(from the March 17, 2020 ACP Internist Weekly Newsletter)
Several recent articles offered guidance on preparing for the spread of the novel coronavirus disease (COVID-19) in the U.S., and ACP has released a new practice management resource.
I.M. Internal Medicine
Dr. Varun Malayala was born into medicine. His father, an internist, and his mother, a gynecologist, have their practices on the first two floors of the family's home in Hyderabad, in southern India. “And we lived on the third floor. I was born in the hospital. I grew up in the hospital. I lived all of my life in the hospital,” he says.
Medical Student Perspectives
I awoke early and quickly ate my meager breakfast while listening to the news. The U.S. President had placed a travel ban on several countries. There was speculation that these travel bans may extend and include my home country. I put on my heavy coat and stepped out into the bitter and still unfamiliar cold. Walking to the bus stop, I thought of all the families being torn apart by the new policies and of my family, as well. I had spent the last months on a tourist visa for my clinical rotation and had begun counting down the days until I would see them again. I was going to be with them for a month and then come back to the United States with a work visa to do a research rotation for 6 months. This was my first time living alone, and I did not want them to worry about me.
“No puedo tener la operación.” I could hear the distress and despair in the patient's voice. Mr. N was being admitted for an acute stroke. Although he received tissue-type plasminogen activator, his symptoms remained unchanged. If we didn't get Mr. N to the cath lab soon, he might never regain full control of the left side of his body. Mr. N had relocated to the Rio Grande Valley (RGV) from Mexico 20 years prior in order to work as a construction worker and provide a better life for his family. He was the breadwinner of the household; if he was unable to work, he would not have the means to provide for his family. This would cost Mr. N not only his livelihood but also his identity. The physician assistant on the case talked to him privately before leaving the room. Afterward, I asked her why Mr. N decided not to have the procedure. Knowing he understood the risks and consequences of not acting diligently, I couldn't understand his decision. With hesitancy and disappointment in her voice, she responded, “He doesn't have the money. He was told he needed to pay a down payment on his procedure before being taken to the cath lab. He fears that if he doesn't pay, he will be taken to jail and deported back to Mexico.”
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Calls for access to and coverage for testing and treatment; and support for internal medicine physicians and others on the front lines.
The ACP Advocate is a bi-weekly e-newsletter that provides ACP members with news about public policy issues affecting internal medicine and patient care.
This case report describes the presentation and evaluation of a patient with abnormal sounds in his chest—and includes an audio recording.
Annals of Internal Medicine is the premier internal medicine academic journal published by the American College of Physicians (ACP). It is one of the most widely cited and influential specialty medical journals in the world.
Altered Expression of Developmental Gene Sine Oculis Homeobox Homolog 1 (Six1) in Idiopathic Pulmonary Fibrosis
Idiopathic pulmonary fibrosis (IPF) is a spontaneously occurring chronic and irreversible lung disease. Treatment for IPF is extremely limited, eventually leading to the need for lung transplantation. The pathophysiology of lung fibrosis is not fully understood, but it is hypothesized to be driven by the loss of alveolar epithelial cell integrity, specifically the type II epithelial cells (AECII), that leads to altered repair and fibroproliferative injury. Recapitulation of developmental genes, like Sonic hedgehog (Shh), have been reported to play a role in the development of IPF, however the role these genes play in IPF is poorly understood.
Want to have your abstract featured here? ACP holds a National Abstracts Competition as part of the ACP Internal Medicine Meeting every year. Find out more at ACP Online.
Infectious disease medicine is the subspecialty of internal medicine that focuses on diagnosing and managing infections. Although most common infections are treated by general internists and other specialty physicians, internists practicing infectious disease medicine are frequently called upon to help diagnose unknown infections and assist in managing difficult, unusual, or complicated infections.
Community-acquired pneumonia (CAP) can vary from a mild outpatient illness to a more severe disease requiring hospital admission and, at times, intensive care. CAP is the eighth leading cause of death, along with influenza, and is the leading cause of death from infectious diseases in persons in the United States older than 65 years. The key management decisions related to CAP are recognition and treatment in a timely and effective manner, defining the appropriate site of care (home, hospital, or intensive care unit [ICU]), and ensuring effective prevention. Health care–associated pneumonia (HCAP), or pneumonia in persons in contact with such health care environments as nursing homes and chronic hemodialysis centers or persons recently discharged from the hospital, can be caused by multidrug-resistant (MDR) organisms. Whether HCAP is best classified as a form of community-acquired or hospital-acquired pneumonia is controversial.
ACP IMpact's Medical Student Perspective series presents essays by medical students about their experience in medical school. Anyone that's a medical student can submit an article. Essays can be on any topic such as what inspired you to choose internal medicine, hacks for surviving medical school, or a memorable clerkship experience.
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