“In general, we are defined more by our response to defeat, than the defeat itself.”
A recent review article in the American Journal of Medicine discusses physician stress and burnout due to physician occupational dissatisfaction.1 It discusses etiologies and offers solutions. Key points of the article are that physicians need to take better care of themselves, good medical care is dependent on healthy caregivers, the medical system we practice in currently creates much of physicians ’ stress, and the difficulty physicians face when obtaining psychological assistance, as the need for this is stigmatized. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 17, 2021 Category: General Medicine Authors: Daniel M. Gelfman Tags: Commentary Source Type: research

Dietary Choline Supplements, but Not Eggs, Raise Fasting TMAO Levels in Participants with Normal Renal Function: A Randomized Clinical Trial
Choline is a dietary precursor to the gut microbial generation of the pro-thrombotic and pro-atherogenic metabolite trimethylamine-N-oxide (TMAO). Eggs are rich in choline, yet the impact of habitual egg consumption on TMAO levels and platelet function in human subjects remains unclear. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 16, 2021 Category: General Medicine Authors: Jennifer Wilcox, Sarah M. Skye, Brett Graham, Allyson Zabell, Xinmin S. Li, Lin Li, Shamanthika Shelkay, Xiaoming Fu, Sarah Neale, Cathy O'Laughlin, Kimberly Peterson, Stanley L. Hazen, W.H. Wilson Tang Tags: Clinical Research Study Source Type: research

Outcomes of Acute Myocardial Infarction in Patients with Familial Hypercholesteremia
There is a paucity of contemporary data regarding the outcomes of acute myocardial infarction among patients with familial hypercholesteremia. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 16, 2021 Category: General Medicine Authors: Ayman Elbadawi, Islam Y. Elgendy, Mohamed Omer, Mohamed Abdelazeem, Vijay Nambi, Chayakri Krittawong, Ravi S. Hira, Jacqueline Tamis-Holland, Christie Ballantyne, Hani Jneid Tags: Clinical Research Study Source Type: research

Does subclinical hypothyroidism add on any symptoms? evidence from a Danish population-based study
Hypothyroidism is a very common disorder worldwide1. We have previously reported the lifetime risk for developing overt hypothyroidism in Denmark to be 3.5% in women and 1.0% in men2. However, the life-time risk of developing subclinical thyroid dysfunction is even higher3,4. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 15, 2021 Category: General Medicine Authors: Allan Carl é, Jesper Scott Karmisholt, Nils Knudsen, Hans Perrild, Bettina Heinsbæk Thuesen, Lars Ovesen, Lone Banke Rasmussen, Inge Bülow Pedersen Tags: Clinical Research Study Source Type: research

Desmopressin as a novel long-term treatment in postural tachycardia syndrome patients with polyuria
Hypovolaemia is a well-recognized phenotype in patients with postural tachycardia syndrome (POTS). Previous work has identified paradoxical low renin-aldosterone levels as well as red blood cell deficit to indicate a potential renal cause for postural tachycardia syndrome.1 Here we present the first published report of postural tachycardia syndrome exacerbation due to partial central diabetes insipidus (pCDI) related polyuria and hypovolaemia; and successful treatment following chronic desmopressin (DDAVP) therapy. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 15, 2021 Category: General Medicine Authors: Marie-Claire Seeley, Tilenka R. Thynne, Wilton J Braund, Daniel L Worthley, Celine Gallagher, Prashanthan Sanders, Dennis H. Lau Tags: Clinical Communication to the Editor Source Type: research

COVID-19 Disease and its Electrocardiographic Manifestations: Our Experience
Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) responsible for the recent pandemic is clinically manifested as Coronavirus Disease 2019 (COVID-19). Although COVID-19 has a predominant effect on the respiratory system, it also has deleterious impacts on other organs especially cardiovascular system.1 Cardiovascular manifestations of COVID-19 include cardiac arrhythmias, heart failure, cardiomyopathy, myocarditis, cardiac injury, myocardial infarction, cardiogenic shock and venous thromboembolism. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 15, 2021 Category: General Medicine Authors: Muhammad Ajmal, Khurrum Butt, Talal Moukabary Tags: Clinical Communication to the Editor Source Type: research

Impact of refeeding syndrome on short- and medium-term all-cause mortality: a systematic review and meta-analysis
The refeeding syndrome has been described as a potentially life-threatening complication of re-nutrition. However, moving from single reports to larger population studies, the real impact of refeeding syndrome on all-cause mortality is still unknown. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 14, 2021 Category: General Medicine Authors: Fabio Bioletto, Marianna Pellegrini, Valentina Ponzo, Iolanda Cioffi, Antonella De Francesco, Ezio Ghigo, Simona Bo Tags: Clinical Research Study Source Type: research

Myocardial Perfusion and Viability imaging in Coronary Artery Disease: Clinical Value in Diagnosis, Prognosis and Therapeutic Guidance
Coronary artery disease is a leading cause of mortality and morbidity worldwide.1 While coronary angiography remains the “gold standard” for diagnosing the presence and severity of coronary artery disease, various non-invasive imaging tests offer high sensitivity and specificity for diagnosis and risk stratification, and provide guidance for revascularization. In this article, we will 1) review the clinical useful ness of myocardial perfusion imaging – single photon emission computed tomography and positron emission tomography, for the evaluation of coronary artery disease and myocardial viability; 2) com...
Source: The American Journal of Medicine - April 14, 2021 Category: General Medicine Authors: Dan L. Li, Marvin W. Kronenberg Tags: Review Source Type: research

A recurrent, painful, and vesicular rash in a dermatomal distribution
A 62-year-old woman was seen on the dermatology consult service for evaluation of a painful, reoccurring, blistering rash near the right waistline. The patient described a history of repeated outbreaks (>15 episodes) over the course of a year prompting her to seek medical attention on multiple occasions in the emergency department and her primary care's office where she was diagnosed with recurrent herpes zoster infection. She was prescribed antiviral drugs but stated that they were of no benefit to her symptoms. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 14, 2021 Category: General Medicine Authors: Alfredo Siller, Mojahed M.K. Shalabi, Joseph Jebain, Stephen K. Tyring Tags: Images in Dermatology Source Type: research

Mechanistic Insights from REDUCE-IT STRENGTHen the Case Against Triglyceride Lowering as a Strategy for Cardiovascular Disease Risk Reduction
Elevated triglyceride (TG) levels have been linked to residual atherosclerotic cardiovascular risk in patients with controlled low-density lipoprotein cholesterol (LDL-C). However, outcome trials testing TG-lowering agents have failed to demonstrate cardiovascular risk reduction in statin-treated subjects. One such example is the recent STRENGTH trial, which tested mixed omega fatty acids (n3-FAs, 4g/d) in high-risk patients with elevated TGs. Similar to trials using fibrates and niacin, STRENGTH failed despite effective TG-lowering. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 14, 2021 Category: General Medicine Authors: R. Preston Mason, Robert H. Eckel Tags: Commentary Source Type: research

Inpatient measurements of urine metanephrines are indistinguishable from pheochromocytoma: retrospective cohort study
Pheochromocytoma is a rare cause of acute cardiovascular disease however, any severe illness may have high catecholamines, simulating pheochromocytoma. We determined the spectrum of urine metanephrines from inpatient and outpatient collections without pheochromocytoma compared to confirmed pheochromocytoma patients. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 14, 2021 Category: General Medicine Authors: Gregory A Kline, Jessica Boyd, Hossein SM Sadrzadeh, Alexander A Leung Tags: Clinical Research Study Source Type: research

Pseudohyperchloremia and Negative Anion Gap – Think Salicylate!
We describe five such patients and quantitate the error generated by this measurement artifact. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 14, 2021 Category: General Medicine Authors: Michael R Wiederkehr, Raul Benevides, Carol A. Santa Ana, Michael Emmett Tags: Clinical Research Study Source Type: research

Temporal trends and patient characteristics associated with 30-day hospital readmission rates after a first acute myocardial infarction
This study examined trends in the frequency and socio-demographic and clinical characteristics of patients readmitted to the hospital within 30 days after an initial acute myocardial infarction. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 14, 2021 Category: General Medicine Authors: Mayra Tisminetzky, Jordy Mehawej, Ruben Miozzo, Jerry H. Gurwitz, Joel M. Gore, Darleen Lessard, Hawa O. Abu, Benita A. Bamgbade, Jorge Yarzebski, Edgard Granillo, Robert J. Goldberg Tags: Clinical Research Study Source Type: research

A new kind of barrel chest: alcoholic fermentation due to Candida albicans in a pleural effusion
Pleural effusions are common in critically ill patients. They can be infected with fungi, especially in cases of gastro-esophageal perforations 1. If yeasts and sugar-containing fluids come together in the body, alcohol can be produced. This phenomenon, called auto-brewery-syndrome, has been described in the intestinal or urinary system 2, 3. We hypothesized that alcohol can develop in a yeast-infected pleural effusion. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 14, 2021 Category: General Medicine Authors: David Tobys, Wibke Johannis, Martin Juebner, Hendrik Drinhaus Tags: Clinical Communication to the Editor Source Type: research

Should Senior Citizens Take Aspirin Daily to Prevent Heart Attacks or Strokes??
More than one-half of Americans aged 45 to 75 years take aspirin daily to prevent a stroke or a heart attack.1 Nearly half of American adults 75 years and older take daily aspirin even though they do not have a history of stroke or heart attack; they take it for the primary prevention of cardiovascular disease.2 Half of these individuals had discussed this with a physician.1 Was this a good or a bad idea? And how did the controversy surrounding the use of aspirin to prevent cardiovascular disease get started? (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 13, 2021 Category: General Medicine Authors: James E. Dalen, Robert Goldberg, Anna Waterbrook, Laura Wylie, Joseph S. Alpert Tags: COMMENTARY Source Type: research

Strange Bedfellows: Migraine Headache and Patent Foramen Ovale
Migraine headaches are one of the commonest forms of primary headache, often occurring in individuals between ages 24-65. The disease is associated with a high rate of disability.1 The Global Burden of Disease Survey from the World Health Organization found migraine to be the 3rd most common disease, ranking sixth as a cause of major disability.2 In 1998, Del Sette et al first proposed that a relationship existed between the occurrence of migraine headaches and the presence of a patent foramen ovale (PFO). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 12, 2021 Category: General Medicine Authors: Joseph S. Alpert Source Type: research

Voices for Social Justice and Against Racism: An AAIM Perspective
Departments of internal medicine (DOMs) provide a key perspective on the importance of diversity, equity, and inclusion (DEI) within academic medicine. Nationwide, 11 % of DOM chairs are from underrepresented groups (URGs) and 17% are women.1. As leaders, we are responsible for establishing and promoting basic discussions of how we want to lead and communicate our values. Current events compel us as academic leaders to speak out about societal issues that extend beyond our academic domains. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 10, 2021 Category: General Medicine Authors: Patricia W. Finn, E. Dale Abel, Alpesh Amin, Mark E. Anderson, John M. Carethers, David L. Coleman, Anne B. Curtis, Mark W. Geraci, Mark T. Gladwin, Anthony Hollenberg, Michael S. Parmacek, Richard J. Robbins Tags: AAIM Perspectives Source Type: research

Optimizing the potential for telehealth in cardiovascular care (in the era of covid-19): time will tell
Before the COVID-19 pandemic, use of telehealth services had been limited in cardiovascular care. Potential benefits of telehealth include improved access to care, more efficient care management, reduced costs, the ability to assess patients within their homes while involving key caretakers in medical decisions, maintaining social distancing, and increased patient satisfaction. Challenges include changes in payment models, issues with data security and privacy, potential depersonalization of the patient-clinician relationship, limitations in the use of digital health technologies, and the potential impact on disparities &n...
Source: The American Journal of Medicine - April 8, 2021 Category: General Medicine Authors: Parth Patel, Devinder Dhindsa, Danny J. Eapen, Amit Khera, Martha Gulati, Neil J. Stone, Clyde W. Yancy, John S. Rumsfeld, Laurence S. Sperling Tags: Review Source Type: research

When more is better: Underused advanced imaging exams that can improve outcomes and reduce cost of care
Appropriate use of resources is a tenant of care transformation efforts, with a national campaign to reduce low value imaging. The next level of performance improvement is to bolster evidence-based screening, imaging surveillance and diagnostic innovation, which can avert more costly, higher risk elements of unnecessary care like emergent interventions. Clinical scenarios where underused advanced imaging can improve outcomes and reduce total cost of care are reviewed: abdominal aortic aneurysmsurveillance, coronary artery disease diagnosis, and renal mass characterization. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 2, 2021 Category: General Medicine Authors: Ryan W. England, Sara S. Sheikhbahaei, Alex J. Solomon, Armin Zadeh, Lilja B. Solnes, Jay Bronner, Pamela T. Johnson Tags: Review Source Type: research

Aspirin Resistance in Obese and Elderly Patients with COVID-19?
We read with great interest the recent publication by McCullough et al proposing a comprehensive management strategy for ambulatory patients with coronavirus disease 2019 (COVID-19).1 The authors should be commended for proposing antiplatelet and antithrombotic therapy early in the disease.2 McCullough et al recommend 81 mg aspirin daily for high-risk, ambulatory patients with COVID-19.1 We suggest caution in relying on low-dose aspirin as chemoprophylaxis or treatment for immunothrombosis in COVID-19, especially in patients who are obese or elderly. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 1, 2021 Category: General Medicine Authors: Kate Chander Chiang, Ajay Gupta Tags: Letter Source Type: research

An Alternate Factor Creating False Magnification of the Ratio of the Two Cardiac Biomarkers
Pandey et al demonstrated a novel finding about utility of cardiac biomarkers to differentiate type 1 and type 2 myocardial infarction (MI) in a recently published article entitled “A Comparison of Biomarker Rise in Type 1 and Type 2 Myocardial Infarction.”1 From the viewpoint of clinical practices, finding new methods to distinguish type 1 MI from type 2 MI is important because the initial approaches and aims of treatment are different between these types. Although cardia c troponin T (cTnT) is preferred over creatine kinase MB (CK-MB) due to its higher sensitivity and specificity, CK-MB assay is still widely ...
Source: The American Journal of Medicine - April 1, 2021 Category: General Medicine Authors: Atsuyuki Watanabe Tags: Letter Source Type: research

Aspirin Use for Primary Cardiovascular Prevention During the COVID-19 Pandemic
The meta-regression analysis by Nudy et al1 demonstrates a benefit from aspirin use for primary cardiovascular prevention, corroborating the final report on aspirin in the Physicians ’ Health Study.2 Based on a consensus that “exercise is known to acutely, albeit transiently, increase the relative risk for sudden cardiac death and acute myocardial infarction,”3 low-dose aspirin has been proposed to mitigate the increasing frequency of such events resulting from coronary at herosclerosis in middle-aged male recreational athletes. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 1, 2021 Category: General Medicine Authors: Arthur J. Siegel Tags: Letter Source Type: research

The Reply
We thank Watanabe for his interest in our article.1 We agree with the notion that there may yet be some clinical use to creatine kinase MB (CK-MB), despite the widespread adoption of cardiac troponin (cTn) as the preferred biomarker for the initial diagnosis of myocardial infarction. In our study, patients were only included if they presented with findings consistent with myocardial infarction (ie, a rise and/or fall in cTn, in conjunction with signs or symptoms consistent with acute myocardial ischemia). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 1, 2021 Category: General Medicine Authors: Lori B. Daniels, Amit K. Pandey Tags: Letter Source Type: research

The Reply
We thank Drs Chiang and Gupta for their thoughtful comments on our paper1 relating to thromboxane A2 activation and thrombosis in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus disease 2019 [COVID-19]) infection. We share the same concerns that there may be an overwhelming activation of this pathway that could overcome the inhibitory effects of aspirin on cyclooxygenase-1 and induce the converse process of “aspirin resistance.”2 Recently Chow et al3 reported that 23.7% of hospitalized patients received antecedent aspirin and after adjustment, aspirin use was associated with decreased r...
Source: The American Journal of Medicine - April 1, 2021 Category: General Medicine Authors: Peter A. McCullough Tags: Letter Source Type: research

The Reply
We agree with Dr. Siegel's comments on our recent article1 that plausible pathophysiologic mechanisms and observational data supporting a benefit for aspirin in Coronavirus Disease 2019 (COVID-19) exist. However, we would not recommend the generalized adoption and use of aspirin for the primary prevention of atherosclerotic cardiovascular disease events in the setting of the COVID-19 pandemic without a well-designed, placebo-controlled, randomized trial showing benefit. Throughout this pandemic, promising therapies have been used widely in patients with and without COVID-19 on the basis of pathophysiologic mechanisms and o...
Source: The American Journal of Medicine - April 1, 2021 Category: General Medicine Authors: Matthew Nudy, Jennifer Cooper, Andrew J. Foy Tags: Letter Source Type: research

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

Prognostic implications of high sensitivity Troponin T levels among patients attending emergency departments and evaluated for an acute coronary syndrome
With increasing age, patients with suspected acute coronary syndromes (ACS) and elevated high sensitivity Troponin T (HsTnT) levels, type-1 myocardial infarction (MI) is diagnosed less often, though associations between these factors and gender, and prognosis is unclear. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 1, 2021 Category: General Medicine Authors: Aisha Etaher, Derek P. Chew, Steven Frost, Yousef M. Saad, Ian Ferguson, Tuan L. Nguyen, Craig P. Juergens, John K. French Tags: Clinical Research Study Source Type: research

Troubling Tenosynovitis: When a Serious Sign Persists
A 42-year-old woman was admitted to hospital with five days of diffuse joint pain and swelling associated with prolonged morning stiffness and intermittent fevers up to 38.7 °C. The review of systems was negative for rashes, mouth sores, pleuritic chest pain, alopecia, dysuria, vaginal discharge, diarrhea or vomiting, cough or shortness of breath, recent travel, sick contacts or tick exposure. Her medical history is significant for a two-year history of an undifferenti ated connective tissue disease (UCTD) which presented with inflammatory arthritis, palpable skin rashes (biopsy showed immunoglobulin G and immunoglobul...
Source: The American Journal of Medicine - April 1, 2021 Category: General Medicine Authors: Griffin Reed, Jesse Dabit, Shreyasee Amin Tags: Diagnostic Dilemma Source Type: research

Malignant catatonia - sepsis or psychiatric emergency
Malignant catatonia is a potentially fatal subtype of catatonia characterized by mutism, rigidity, stereotypy, autonomic dysfunction, and delirium.1 Although it is similar to neuroleptic malignant syndrome (NMS), it is classically associated with depression and psychosis rather than with use of psychotropic medications. Brain imaging may reveal frontal atrophy, and nonspecific lab findings are common.2 Treatment typically includes short-term benzodiazepines, followed by electroconvulsive therapy (ECT). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Hunter Bechtold, Bernard Danna, Marco Marcelli Tags: Clinical Communication to the Editor Source Type: research

Acute Abdominal Pain Caused by Internal Oblique Muscle Rupture
A 52-year-old Japanese male patient was transported to the emergency room because of acute-onset abdominal pain. The pain persisted without waxing or waning, did not radiate, and was not associated with other symptoms. The patient's vital signs were within normal limits. Initial physical examination revealed tenderness at the left lower abdominal quadrant and knocking pain over the left costovertebral angle. Plain CT performed to rule out critical diseases, such as gastrointestinal perforation, aortic diseases, and ureteral calculus, revealed no abnormal findings. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Junki Mizumoto Tags: Clinical Communication to the Editor Source Type: research

Idiopathic spontaneous pneumomediastinum
A 25-year-old Singaporean male presented to the emergency department with sudden throat and chest pain. He had no known past medical or surgical history and was not on any chronic medications or supplementations. He was a lifelong non-smoker and did not use recreational drugs. His throat pain started whilst eating dinner and was associated with dysphagia, odynophagia with both liquids and solids, and rhinolalia. His chest pain was pleuritic in nature and was not associated with any shortness of breath or diaphoresis. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Stephen Ching-Tung So, Joo Hong Chuah, Woan Jia Lee, Yoke Chen Poon Tags: Images in Radiology Source Type: research

Paraneoplastic Neurologic Syndrome in Ewing Sarcoma
A 30-year-old previously healthy man presented with acute onset diplopia for one month along with vertigo. A day before symptom onset, he also reported mid-back pain radiating to the right abdomen and erectile dysfunction. Two weeks after symptom onset, he developed hypersensitivity in his feet, an urge to move his legs, and intermittent numbness in the groin with constipation and urinary hesitancy. The patient subsequently saw a neurologist who diagnosed him with restless leg syndrome that improved with pramipexole. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Andy Dong, Mung Yan Lin, Matthew T. Brown, Ananth Vadde Tags: Clinical Communication to the Editor Source Type: research

Premature Atherosclerotic Cardiovascular Disease Risk Among Patients with Inflammatory Bowel Disease
Recent literature has shown an association between atherosclerotic cardiovascular disease and inflammatory bowel disease, potentially mediated through chronic inflammatory pathways. However, there is a paucity of data demonstrating this relationship among young patients with premature atherosclerotic cardiovascular disease. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Michelle T. Lee, Dhruv Mahtta, Liang Chen, Aliza Hussain, Mahmoud Al Rifai, Preetika Sinh, Umair Khalid, Khurram Nasir, Christie M. Ballantyne, Laura A. Petersen, Salim S. Virani Source Type: research

A middle-aged woman with elevated serum CA19-9 and lymphadenopathy
Primary biliary cholangitis (PBC) is a rare liver disorder, characterized by slow progression of cholestasis and the development of liver cirrhosis. Most patients are middle aged woman; the ratio of women to men has been reported to be 6.1:1.0.1 Primary biliary cholangitis patients are often asymptomatic or only general fatigue when diagnosed. However, in some cases, the primary biliary cholangitis patients present with symptoms of being similar to malignancies, which makes diagnosis difficult. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Yasuhiko Hamada, Kyosuke Tanaka, Norihiko Yamamoto Tags: Clinical communication to the Editor Source Type: research

The Limits of Advance Directives in Maintaining Autonomy in Patients with Advanced Dementia
As dementia becomes more prevalent in the aging population, clinicians increasingly face the challenge of caring for patients who had told family members that they preferred death to life with advanced dementia. Advance directives can guide management, but usually are inadequate in caring for patients with advanced dementia. The “now” patient has very different sensibilities than the “then” patient who had expressed preferences for terminal care before dementia severely impaired cognition and executive function. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Donald O. Kollisch, Robert B. Santulli, James L. Bernat Tags: Review Source Type: research

Spontaneous extracranial internal carotid artery dissection with complete obstruction from intraluminal thrombus
A 54-year old woman, with a previous history of Prinzmetal angina, presented to the emergency department complaining of new onset severe and persistent, left sided, frontal headache accompanied by vomiting. The patient also reported transient blurred vision of the left eye during the headache onset. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: KS Natsis, A Kalyvas, E Theochari, E Papamichalis, F Sofianou, C Karagiannidou Tags: Images in Radiology Source Type: research

Cavitary Lung Mass Presenting in an Outpatient
A 62-year-old laundry boss had history of hypertension and poorly controlled diabetes. He presented to an urban medical center emergency department with a 4-day history of cough with rusty-color sputum and left chest pain. He denied fever, dyspnea, and body weight loss. He also denied any episode of aspiration after vomitus. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Hsiu-Wu Yang, Yu-Jang Su Tags: IMAGES in RADIOLOGY Source Type: research

Bartonella and the Spleen
A healthy 54-year-old woman was admitted with a 4-day history of high fever and left upper quadrant pain radiating to the back associated with nausea. Her temperature was 39 °C but examination findings were normal except for left upper quadrant and left costovertebral tenderness. Chest X-ray and urinalysis were normal. Hemoglobin was 10 gr/dL (normocytic), white blood cells (WBC) 10×109/L, platelets 141×109/L, albumin 3.5 g/dL, and globulins 3.2 g/dL. Other tests wer e normal except for lactic dehydrogenase (LDH) 784 IU/L (N 240-480 IU/L) despite normal liver and muscle enzymes. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Yair Glick, George Habib, Ami Schattner Tags: Clinical Communication to the Editor Source Type: research

An Elusive Case of Recurrent Gram-negative Sepsis
An 85-year old man was admitted to the hospital for evaluation of recurrent fever and chills. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 31, 2021 Category: General Medicine Authors: Olaya Brewer Gutierrez, Samuel C Durso Tags: Diagnostic Dilemma Source Type: research

Excipient Hypersensitivity masquerading as Multi Drug Allergy
Drug allergy to excipients remains underappreciated and frequently leads to inappropriate medication discontinuation.1 Here, we report a patient with multi-drug allergy, which was subsequently determined to be due to hypersensitivity to an excipient common to those medications' specific formulations. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 30, 2021 Category: General Medicine Authors: Vikas Taneja, Isha Taneja, Albana B. Mihali, Rahul Pawar Tags: Clinical communication to the Editor (Case report) Source Type: research

An Unusual Case of Hyperammonemia Following Gastric Bypass Surgery
We describe a patient who presented with hyperammonemia, a potentially fatal complication of gastric bypass surgery. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 30, 2021 Category: General Medicine Authors: Richa Sharma, Dustin Romain, Amit Gupta Tags: Clinical Communication to the Editor Source Type: research

Peripheral Plasma Cells Associated with Mortality Benefit in Severe COVID-19: A Marker of Disease Resolution
Cytokines seen in severe COVID-19 are associated with proliferation, differentiation, and survival of plasma cells. Plasma cells are not routinely found in peripheral blood, though may produce virus-neutralizing antibodies in COVID-19 later in the course of an infection. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 30, 2021 Category: General Medicine Authors: Mary Boulanger, Emily Molina, Kunbo Wang, Thomas Kickler, Yanxun Xu, Brian T. Garibaldi Tags: Clinical Research Study Source Type: research

Manubriosternal arthritis/osteitis: chest wall pain aggravated by Carnett's sign posture
A 56-year-old woman presented to the University hospital with a 4-year history of relapsing chest and upper back pain. The pain was not localized but a generalized chest pain, and was exacerbated while sneezing and turning over or getting up. She was prescribed loxoprofen and tramadol hydrochloride/acetaminophen for the pain. Her past medical history included hypertension, for which she was prescribed amlodipine 5 mg a day. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 30, 2021 Category: General Medicine Authors: Takanori Uehara, Kazutaka Noda, Tomoko Tsukamoto, Hajime Fujimoto, Takuro Horikoshi, Masatomi Ikusaka Tags: Clinical Communication to the Editor Source Type: research

A 70-Year-Old Woman with a “Lung Stone”
A 70-year-old immunocompetent woman from the Midwest with past medical history of pulmonary nodules presented the emergency department with a 3-day history of fever, malaise, and severe productive cough. She recently cared for a relative's cats, dog, and pet birds, but she has not traveled outside of the region. She has no history of tobacco use, but does frequently garden and landscape. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 30, 2021 Category: General Medicine Authors: Matthew T Koroscil, Devin C. Kelly Tags: Images in Radiology Source Type: research

The Impact of Guideline Integration into Electronic Medical Records on Outcomes for Patients with Diabetes: A Systematic Review
Optimal strategies for integration of clinical practice guidelines into electronic medical records and its impact on processes of care and clinical outcomes in diabetic patients are not well understood. A systematic review of CINAHL, MEDLINE, PubMed, and Cochrane Library databases in August 2016, November 2017, and June 2020 was conducted. Studies investigating integration of diabetes guidelines into ambulatory care electronic medical records reporting quantitative results were included. After screening 15,783 records, 21 articles were included. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 25, 2021 Category: General Medicine Authors: Sapna Shah, Ariel Yeheskel, Abrar Hossain, Jenessa Kerr, Kelsey Young, Sharara Shakik, Jennica Nichols, Catherine Yu Tags: Review Source Type: research

Low Prevalence of Vaccination or Documented Immunity to Hepatitis A and Hepatitis B Viruses Among Individuals with Chronic Liver Disease
Despite national guidelines emphasizing importance of vaccination or documenting immunity to hepatitis A virus and hepatitis B virus for patients with chronic liver disease, the success of adhering to these recommendations is sub-optimal. We aim to evaluate the prevalence of vaccination or documented reactivity to hepatitis A antibody and hepatitis B surface antibody among U.S. adults with chronic liver disease. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 24, 2021 Category: General Medicine Authors: Robert J. Wong, Robert G. Gish, Ramsey Cheung, Amit S. Chitnis Tags: Clinical Research Study Source Type: research

Epilepsy: A Clinical Overview
The diagnosis and treatment of seizures and epilepsy is a common task of the physician. Approximately 1 in 10 people will have a seizure during their lifetime. Epilepsy is the tendency to have unprovoked seizures. Epilepsy is the fourth most common neurological disorder and affects one in twenty-six people in the United States and 65 million people world-wide. Evaluation of a patient presenting with a seizure involves excluding an underlying neurologic or medical condition, classifying the seizure type and determining if the patient has epilepsy. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 24, 2021 Category: General Medicine Authors: Tracey A Milligan Tags: Review Source Type: research

Update in Outpatient General Internal Medicine: Practice-Changing Evidence Published in 2020
In a time of rapidly shifting evidence-based medicine, it is challenging to stay informed of research that modifies clinical practice. To enhance knowledge of practice-changing literature, a group of seven internists reviewed titles and abstracts in seven internal medicine journals with the highest impact factors and relevance to outpatient general internal medicine. Coronavirus Disease-19 research was purposely excluded to highlight practice changes beyond the global pandemic. New England Journal of Medicine (NEJM), The Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA Internal ...
Source: The American Journal of Medicine - March 24, 2021 Category: General Medicine Authors: Majken T. Wingo, Jill M. Huber, Jason H. Szostek, Shari L. Bornstein, Jason A. Post, Karen F. Mauck, Mark L. Wieland Tags: Review Source Type: research

Resilience for Frontline Healthcare Workers: Evidence-based Recommendations
In the battle against COVID-19, frontline healthcare workers are dealing with enormous levels of stress and uncertainty. They are facing fears about infecting their patients, colleagues and family, being re-assigned to practice in settings where they feel insufficiently prepared, having to make life and death decisions based on limited availability of resources, knowing that some of their colleagues, or they themselves, will become ill and perhaps die, and watching patients die alone without being able to say good-bye to their loved ones. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 24, 2021 Category: General Medicine Authors: Steven M Southwick, Dennis S Charney Tags: Commentary Source Type: research

Long-Term Outcomes Comparing Medical Therapy versus Revascularization for Spontaneous Coronary Artery Dissection: A Systematic Review and Meta-Analysis
The ideal management of spontaneous coronary artery dissection (SCAD) has yet to be clearly defined. We conducted a comprehensive search of Ovid MEDLINE, Ovid Embase, Ovid Cochrane Database of Systematic Reviews, Scopus, and Web of Science from database inception from 1966 through September 2020 for all original studies (randomized controlled trials and observational studies) that evaluated patients with SCAD. Study groups were defined by allocation to medical therapy (medical therapy) vs invasive therapy (invasive therapy) (i.e., percutaneous coronary intervention or coronary artery bypass grafting). (Source: The American...
Source: The American Journal of Medicine - March 24, 2021 Category: General Medicine Authors: Chayakrit Krittanawong, Salik Nazir, Hafeez Hassan Virk, Joshua Hahn, Zhen Wang, Sonya E. Fogg, Samin K. Sharma, Mahboob Alam, Hani Jneid Tags: Review Source Type: research