Table of Contents
(Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 17, 2023 Category: General Medicine Source Type: research
Do we stop SGLT2 inhibitor after UTI with septic shock?
A 90-year-old male with history of Coronary artery disease, Chronic obstructive pulmonary disease, Diabetes Mellitus, heart failure with reduced ejection fraction, urge incontinence, Gastro esophageal reflux disease, hypertension, Obstructive sleep apnea, stroke arrived at our Emergency Department for altered mental status of 1 day duration. He was started on empagliflozin 10 mg two months prior to presentation. His Blood pressure was 98/43 mmHg, pulse 93 bpm, temperature 37.9 °C, respirations 17 rpm, 92% on pulse oximetry on 2L nasal cannula. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 17, 2023 Category: General Medicine Authors: Ivan Arnaud-Borboa, Monish Sheth Tags: Clinical Communication to the Editor Source Type: research
Lifestyle approach and medical therapy of lower extremity peripheral artery disease
Lower extremity peripheral artery disease (PAD) is common among patients with several risk factors, such as elderly, smoking, hypertension, and diabetes mellitus (DM). Notably, PAD is associated with a higher risk of cardiovascular complications. Non-invasive interventions are beneficial to improve morbidity and mortality among patients with PAD. Traditional risk factors like smoking, DM, hypertension, and dyslipidemia play a significant role in the development of PAD. Still, additional factors such as mental health, glycemic control, diet, exercise, obesity management, lipid-lowering therapy, and antiplatelet therapy have...
Source: The American Journal of Medicine - November 17, 2023 Category: General Medicine Authors: Chayakrit Krittanawong, Johao Escobar, Hafeez Ul Hassan Virk, Mahboob Alam, Salim Virani, Carl J Lavie, K M Venkat Narayan, Raman Sharma Tags: Review Source Type: research
Recurrent Painless Orogenital Ulcers for Two Decades
A man in his fifties was admitted acutely for a perforated prepyloric ulcer requiring emergent laparotomy and repair. He was referred to dermatology the next day for incidental painless orogenital ulcers for the past one week. He had a history of recurrent orogenital ulcers for two decades, having 3-4 episodes a year. These ulcers could present in his mouth, on his genitals, or both during each episode; lasting 3-4 days before spontaneously resolving. There were no associated ocular, synovial, gastrointestinal symptoms or chondritis. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 16, 2023 Category: General Medicine Authors: Woo Chiao TAY, Wei Liang KOH Tags: Clinical Communication to the Editor Source Type: research
Sclerodactyly, tongue telangiectasias, premature severe aortic stenosis, and rna polymerase iii autoantibodies in a patient with syncope
A 61-year-old man first presented in 2013 for evaluation of syncope, fatigue, and Raynaud's phenomenon affecting his fingers. He had positive speckled pattern anti-nuclear antibodies (ANA), but negative anticentromere and anti-topoisomerase I (anti-Scl-70) autoantibodies. Examination revealed sclerodactyly (Fig. 1A) with skin thickening distal to elbows and ankles, and telangiectasias on face, hands, lips, and tongue (Fig. 1B). A diagnosis of limited cutaneous systemic sclerosis was made. Premature onset of severe trileaflet aortic valve stenosis was also established by echocardiography based on severely thickened, calcifi...
Source: The American Journal of Medicine - November 16, 2023 Category: General Medicine Authors: Konstantinov KN, Roldan CA, Konstantinov NK Tags: Clinical Communication to the Editor Source Type: research
Multifocal Oral Mucosal Nodules in a Patient Living With HIV
A 38-year-old Caucasian male presented to a primary care provider for evaluation recent onset of progressive vision loss as well as multiple submucosal nodules involving the lower lip, right buccal mucosa, gums, and palate. The patient's medical history included uncontrolled HIV, depression, gastroesophageal reflux disease, and hearing loss. Medications included omeprazole 20 mg once daily; and venlafaxine 150 mg once daily. Social history included occasional marijuana use. Review of systems revealed fatigue, lack of concentration, and a mild headache. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 16, 2023 Category: General Medicine Authors: Mohammed Bindakhil, Ghaida AlHassan, Richard Kilgore-Rodriguez, Rafik Abdelsayed Tags: Diagnostic Dilemma Source Type: research
Elevated International Normalized Ratio and Mortality in Hospitalized Patients Treated with Direct Oral Anticoagulants
This study aimed to examine the association between an elevated INR on admission and in-hospital death and long-term survival in patients treated with DOACs. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - November 3, 2023 Category: General Medicine Authors: Orly Efros, Aya Berman, Gili Kenet, Aharon Lubetsky, Alon Doron, Gadi Shlomai, Eyal Klang, Shelly Soffer, Noam Barda, Avshalom Leibowitz Tags: Clinical Research Study Source Type: research
Body Mass Index and Clinical and Health Status Outcomes in Chronic Coronary Disease and Advanced Kidney Disease in the ISCHEMIA-CKD Trial
Although overweight and obesity are associated with greater mortality and cardiovascular morbidity in patients without known cardiovascular disease, a paradoxical relationship between body mass index (BMI) and clinical outcomes has been observed in patients with cardiovascular disease.1-4 For example, the INternational VErapamil SR-Trandolapril STudy demonstrated that participants with chronic coronary disease and hypertension with class I obesity (BMI 30 to 35 kg/m2) had a lower risk for all-cause mortality, non-fatal myocardial infarction, or non-fatal stroke than those with normal BMI (20 to 25 kg/m2). (Source: The Amer...
Source: The American Journal of Medicine - November 2, 2023 Category: General Medicine Authors: Roy O. Mathew, Evgeny I. Kretov, Zhen Huang, Philip G. Jones, Mandeep S. Sidhu, Sean M. O'Brien, Aleksei A. Prokhorikhin, Janani Rangaswami, Jonathan Newman, Gregg W. Stone, Jerome L. Fleg, John A. Spertus, David J. Maron, Judith S. Hochman, Sripal Bangal Tags: Clinical Research Study Source Type: research
BMI and Clinical and Health Status Outcomes in Chronic Coronary Disease and Advanced Kidney Disease in ISCHEMIA-CKD
Although overweight and obesity are associated with greater mortality and cardiovascular morbidity in patients without known cardiovascular disease, a paradoxical relationship between body mass index (BMI) and clinical outcomes has been observed in patients with cardiovascular disease.1 –4 For example, the International VErapamil SR-trandolopril Study demonstrated that participants with chronic coronary disease and hypertension with Class I obesity (BMI 30 to 35 kg/m2) had a lower risk for all-cause mortality, non-fatal myocardial infarction or non-fatal stroke than those with no rmal BMI (20 to 25 kg/m2). (Source: The A...
Source: The American Journal of Medicine - November 2, 2023 Category: General Medicine Authors: Roy O. Mathew, Evgeny I. Kretov, Zhen Huang, Philip G. Jones, Mandeep S. Sidhu, Sean M. O'Brien, Aleksei A. Prokhorikhin, Janani Rangaswami, Jonathan Newman, Gregg W. Stone, Jerome L. Fleg, John A. Spertus, David J. Maron, Judith S. Hochman, Sripal Bangal Tags: Clinical Research Study Source Type: research
Reviewing your ABCs - Acute Kidney Injury, Bartonella Endocarditis, and C-ANCA Vasculitis
A 67-year-old man presented to the emergency department with epistaxis, pancytopenia, and renal failure (creatinine, 633 umol/L; normal, 52-112 umol/L). He was recently diagnosed with cytoplasmic-antineutrophil cytoplasmic autoantibody (c-ANCA)-associated glomerulonephritis. Three weeks earlier, he presented with new-onset renal failure (creatinine, 738 umol/L), hyperkalemia (6.2 mmol/L; normal, 3.5-5.0 umol/L), and normocytic anemia (hemoglobin, 91 g/L; normal, 130-170 g/L). Urine microscopy revealed red blood cell and heme granular casts, concerning for rapidly progressive glomerulonephritis. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 31, 2023 Category: General Medicine Authors: Tina B. Marvasti, Rohan Philip, Harsh Parikh, Elias Hazan, Peter Jianrui Liu, Omar Saeed, Maxime Billick Tags: Diagnostic Dilemma Source Type: research
Clinical outcomes in older patients with atrial fibrillation: insights from the GARFIELD-AF registry
Oral anticoagulants (OAC) are underutilized in older patients with atrial fibrillation, despite proven clinical benefits. Our objective was to investigate baseline characteristics, treatment patterns, and impact of anticoagulation upon clinical outcomes with respect to age. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 31, 2023 Category: General Medicine Authors: Samuel Z. Goldhaber, Jean-Pierre Bassand, A. John Camm, Saverio Virdone, Karen Pieper, Frank Cools, Ramon Corbalan, Bernard J. Gersh, Shinya Goto, Sylvia Haas, Frank Misselwitz, Alexander Parkhomenko, Jan Steffel, Janina Stepinska, Alexander G.G. Turpie, Tags: Clinical Research Study Source Type: research
The safe use of analgesics in patients with cirrhosis: a narrative review
Pain is prevalent in patients with cirrhosis. Due to potential alterations in drug metabolism, risk for adverse effects, and complications from cirrhosis, physicians are often faced with difficult choices when choosing appropriate analgesics in these patients. Overall, acetaminophen remains the preferred analgesic. Despite its potential for intrinsic liver toxicity, acetaminophen is safe when used at 2g/day. In contrast, non-selective nonsteroidals should be avoided due to their multiple side effects including worsening renal function, blunting diuretic response, and increasing risk of portal hypertensive and peptic ulcer ...
Source: The American Journal of Medicine - October 30, 2023 Category: General Medicine Authors: Jiayi Ma, Einar Stef án Björnsson, Naga Chalasani Tags: Review Source Type: research
Underrecognition and Suboptimal Quality of Care for Nonalcoholic Fatty Liver Disease Cirrhosis in Primary Care Patients with Diabetes Mellitus
Approximately 25-37% of the U.S. population has NAFLD, including up to 70% of adults with type 2 diabetes mellitus.1,2 About 30% of NAFLD patients have nonalcoholic steatohepatitis (NASH), of whom roughly 11% develop cirrhosis,3 resulting in an extraordinarily large NAFLD cirrhosis population. NASH is now the fastest growing etiology of cirrhosis and hepatocellular carcinoma among patients awaiting liver transplantation (LT).4,5 Nevertheless, both NAFLD and cirrhosis are underrecognized by primary care providers (PCPs). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 25, 2023 Category: General Medicine Authors: JN Chu, ML Goldman, D Brandman, JH Sohn, K Islam, L Ross, RK Fox Tags: Brief Observation Source Type: research
COVID Vaccine Hesitancy and Long-term Traffic Risks
COVID vaccine hesitancy identifies a discrepancy between personal decisions and public guidelines. We tested whether COVID vaccine hesitancy was associated with the long-term risks of a traffic crash. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 25, 2023 Category: General Medicine Authors: Donald A. Redelmeier, Jonathan Wang, Samantha S.M. Drover Tags: Clinical Research Study Source Type: research
Systematic review and meta-analysis of randomized trials testing interventions to reduce physician burnout
Professional burnout, including among physicians, has been increasing in the past few years, with the prevalence of burnout symptoms in physicians rising from 38.2% in 2020 to 62.8% in 2021.1 Increasing burnout, which may be contributing to a higher number of physicians leaving the practicing care,2 is a concerning trend, especially considering the increasing number of people with chronic conditions who need care.3 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - October 24, 2023 Category: General Medicine Authors: Alyson Haslam, Jordan Tuia, Sarah L. Miller, Vinay Prasad Tags: Clinical Research Study Source Type: research
