Blood Pressure Trajectories and Outcomes for Veterans Presenting at VA Medical Centers with a Stroke or Transient Ischemic Attack
Blood pressure control has been shown to reduce risk of vascular events and mortality after an ischemic stroke or transient ischemic attack (TIA). Yet, questions remain about effectiveness, timing, and targeted blood pressure reduction. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 12, 2022 Category: General Medicine Authors: Greg Arling, Anthony Perkins, Laura J. Myers, Jason J. Sico, Dawn M. Bravata Tags: Clinical Research Study Source Type: research

Hypocalciuric Hypercalcemia due to Isolated Renal Granulomatous Disease
Macrophages in granulomas produce 1- α hydroxylase, which converts 25-hydroxyvitamin D to 1,25-dihydroxyvitamin D (1,25OH-D).1 Hence, in granulomatous diseases, hypercalcemia is a common complication and is generally hypercalciuric.2,3 Here, we present a case of isolated renal granulomatous disease with hypocalciuric hypercalcemia. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 12, 2022 Category: General Medicine Authors: Masayuki Tanemoto, Takahide Kimura Source Type: research

A Rare Case of Non-Acidotic High Anion Gap Pancreatic Ketonemia
To the Editor: (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 11, 2022 Category: General Medicine Authors: Dana Rubenstein, Gregg A. Robbins-Welty, Margaret Sahu, Andrew Vista, Jenny Van Kirk Tags: Clinical Communication to the Editor Source Type: research

Psychological Stress and Heart Disease: Fact or Folklore?
For at least a few centuries, if not millennia, psychological stress has been popularly believed to contribute to heart disease. Does psychological stress really contribute to heart disease? Are anecdotal, patient, and lay press reports that angina, heart attack, and even cardiac death are caused by stress based on fact, or are they just folklore? In this review, the study data supporting associations between stress and cardiovascular risk, as well as potential mechanisms by which psychological stress might contribute to heart disease and precipitate myocardial ischemia and infarction, is critically reviewed and summarized...
Source: The American Journal of Medicine - March 8, 2022 Category: General Medicine Authors: Glenn N. Levine Source Type: research

And to Survive, She Became a Shark
She presented to the hospital for feeling tired and with burning when she urinated, and she was found to have an increase in her creatinine. The patient was found to have a urinary tract infection and was started on IV antibiotics. As part of her initial workup, a resident in the emergency department performed a bedside renal ultrasound that revealed a mass along her left kidney. A formal ultrasound confirmed the findings. It was not clear from the ultrasound whether the mass was a cyst in her kidney or a structure adjacent to the kidney. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 8, 2022 Category: General Medicine Authors: Michelle Izmaylov Tags: Personomics Source Type: research

Is massage a beneficial intervention?
I admit it! I love hands-on massage. I had my first massage when I was a teenager, and my family and I were spending a long weekend in a resort in the New York Catskill Mountains. After exercise that included jogging and swimming, I was taking a shower in the locker room when the masseur approached me and suggested that a massage after vigorous exercise would be a good idea. I had never had a massage before but decided “why not”. After a one-hour hand massage, I went up to our room and slept for an hour awakening with a huge sense of well-being. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 6, 2022 Category: General Medicine Authors: Joseph Alpert Source Type: research

Teaching More About Less: Preparing Clinicians for Practice
The purpose of medical education is to prepare learners for independent practice, where they must recognize and treat the most prevalent and most morbid conditions across society.1,2 This requires the development of clinicians who recognize the subtleties and varied presentations of common conditions. However, throughout their training, learners receive an unspoken message that encyclopedic knowledge of myriad diseases —including rare ones—rather than mastery of common conditions, is a hallmark of clinical excellence. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 6, 2022 Category: General Medicine Authors: Juan N. Lessing, Read G. Pierce, Gurpreet Dhaliwal Tags: Commentary Source Type: research

Concerns About Our Public Medical Response to COVID 19
For two years now, I have been watching the official representatives of the medical profession publicly responding to the public health crisis posed by COVID 19. A retired Primary Care physician with experience in teaching, management, and research, I've been surprised and somewhat disturbed by what seemed to me to be obvious missteps, but I have been hesitant to go on the record myself when so many more highly regarded physicians have been involved in recommended policy. However, as the policies endorsed have so far proven to have less than ideal results, I think it worthwhile to make a few observations, which seem not to...
Source: The American Journal of Medicine - March 6, 2022 Category: General Medicine Authors: Alan Cohen Tags: Commentary Source Type: research

Eleven Lifestyle and Clinical Reminders from Our Dogs
For most of our lives, my family lived with household pets, including dogs, cats, fish, and turtles. However, until recently, we lived without pets because of our busy professional lives and travel schedules, promising ourselves that there would be dogs in our future when things became less hectic. Then the pandemic arrived, and everything changed. Meetings were cancelled, dinner parties evaporated, and attendance at movies, plays, and concerts ended. We left home only to go to work and then return with occasional brief visits to the supermarket for food supplies. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 6, 2022 Category: General Medicine Authors: Joseph S. Alpert, Qin M. Chen Source Type: research

Recruitment of Underrepresented in Medicine Applicants to US Internal Medicine Residencies: Results of a National Survey
Racial and ethnic concordance between physicians and patients can improve health care delivery.1-3 However, the US physician workforce does not adequately reflect the demographic composition of the US population: as of 2018, only 17.1% of physicians self-reported as Asian, 5.8% Hispanic, and 5% Black or African American.4 Such disparities within internal medicine have broad health and societal repercussions, because internists and other generalists represent frontline providers to the majority of the population seeking health care. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 5, 2022 Category: General Medicine Authors: Monica Mendiola, Anna M. Modest, Michael Kisielewski, Grace C. Huang Tags: AAIM Perspectives Source Type: research

Recruitment of Underrepresented in Medicine Applicants to U.S. Internal Medicine Residencies: Results of a National Survey
Racial and ethnic concordance between physicians and patients can improve health care delivery.1 –3 However, the US physician workforce does not adequately reflect the demographic composition of the US population: as of 2018, only 17.1% of physicians self-reported as Asian, 5.8% Hispanic, and 5% Black or African American.4 Such disparities within internal medicine have broad health and societ al repercussions, since internists and other generalists represent frontline providers to the majority of the population seeking health care. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 5, 2022 Category: General Medicine Authors: Monica Mendiola, Anna M. Modest, Michael Kisielewski, Grace C. Huang Tags: AAIM Perspectives Source Type: research

Unmasking a Vulnerable Patient Care Process: A Qualitative Study Describing the Current State of Resident Continuity Clinic in a Nationwide Cohort of Internal Medicine Residency Programs
Residents serve as access points to the health care system for the most vulnerable patients in the United States. Two large academic medical centers have identified performance gaps between resident and faculty physicians. Our intent in this study was to measure the scope of resident-faculty performance gaps in a nationwide sample and identify potential targets for intervention. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 4, 2022 Category: General Medicine Authors: Maelys Amat, Elizabeth Norian, Kelly L. Graham Tags: Brief Observation Source Type: research

A Qualitative Study Describing the Current State of Resident Continuity Clinic in a Nationwide Cohort of Internal Medicine Residency Programs
: Residents serve as access points to the healthcare system for the most vulnerable patients in the US. Two large academic medical centers have identified performance gaps between resident and faculty physicians. Our intent in this study was to measure the scope of resident-faculty performance gaps in a nationwide sample and identify potential targets for intervention. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 4, 2022 Category: General Medicine Authors: Maelys Amat, Elizabeth Norian, Kelly L. Graham Source Type: research

The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Resting heart rate can predict cardiovascular disease. Heart rate increases with tobacco smoking, but its association with cannabis use is unclear. We studied the association between current and cumulative cannabis use and heart rate. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 1, 2022 Category: General Medicine Authors: Julian Jakob, Odile Stalder, Tali Kali, Etienne Pruvot, Mark J. Pletcher, Jamal S. Rana, Stephen Sidney, Reto Auer Tags: Clinical Research Study Source Type: research

Remdesivir for Outpatient Management: Time to  Wait, Not to Act
In their Commentary, Mardikar et al1 describe their case conducted within one hospital where only 15 moderate risk patients with oxygen saturation ≥ 94% required neither actual hospitalisation nor remdesivir. None of the guidelines across the globe recommend remdesivir for patients having saturation ≥ 94% who can stay at home. The Infectious Diseases Society of America (ISDA) guidelines recommended the use of remdesivir only for hospitaliz ed patients with severe COVID-19 (which is defined as patients with SpO2 ≤ 94% on room air, or those who require supplemental oxygen). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - March 1, 2022 Category: General Medicine Authors: Prasanta Raghab Mohapatra Tags: Letter Source Type: research