A Missing Link: Sarcoid-lymphoma syndrome
When the patient's autoimmune disorder didn't respond to treatment, an additional workup uncovered a malignancy; one with an undefined connection. A 73-year-old woman presented with fatigue, left upper quadrant pain, headache, nausea, and cognitive dysfunction. An initial workup revealed  hypercalcemia, a low level of parathyroid hormone, elevated levels of angiotensin converting enzyme and alkaline phosphatase, pancytopenia, and mediastinal lymphadenopathy (Table 1). While magnetic resonance imaging (MRI) of her brain produced unremarkable results, abdominal imaging showed tra ce ascites, mil...
Source: The American Journal of Medicine - August 10, 2018 Category: General Medicine Authors: Anand Kumthekar, Philipp W. Raess, Daniela Ghetie Source Type: research

Contemporary Management and Outcomes of Patients with Massive and Submassive Pulmonary Embolism
We report clinical characteristics, therapies and outcomes stratified by pulmonary embolism type. Treatment escalation beyond systemic anticoagulation was defined as advanced therapy. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 10, 2018 Category: General Medicine Authors: Eric Secemsky, Yuchiao Chang, C. Charles Jain, Joshua A. Beckman, Jay Giri, Michael R. Jaff, Kenneth Rosenfield, Rachel Rosovsky, Christopher Kabrhel, Ido Weinberg Source Type: research

A hoarse warning: ortner's syndrome
A sudden change in voice portended the rupture of an aortic aneurysm. One day after discharge for atypical chest pain, an 80-year-old man presented to the emergency department following an unwitnessed fall. While getting up from a chair, he became dizzy, fell backwards, and suffered a minor head injury without losing consciousness. After the fall, he noticed that his voice had become hoarse. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 10, 2018 Category: General Medicine Authors: Meng Ying Sim, Yong Chean Lim, Stephen Ching-Tung So, Junwei Zhang, Desmond B. Teo Tags: Images in Radiology Source Type: research

B Minus: Wernicke's Encephalopathy
  (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 10, 2018 Category: General Medicine Authors: Christopher L. Robinson, Jayshil J. Patel Tags: Images in Radiology Source Type: research

Quite a Stretch: Internal Oblique Muscle Hematoma
Vigorous coughing produced vivid consequences in a 76-year-old woman. She presented to the emergency department with a 1-week history of severe cough and a 2-day history of left abdominal pain. She had been healthy until the onset of symptoms. At a body mass index (BMI) of 28.1, she was obese according to the BMI standards for Asians and Asian Americans. She had not had any abdominal surgery or trauma and was not using anticoagulant drugs. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 10, 2018 Category: General Medicine Authors: Wen-Shan Chiu, Yu-Jang Su, Chih-Chun Huang Tags: Image of Radiology Source Type: research

Fast, broad, and irregular: Wolff-Parkinson-White syndrome
Sometimes, it is fairly safe to assume that a patient is more likely to have a familial disorder than a sporadic form of the same disease. A 39-year-old man was brought to the emergency department by ambulance with chest pain and palpitations. He had a history of migraines and dyspepsia. His family history was remarkable for a sister with Wolff-Parkinson-White syndrome, detected at age 18 years during pregnancy, and a brother with Wolff-Parkinson-White syndrome. The patient's son, born prematurely, was diagnosed with Wolff-Parkinson-White syndrome at 1 month of age, and he underwent ablation therapy when he was 8 years old...
Source: The American Journal of Medicine - August 10, 2018 Category: General Medicine Authors: Rakhee R. Makhija, Theodore Chow, Sandhya Venugopal, Ezra A. Amsterdam Tags: ECG image of the month Source Type: research

An Oscillating Thrombus Inside the Inferior Vena Cava
Thrombosis of the inferior vena cava is an under-recognized entity that is associated with significant morbidity and mortality.1 It is estimated that 2.6%-4% of patients with deep vein thrombosis of the lower extremities have inferior vena cava thrombosis. The most common cause of inferior vena cava thrombosis is the presence of an unretrieved inferior vena cava filter in absence of a congenital anomaly. The mortality rate of inferior vena cava thrombosis is twice as high as that of deep vein thrombosis confined to the lower extremities. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 10, 2018 Category: General Medicine Authors: Christos Tourmousoglou, Gerasimos Gogas, Dimitrios Siskos, Dimitrios Zioutas Tags: To The Editor Source Type: research

Weight Gain and Health Affliction Among Former National Football League Players
Professional American-style football players are among the largest athletes across contemporary sporting disciplines, and weight gain during the years of football participation is common. At present, the health implications of this early-life weight gain remain incompletely understood. We sought to define weight trajectories of former professional American-style football athletes and to establish their relationship with 5 health afflictions common in this population (cardiovascular disease, cardiometabolic disease, neurocognitive impairment, sleep apnea, and chronic pain). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 10, 2018 Category: General Medicine Authors: Timothy W. Churchill, Supriya Krishnan, Marc Weisskopf, Brandon Yates, Frank E. Speizer, Jonathan H. Kim, Lee E. Nadler, Alvaro Pascual-Leone, Ross Zafonte, Aaron L. Baggish Tags: Clinical Research Study Source Type: research

Advanced Therapies for Massive Pulmonary Embolism
The report by Secemsky et al (1) in this issue of the Journal illustrates the current management of pulmonary embolism at the Mass General Hospital (MGH). A Pulmonary Embolism Response Team sees all patients in whom pulmonary embolism is diagnosed by computed tomography. The team manages these patients during their hospitalization and after discharge for up to one year. (1) (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 8, 2018 Category: General Medicine Authors: James E. Dalen Tags: Commentary Source Type: research

Introduction to Neurogenetics
Neurogenetics has evolved considerably over the last twenty years. Advancements in human genome sequencing have led to the identification of mutations that cause neurologic disease and to fundamentally new insights into disease pathophysiology. These advances along with technological breakthroughs in gene therapy have already translated genetic insight into disease treatments for previously incurable diseases, a process that will accelerate over the coming decade. Given the increasing role genetic diagnosis and treatment is playing in neurological care, we aim to summarize basic genetic concepts and to provide a framework ...
Source: The American Journal of Medicine - August 8, 2018 Category: General Medicine Authors: Angeliki Vgontzas, William Renthal Source Type: research

Serotonin Syndrome Masquerading as Ventricular Tachycardia Storm
A 60-year-old woman with bipolar disorder presented to a local hospital after being found unresponsive at home. When assessed by emergency medical services, she was found to be tachycardic to 180 beats per minute and received three doses of adenosine on transport with no effect. Given concern for altered mental status, she was intubated for airway protection. In the emergency department, the patient's rhythm was described as a wide complex tachycardia and she was found to be hypotensive leading to multiple attempted cardioversions at 100 Joule, 200 Joule and 360 Joule (twice). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 3, 2018 Category: General Medicine Authors: Ramzi Dudum, M. Imran Aslam, Jose Madrazo Tags: Clinical Communication to the Editor Source Type: research

Misconceptions and Facts about Takotsubo Syndrome
Takotsubo syndrome, first described in the early 1990s by Sato in Japanese population as a transient cardiomyopathy after a stressful event in the absence of coronary artery disease 1, 2, has gone from a relatively rare disease that frequently went undiagnosed, to a common and frequently diagnosed cardiological problem associated not only with mentally stressful events but also with physical and organic conditions. Although full recovery is expected, it is associated with several complications, some of them fatal and recent evidence has linked Takotsubo syndrome to poor long-term prognosis. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 2, 2018 Category: General Medicine Authors: Mario Rodr íguez, Wojciech Rzechorzek, Eyal Herzog, Thomas F. Lüscher Tags: Review Article Source Type: research

Reform in House Staff Working Hours and Clinical Supervision: A Thirty Year Reflection following the Release of the Bell Commission Report
When we were medical interns (WF and JA), training in 1969, the week-day work schedule on the ward services was 36 hours on and 12 hours off. Every other week-end there was a shift from Saturday morning to late Monday afternoon, 56 straight hours. We were off one Sunday every two weeks. There were only 3 patient hand-offs a week, and we knew all the patients including those of our covering co-interns as if they were members of our own families. In hospital on-call supervision was provided by senior (PGY-3) or chief residents (PGY-4). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 2, 2018 Category: General Medicine Authors: William H. Frishman, Joseph S. Alpert Tags: Editorial Commentary Source Type: research

See one, be one, teach one: How becoming a patient informed my role as a teaching physician
Many essays, books, even movies have centered on the theme of doctor as patient. As an academic internist diagnosed with breast cancer in 2016, I could appreciate the profound impact it had on me personally, as well as my patient interactions and practice style; but what was rather unexpected was the additional transformation of my clinical teaching. In the educator role, I noticed my priorities shifting and approach changing, whether it was as course director in the medical school or preceptor in resident clinic or attending on the inpatient service. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 2, 2018 Category: General Medicine Authors: Heather A. Thompson Buum Tags: Personomics Source Type: research

Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications
Dementia and atrial fibrillation have several epidemiologic characteristics in common, including high overall prevalence, increasing incidence with aging, and an expected rise in incidence.1,2 Atrial fibrillation has been associated more closely with dementia3-18 than other potentially comorbid age-related conditions.19,20 However, while atrial fibrillation increases the risk of stroke by a factor of 4- to 5-fold,21 it is uncertain whether cognitive impairment in the context of atrial fibrillation is mediated by an increased risk of stroke or whether other factors are responsible. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Romain Chopard, Gregory Piazza, Seth Alan Gale, Umberto Campia, Ida Ehlers Albertsen, Jisoo Kim, Samuel Z. Goldhaber Tags: Review The American Journal of Medicine Source Type: research

Role of High-Dose Beta-Blockers in Patients with Heart Failure with Preserved Ejection Fraction and Elevated Heart Rate
Heart failure with preserved ejection fraction (HFpEF) accounts for about half of all patients admitted for HF and has emerged as a prominent cause of significant morbidity and mortality.1,2 Evidence-based pharmacotherapy effective in the treatment of patients with heart failure with reduced ejection fraction (HFrEF) so far has not been shown to be effective in HFpEF.3 High-dose beta-blockers are recommended for patients with heart failure with reduced ejection fraction (HFrEF), but no such evidence exists for HFpEF. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Phillip H. Lam, Neha Gupta, Daniel J. Dooley, Steven Singh, Prakash Deedwania, Michael R. Zile, Deepak L. Bhatt, Charity J. Morgan, Bertram Pitt, Gregg C. Fonarow, Ali Ahmed Tags: Clinical Research Study Source Type: research

Vitamin D Status and Exercise Capacity in Older Patients with Heart Failure with Preserved Ejection Fraction
The predominant form of heart failure in older age is heart failure with preserved ejection fraction (HFpEF).1,2 Exercise intolerance, characterized by dyspnea and exertional fatigue, is the primary symptom of chronic HFpEF.3 However, its pathophysiology is not well understood, and to date, few treatments have proven effective.1 Cardiac output and arteriovenous oxygen difference (AVO2-Diff), the two components of peak VO2 according to the Fick equation, are both reduced during peak exercise and contribute equally to the reduced peak VO2 in HFpEF. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Ambarish Pandey, Dalane W Kitzman, Denise K Houston, Haiying Chen, M Kyla Shea Source Type: research

Sleep duration and risk of fatal coronary heart disease, sudden cardiac death, cancer death and all-cause mortality
Sleep duration and its impact on health outcomes has received considerable attention in recent times (Soldatos et al., 2005). Several studies have demonstrated the association of sleep duration with incident diabetes mellitus, cardiovascular disease and obesity (Cappuccio et al., 2011; Yaggi et al., 2006; Wu et al., 2014). Similarly it has also been associated with increased all-cause mortality, as several studies have reported a non-linear yet significant relationship between sleep duration and all-cause mortality (Liu et al., 2017; Cappuccio et al., 2010). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Hassan Khan, Danesh Kella, Setor K Kunutsor, Kai Savonnen, Jari A Laukkanen Source Type: research

The Meaning of Vermoulu in Henrik Ibsen's Ghosts
In 1881, Henrik Ibsen's play, Ghosts, shocked the theatrical world by bringing to center stage the taboo topic of venereal disease. A major character in the drama, Oswald Alving, age 26, suffers from neurosyphilis. Oswald's headaches and neck stiffness ( “like a tight iron band squeezing me from my neck up”) 1 indicate chronic meningitis. His difficulty concentrating (“I couldn't focus any of my thoughts”) 1 and inability to work suggests the meninoencephalitis of general paresis. And in the play's tragic climax, Oswald suffers a devastating , catastrophic neurologic deterioration on stage with alte...
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Leonard J. Hoenig Source Type: research

Febrile Calcinosis in Scleroderma
In this report, we highlight the challenging diagnostic and therapeutic predicament, centered around daily high spiking fevers, of an enigmatic patient whose hospital course achieved a favorable outcome once the etiology of the fever was reformulated and managed in a novel manner. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Allan C. Gelber, Michael I. Brener, Kaelin O'Connell, Michael Wu, Julie J. Paik, Jemima F. Albayda Tags: Clinical Communication to the Editor Source Type: research

Intracardiac Metastasis as the Initial Presentation of Non Small Cell Lung Cancer
Cardiac tumors have generally been considered to be rare. They are often found incidentally as they tend to remain clinically silent, but they can sometimes present with symptoms secondary to obstruction, embolization, or invasion of the myocardium. Most cardiac tumors are secondary tumors from metastases, with primary cardiac tumors constituting approximately 15% of all cardiac tumors1. Although melanoma and pleural mesothelioma often have cardiac involvement, the most common cancers to be identified in cardiac metastases are lung cancer (36-39%), breast cancer (10-12%), and hematologic cancers (10-21%)2. (Source: The Ame...
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Carmel Moazez, Emily Howard, Azar Mehdizadeh, Raina Roy, Surabhi Amar Tags: Clinical Communication to the Editor Source Type: research

Point-of-care ultrasound for the assessment of digital clubbing
Digital clubbing, a resultant finding from the proliferation of connective tissue in the terminal portion of fingers or toes, has long been recognized as a sign for a number of underlying infectious, inflammatory, malignant, and vascular conditions.1 A profile angle of> 176 degrees and a hyponychial angle> 192 degrees supports the diagnosis of clubbing.1 Quantification of these angles can be done using plaster casts, shadowgraphs, planimeters, or digital photography – techniques that are cumbersome. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Inka Toman, Peter Rye, Janeve Desy, Irene W.Y. Ma Tags: Clinical communication to the editor Source Type: research

A dangerous entrapment: pelvic aneurysms causing hydronephrosis
A 75-year-old patient with end-stage kidney disease on chronic hemodialysis was admitted with fever (38.5 °C) and rigor. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Ami Schattner, Ina Dubin, Yair Glick Source Type: research

Are We Ready to Practice Lifestyle Medicine?
There is no longer any serious doubt that what each of us does in our daily lives profoundly affects our short and long term health and quality of life. An overwhelming body of scientific and medical literature supports this concept. But are we really utilizing this evidence to help our patients and in our own lives to achieve better health and quality of life? (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: James M. Rippe Tags: COMMENTARY Source Type: research

Recertification: A Tale of Good Intentions but Lots of Strife
The American Board of Internal Medicine (ABIM) is the largest of 24 certifying boards recognized by the American Board of Medical Specialties (ABMS) and currently certifies approximately 25% of all physicians in the United States1. The ABIM was founded in 1936 and, in December of that year, offered its first certifying written examination in Internal Medicine. In later years, the ABIM offered certifying examinations in various subspecialties of medicine. Since its foundation, the mission of the ABIM has been ” to enhance the quality of health care by certifying internists who demonstrate the knowledge, skills and att...
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: James J Glazier, Amir Kaki Tags: Commentary Source Type: research

Applying Evidence-Based Medicine to Shared Decision Making: Value of Restricted Mean Survival Time
  (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Zachary R. McCaw, Ariela R. Orkaby, Lee-Jen Wei, Dae Hyun Kim, Michael W. Rich Tags: Commentary Source Type: research

Periprocedural Bridging Anticoagulation: Measuring the Impact of a Clinical Trial on Care Delivery
Warfarin remains the most commonly prescribed oral anticoagulant in North America for patients with atrial fibrillation.1 –3 Historically, when patients underwent surgical procedures, many clinicians chose to give shorter acting “bridging” anticoagulants to help reduce the risk of stroke while the effect of warfarin was wearing off before surgery or building back up after surgery. In response to observational stu dies, the BRIDGE trial was conducted to test the safety and efficacy of short acting low-molecular-weight heparin (LMWH) as a bridge before and after surgery in patients with atrial fibrillation ...
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Geoffrey D Barnes, Yun Li, Xiaokui Gu, Brian Haymart, Eva Kline-Rogers, Steven Almany, Jay Kozlowski, Gregory Krol, Michael McNamara, James B Froehlich, Scott Kaatz Tags: Clinical Research Study Source Type: research

Career-Focused Mentoring for Early-Career Clinician Educators in Academic General Internal Medicine
Clinician educators serve vital roles in academic medicine by providing clinical care, applying educational theory to practice, training future physicians, producing scholarship, serving as administrators, and consulting with other professionals.1 Clinician educators in general internal medicine work in outpatient and inpatient settings, some as hospitalists. Despite their essential contributions, clinician educators face challenges in developing academic careers and advancing in rank. They may have limited knowledge and skills in curriculum development and research methods2 or in pedagogy and medical education theory. (So...
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Jonathan D. Kirsch, Alisa Duran, Alexander M. Kaizer, Heather Thompson Buum, William N. Robiner, Anne Marie Weber-Main Source Type: research

After the Match: Cultivating a Community of Support, Retention and Mentoring to Enhance Diversity
The Association of American Medical Colleges (AAMC) defined underrepresented in medicine in 2004 as “racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population.” The population of the United States is composed of 30% underrepresented minorities while the current physician workforce identified as underrepresented minorit ies is less than 10%1. Underrepresented minority physicians are more likely to practice in underserved areas and care for patients in their own ethnic groups, who are on Medicaid, uninsured and of poorer health status, th...
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: C. Colford, M.S. Kraemer, M. Contarino, N. Denizard-Thompson, K. Evans, K. Hairston, R. Harris, D. Mcneill Source Type: research

The Necessity of Sham Controls
A fundamental issue in biomedical research is how do we prove a therapy is effective? When considering medications intended to improve objective endpoints such as mortality, the randomized, blinded, placebo control trial is the standard. There is less agreement when it comes to procedural interventions intended to improve subjective endpoints such as pain, dyspnea, or angina. Recent trials evaluating the efficacy of two widely accepted practices make the case that the comparison of procedural interventions to sham controls is not only ethically permissible, but should be the expected standard prior to widespread uptake. (S...
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Vinay Prasad, Adam S. Cifu Tags: Commentary Source Type: research

More Sub-subs are Coming!
Prior to World War I the vast majority of US physicians were general practitioners.1 A smaller number considered themselves to be “specialists”, Specialties were not clearly defined. Specialists may, or may not have had special training in their specialty. The public had no way to determine what skills a physician might have. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: James E. Dalen, Kenneth J. Ryan, Joseph S. Alpert Tags: Commentary Source Type: research

Public awareness and perceptions of palliative and comfort care
In April 2018, Barbara Bush, champion for universal literacy and former First Lady of the United States, died at the age of 92 after a prolonged illness. Two days prior, a family spokesperson announced that she had “decided not to seek additional medical treatment and [would] instead focus on comfort care.” We analyzed Google Trends data to assess whether this announcement generated public curiosity regarding the phrase “comfort care.” Google searches for the phrase “what is comfort care?” spiked i mmediately after the April 15th announcement, exceeding the prior year's search frequency ...
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Trevor Lane, Deepa Ramadurai, Joseph Simonetti Tags: Commentary Source Type: research

Pectus Excavatum and Right Ventricular Compression in a Young Athlete with Syncope
  (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Alejandro E De Feria, Navkaranbir S Bajaj, Donna M Polk, Akshay S Desai, Ron Blankstein, Muthiah Vaduganathan Tags: Images in Radiology Source Type: research

Ideal cardiovascular health is inversely associated with non-alcoholic fatty liver disease: a prospective analysis
Non-alcoholic fatty liver disease (NAFLD) is one of the most important causes of liver diseases worldwide with a global prevalence currently estimated to be 24% and will probably emerge as the leading cause of end-stage liver disease in the coming decades.1-3 In addition to progression into nonalcoholic steatohepatitis (NASH), cirrhosis, and liver carcinoma,4 NAFLD has also been proved to be independently associated with cardiovascular disease, chronic kidney disease, type 2 diabetes, neoplasms, and other extrahepatic diseases. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Long Wang, Mian Li, Zhiyun Zhao, Min Xu, Jieli Lu, Tiange Wang, Yuhong Chen, Shuangyuan Wang, Meng Dai, Yanan Hou, Xueyan Wu, Lina Ma, Lin Li, Shanshan Liu, Weiqing Wang, Yu Xu, Yufang Bi, Guang Ning Tags: Clinical Research Study Source Type: research

Motor Neuron Disease: Pathophysiology, Diagnosis, and Management
Motor neuron diseases are the result of dysfunction of upper motor neurons in the precentral gyrus of the frontal lobe and/or lower motor neurons in the ventral horn of the spinal cord. In general, they cause weakness without notable sensory symptoms or pain. The most common motor neuron disease is amyotrophic lateral sclerosis, which is the primary focus of this review. Other motor neuron diseases include hereditary spastic paraparesis, spinobulbar muscular atrophy, and infectious motor neuron diseases including polio and West Nile virus. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Laura A. Foster, Mohammad Kian Salajegheh Tags: Review Source Type: research

A Unifying Diagnosis: IgG4-Related Disease
The patient had long grappled with a disease attributed to toxin exposure after the World Trade Center attack on September 11, 2001. Years later, a biopsy specimen offered a different possible explanation for his signs and symptoms. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Rachel Broderick, Angeliki Kazeros, Ainat Beniaminovitz, Ladan Fazlollahi, Pauline Yi, David Brogno, Katherine G Nickerson Tags: Diagnostic Dilemma Source Type: research

Not All It's CrAg-ed Up to Be: Disseminated Cryptococcosis
Phenomena known as cognitive biases, when applied to the details of a patient's medical history, pushed the beginning attempts at diagnosis in the wrong direction. The 60-year-old man presented after 6 weeks of progressively worsening fevers, weight loss, malaise, night sweats, and confusion. Originally, the fevers were intermittent and low-grade at 37.7 °C (99.9°F). In the 2 weeks prior to presentation, they occurred daily, with temperatures rising to 39°C (102°F). He also reported mild headaches, a dry cough, and palpable lymphadenopathy in his axilla and neck. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - August 1, 2018 Category: General Medicine Authors: Jessica Haraga, Melissa LeBlanc, Joseph Chiovaro Tags: Diagnostic Dilemma Source Type: research

Is Science Important?
I read with interest the commentary “Is Science Important? A Recent Lecture.”1 Something troubled me about the conclusion, “Long live Science!!” (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 30, 2018 Category: General Medicine Authors: Robert T. Lawrence Tags: Letter Source Type: research

Reducing Unnecessary Vitamin D Screening in an Academic Health System: What Works and When
Vitamin D deficiency is relatively common, with an estimated prevalence between 19 and 77% in the United States.1,2 Low serum 25(OH)D levels have been associated with increased cardiovascular and all-cause mortality3 and other adverse outcomes.4,5 Further, Vitamin D supplementation is safe and low-cost. However, associations between Vitamin D supplementation and various outcomes have been mixed/have not been definitive,6 and there is limited evidence that population-based screening for Vitamin D deficiency improves outcomes. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 28, 2018 Category: General Medicine Authors: Christopher M Petrilli, James Henderson, Jenna Keedy, Emily Dibble, Melissa Y. Wei, Julie K. Prussack, Grant Greenberg, Eve Kerr Tags: Advancing High Value Health Care Source Type: research

The Reply
We recently applied the lower blood pressure thresholds included in the 2017 American College of Cardiology/American Heart Association high blood pressure guidelines1 to participants enrolled in SPRINT (Systolic Blood Pressure Intervention Trial).2 We estimated that this recent iteration of clinical practice guidelines would be expected to increase the prevalence of hypertension and identify a greater proportion of patients who will ultimately experience adverse cardiovascular events. Broad-scale cardiovascular risk reduction strategies are thus needed to lessen this potential population-level burden of cardiovascular dise...
Source: The American Journal of Medicine - July 27, 2018 Category: General Medicine Authors: Muthiah Vaduganathan, Manan Pareek, Arman Qamar, Ambarish Pandey, Michael H Olsen, Deepak L Bhatt Tags: LETTER Source Type: research

Caught on Colonoscopy: Schistosomiasis Manifesting as a Single Colonic Polyp
A screening colonoscopy identified an unexpected diagnosis in a 64-year-old male patient. He is an asymptomatic landscaper who presented for a first-time screening colonoscopy based upon age. His only active medical issue is psoriasis for which he takes apremilast. At the time of colonoscopy, he denies any bright red blood per rectum, melena, changes in stooling habits, abdominal pain, nausea, vomiting, changes in appetite, weight loss, or night sweats. He does not report any family history of colon cancer. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 27, 2018 Category: General Medicine Authors: Jessica Seidelman, Edward F. Hendershot, Nancy Henshaw, Matthew Rein Tags: Diagnostic Dilemma Source Type: research

Association of long-term diet quality with hippocampal volume: longitudinal cohort study
Findings from cohort studies suggest that healthy diet, that is, a diet rich in anti-oxidants and anti-inflammatory compounds1 that improve insulin sensitivity and endothelial function, may also prevent depression and delay cognitive decline.2-4 In parallel, research investigating mechanisms by which overall diet might exert its protective effects on the brain is starting to emerge. Indeed, rodent models have shown that diet rich in saturated fat, trans fat, and sugar adversely affects learning and memory performances that rely on the integrity of the hippocampus. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 26, 2018 Category: General Medicine Authors: Tasnime Akbaraly, Claire Sexton, Enik ő Zsoldos, Abda Mahmood, Nicola Filippini, Clarisse Kerleau, Jean Michel Verdier, Marianna Virtanen, Audrey Gabelle, Klaus P. Ebmeier, Mika Kivimaki Tags: Clinical Research Study Source Type: research

The Burden of Modifiable Risk Factors in Newly Defined Categories of Blood Pressure
The 2017 American College of Cardiology/American Heart Association (ACC/AHA) Guideline introduced new categories of high blood pressure. The vast majority of individuals in these newly defined categories are recommended for nonpharmacological intervention rather than antihypertensive therapy. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 26, 2018 Category: General Medicine Authors: Anna Gu, Yu Yue, Joohae Kim, Edgar Argulian Tags: Clinical Research Study Source Type: research

Utilization of Vasculoprotective Therapy for Peripheral Artery Disease: A Systematic Review and Meta-analysis
Practice guidelines recommend that patients with peripheral artery disease receive antiplatelets, statins and ACE inhibitors or angiotensin receptor blockers (ARBs). We sought to quantify rates of prescribing of these therapies in patients with peripheral artery disease in the literature. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 26, 2018 Category: General Medicine Authors: Daniel G. Hackam, Manav V. Vyas Tags: Clinical Research Study Source Type: research

Don't Move a Muscle: A Case of Diabetic Myonecrosis
We present a case of a much less recognized complication, diabetic myonecrosis, and review the current literature with regard to diagnostic and management considerations. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 25, 2018 Category: General Medicine Authors: Margaret Ivanov, Bilal Asif, Rebecca Jaffe Tags: Diagnostic Dilemma Source Type: research

Sustained socio-economic inequalities in hospital admissions for cardiovascular events among people with diabetes in England
Cardiovascular disease remains a leading cause of morbidity and premature mortality and is a substantial contributor to health inequalities globally1. The risk of morbidity and death, particularly cardiovascular mortality, shows marked variations according to socio-economic status, as measured by income, education, social class and area-based deprivation indices2. Lower socio-economic status is also a powerful predictor of higher incidence of Type 2 diabetes as well as its acute and long-term complications3. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 25, 2018 Category: General Medicine Authors: Zainab Shather, Anthony A. Laverty, Alex Bottle, Hilary Watt, Azeem Majeed, Christopher Millett, Eszter P. Vamos Source Type: research

Duodenal Diverticula: Unusual Case of Upper Gastrointestinal Obstruction
A 78-year-old woman came to our attention with an 18-month history of delayed post-prandial nausea and vomiting associated with significant weight loss (about 20 kg in the last year). The patient denied previous history of abdominal pain or discomfort. She never underwent abdominal surgical procedures. She was on corticosteroids and tocilizumab for rheumatoid arthritis. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 25, 2018 Category: General Medicine Authors: Gabriele Bellio, Laura Bernardi, Nicol ò de Manzini Tags: Images in Radiology Source Type: research

A case of Addison's disease nearly mistaken for anorexia nervosa
A 22 year old woman presented to her primary care physician due to unintentional weight loss of 30 pounds (Fig 1A) associated with nausea, vomiting, anorexia, and generalised abdominal pain. She also described symptoms of anxiety and low mood that coincided with a relationship breakdown. Although she did not report body image distortion or fear of weight gain, anorexia nervosa and depressive disorder were both strongly suspected and she underwent a trial of antidepressant therapy that was eventually stopped due to worsening of her symptoms. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 25, 2018 Category: General Medicine Authors: Claire Feeney, Kevin Buell Tags: Clinical Communication to the Editor Source Type: research

Not Just Another Infection
A 37-year-old Hispanic man with history of hepatitis B exposure, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), presented with increasing neck pain and dysphagia for one month. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 25, 2018 Category: General Medicine Authors: Bingnan Zhang, Aashini K Master, Claire E Brown, Alexandra Drakaki Tags: Clinical Communication to the Editor Source Type: research

A Grave Case of Vomiting
A 60-year-old woman presented with intractable nausea and vomiting, which had progressively intensified over the past two weeks. Her past medical history was remarkable for mild thrombocytopenia and mildly elevated liver enzymes. Her vomiting was triggered by oral intake, was non-bloody and non-bilious, and was associated with non-resolving epigastric pain, dysphagia, anorexia, and weight loss. She had no remarkable exposures nor ill-contacts. Examination revealed an ill-looking patient with sinus tachycardia and clinical volume depletion. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - July 25, 2018 Category: General Medicine Authors: Ari B. Cuperfain, Eric A. Coomes, Edward Etchells Source Type: research