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November 2012


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ACP Leaders on the Road: Brazil

Patrick Alguire, MD, FACP

For travel, the month of October was a whirlwind month for me; Prague the first week, Phoenix the third week and San Diego the last days of the month. But nothing can compare to the excitement and energy I experienced as the ACP Ambassador to the Brazil Chapter Meeting, held October 4-6, 2012 in Rio de Janeiro, Brazil. For starters, I could not have picked a more gracious host than Dr. Auro del Giglio and his family. Auro and I talked on the telephone some weeks before the meeting and I was well prepared for my debut as an international speaker. Dr. del Giglio was clear in expressing his unique vision for the meeting and was willing to take some risks to see it through. He convinced me to present four lectures but he did not insist that I learn Portuguese.

The Brazil ACP Chapter meeting was held in conjunction with the Brazilian Society of Internal Medicine meeting, an idea transformed into reality by Dr. del Giglio to minimize cost and maximize ACP exposure. I would estimate that there were approximately 1000 attendees representing the usual mix of students, residents, practicing physicians and academic physicians. I presented an overview of ACP with special emphasis on the importance of the international chapters. My next presentation was the most interesting. Dr. del Giglio asked that I review the American Board of Internal Medicine 2012 Update in Internal Medicine Medical Knowledge Self-Assessment questions. He arranged to purchase the questions from the ABIM, obtained an audience response system, and made sure that two earnest and competent translators were available to provide a simultaneous translation for the audience and even make my tired old jokes funny. The program was a hit; the audience enjoyed the challenge of answering the questions prior to my commentary. Later in the day I was part of a panel presentation on studying medicine in the United States (possibly the best attended presentation) and ended my day presenting High Value Care and Medical Education. I was impressed that Brazilian internists were as receptive to the high value care message as my colleagues in the States. During breaks I was able to see our ACP international representative, Monica Lizarraga, at the ACP exhibit. During the day I had the pleasure of meeting with previous Governors of the Brazilian ACP Chapter, Drs. Mario Geller and Morton Scheinberg. Dr. Scheinberg proved to be a most provocative intellectual with wide ranging academic interests. Dr. Geller, Brazil?s first ACP Governor, was most gracious and bid me to make his complements and hellos to a number of mutual friends back in the States. Our list of mutual acquaintances proved once again the world of Internal Medicine is a tightly knit community.

Dr. Alguire, second from left, participates in a panel discussion.

The following day, Sandra del Giglio spent her entire day as the charming and tireless tour guide, making sure that we saw the botanical gardens. The number and variety of orchids that grow in Brazil is absolutely astounding. We went to the top of Sugarloaf Mountain and experienced breath-taking views of the southern part of the city and beaches. We ended our day in a wonderfully cool and relaxed café located on the grounds of the old military fort, Fort Copacabana. Here I saw a cannon donated by the United States to defend the beaches of Rio during the World War I conflict.

Near the end of my stay, Dr. del Giglio and I had an opportunity to debrief on the meeting. We agreed that the use of the audience response system captivated audience interest and we were pleased with the flawless use of this interactive technology. We agreed that we could have done a better job describing the actual content of the presentation which was wide-ranging (Tdap vaccination to C. difficile infection) and because studying in the United States generated so much interest among the students, it should be repeated next year.

We were sad to leave Rio and our new friends in Brazil but were comforted to learn that we will be seeing many of them at Internal Medicine 2013 in San Francisco, April 11-13.

For more photos from this meeting, click here

From left: Dr. Auro del Giglio, Dr. Patrick Alguire, Sandra del Giglio.









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ACP Leaders on the Road: Colombia

Max Brito, MD, FACP

The city of Cartagena de Indias, located on the Caribbean coast of Colombia, was one of the most important trading posts of the Spanish crown in America. The old colonial walled city is a true gem of 16th century architecture and a major port of commerce in the region. In 1984,the city was designated a World Heritage Site by UNESCO.

Cartagena was also the site of the 22nd Colombian Congress of Internal Medicine and of the first meeting of the newly created Colombian ACP Chapter. After 30 years of hard work and perseverance, our Colombian colleagues were able to recruit and retain the required number of internists to create a new chapter. I had the privilege of representing ACP as an Ambassador at the conference and participated in the first work meeting of the Chapter. José Rodríguez Portales, MD, FACP, former ACP regent; Guillermo Conte, MD, FACP, Governor of the ACP Chile Chapter; and Wendy Rivera, Administrator of ACP?s International Programs, were also in attendance. Roberto Esguerra, MD, FACP, the new Governor, opened the meeting by providing a historical perspective on the events that led to the creation of the Chapter. He also outlined his plans for the formation of the Chapter?s council and different committees. It was an honor to participate in these discussions and especially gratifying to share my experiences on the national Council of Associates and the Young Physicians? Subcommittee with the colleagues who were working on starting these committees at the local level. Candidates for committee chairpersons were presented to the audience by their sponsors and elected by a simple majority vote. If the meetings continue to run in such an organized manner and the local colleagues continue to show the same level of unbound enthusiasm in ACP activities, this chapter will have a very bright future.

More than two thousand internists from all over Colombia gathered at the sprawling convention center in downtown Cartagena for three days of symposia and keynote lectures. A series of pre-meeting workshops were held the day before the conference started. The scientific program was diverse and balanced with topics covering the entire breadth of internal medicine. The opening ceremony included a keynote lecture delivered by Dr. Dora Inés Molina, FACP, who provided an excellent overview on the status of medical research in Colombia. Following her lecture, participants were treated to a social event at an outside terrace in the convention center overlooking the walled city- a truly spectacular setting. A magnificent show featuring Colombian music, colorfully dressed performers and delicious food followed. The first day of the conference was devoted to popular and important general medicine topics such as hypertension, appropriate use of antimicrobials and medical complications of pregnancy. On the second day, lectures were more specialized and included HIV medicine topics, lupus and tropical diseases. The last day of the program had presentations mostly dealing with the metabolic syndrome- coronary heart disease, dyslipidemia and obesity to cite a few.

I was also able to do a little sightseeing between talks and meetings. Walking around the colorful old city is a true pleasure to the senses. The area is so well preserved and retains so much of its original architecture that you can almost hear the voices of the ancient sailors unloading goods from merchant ships or the clucks of the villagers hurrying their horses. Cartagena is a charming town with a rich history and welcoming people. It was indeed the perfect setting for a gathering of friends and colleagues.

For more photos from this meeting, click here

From left: Dr. Brito, Wendy Rivera, Dr. Esguerra, Dr. Rodriguez-Portales, and Dr. Conte.







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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. MKSAP 16 is published in two sections. Part A is now available and Part B will be available December 31, 2012.

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 33-year-old woman is evaluated for a 2-month history of diffuse hair shedding. She delivered a healthy baby 5 months ago. There were no complications during the birth, and her postpartum recovery has been uneventful. She has no symptoms and takes no medications other than a multivitamin. She is in excellent health and has no history of hair loss or autoimmune disease.

On physical examination, she is afebrile, and her vital signs are normal. Her scalp appears normal, without any scale or inflammation. She has mild diffuse hair loss, but no areas of total alopecia are present. Her hair is worn in a loose style. Her eyebrows and eyelashes appear normal. She has no rash on the trunk or extremities.

Which of the following is the most likely diagnosis?

A. Alopecia areata
B. Androgenetic alopecia
C. Lichen planopilaris
D. Lupus
E. Telogen effluvium

Click here for the answer and critique.

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International Meetings Update

Canadian Society of Internal Medicine Meeting
October October 17-20, 2012

The Annual Meeting of the Canadian Society of Internal Medicine was held October 17-20, 2012, in Quebec City, Quebec, Canada. The meeting was held in collaboration with the local ACP Quebec Chapter. Around 500 attendees from throughout Canada were present at the meeting.

Drs. Robert and Suzanne Fletcher, both Fellows of ACP, served as ACP Ambassadors to the meeting where they spoke on High-Value, Cost Conscious Care.

11th Congress of the European Federation of Internal Medicine
October 24-27, 2012

The 11th Congress of the European Federation of Internal Medicine was held October 24-27, 2012 in Madrid Spain. The meeting was held in conjunction with the Spanish Society of Internal Medicine. Dr. David Bronson, FACP, was invited to serve as the ACP International Ambassador to the meeting by Dr. Ramon Pujol, President of the European Federation of Internal Medicine. Dr. Bronson spoke on the current situation of internal medicine in the US.

Approximately 2,000 physicians, residents, and medical students from Spain and other countries attended the meeting. An ACP exhibit booth was also present at the meeting

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Future Worldwide Internal Medicine Meetings

Upcoming meetings will be held in Canada, Chile, and Taiwan.

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 November 1, 2012. They are listed by current location and may have been credentialed through a different Chapter.

Anguilla

  • Clyde L. Bryan, MD, CM, FACP - The Valley, BWI

Argentina

  • Guillermo Mendoza, MD, FACP - Buenos Aires

Australia

  • Vernon J. Heazlewood, MBBS, FACP - Queensland

Bangladesh

  • SK A. Fattah, MBBS, FACP - Dhaka

Brazil

  • Heitor Moreno Jr., MD, PhD, FACP - Campinas

Canada

  • Irene M. Hramiak, MD, FACP - London, ON

  • Marko Mrkobrada, MD, FACP - London, ON

Cayman Islands

  • Komal S. Lawrence, MBBS, FACP - Georgetown

Guatemala

  • Edwin Ivan Martinez Ortiz, MD, FACP - Coatepeque Quetzaltenango

Israel

  • Adi Leiba, MD, FACP - Ramat Gan

Japan

  • Akimitsu Miyauchi, MD, FACP - Takatsuki Osaka

  • Yasuo Tate, MD, FACP - Ishioka Ibaraki
  • Masakazu Yamamoto, MD, FACP - Takaoka
  • Takeshi M. Tanagawa, MD, FACP - Kanagawa

Mexico

  • Jose Angel Valdes Garcia, MD, FACP - Mexico DF

Nigeria

  • Charles A. Onyekwere, MBBS, FACP - Lagos

Pakistan

  • Kamran A. Khan, MD, FACP - Peshawar

  • Mehmood M. Riaz, MBBS, FCPS, FACP - Karachi

Saudi Arabia

  • Suhail A. Abbasi, MD, FACP - Dhahran

  • Mamdouh H. Kalakatawi, MBChB, MD, FACP - Makkahi

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Highlights from ACP Internist and
ACP Hospitalist

ACP Internist October/November 2012

ACP Hospitalist September/October 2012


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College Corner

Renew Your ACP Membership

ACP's membership year began on July 1. Renew today to reactivate your membership benefits through June 30, 2013. Members that do not pay their dues by December 21, 2012 are at risk of being dropped from the College's membership rolls.

Please note that if you currently receive print copies of ACP journals, you may elect to access them only online. This option --- available exclusively to our international members -- will lower your annual dues and provides a significant tax savings for members in Canada. You will be able to select an online-only membership when you renew.

Chapter Excellence Award Winners

We are happy to announce that six international chapters are in receipt of the 2012 Chapter Excellence Award. These are the Central America, Chile, Japan, Mexico, Saudi Arabia and Venezuela Chapters. These chapters are in receipt of this award because they have made great strides in chapter management in numerous ways. These include such activities as formulating an effective Governor?s Council and committees, communicating frequently with their membership, providing educational opportunities, recruiting and advancing members and celebrating their membership through local awards. Congratulations to these chapters on a job well done!

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Register Now for Internal Medicine 2013

Join ACP and thousands of your colleagues in San Francisco, California, and transform the way you practice medicine. Internal Medicine 2013 is the only meeting of its kind?combining clinical skills workshops with over 200 scientific sessions to update your knowledge in all facets of internal medicine and the subspecialties.

Refresh your internal medicine knowledge, sharpen your practice management skills, and network with the best and brightest physicians from around the globe. All of this plus a variety of special events including a reception for International attendees make this a meeting not to be missed.

Substantial registration discounts are available for international delegations. Groups of 10 or more are eligible for the special delegation rates. The guidelines require that one person organize the group, provide the registration forms, and submit one payment by check or credit card for the entire group. Not all participants in group delegations are required to be ACP members. Visit im2013.acponline.org/for-meeting-attendees/international-attendees/ for more information.






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MKSAP 15 Answer & Critique

Answer: E, Telogen effluvium

Educational Objective: Diagnose telogen effluvium.

Key Point: Telogen effluvium is an interruption of the normal hair growth cycle caused by stress and commonly follows childbirth.

This patient has telogen effluvium, which is a common cause of nonscarring hair loss. It is particularly common in young women in the postpartum period. It results from a tendency of the body to bring a higher than average number of hair follicles from the anagen phase of hair development into the telogen phase under conditions of stress. Approximately 3 months after the inciting event, the hairs are shed, leading to noticeable hair loss with white bulbs at the end of the hair. The scalp appears normal, without any evidence of inflammation or scale; the hair loss is diffuse rather than focal. The hair follicle cycling returns to normal over a period of months. Seborrheic dermatitis, psoriasis, iron deficiency, and thyroid disease may also cause telogen effluvium. For stress-related hair loss, no treatment is required.

Alopecia areata is characterized by scattered focal oval patches of total alopecia with normal-appearing hair follicles and no evidence of scarring or inflammation. The diffuse and partial nature of this patient's hair loss, coupled with a clinical circumstance classic for telogen effluvium, makes alopecia areata unlikely.

Androgenetic alopecia (male and female pattern hair loss) is the most common type of hair loss overall. It tends to occur gradually rather than suddenly and in clearly identifiable patterns typically involving the crown of the head and temporal areas. The sudden onset of this patient's hair loss and diffuse distribution make androgenetic alopecia unlikely.

Lichen planopilaris is a form of scarring alopecia characterized by perifollicular inflammation. Since the patient's scalp examination is normal, lichen planopilaris is unlikely.

Chronic cutaneous lupus may cause significant scarring alopecia. It is characterized by inflammation, scale, and dyspigmentation, generally in well-defined areas of the scalp. Since this patient's scalp examination is normal, lupus is unlikely.

Bibliography:

Mounsey AL, Reed SW. Diagnosing and treating hair loss. Am Fam Physician. 2009;80(4):356-362. PMID: 19678603

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