, dyslexia, bilateral cryptorchidism and scoliosis in infancy. He practiced water polo, swimming and martial arts, but in recent years, amyotrophy and weakness of both arms had developed (Figure, a) without dyspnea or swallowing troubles. Search for an underlying disease including malabsorption, endocrinopathy, infections, cancer, and anorexia nervosa had been ruled out previously by many sp...
Source: The American Journal of Medicine - August 21, 2020 Category: General Medicine Authors: Rim Bourguiba, Marion Masingue, Pierre-Jean Marc, Thimoth ée Langlet, Claude Bachmeyer Source Type: research

A Curious Case of a Cardiac Mass: Tumor or Thrombus? Examining Clinical-Radiologic-Pathologic Correlation
We present a case in which the clinical presentation and radiologic findings broaden the differential diagnosis, with the pathologic diagnosis providing the definitive diagnosis. Here, we report a case of a 79-year-old Caucasian woman with past medical history of ventricular tachycardia treated with ablation, childhood rheumatic fever, sinus sick syndrome with an implantable pacemaker, idiopathic thrombocytopenic purpura with history of splenectomy, breast cancer treated with mastectomy, type 2 diabetes, and hypertension who presented to the Emergency Department with new-onset of left-side numbness. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 20, 2020 Category: General Medicine Authors: Ivy Riano, Gabriela Milla-Godoy, Stephanie Conrad, Thomas Treadwell Tags: Clinical Communication to the Editor Source Type: research

Disseminated Gonococcal Infection in an Immunosuppressed Patient
Gonococcal infection primarily affects the mucosal surfaces of the urogenital tract, but rarely causes bacteremia and sepsis due to dissemination1. Disseminated gonococcal infection (DGI) is prevalent in the United States, with a rate of 0.5-3% in patients infected with Neisseria gonorrhoeae2.   The main presentation of disseminated gonococcal infection is tenosynovitis, dermatitis, and polyarthralgia, with cutaneous lesions present in 60-90%1. It is critical to have high clinical suspicion of disseminated gonococcal infection, especially in patients presenting with sepsis and immunocomp romised status, given the risk...
Source: The American Journal of Medicine - August 20, 2020 Category: General Medicine Authors: China Rae Newman, Kshipra Joshi, Eric Brucks, Joao Paulo Ferreira Tags: Clinical Communication to the Editor Source Type: research

Blunt Chest Wall Trauma and Troponin Elevation: Is it a Cardiac Contusion or a Myocardial Infarction?
We present a rare case of myocardial infarction as a result of atherosclerotic plaque rupture of the right coronary artery (RCA) following blunt chest wall trauma. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 20, 2020 Category: General Medicine Authors: Siddharth Shah, Syed Huda, Vijay Raj Tags: Clinical Communication to the Editor Source Type: research

Herpes Zoster associated Abdominal Pseudohernia
An 80-year-old man with past medical history of Type 2 diabetes mellitus, hypertension, hyperlipidemia and ischemic heart disease, presented with left sided abdominal pain for 1 day. His pain severity was 8/10 on Visual Analogue Scale. He described the pain as gripping and constant in nature, with radiation, worse on palpation and relieved mildly with paracetamol. Initial physical examination revealed a left flank bulge (Figure, Left), more prominent when standing, with pain on palpation. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 20, 2020 Category: General Medicine Authors: Sandra M.Y. Tan, Kathleen S.Y. Sek, Gim Gee Teng Tags: Clinical Communication to the Editor Source Type: research

Disseminated arterial and venous thrombosis: an unusual combination
HIV infection has been recognized as a prothrombotic condition1. The clinical presentation and distribution of thrombotic events in HIV patients are usually similar to those of the general population2. Here, we report an unusual case of disseminated arterial and venous thrombosis. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 20, 2020 Category: General Medicine Authors: Gian Battista Danzi, Gianluca Galeazzi, Debora Robba, Margherita Muri Tags: Clinical Communication to the Editor Source Type: research

A Contemporary 20-Year Cleveland Clinic Experience of Nonbacterial Thrombotic Endocarditis: Etiology, Echocardiographic Imaging, Management, and Outcomes
Nonbacterial thrombotic endocarditis, or marantic endocarditis, is rare. Contemporary data on the etiology, echocardiographic evaluation, and management of nonbacterial thrombotic endocarditis are limited. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 19, 2020 Category: General Medicine Authors: Mohammad A. Zmaili, Jafar M. Alzubi, Duygu Kocyigit, Agam Bansal, Gursharan S. Samra, Richard Grimm, Brian P. Griffin, Bo Xu Tags: Clinical Research Study Source Type: research

The Association of Ideal Cardiovascular Health and Ocular Diseases Among US Adults
Globally, about 2.2 billion people have a vision impairment or blindness and approximately half of the cases could have been prevented. Several ocular diseases share common characteristics that overlap with risk factors for cardiovascular diseases. The aim of this study was to evaluate the relation between the American Heart Association's prescription for health called the Life's Simple 7 (LS7) metrics and the occurrence of ocular diseases. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 19, 2020 Category: General Medicine Authors: Noah De La Cruz, Obadeh Shabaneh, Duke Appiah Tags: Clinical Research Study Source Type: research