QT Interval Abnormalities with Pulmonary Emboli
I read with interest the report “Telltale T Waves” by Kondamudi et al1 in the February 2019 issue of The American Journal of Medicine. While I take no issue with the findings and points discussed, I believe at least 2 items of importance received no attention but should have. First, marked and diffuse T-wave inversion in assoc iation with pulmonary emboli have been reported previously.2,3 Given Kondamudi et al’s1 focus on the T-wave abnormalities in this patient, I am surprised no references to this point were mentioned. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 27, 2020 Category: General Medicine Authors: James A. Reiffel Tags: Letter Source Type: research

Why Are Women Underrepresented in Cardiology?
When I was an intern many years ago at the Peter Bent Brigham Hospital in Boston, the only women working there were nurses, secretaries, technicians, and a small cadre of nursing school administrators. All the doctors and all the physician trainees were men. Less than 10% of the students in my Harvard Medical School class were women. The system has evolved dramatically since then; currently, 49.9% of US medical students are women.1 In fact, at the two campuses of the University of Arizona College of Medicine, 54% of medical students are women. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 27, 2020 Category: General Medicine Authors: Joseph S. Alpert Tags: Commentary Source Type: research

The Reply
We thank Dr Reiffel for his interest in our case description1 and his comments. Indeed, the presence of precordial T-wave inversions in the setting of pulmonary embolism has been described periodically in the literature. The cases described by Dr Reiffel supplement the cases we referenced in our report to reinforce this point. Two theories are often cited as an explanation for this finding. The first is heightened sympathetic tone caused by an autonomic nervous system –mediated response triggered by acute pulmonary embolism. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 27, 2020 Category: General Medicine Authors: Nitin Kondamudi, Shah R. Ali, Amit Khera Tags: Letter Source Type: research

Table of Contents
(Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 27, 2020 Category: General Medicine Source Type: research

Correlation between Oral Health and Systemic Inflammation (COHESION): A Randomized Pilot Follow Up Trial of a Plaque Identifying Toothpaste
Inflammation is intimately involved in the pathogenesis of atherosclerosis and is accurately measured by high sensitivity C-reactive protein (hs-CRP), a sensitive marker for future risk of cardiovascular disease. The Correlation between Oral Health and Systemic Inflammation (COHESION) trial was designed to test the hypothesis that PlaqueHD, a plaque identifying toothpaste, reduces hs-CRP. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 23, 2020 Category: General Medicine Authors: Amit Acharya, Ingrid Glurich, Scott Hetzel, KyungMann Kim, Matthew C. Tattersall, David L. DeMets, Charles H. Hennekens Tags: Brief Observation Source Type: research

Generalized Erythroderma with Fever
A 74-year-old disabled woman with multiple sclerosis, complicated by chronic lower extremity weakness precluding ambulation, presented with fever (Tmax 39.3C), hypotension and a diffuse, erythematous rash. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 20, 2020 Category: General Medicine Authors: Ruth Jobarteh, Yiran Emily Peng, Abha Soni, Allan C. Gelber, Paul D. O'Rourke Tags: Diagnostic Dilemma Source Type: research

Manifestation of Zollinger-Ellison-Syndrome with hypovolemic shock
A 63-year-old male patient presented to a secondary hospital suffering from severe epigastric pain, vomiting and mild diarrhea for the last few hours. Since many months he experienced increasing fatigue and loss of appetite. Furthermore, recurring mild epigastric pain persisted since many years. A gastroscopy in the ambulatory setting has been unremarkable. These gastrointestinal symptoms had improved under proton-pump-inhibitor (PPI) therapy but recurred after discontinuation. Medical history revealed a diagnosis of arterial hypertension treated with lisinopril 20mg and hydrochlorothiazide 25mg, each once daily. (Source: ...
Source: The American Journal of Medicine - February 19, 2020 Category: General Medicine Authors: Alexander C. Reisinger, Philipp Eller, Gernot Schilcher, Florian Eisner, Philipp Kreuzer, Gerald Hackl, Walter Spindelb öck, Johannes Plank, Patrizia Kump Tags: Diagnostic Dilemma Source Type: research

Unusual Case of Longitudinally Extensive Transverse Myelitis
The patient, a 57- year- old African American Female with prior history of positive Anti-Nuclear antibody (ANA), was admitted at our institution due to progressive lower extremity numbness, weakness, inability to stand and urinary and bowel incontinence of 2 weeks duration. She reported no additional systemic complaints. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 19, 2020 Category: General Medicine Authors: Syed Hasan Raza, Sandeepkumar Gupta, Debendra Pattanaik, Rafal Kedzierski Tags: Images in Radiology Source Type: research

A confusing picture: Refractory encephalopathy complicating non-alcoholic steatohepatitis
A 72-year-old veteran with a past medical history of non-alcoholic steatohepatitis with compensated cirrhosis, history of grade 1 esophageal varices managed medically, diabetes mellitus, and coronary artery disease, presented to the emergency department with increasing confusion. He had been seen by his primary care provider one week prior to the onset of symptoms without any complaints and had been working on his roof to clean out the gutters 4 days prior to presentation. Per the family, the patient began to perseverate on his computer and became progressively less interactive with his family over the 3 days prior to pres...
Source: The American Journal of Medicine - February 19, 2020 Category: General Medicine Authors: Jeffrey D. Kravetz, Pradeep Varma, Reza Hosseini, Alexander Thomas, Maxwell D. Eder Tags: Diagnostic Dilemma Source Type: research

Born this way: an elderly woman with a heart murmur
We describe the case of an elderly woman who was found to have a murmur after presenting with dyspnea. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 19, 2020 Category: General Medicine Authors: Katia Bravo-Jaimes, Jamie Essig, Shamim Badruddin Mawji Tags: Clinical Communication to the Editor Source Type: research

Diffuse Cystic Lung Disease: Consider Sj ögren Syndrome in the Differential Diagnosis
To the editor: (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 19, 2020 Category: General Medicine Authors: Luis Alonso Gonz ález, Adelis Enrique Pantoja-Marquez, Philip Johnson Tags: Clinical Communication to the Editor Source Type: research

Nausea, Vomiting and Refractory Hiccups: Contemplate Beyond Stomach
Gastrointestinal amyloidosis most notably occurs in the liver and small intestine. Its presentation is highly nonspecific and may include gastrointestinal bleeding, malabsorption syndromes and protein-losing enteropathy. Chronic gastrointestinal dysmotility, while relatively uncommon, carries a particularly grave prognosis. In those with amyloidosis, gastric involvement occurs in 8% of patients with only 1% being symptomatic.1 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 19, 2020 Category: General Medicine Authors: Tian Li, Mouyed Alawad, Rishard Abdul Tags: CLINICAL COMMUNICATION TO THE EDITOR Source Type: research

Unusual Presentation of Hepatitis E with Autoimmune Hemolytic Anemia – A Case Report
Hepatitis E virus (HEV) infection affects almost 20 million individuals worldwide annually and causes acute liver injury in 3.5 million, with approximately 56000 deaths. Like other viral hepatitis infections, it is also associated with extra hepatic complications and several autoimmune phenomena (Cryoglobulinemia, Glomerulonephritis, SLE and Arthritis). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 19, 2020 Category: General Medicine Authors: Dr B J Subhashchandra, Dr M.C. Prasad, Dr P Ashok Tags: Diagnostic Dilemma Source Type: research

Fisherman's Dilemma: Disseminated Mycobacterium Marinum in an Immunosuppressed Patient
A 54 year-old male with a history of ankylosing spondylitis on treatment with infliximab presented with a 6-month history of progressive skin lesions. The initial lesion developed as a single nodule on the right leg following an abrasion while fishing for oysters in fresh water. Four months later, the lesions abruptly spread to involve the remainder of his trunk and extremities. Additionally, the patient reported developing intermittent fevers, night sweats, and painful swelling in his hands and wrists as well as a dry cough. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 19, 2020 Category: General Medicine Authors: Usaamah M. Khan, Alexander Rittenberg Tags: Images in Dermatology Source Type: research

The Great Meat Debate
For decades, the standard approach to a heart healthy diet has included the command to decrease consumption of “red meat” with its heavy accompaniment of saturated fat.1-9 This directive was based on a large number of retrospective population studies and an occasional randomized investigation carried out over many years. The results of these studies suggested that consumption of high levels of red meat a nd processed meat products was associated with an increased risk for developing atherosclerotic cardiovascular disease as well as certain malignancies such as colon cancer. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 19, 2020 Category: General Medicine Authors: Joseph S. Alpert Tags: Commentary Source Type: research

Seeing Snakes: An HIV Patient with Visual Hallucinations
A 45-year-old African American man with HIV presented to an outside hospital two months prior to the current hospitalization with unsteady gait and left hemiparesis. Magnetic resonance imaging (MRI) of the brain demonstrated a left postcentral gyrus and two left temporal lobe enhancing lesions. Mycobacterium tuberculosis polymerase chain reaction was negative, however, he had a history of exposure to a family member with tuberculosis and was consequently started on rifampin, isoniazid, pyrazinamide, and  ethambutol (RIPE) as well as antiretroviral therapy (ART). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 18, 2020 Category: General Medicine Authors: Matthew J. Meyer, Jeffrey J. Carlson, Doris Lin Tags: Images in Radiology Source Type: research

Gout and Progression of Aortic Stenosis
Patients with aortic stenosis are nearly twice as likely to have a diagnosis of gout compared with individuals without aortic valve disease. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 18, 2020 Category: General Medicine Authors: Andrew Adelsheimer, Binita Shah, Alana Choy-Shan, Craig T. Tenner, Jeffrey D. Lorin, Nathaniel R. Smilowitz, V. Courtney Pike, Michael H. Pillinger, Robert Donnino Tags: Clinical Research Study Source Type: research

An Underappreciated Embolic Source: Aortic Arch Floating Thrombus
An 85-year-old man presented with left hemiparesis, too late for any intervention. Brain computed tomography (CT) revealed a right hemispheric infarct. He had a history of diabetes mellitus (on metformin, statin), hypertension (on losartan/lercanidipine), past smoking, COPD (on inhalers) and peripheral artery disease (on aspirin). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 18, 2020 Category: General Medicine Authors: Ami Schattner, Yair Glick, Ina Dubin Tags: Clinical Communication to the Editor Source Type: research

A Case of Dual Positive Glomerulonephritis with Plasma Cell Dyscrasia
A 64-year old female with a history of a pulmonary embolism on rivaroxaban, breast cancer (mastectomy in 2013), hypertension, and diabetes presented for fatigue for one month. She had intermittent hemoptysis for six months. She was brought to the emergency department complaining of fatigue. Blood pressure was elevated to 165/75 mmHg. On exam, she appeared lethargic with pale conjunctiva and leg edema. She did not have a skin rash. Laboratory studies were significant for creatinine of 15.3 mg/dL, blood urine nitrogen 140 mg/dL, potassium 6.5 mEq/L. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 18, 2020 Category: General Medicine Authors: Takayuki Yamada, Hirotaka Miyashita, Mohamed Rasheed, Miriam Chung, LiLi, Fadi El Salem, Kirk N Campbell Tags: Clinical Communication to the Editor Source Type: research

Sleeping with elevated upper body does not attenuate acute mountain sickness - pragmatic randomized clinical trial
Acute mountain sickness commonly occurs following ascent to high altitude and is aggravated following sleep. Cephalad fluid shifts have been implicated. We hypothesized that sleeping with the upper body elevated by 30 °, reduces the risk of acute mountain sickness. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 18, 2020 Category: General Medicine Authors: Ulrich Limper, Vera Fiala, Jens Tank, Eva-Maria Elmenhorst, Gereon Schaelte, Ya-Yu Monica Hew, Peter Gauger, Peter Martus, Jens Jordan Tags: Brief Observation Source Type: research

Lessons from three pairs of socks for a third-year medical student
Mr. R, a man with raging bacteremia and a permanent scowl on his face, was probably not the patient a medical student starting their first rotation wanted to admit. I knew it was going to be tough as soon as I met him in the emergency department where I found him complaining loudly about the inedible hospital food, the unbearable temperature in his room, the staff who did not empty his urinal quickly enough, and of course that he did not feel well. It seemed clear he did not like the hospital or anyone in it. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 15, 2020 Category: General Medicine Authors: Hursuong Vongsachang Tags: Personomics Source Type: research

Chocolate Consumption and Indicators of Adiposity in US Adults
To investigate the association between consumption of chocolate and measures of adiposity in a large, representative sample of US adults. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 15, 2020 Category: General Medicine Authors: Lee Smith, Igor Grabovac, Sarah E. Jackson, Nicola Veronese, Ce Shang, Guillermo F. L ópez-Sánchez, Felipe B. Schuch, Ai Koyanagi, Louis Jacob, Pinar Soysal, Lin Yang, Xiangzhu Zhu Tags: Clinical Research Study Source Type: research

Does Metformin Interfere With the Cardiovascular Benefits of SGLT2 Inhibitors? Questions About Its Role as the Cornerstone of Diabetes Treatment
Metformin is widely used as first-line therapy to lower blood glucose in type 2 diabetes, because it is inexpensive and does not cause weight gain. However, the evidentiary basis for the primacy of metformin is not persuasive. A clinical trial performed>20 years ago reported that initial therapy with metformin reduced the risk of myocardial infarction when compared with other glucose-lowering drugs.1 However, this finding represented a subgroup analysis that relied only a small number of events, with confidence intervals that did not exclude a neutral effect. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 13, 2020 Category: General Medicine Authors: Milton Packer Tags: Commentary Source Type: research

An unusual case of pleural effusion associated to fitz-hugh-curtis syndrome
Fitz-Hugh-Curtis syndrome is the perihepatic inflammation of Glisson's capsule caused by pelvic inflammatory disease, and it is often unrecognized. Here we report a rare case of Fitz-Hugh-Curtis syndrome associated to Neisseria gonorrhoeae infection with secondary right pleural effusion. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 13, 2020 Category: General Medicine Authors: Alba Palau-Dom ínguez, Carlos Feijoo-Massó, Ricard Comet, Ramón Florensa Masip, Manuel Monteagudo Tags: Clinical Communication to the Editor Source Type: research

Efficacy and Safety of Intensive Blood Pressure Therapy Using Restricted Mean Survival Time – Insights from the SPRINT Trial
Restricted mean survival time has limited current use in cardiovascular clinical trials. It's considered a translational statistic – a summary measure that can be readily understood by clinicians and patients. Restricted mean survival time, the area under the Kaplan-Meier curve, provides an intuitive method to assess the impact of an intervention. It complements current methods by quantifying treatment-related gains [days gai ned from reduction of major adverse cardiovascular events] and treatment-related losses [days lost from increase in serious adverse events] within a pre-defined timeframe. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 13, 2020 Category: General Medicine Authors: Ashok Krishnaswami, Eric Peterson, Dae Hyun Kim, Parag Goyal, Michael W. Rich Tags: Clinical Communication to the Editor Source Type: research

A frequently missed diagnosis
Last year, 3 of the 64 applicants for our medical residency program I interviewed had the same unrecognized malady. During the last two weeks, I identified 4 additional students with the same problem. To my surprise, none had had their problem diagnosed by the many physician educators they had interacted with during their 3.5-8.5 years as a medical student at some of the most prestigious American medical schools, two at my own medical school. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 13, 2020 Category: General Medicine Authors: Marshall A. Wolf Tags: Commentary Source Type: research

Disseminated Erythema Migrans
A 66- year old lady, with comorbidities of hypertension, hyperlipidemia, and obesity presented to the emergency department with fever and malaise of two weeks duration. Four weeks before the presentation she reported having a tick bite on her right groin. A few days later she noticed a bull's eye lesion over the same area which she ignored. Within the next two weeks, she developed high grade, intermittent fever, malaise, and fatigability. She also developed multiple, painless, red color skin lesions involving her arms, legs and lower back. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 13, 2020 Category: General Medicine Authors: Ajay Kumar Mishra, Zeba Hashmath, Issam Oneyssi, Abhishek Bose Tags: Clinical communication to the editor Source Type: research

The association between resident physician work hour regulations and physician safety and health
In 2011, the Accreditation Council for Graduate Medical Education (ACGME) instituted a 16-h limit on consecutive hours for first-year resident physicians. We sought to examine the effect of these work-hour regulations on physician safety. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 13, 2020 Category: General Medicine Authors: Matthew D. Weaver, Christopher P. Landrigan, Jason P. Sullivan, Conor S. O'Brien, Salim Qadri, Natalie Viyaran, Wei Wang, C éline Vetter, Charles A. Czeisler, Laura K. Barger Tags: Clinical Research Study Source Type: research

Taking Action to Address Medical Overuse: Common Challenges and Facilitators
Medical overuse is defined as the provision of health care services whose potential for harm exceeds the possible benefit.1 These include services such as advanced imaging for chronic low-back pain and antibiotics for viral upper respiratory infections.2 Medical overuse is a pervasive global problem and is seen across multiple settings of care and diverse patient populations.3 It is estimated that 8-10% of patients receive an overused service in any given year in a commercially insured population and up to 25% of Medicare beneficiaries. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 4, 2020 Category: General Medicine Authors: Michael L. Parchman, Lorella Palazzo, Brian T. Austin, Paula Blasi, Nora B. Henrikson, Gabrielle Gundersen, Emmy Ganos Tags: Advancing High Value Care Source Type: research

Cardiac Rehabilitation: An Underutilized Class I Treatment for Cardiovascular Disease
What is cardiac rehabilitation? Cardiac rehabilitation is a comprehensive exercise, education, and behavior modification program designed to improve the physical and emotional condition of patients with heart disease. It is prescribed to control symptoms, improve exercise tolerance, and overall quality of life. The primary goal of cardiac rehabilitation is to enable the participant to achieve his/her optimal physical, psychological, social and vocational functioning through exercise training and lifestyle change. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 4, 2020 Category: General Medicine Authors: Joseph S. Alpert Tags: Commentary Source Type: research

Corrigendum to “Twenty Common Mistakes Made in Daily Clinical Practice” American Journal of Medicine 2020:133(01):1-3
The authors regret that an error in terminology was overlooked in the first paragraph of our article in the January 2020 issue. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 3, 2020 Category: General Medicine Authors: William H. Frishman, Joseph S. Alpert Tags: Corrigendum Source Type: research

The silent symphony of Ludwig van Beethoven (1770-1827)
This year is the 250th anniversary of Ludwig van Beethoven's birth. His life was strongly affected by an important health problem: the hearing loss. Since the age of 26 years, the composer became aware of his sensorial deficit. From his correspondence emerges that Beethoven suffered from a progressive1 and fluctuating hearing loss,2 starting with difficulties to hear high tones ( “I do not hear the high notes of the instruments and voices”) and associated to tinnitus (“buzzing and humming”) and recruitment phenomenon (“if someone yells, it is unbearable to me”). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 2, 2020 Category: General Medicine Authors: A Perciaccante, A. Coralli Tags: Medical Humanities Source Type: research

Aspirin in primary prevention: needs individual judgments
Primary care providers prescribing aspirin for primary prevention need to make individual clinical judgements. To do so requires less heat and more light. The need for less heat derives from the most recent guidelines that recommend aspirin for those 40 to 70 years of age at higher risk of a first cardiovascular event, but not those over 70.1 The need for more light derives from the fact that people over 70 are at higher risks than those under 70. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 1, 2020 Category: General Medicine Authors: Alexander Gitin, Marc A Pfeffer, David L. DeMets, Charles H. Hennekens Tags: Commentary Source Type: research

The Blue Zones as a model for physician well-being
We need a new model to understand physician burnout. Presently, we have a disease model. Physicians are broken. Physician burnout has been hovering around 40-50%.1 We are increasingly aware of the costs to patients and physicians alike. Physician burnout has been associated with increased errors, unprofessional behavior, and poor patient satisfaction. Personal characteristics are well known. Burned out physicians tend to be younger, unmarried, and engaged in certain specialties such as emergency medicine. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 1, 2020 Category: General Medicine Authors: Benjamin R. Doolittle Tags: Commentary Source Type: research

Time to Care – Primary Care Visit Duration and Value-Based Healthcare
How long should a primary care visit take? Answering this question is essential to realizing the full promise of primary care as an effective strategy for improving patient outcomes and reining in out of control health care spending.1,2 Moving from volume to value-based health care has been shown to improve patient experience, and decrease emergency department and urgent care visits, hospitalizations, referrals to specialists, and overall cost.1 However, value-based professional care also takes time. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - February 1, 2020 Category: General Medicine Authors: Steven I. Berk Tags: Commentary Source Type: research

Non-Alcoholic Fatty Liver Disease: What Does the Primary Care Physician Need to Know?
NAFLD is defined as hepatic steatosis, either by imaging or histology, in the absence of secondary factors such as alcohol abuse, medications or other causes for fatty liver disease. Nonalcoholic steatohepatitis (NASH) is the association of steatosis with hepatocyte injury (hepatocyte ballooning) or with inflammation (hepatitis). In contrast to “simple” steatosis or nonalcoholic fatty liver (NAFL), NASH is often progressive and carries a significant risk of cirrhosis over time. This division is potentially dynamic, because NAFL can progress to NASH if metabolic (or other unknown) factors deteriorate and NASH ca...
Source: The American Journal of Medicine - February 1, 2020 Category: General Medicine Authors: Jeffrey Budd, Kenneth Cusi Tags: Review Source Type: research

Methodological Issues on the Study of the Significance of Longitudinal Clinical Congestion Pattern in Chronic Heart Failure
We read with great interest the article in an issue of The American Journal of Medicine by Simonaviius et al.1 The article concluded that severe congestion was accompanied by early death, and clinical decongestion treatment could result in improved outcome. Though this study sounds scientific, some critical methodological issues should be discussed. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 31, 2020 Category: General Medicine Authors: Xianshi Zhou, Guanghua Tang Tags: Letter Source Type: research

Association of Reversal of Anticoagulation Preoperatively on 30-Day Mortality and Outcomes for Hip Fracture Surgery
Hip fracture is common in the elderly, many of whom are on anticoagulation. However, data are limited on outcomes with anticoagulation reversal in patients undergoing hip fracture surgery. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2020 Category: General Medicine Authors: Michael S. Yoo, Shiyun Zhu, Sheng-fang Jiang, Helen L. Hammer, Wesley J. McBride, Caitlin M. McCarthy, Cheryl E. Green, Martin P. Ananias Tags: Clinical Research Study Source Type: research

Cardiorespiratory Fitness Is Associated with Early Death Among Healthy Young and Middle-aged Baby Boomers and Generation Xers
Increased mortality associated with low cardiorespiratory fitness has shown to take effect during late adulthood in previous generations. A recent rise in early death was observed in the US. We investigated the impact of low cardiorespiratory fitness during young and middle adulthood on premature death in healthy adults from recent generations. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2020 Category: General Medicine Authors: Chao Cao, Lin Yang, W. Todd Cade, Susan B. Racette, Yikyung Park, Yin Cao, Christine M. Friedenreich, Mark Hamer, Emmanuel Stamatakis, Lee Smith Tags: Clinical Research Article Source Type: research

The Wide-Ranging Spectrum of Cough-Induced Complications and Patient Harm
Cough is one of the most common complaints encountered in every setting, however, complications associated with coughing have received relatively little attention. An exhaustive systematic review of the English literature revealed an exceedingly large and varied spectrum of cough-induced complications affecting many systems including upper airways, chest wall and thorax, abdominal wall, heart and aorta, central nervous system, eye, gastrointestinal tract, urogenital system, and emotional and psychological harm. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2020 Category: General Medicine Authors: Ami Schattner Tags: Systematic Review Source Type: research

A Roadmap for Creating a Successful Peer Mentorship Group for Medical Educators
Many medical educators do not fully realize their leadership potential, achieve their desired productivity, or develop their teaching expertise due to a lack of mentorship in academic medicine.1-3 Given that academic institutions are often unable to meet the need for senior mentors in a traditional dyad model,4,5 peer mentorship is one solution to fill this need and offer a complementary perspective. A thoughtfully created peer mentorship program allows for candid discussions focused on content most relevant to members, creates a support network, and encourages scholarly productivity. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 30, 2020 Category: General Medicine Authors: Sarita Warrier, Kate Cahill, Stephanie Catanese, Mindy Sobota, Rebekah Gardner Tags: AAIM Perspectives Source Type: research

A Diffuse Papular Rash in an Adult
A 39-year-old female presented to the clinic with a chronic rash that initially presented at the age of ten. The rash had previously resolved with omalizumab, but recurred upon discontinuation of the medication two months ago. She noted that the rash appeared more widespread than prior episodes. Patient reported significant pruritus, but denied bleeding and pain on the lesions. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 28, 2020 Category: General Medicine Authors: Ritu N. Swali, Claire Wiggins, Stephen K. Tyring Tags: Images in Dermatology Source Type: research

Intestinal pseudo-obstruction and livedo reticularis: rare manifestations of catecholamine excess
Paraganglioma are neuroendocrine neoplasms of the peripheral nervous system. Sympathetic paraganglioma can secrete catecholamines and present clinically with the classical triad of hypertension, palpitations and sweating. However, clinicians must remain astute to other presentations from adrenoceptor-mediated responses of other effector organs. Herein, we report a case of metastatic paraganglioma complicated by intestinal pseudo-obstruction and livedo reticularis. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 27, 2020 Category: General Medicine Authors: Aviva S Frydman, Brendan J Nolan, Jeffrey D Zajac Tags: Clinical Communication to the Editor Source Type: research

Reversible cerebral vasoconstriction syndrome: perhaps not so reversible?
Headaches with abrupt onset or with relentless progression are more likely to be pathological and should be investigated. A 38-year-old white, high-functioning woman presented to the emergency department for the 6th time in 12 months with recurrent thunderclap occipital headache and associated nausea. On previous occasions, she had received diagnoses of musculoskeletal pain or migraine after normal investigations and brain imaging. She felt that she had not been completely headache free during the last year, and the thunderclaps signified another protracted period of intense headache. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 27, 2020 Category: General Medicine Authors: Harrison Howarth, Amit K J Mandal, Elena Boyd, Constantinos G Missouris Tags: Images in Radiology Source Type: research

Acute Myopericarditis due to Campylobacter Jejuni
A 57-year-old female with a history of hypertension presented to a local hospital describing one day of intermittent central chest pain that radiated to the jaw.  Five days prior to admission, she attended the Minnesota State Fair where she ate a variety of items including chicken quesadillas. The following day she developed abdominal pain with vomiting and diarrhea. On examination, she was afebrile (36.6 C) and mildly hypertensive to 149/84 mmHg. Cardio-re spiratory and abdominal examinations were unremarkable. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 27, 2020 Category: General Medicine Authors: Kristen Westenfield, Christine Wagner, Victor Cheng, Kevin M. Harris Tags: Clinical Communication to the Editor Source Type: research

A heart murmur is discovered on an oncology ward: Extramedullary AML
An internist, an oncologist, a cardiologist, and a dermatologist walk into a patient's room. This case highlights a multidisciplinary approach which required looking deeper into a chief complaint and following a murmur, a groin lesion, and the patient's preference to a unifying diagnosis. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 27, 2020 Category: General Medicine Authors: Andrew Abboud, Jorge Rojas Zamalloa, Maclean Sellars, A. Cristina Garza-Mayers, Anubodh S. Varshney, Michael T. Osborne, Yen-Lin Evelyn Chen, Steven McAfee, Zachariah DeFilipp Tags: Diagnostic Dilemma Source Type: research

Temporal Changes in Resting Heart Rate, Left Ventricular Dysfunction, Heart Failure and Cardiovascular Disease: CARDIA Study
The prognostic significance of temporal changes in resting heart rate in young adults for premature heart failure and cardiovascular disease is unclear. We investigated the association between temporal changes in resting heart rate in young adults and early adult risk factors, subsequent cardiac function, and the risk of heart failure and cardiovascular by middle age. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 27, 2020 Category: General Medicine Authors: Chike C. Nwabuo, Duke Appiah, Henrique T. Moreira, Henrique D. Vasconcellos, Queen N. Aghaji, Bharath Ambale-Venkatesh, Jamal S. Rana, Norrina B. Allen, Donald M. Lloyd-Jones, Pamela J. Schreiner, Samuel S. Gidding, Jo ão A.C. Lima Tags: Clinical Research Study Source Type: research

Adrenal incidentaloma: nothing is ever as it seems
A 58-year-old female patient with cholelithiasis was referred for abdominal ultrasonography in January 2017. The ultrasonography revealed a large left adrenal tumor. The size of the lesion was 65  × 47 mm. High-resolution computed tomography was then performed. It showed a well-circumscribed left adrenal mass (RECIST: 64 mm) with fat stranding. The radiation attenuation coefficient was 27 Hounsfield units. After intravenous administration of contrast media, the tumor showed slight enhan cement to 37 Hounsfield units, resulting from partition reinforcement. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 27, 2020 Category: General Medicine Authors: Hanna Komarowska, Barbara Bromi ńska, Małgorzata Janicka-Jedyńska, Marek Ruchała Tags: Diagnostic Dilemma Source Type: research

Xanthogranulomatous Pyelonephritis with Direct Extension into the Liver
A previously healthy 42-year-old woman presented with three weeks of persistent right lower quadrant abdominal pain, flank pain, dysuria, and subjective fevers. She had no history of prior urinary tract infections. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - January 25, 2020 Category: General Medicine Authors: Benjamin Titus, Supaksh Gupta, Peter Edpao, Sarah P. Psutka, Ajit P. Limaye, Ramasamy Bakthavatsalam, Robert M. Rakita Tags: Images in Radiology Source Type: research

A Sticky Situation: Aortic Valve Thrombus in Patient with Anti-Phospholipid Antibody Syndrome and Immune Thrombocytopenia
A 29-year-old woman of south Asian descent with past medical history of well-controlled immune thrombocytopenia on Eltrombopag and MYH9 (myosin heavy chain) mutation presented to the emergency department with four days of diffuse chest pain and cough. Her blood pressure was 133/88mmHg with a pulse of 92 beats per minute. There was a 3/6 systolic murmur at the right upper sternal border. The remainder of her physical exam was unremarkable. Platelet count was 81 K/ μL. A transthoracic echocardiogram showed a severely dilated left ventricle, moderately reduced left systolic function with an LV ejection fraction (LVEF) of 3...
Source: The American Journal of Medicine - January 25, 2020 Category: General Medicine Authors: Sudhakar Deepthi, Kamran Hassan, Chen Nan, Mims Martha, Hamzeh Ihab Tags: Diagnostic Dilemma Source Type: research