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September 2014


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ACP's First National Conference in India

ACP held its first national conference in India on September 5-6, 2014, at the Le Meridien Hotel in New Delhi. Physicians from various parts of India attended the two-day conference focusing on “The Burden of Non-communicable Diseases.” Members of the Scientific Program Committee include: Tanveer Mir, MD, MACP (Committee Chair); Patrick Alguire, MD, FACP; Jack Ende, MD, MACP; S.B. Gupta, MD, FACP (Hon) (Committee Co-Chair), Mumbai, Past President of The Association of Physicians of India (API); Sarma Rachakonda, MD, FACP, Chennai, Professor, Tamil Nadu Dr. MGR Medical University; and Suneela Garg, MD, Delhi, Former Head of Delhi University. MCI Management India Pvt. Ltd. was the conference manager.

The conference featured informative sessions on Hypertension, Diabetes, Gastroenterology & Hepatology, Hematology & Oncology, Infectious Diseases, Gerontology, and Cardiology. Many of these sessions were presented in a panel format comprised of 1 U.S. and 1 India speaker. There was also an interactive session featuring questions from the Medical Knowledge Self-Assessment Program (MKSAP) using an audience response system. A total of 25 distinguished faculty participated in the conference.

According to ACP President David Fleming, MD, MA, FACP, "The ACP India Conference was a huge success and offered a wonderful introduction of ACP as the convener of excellence in education and professional development for internists in India. ACP membership in India has been steadily growing and it is clear that those in attendance are eager to take advantage of what the College has to offer, including Fellowship and the prospect of becoming our next international chapter. Congratulations to the Scientific Program Committee, ACP International Staff and MCI for providing a wonderful venue and crafting a timely and important program on the burden of non-communicable diseases. This is a timely theme and multiple challenging topics were addressed by expert speakers from both India and the United States."

Dr. Mir noted, “There is a significant demand for quality CME activities in India. The eminent speakers from the US and India kept the audience engaged. The interactive MKSAP session was particularly well-received by attendees. We look forward to establishing a chapter in India and it is our hope to continue an ongoing CME collaborative in India.”


















Scientific Program Committee Chair, Tanveer Mir, MD, MACP, participates in traditional lamp-lighting ceremony at the opening session of the ACP India Conference. She is joined by Jagdish Prasad, MD Director, General Health Services, Ministry of Health and Family Welfare, Government of India.


















Scientific Program Committee Co-Chair, S.B. Gupta, MD, FACP (Hon), moderates Cardiology update session with Balram Bhargava, MD, DM (speaking), David Fleming, MD, MA, FACP, and Upendra Kaul, MD, DM.


















Scientific Program Committee Co-Chair, S.B. Gupta, MD, FACP (Hon), presents token of appreciation to ACP President, David Fleming, MD, MA, FACP.

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Discounted IM15 Registration Rates for International Attendees

For the 100th anniversary, ACP is offering special registration and delegation rates for many international attendees. ACP members in low income/low middle income countries and upper middle income countries, as defined by the World Bank Economic Indicators, will be offered these special discount registration rates for ACP Internal Medicine 2015 in Boston. These discounts will apply to individual registrations as well as group delegations.

To see the individual registration rates by country of residence, visit the International Rates page im2015.acponline.org/internationalrates.

ACP Internal Medicine 2015 Flyer

The discounted group delegation rates will be as follows:

ACP Internal Medicine 2015 International Delegation Rates

Number of Delegates 10-19 20-49 50+
All non-members $495 $470 $470
High income countries - Members* $495 $470 $470
Upper-middle income countries - Members** $395 $370 $345
Low/Low-middle income countries - Members*** $345 $320 $295


*Members in high income countries pay ACP dues of $220.
**Members in upper-middle income countries pay ACP dues of $160.
***Members in low and low-middle income countries pay ACP dues of $110.

For more information, as well as a group delegation registration form, visit www.acponline.org/delegations.

If you have questions, please contact internationaloffice@acponline.org.



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Spanish Language Interpretation of Select Courses at IM 2015

This year, for the first time, ACP will be offering simultaneous interpretation of select scientific courses for attendees who would prefer to hear lectures in Spanish. Headsets will be available for pickup onsite for those who are interested. The courses that will be interpreted into Spanish include:

Friday, May 1, 2015

  • Update in Hospital Medicine - 8:15-9:15 AM
  • Update in Critical Care - 9:30-10:30 AM
  • Update in Women's Health - 11:15-12:45 PM
  • Update in Cardiology - 2:15 - 3:45 PM

Saturday, May 2, 2015

  • Update in Geriatric Medicine - 8:15-9:15 AM
  • Update in Nephrology - 9:30-10:30 AM
  • Update in Infectious Diseases - 11:15-12:45 PM
  • Update in Pulmonary Medicine - 2:15-3:45 PM

All courses will be conveniently located in Ballroom East of the Convention Center.

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Available now: ACP Smart Medicine module on Ebola and Marburg viruses

In response to the recent outbreak of the Ebola virus, ACP Smart Medicine's module on Ebola and Marburg viruses is being offered free to all members of the health care community and the public at large. The Ebola module is designed to help physicians treat patients who present with fever and nonspecific symptoms and who traveled to rural sub-Saharan Africa or had possible occupational exposure.

ACP Smart Medicine is a Web-based clinical decision support tool developed specifically for internal medicine physicians and contains 500 modules that provide guidance and information on a broad range of diseases and conditions. The Ebola module and other disease-related modules include helpful glossaries for clinical terms and acronyms and provide evidence-based recommendations concerning prevention, screening, diagnosis, therapy, consultation, patient education, and follow-up.

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Update Your Knowledge with MKSAP 16 Q & A

The new Medical Knowledge Self-Assessment Program® (MKSAP® 16) provides you with the most current and critical information in the core of internal medicine and its subspecialties so you can stay aware of what you need to know as a practicing physician in internal medicine today.

For more information on MKSAP 16, or to order your copy, visit http://www.acponline.org/products_services/mksap/16/

MKSAP 16 Q & A

A 42-year-old man is evaluated for a 4-month history of left elbow pain. The pain radiates to his hand and is worse at night, with flexion of the arm at the elbow, and with wrist flexion. The pain is accompanied by an intermittent tingling sensation in the fourth and fifth fingers. He has no weakness and has never had this problem before.

On physical examination, vital signs are normal. Pain is elicited in the left elbow with flexion of the arm at the elbow. There is decreased light touch sensation involving both palmar and dorsal surfaces of the fourth and fifth fingers to the level of the wrist. No tenderness to palpation of any of the structures of the elbow is elicited.

Which of the following is the most likely diagnosis?

A. Lateral epicondylitis
B. Medial epicondylitis
C. Olecranon bursitis
D. Ulnar nerve entrapment

Click here for the answer and critique.

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ACP Leaders on the Road: Colombia

Steven Weinberger, MD, FACP, Executive Vice President & CEO, ACP
Robert E. Jackson, MD, FACP, Governor, ACP Texas Southern Chapter
ACP Colombia Chapter/Colombian Association of Internal Medicine Meeting
August 7-10, 2014

From Dr. Weinberger:

I was delighted to be invited to speak at the XXIII Congreso Colombiano de Medicina Interna, which served as a combined meeting of the ACP Colombia Chapter and the Asociacion Colombiana de Medicina Interna (ACMI). The meeting took place from August 7-10 in the beautiful city of Cartagena, located on the northern coast of Colombia, right on the Caribbean Sea. Dr. Roberto Esguerra, FACP, ACP Governor of the Colombia Chapter, was a most gracious host throughout the meeting, and it was readily apparent how effective and successful he is as a Governor. The two talks I presented at the meeting were: "Internal Medicine: Capturing the Past and Looking to the Future" and "Update on the American College of Physicians: A View from the CEO."

Since my knowledge of Spanish is unfortunately negligible, I was most pleased that I was able to enjoy the company (and the fluent Spanish linguistic skills) of Dr. Robert Jackson, FACP, Texas Southern Chapter Governor. I was most impressed that he presented his talks in Spanish, and I am now stimulated to improve my Spanish for whenever I am next invited to Latin America!

Cartagena is a lovely city with a fascinating history that dates back to 1533. In our free time, Dr. Jackson and I had a wonderful time walking around the charming older, walled part of the city - and with his fluency in Spanish, we never had a problem communicating. We also enjoyed an evening water cruise on a pirate ship, which provided a reception for speakers and other organizational leaders.

My only regret is that I did not have more time to spend in Cartagena, since I had to squeeze the trip to Colombia between other meetings and commitments. However, there will hopefully be another time!

From Dr. Jackson:

I had the privilege of representing the College as it's Ambassador to Colombia's combined ACMI / ACP meeting last month in Cartagena. It was an extraordinary event hosted by Governor Roberto Esguerra, MD, FACP (ACP Colombian chapter) and Dr. Heli Hernandez, FACP, who is President of ACMI. ACMI and the ACP have been collaborating for fifty years in presenting high quality scientific meetings for Colombian internists, residents and medical students. This Jubilee coincides with the College's own Centennial Celebration!

A real thrill was to be invited to participate in the presentation of the Colombian Chapter's Laureate Award to Professor William Rojas, MD, FACP who spearheaded forging the relationship between ACP and ACMI fifty years ago. Also receiving the Laureate Award was Professor Hernando Matiz, MD, FACP who is one of the most well respected cardiologists in Colombia.

Cartagena is a wonderful city full of history, friendly residents and wonderful food. I had the pleasure of spending some time with Dr. Steven Weinberger, FACP, Executive Vice President and CEO of the ACP who participated in the Congress with presentations on the College and it's future. Dr. Weinberger's presence spoke volumes about the value ACP places on its relationship with international chapters.

For me, listening to the problems of the physicians and leaders of Colombian medicine felt like I was back in the United States. The challenges appear to be universal: fragmented care, poverty, multiple stakeholders wanting changes and not understanding how it affects the doctors in the trenches...the list goes on and on and on. When asked to say a few words at the Chapter's business meeting I emphasized how important it was for medicine in Colombia to speak with one voice. When dealing with outside forces contrary to the principles of internal medicine it is absolutely essential to keep our patients' priorities first and foremost. The College has always taken this stance and over the decades it has served us well.

Finally, I want to thank my hosts and their staff as well as Wendy Rivera from ACP who made my trip such a memorable experience . The venue at the Convention Center was modern and efficient. They had simultaneous interpretation from English to Spanish and I'm delighted to say we are reciprocating at the 2015 ACP meeting in Boston. The Colombian Chapter was extremely pleased to have Dr. Weinberger present. It was time well spent and the Colombian internists hold ACP in high esteem, value the fifty year relationship and are truly enthusiastic about future possibilities as we forge stronger ties with out international chapters.

Dr. Weinberger speaking at the XXIII Congreso Colombiano de Medicina Interna meeting.


























Leaders from Colombia and invited faculty at the XXIII Congreso Colombiano de Medicina Interna meeting.



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ACP Leaders on the Road: Argentina

Darren Taichman, MD, FACP
15th International Congress of Internal Medicine of the Hospital de Clinicas
August 19-22, 2014

Any trip to Buenos Aires would be a treat, but having the opportunity to meet physician colleagues at the 15th International Congress of Internal Medicine of the Hospital de Clinicas made for an unique experience. I had the pleasure of presenting a talk discussing recent papers published in Annals of Internal Medicine that will change practice. Although over 5,000 miles (8,400 km) away from the offices in Philadelphia where we publish Annals and where I see patients, physicians in Buenos Aires are focusing on the same clinical issues as I do in my practice. The articles discussed, including new randomized controlled trials, a systematic review and meta-analysis each concluding there is no benefit to the use of daily multivitamins for the prevention of chronic disease, addressed issues we all face as our patients (and ourselves) hunt for seemingly simple ways to stave off disease. Another article focused on patients we all struggle to help – like those with depression, and those with trouble battling their tobacco addiction. Finally, although as one member of the audience pointed out to me, a trial of using sunscreen to prevent skin ageing does not address a medically pressing issue, it is one that our patients all worry about no matter the country in which we practice.

In addition to the common clinical conundrums we share, it was similarly impressive how the practice of internal medicine has similar rewards and stessors on both sides of the equator. We know our patients’ concerns and goals, and are proud of our ability to help with them. We lack sufficient time to talk to our patients, as time in the examination room seems to be ever reduced, more patients need to be seen (and billed for!) in a day, while paper work mounts. The need to maintain our knowledge is a constant concern for all.

One thing was very different so many miles from the ACP Internal Medicine meetings in the USA: the opening session of the 15th International Congress of Internal Medicine of the Hospital de Clinicas included a rousing and powerful operatic performance. And everyone joined in! I confess I have no idea what was being sung, but the excitement it stirred in the room was palpable!

Dr. Taichman (far right) stands with ACP Fellows Dr. Ricardo Barcia, Dr. Cecilia Arevalo, and Dr. Myriam Levi

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Future Worldwide Internal Medicine Meetings

Upcoming meetings will be held in Canada, Peru, and UAE. Also, don't forget the World Congress of Internal Medicine in Seoul, Korea.

A complete list of other Future Worldwide Internal Medicine Meetings is available here.

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New International Fellows

ACP is pleased to announce the following newly elected International Fellows, who were recommended by the Credentials Committee and approved for election by the Board of Regents as of September 1, 2014. They are listed by current location and may have been credentialed through a different Chapter.

Brazil

  • Phillip Scheinberg, MD, FACP - Sao Paulo

Canada

  • Yasser Rifaat Abou Mourad, MD, FACP - Vancouver

  • Sepehr Javaheri, MD, CM, FACP - Amos
  • Amer M. Jilani, MBBS, FACP - Courtice
  • Barry N. Nathanson, MD, FACP - Toronto
  • Matthieu Touchette, MD, FACP - Sherbrooke

Germany

  • Stephan Hellmig, Phd, MD, FACP - Kiel

Guyana

  • Mahendra A. Carpen, MBBS, DM, FACP - Georgetown

India

  • Ahmer Ali Khan, MBBS, FACP - Hyderabad

  • Pankaj Malhotra, MD, FACP - Chandigarh
  • Milind Y. Nadkar, MD, FACP - Mumbai
  • Jyotirmoy Pal, MD, FACP - West Bengal
  • Banshi Saboo, MD, FACP - Ahmedabad

Indonesia

  • Hans Tandra, MD, FACP - Surabaya

Japan

  • Koji Miyazaki, MD, PhD, FACP - Sagamihara Kanaga

Mexico

  • Rodolfo Rene Acosta Dominguez, MD, FACP - Jalisco

  • Rachid Elias Cesin Sanchez, MD, FACP - Puebla
  • Esperanza Martinez-Abundis, MD, FACP - Guadalajara
  • Hugo Mendieta Zeron, MD, FACP - Mexico City
  • Marcela Rodriguez-Flores, MD, MC, FACP - Mexico City
  • Alejandro Tovar Serrano, MD, FACP - Mexico DF

New Zealand

  • Adel W. Ekladious, MD, FACP - Wellington

Panama

  • Luis Manuel Carrillo, MD, FACP - Panama

  • Ribana Molino Vargas, MD, FACP - Panama

Peru

  • Luis A. Camacho Cosavalente, MD, FACP - Trujillo

  • Fernando N. Carballo Ordonez, MD, FACP - Lima
  • Danilo H. Villavicencio, MD, FACP - Cusco

Saudi Arabia

  • Ammar Al-Kawi, MD, FACP - Riyadh

  • Sheikh Khurshid Anwar, MD, FACP - Taif

Switzerland

  • Maria Bibiana Walshe, MD, FACP - Zuerich

United Arab Emirates

  • Anthony Amobi Okeke, MBBS, FACP - Dubai

Venezuela

  • Pedro G. Escalona, MD, FACP - Valencia

Yemen

  • Hamed Omer Alkaff, MD, FACP - Sana'a

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Highlights from ACP Internist and
ACP Hospitalist

ACP Internist September 2014

  • Gluten not a bread-and-butter diagnosis
    Internists have to sort through the symptoms of gluten sensitivity to confirm a diagnosis. Excluding celiac disease and wheat allergy is essential, as is managing the patient’s expectations and lifestyle.

  • Target preop visits for efficiency, best outcomes
    Internists can guide preoperative anticoagulation, ensure that patients are in optimal condition for procedures, and—perhaps most importantly—judiciously choose which tests to perform and which ones aren’t needed.

ACP Hospitalist August 2014


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MKSAP 16 Answer & Critique

Answer: D, Ulnar nerve entrapment

Educational Objective: Diagnose ulnar nerve entrapment at the level of the elbow.

Critique:This patient's presentation is consistent with ulnar nerve entrapment at the elbow (cubital tunnel syndrome). The cubital tunnel is the path followed by the ulnar nerve as it passes around the elbow toward the hand. In this region, the nerve is near the surface of the skin and therefore susceptible to injury. Injury may occur from mild and often unrecognized trauma, sustained pressure on the nerve as may occur during sleep, or activities that involve sustained flexion of the elbow and stretching of the nerve. Diagnostically, maneuvers that compress or stretch the injured nerve, such as flexing the arm (as seen in this patient), result in elbow pain. Paresthesias are also commonly present in the ulnar nerve distribution in the hand. These paresthesias are characteristically located on both the palmar and dorsal surfaces of the hand, which contrasts with entrapment of the ulnar nerve at the wrist, which only involves the palmar surface.

Patients with lateral epicondylitis (tennis elbow) typically present with pain in the lateral elbow that radiates down the forearm to the dorsal hand. On examination, there is tenderness to palpation at the location of the insertion of extensor muscles on the lateral epicondyle. Pain is reproduced by forced extension of the wrist.

Patients with medial epicondylitis (golfer's elbow) typically present with pain in the medial elbow and proximal forearm. On examination, there is tenderness to palpation from the medial epicondyle to the pronator teres and flexor carpi radialis muscles. Pain can be reproduced with wrist flexion and resisted forearm supination.

Olecranon bursitis is characterized by pain in the posterior elbow and swelling of the bursal sac that overlies the olecranon process. Range of motion of the elbow is not limited.

Key Point: Ulnar nerve entrapment at the elbow is characterized by pain that occurs with flexion of the arm and paresthesias on both the palmar and dorsal surfaces of the hand, in the distribution of the ulnar nerve.

Bibliography:

Caliendro P, La Torre G, Padua R, Giannini F, Padua L. Treatment for ulnar neuropathy at the elbow. Cochrane Database Syst Rev. 2011;(2):CD006839. [PMID: 21328287]

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