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Source: The American Journal of Medicine

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Total 259 results found since Jan 2013.

Safety and Efficacy of Thiazide Diuretics in Hypertension
More than 30 years ago the prospective, randomized Systolic Hypertension in the Elderly Program (SHEP) study documented that treatment with a thiazide, specifically chlorthalidone, substantially reduced outcome in elderly patients with isolated systolic hypertension.1 Treatment was associated with a 36% reduction in stroke in 4736 patients, and a reduction in major cardiovascular events, by 55 events per 1000 patients over 5 years. In view of the above and other prospective studies in aggregate, we are puzzled by the conclusions of Ravioli et al,2 that taking of a thiazide was the strongest independent predictor of falls a...
Source: The American Journal of Medicine - May 1, 2022 Category: General Medicine Authors: Franz H. Messerli, Stefano F. Rimoldi, Samuel J Mann Tags: Letter 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 - 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

Microvascular dysfunction as a systemic disease: A review of the evidence
Microvascular dysfunction describes a varied set of conditions which includes vessel destruction, abnormal vasoreactivity, in situ thrombosis, and fibrosis which ultimately results in tissue damage and progressive organ failure. Microvascular dysfunction has a wide array of clinical presentations, ranging from ischemic heart disease to renal failure, stroke, blindness, pulmonary arterial hypertension, and dementia. An intriguing unifying hypothesis suggests that microvascular dysfunction of specific organs is an expression of a systemic illness that worsens with age and is accelerated by vascular risk factors.
Source: The American Journal of Medicine - April 22, 2022 Category: General Medicine Authors: Daniel S. Feuer, Eileen M. Handberg, Borna Mehrad, Janet Wei, C. Noel Bairey Merz, Carl J. Pepine, Ellen C. Keeley Tags: Review article Source Type: research

It is time to abandon the use of body surface area derived from a 100-year-old formula
Clinical parameters and drug dosing indexed to body surface area (BSA) have been widely used. For example, cardiologists use indexation to BSA for the cardiac linear measurements, aortic valve area (AVA), stroke volume, left ventricular mass, et al.; Oncologists use BSA indexed dosing for chemotherapeutic agents; Nephrologists use indexation of renal function parameters to BSA. BSA is calculated by the two most commonly used formulas, Du Bois& Du Bois ’(Du Bois) or Mosteller's formula. However, despite its wide utilization, little attention was paid to the accuracy and validation of the calculated BSA.
Source: The American Journal of Medicine - April 22, 2022 Category: General Medicine Authors: Haoyi Zheng Tags: Commentary Source Type: research

Sickle Cell Trait and Risks for Common Diseases: Evidence from the UK Biobank
Sickle cell disease is an autosomal recessive disease caused by the inheritance of two pathogenic mutations of the hemoglobin subunit beta gene (HBB) (usually Glu6Val, though other pathogenic mutations exist).1 The altered hemoglobin makes red blood cells prone to being crescent-shaped, which can cause vaso-occlusion and result in numerous serious complications and comorbidities including: vaso-occlusive crisis, acute chest syndrome, infections, pulmonary hypertension, stroke, pulmonary embolism, renal failure, retinopathy, splenic sequestration, priapism, cholelithiasis, and osteonecrosis.
Source: The American Journal of Medicine - April 21, 2022 Category: General Medicine Authors: Joseph Hulsizer, W. Kyle Resurreccion, Zhuqing Shi, Jun Wei, Skylar Ladson-Gary, S. Lilly Zheng, Brian T. Helfand, Liana Billings, Michael S. Caplan, Jianfeng Xu Source Type: research

Oral Anticoagulant Use for Patients with Atrial Fibrillation with Concomitant Anemia and/or Thrombocytopenia
Atrial fibrillation is the most common sustained cardiac arrhythmia in clinical practice, which is associated with an increased risk of thromboembolism, heart failure and mortality.1 Previous studies in atrial fibrillation patients have reported that abnormal hemoglobin and platelet counts may be associated with adverse events. However, these studies that specifically examined the associations between hemoglobin and platelet levels and adverse outcomes reported conflicting data.2-5 Although warfarin effectively reduces the risk of ischemic stroke by 64% compared to placebo/control,6 and non-vitamin K antagonist oral antico...
Source: The American Journal of Medicine - April 2, 2022 Category: General Medicine Authors: Yung-Hsin Yeh, Yi-Hsin Chan, Shao-Wei Chen, Shang-Hung Chang, Chun-Li Wang, Chi-Tai Kuo, Gregory Y.H. Li, Shih-Ann Chen, Tze-Fan Chao Tags: Clinical Research Study Source Type: research

Polycythemia Vera Presenting as ST-Segment Elevation Myocardial Infarction
An 80-year-old woman with a history of hypertension, pre-diabetes, chronic kidney disease (stage 3b), and a remote ischemic stroke without residual deficits presented to the emergency department complaining of several hours of epigastric discomfort and malaise. An electrocardiogram (EKG) performed at triage revealed normal sinus rhythm with>1 mm ST segment elevation in leads V4-6 and lead 1, reciprocal ST depression in aVR, and Q waves in V1 and V2 (Figure 1). The troponin I was elevated to 1.66 ng/mL (reference range
Source: The American Journal of Medicine - March 31, 2022 Category: General Medicine Authors: Eric Hirsch, Lindor Qunaj, Azeem Latib, Benjamin Galen Tags: Diagnostic Dilemma Source Type: research

Ischemic stroke due to metastatic cervical bone tumor: the importance of ‘peripheral vision’
To the Editor:
Source: The American Journal of Medicine - March 16, 2022 Category: General Medicine Authors: Akiyuki Hiraga, Satoshi Kuwabara Source Type: research

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 - 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

Peripheral Arterial Disease, Stroke, and Mortality in Patients with Atrial Fibrillation
I read the paper by Vitalis et al1 with great interest. The authors assessed the impact of peripheral arterial disease on mortality and stroke in patients with atrial fibrillation. The adjusted hazard ratio (HR) (95% confidence interval [CI]) of peripheral arterial disease in patients with atrial fibrillation for all-cause mortality was 1.34 (1.06-1.70). In addition, the adjusted HR (95% CI) of peripheral arterial disease in patients with nonanticoagulated atrial fibrillation for ischemic stroke was 3.37 (1.25-9.09).
Source: The American Journal of Medicine - February 1, 2022 Category: General Medicine Authors: Tomoyuki Kawada Tags: Letter Source Type: research

Just another case of acute stroke?
To: The Editor
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Marvin Wei Jie Chua Tags: Clinical Communication to the Editor Source Type: research

Management of Atherosclerotic Carotid Artery Disease. A Brief Overview and Update
The objective of this review is to outline the clin ical presentation of symptomatic carotid artery stenosis and the risk factors associated with development of carotid artery stenosis, and then summarize the current evidence-based medical treatment modalities, along with available surgical and endovascular therapies.
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Sara Hassani, Marc Fisher Tags: Review Source Type: research

Management of Atherosclerotic Carotid Artery Disease: A Brief Overview and Update
The objective of this review is to outline the clinical presentation of symptomatic carotid artery stenosis and the risk factors associated with development of carotid artery stenosis and then summarize the current evidence-based medical treatment modalities, along with available surgical and endovascular therapies.
Source: The American Journal of Medicine - October 31, 2021 Category: General Medicine Authors: Sara Hassani, Marc Fisher Tags: Review Source Type: research

Statin Intolerance and Noncompliance: An Empiric Approach
Statins are among the most widely prescribed drugs. They reduce risk for atherosclerotic cardiovascular disease by lowering serum apolipoprotein B-containing lipoproteins, particularly low-density lipoprotein (LDL) cholesterol (LDL-C).1 Statins inhibit cholesterol synthesis in the liver, which increases expression of LDL receptors and lowers serum LDL-C.2 The latter slows progression of atherosclerotic lesions, reduces coronary plaque rupture, and decreases likelihood of acute cardiovascular syndromes (ie, myocardial infarction and stroke).
Source: The American Journal of Medicine - October 27, 2021 Category: General Medicine Authors: Scott M. Grundy, Gloria L. Vega Tags: Advancing High Value Health Care Source Type: research

A Treacherous Twist on ECG
The patient is a 61-year-old female with a history of well-controlled hypothyroidism on levothyroxine supplementation and prior suspected cardioembolic stroke on chronic anticoagulation who previously underwent surgical mitral valve repair 1 year previously due to symptoms of severe fatigue with a baseline left ventricular ejection fraction of 55-60% and non-obstructive coronary artery disease. Immediately following surgery, her left ventricular ejection fraction declined to 40%. Postoperatively, she continued to experience fatigue with gradual worsening of her left ventricular ejection fraction to 30%.
Source: The American Journal of Medicine - October 26, 2021 Category: General Medicine Authors: Tyler J. Bonkowski, Christopher M. Madison, Sanjay Dandamudi, David A. McNamara Tags: ECG Image of the Month Source Type: research