Crowned Dens Syndrome Presenting as Altered Mental Status
A 77-year-old male presented from a rehabilitation facility for acute onset of confusion, significant pain in his neck and extremities, muscle rigidity and subjective fever. Co-morbidities included Parkinson's disease, Lewy Body Dementia, anxiety, depression and recent right shoulder surgery complicated by pulmonary embolism, for which he was started on Eliquis. On admission, physical exam revealed severely limited range of motion in neck, diffuse rigidity and weakness in all extremities, diffuse joint pain with movement of extremities and neck, and disorientation. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 24, 2022 Category: General Medicine Authors: Joshua Lee, Jonathan Cheah, Prakash Paudel Tags: Clinical Communication to the Editor Source Type: research

The Effect of Hospital Visitor Policies on Patients, Their Visitors, and Health Care Providers During the COVID-19 Pandemic: A Systematic Review
Health care policymaking during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has questioned the precedent of restricting hospital visitors. We aimed to synthesize available data describing the resulting impact on patient, family/visitor, and health care provider well-being. We systematically reviewed articles from the World Health Organization COVID-19 Global Literature on Coronavirus Disease Database published between December 2019 through April 2021. Included studies focused on hospitalized patients and reported 1 or more prespecified main or secondary outcome (coronavirus disease 2019 [COVID...
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Audra N. Iness, Jefferson O. Abaricia, Wendemi Sawadogo, Caleb M. Iness, Max Duesberg, John Cyrus, Vinay Prasad Tags: Review Source Type: research

Do Hospital Visit Restrictions Cause Increase in the Doses of Morphine in Terminal Care? Spiritual Pain and Palliative Care in the COVID-19 Pandemic
The Centers for Disease Control and Prevention (CDC) alerted public health departments, health care professionals, and first responders of “a concerning acceleration of the increase in drug overdose deaths” coinciding with the emergence of the coronavirus disease 2019 (COVID-19) pandemic and said that the surge in deaths was driven primarily by a rapid rise in overdose deaths caused by synthetic opioids.1 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Hiroshi Kudo, Chieko Miyata, Yoshiki Kawaguchi, Yutaka Yachi, Masaki Shinfuku, Takayuki Kinoshita, Tomohiro Kurihara, Yukihiko Momiyama, Tonghyo Chong, Yoshiro Kobayashi, Mihiro Takazawa, Kenji Itoh, Koichi Tsunoda Tags: Commentary Source Type: research

Do hospital visit restrictions cause increase in the doses of morphine in terminal care?-Spiritual pain and palliative care in the COVID-19 pandemic-
The Centers for Disease Control and Prevention (CDC) has alerted public health departments, health care professionals, and first responders of “a concerning acceleration of the increase in drug overdose deaths” coinciding with the emergence of the coronavirus disease 2019 (COVID-19) pandemic and has said that the surge in deaths was driven primarily by a rapid rise in overdose deaths caused by synthetic opioids.1 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Hiroshi Kudo, Chieko Miyata, Yoshiki Kawaguchi, Yutaka Yachi, Masaki Shinfuku, Takayuki Kinoshita, Tomohiro Kurihara, Yukihiko Momiyama, Tonghyo Chong, Yoshiro Kobayashi, Mihiro Takazawa, Kenji Itoh, Koichi Tsunoda Source Type: research

The Two Pandemics
In Heart Transplant Clinic, her first words were always, “How are the kids?” In the ten years since her transplant, she had delighted in my three pregnancies and admired the babies I toted around at transplant holiday parties. But at this visit, her first words were, “You're from India, right?” (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Michelle M Kittleson Source Type: research

Management of Hospitalized Kidney Transplant Recipients for Hospitalists and Internists
The number of kidney transplant recipients have grown incrementally over the years. These patients have a high comorbidity index and require special attention to immunosuppression management. In addition, this population has an increased risk for cardiovascular events, electrolyte abnormalities, allograft dysfunction and infectious complications. . It is vital for hospitalists and internists to understand the risks and nuances in the care of this increasingly prevalent but also high-risk population. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Sam Kant, Sandeep Soman, Michael J. Choi, Bernard G. Jaar, Deborah B. Adey, National Kidney Foundation Education Committee Source Type: research

Ghost of Summer, 1988
He was Admission Number Five from the emergency department during the last week of June 1988. I learned of him through the triage resident, who said he was an easy admission, and for an inefficient Day 3 intern like me, he was something like a gift. I was told that he had uremia due to HIV nephropathy but was not a dialysis candidate; however, that brief case summary would fail to convey his full significance for me. I found him supine on a gurney, cachectic and delirious, his brown skin marked by severe eczema – and we were the same age. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Richard Scott Morehead Tags: Medical Humanities Source Type: research

Temporal Trends in Racial and Ethnic Disparities in Multimorbidity Prevalence in the United States, 1999 –2018
In 2010, the US Department of Health and Human Services published a public health framework for managing patients with multimorbidity, defined as the presence of two or more concurrent chronic conditions in an individual, highlighting the importance of identifying and addressing disparities in its prevalence.1,2 The overall prevalence is increasing in the US. Moreover, studies indicate that multimorbidity is more prevalent among Black people compared with White people, even though race, a social construct, has no intrinsic relationship with morbidity risk. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: C ésar Caraballo, Jeph Herrin, Shiwani Mahajan, Daisy Massey, Yuan Lu, Chima D. Ndumele, Elizabeth E. Drye, Harlan M. Krumholz Tags: Clinical Research Study Source Type: research

Rates of In-hospital Decongestion and Association with Mortality and Cardiovascular Outcomes among Patients admitted for Acute Heart Failure
Decongestion is an important goal in the management of acute heart failure. Whether the rate of decongestion is associated with mortality and cardiovascular outcomes is unknown. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Wendy McCallum, Hocine Tighiouart, Jeffrey M. Testani, Matthew Griffin, Marvin A. Konstam, James E. Udelson, Mark J. Sarnak Tags: Clinical Research Study Source Type: research

The effect of hospital visitor policies on patients, their visitors, and healthcare providers during the COVID-19 pandemic: a systematic review
Healthcare policymaking during the SARS-CoV-2 (COVID-19) pandemic has questioned the precedent of restricting hospital visitors. We aimed to synthesize available data describing the resulting impact on patient, family/visitor, and healthcare provider wellbeing. We systematically reviewed articles from the World Health Organization COVID-19 Global Literature on Coronavirus Disease Database published between December 2019 through April 2021. Included studies focused on hospitalized patients and reported one or more pre-specified main or secondary outcome (COVID-19 disease transmission, global wellbeing, mortality, morbidity,...
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Audra N. Iness, Jefferson O. Abaricia, Wendemi Sawadogo, Caleb M. Iness, Max Duesberg, John Cyrus, Vinay Prasad Tags: Review Source Type: research

Cocaine and the long-term risk of cardiovascular disease in women
Cardiovascular disease is a leading cause of death in women,1 yet little attention is paid to illicit substances that can adversely affect the cardiovascular system.2 –4 Mortality due to substance use is increasing in women, including deaths from stimulants such as cocaine.5 Cocaine is derived from Erythroxylon coca (coca bush) and is one of the most frequently used illicit substances in North America. Reports suggest that about 1% of adolescent girls and young women use cocaine.6–8 Cocaine is extremely addictive and may lead to cocaine use disorders that have a significant impact on women. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: U. Vivian Ukah, Brian J. Potter, Gilles Paradis, Nancy Low, Aimina Ayoub, Nathalie Auger Tags: Clinical Research Study Source Type: research

Stamping Out the Medicaid Coverage Gap: An ACA Imperative
In one of its most striking features, the Patient Protection and Affordable Care Act (ACA) expanded Medicaid eligibility for nearly all U.S. citizens and legal resident adults between the ages of 19-64 whose total household income stood at ≤138% of the Federal Poverty Level.1 To effectuate this goal, states were to receive enhanced federal matching funds commensurate with their Federal Medical Assistance Percentages (FMAPs).1 In so doing, the ACA set in motion a viable pathway for millions of low-income working-age adults who are in eligible to partake in the ACA marketplace to attain health coverage. (Source: The Americ...
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Eli Y. Adashi, Daniel P. O'Mahony, I. Glenn Cohen Tags: Commentary Source Type: research

Frank's sign in a double stroke patient
A 72-year-old male, non-smoker, with a medical history of hypertension, hypercholesterolemia, atrial fibrillation and a past myocardial infarction 15 years ago, presented to the emergency department complaining about difficulty of speaking and left-hand weakness of 6-hour duration. Apart from an elevated blood pressure, at 170/100 mmHg, physical examination revealed dysarthria, accompanied by left brachial monoplegia and hypoesthesia. A bilateral earlobe wrinkle extending obliquely and backward, at a 45o angle, from the tragus to the edge of the auricle (Frank's sign) was observed (Figure 1A). (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Konstantinos C. Christodoulou, Ioannis Stouras, Xafnoula Zlatidou, Despoina Kakagia Tags: Clinical Communication to the Editor Source Type: research

Influence of neighborhood conditions on recurrent hospital readmissions in patients with heart failure: A cohort study
Hospital readmissions are common and costly among heart failure patients. More than 50% of patients are readmitted within six months after discharge.1 Some readmissions may be driven by care processes that are under the control of hospitals or providers while others are more likely to result from patient- and community-level factors.1 (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 23, 2022 Category: General Medicine Authors: Mario Schootman, Brian C. Steinmeyer, Ling Chen, Robert M. Carney, Michael W. Rich, Kenneth E. Freedland Source Type: research

Reversed Halo Sign on Chest Computed Tomography in a 33-Year-Old Man Without Immunosuppression
A 33-year-old man presented to the emergency department (ED) with fatigue, lack of appetite, abdominal pain, and arthralgia for 14 days. He had already consulted his general practitioner 10 days previously, who suspected a diverticulitis and initiated antibiotic treatment with ciprofloxacin and metronidazole. Because his symptoms did not improve, a computed tomography (CT) scan of the abdomen was performed, which was unremarkable. However, as pulmonary infiltrates were evident in the basal lungs, the patient was referred to the ED for further evaluation. (Source: The American Journal of Medicine)
Source: The American Journal of Medicine - April 22, 2022 Category: General Medicine Authors: Sarah Dr äger, Kathleen Jahn, Moritz Vogt, Helmut Hopfer, Diego Kyburz, Michael Osthoff Tags: Diagnostic Dilemma Source Type: research