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Traditionally, the word "Brazil" comes from brazilwood, a timber
tree that many sailors traded from Brazilian regions to Europe in
the 16th century. In Portuguese brazilwood is called pau-brasil,
with the word brasil, "red like an ember", being formed from Latin
brasa ("ember") and -il (from -iculum or -ilium). The month of
October is actually spring in Brazil. It is in these beautiful
surroundings and in the sunny spring Brazilian weather that the
combined ACP Chapter meeting and Brazil Congress of Clinical
Medicine was held in Curitiba on October 26-29th, 2011. As the ACP
Ambassadors, we enjoyed the Brazilian hospitality, the formal and
informal discussions with different groups, and the enthusiastic
interactions and presence of medical students.
Brazil is the largest national economy in Latin America, the
world's seventh largest economy at market exchange rates and the
eighth largest in purchasing power parity , according to the
International Monetary Fund and the World Bank. Brazil has a mixed
economy with abundant natural resources. The Brazilian economy has
been predicted to become one of the five largest in the world in
the decades to come. It is strong and supports a high level of
interest and intellectual curiosity in medical matters ranging from
education to medical practice.
A traditional building in Curitiba
According to the Readers Digest, Curitiba is the best place to
live in Brazil. Curitiba is a beautiful city, the buildings are
covered in striking colors in mosaic tiles and the walkways exhibit
fascinating tile-work and design. A beautiful Japanese Garden
complete with water elements and Koi ponds was just adjacent to our
hotel and offered a great site for walks. Curitiba is one of the
largest cities in the prosperous Southern region, and its
population is largely descended from German, Ukrainian, Russian,
Italian, Japanese and Polish immigrants. The city is known to urban
planners worldwide for its innovative public transit system. The
famous architecture of the Oscar Niemeyer Museum is distinct. This
eye-museum is shaped as a lenticular eye tower and gallery space
with a ramp leading to it, reflecting the pond below, and
rectangular galleries behind. The beautiful Botanical Garden in
downtown is also a significant tourist attraction in Curitiba. The
world-famous train trip that runs between Curitiba and Paranagua
passes through the majestic Serra do Mar Coast mountains and is a
designated UNESCO Biosphere Reserve. The Serra Verde express took
9000 men and 5 years to complete in 1885, an attestation to the
strength and power of the people of Brazil in overcoming
From left: Dr. del Giglio, Dr. Hood, and Dr. Mir
Brazil is one of the thirteen International chapters of the
American College of Physicians. Dr. Auro Del Giglio is the current
Governor of the Chapter and was a wonderful and attentive host. Dr.
Antonio Carlos Lopes, President of the Congress, presided this
meeting. Dr. Virginia Hood, President of the ACP, and I were the
ACP Ambassadors attending this meeting. The total attendance of the
meeting was a record 5,500. The audience was comprised of
physicians in practice and academia, residents, medical students
and emergency department physicians. In addition, ACP Brazil
Chapter members were present as well.
Dr. Virginia Hood and I were able to meet with Dr. Cesar Alfredo
Pusch Kubiak, Chairman of the Congress, President of the Congress
Dr. Lopes, prominent internal medicine and specialist physicians
from Brazil, and some from the neighbouring countries of Argentina
and Colombia. Both Dr. Hood and I had a prominent place in the
program. Dr. Hood presented an overview of ACP and its educational
resources. We presented a total of 4 lectures and 2 panel sessions.
ACP visibility was significant on the program brochure, at the
inauguration ceremony, and at all prominent events. Each session
had over 300 attendees with standing room only in some of the
sessions. The conference was held at the Expo Conference Center
adjacent to the Positivo Medical School. The auditoria and
audio-visual and technical support were excellent. Simultaneous
translation in Portugese was available during all the English
Several issues related to ACP including membership issues,
advancement to fellowship, special groups like student and
associate membership and attendance at Internal Medicine 2012 in
New Orleans were discussed with internal medicine leaders, faculty
and other physicians, residents and medical students. All expressed
a strong interest in ACP and looked forward to future collaboration
and strengthening of the relationship and ACP presence in Brazil.
MKSAP review and all aspects of medical education were considered
The hospitality was outstanding. Every morning we would be
greeted at breakfast by the local medical students, faculty, and
their families with smiles. We were efficiently transported to the
convention center and then presented our lectures and engaged in
discussions with faculty and students. We spent one afternoon
visiting the Positivo Medical school, a local tertiary hospital and
a large urgi-center. Students, residents, and faculty were present
at all sites and showed us around. This allowed us to exchange
ideas, discuss practice patterns and understand more about delivery
models of care in Brazil. Their remarkable interest and enthusiasm
in medicine and College activities specifically was
The presence of two ambassadors allowed us to offer a large
number of lectures and panel discussions and provide high
visibility. The physician work-force was keen on expanding the
relationship with the ACP. The high degree of interest in medical
education, research, self-improvement and ACP activities was
extraordinary at all levels. This visit was a wonderful learning
and personal experience in networking with students, residents, and
faculty. Interactions like this strengthen communications and help
us to meet the needs of our membership, locally and
Dr. Hood and Dr. Weinberger with faculty, residents, and
medical students from Peking Union Medical College
Virginia Hood (the current ACP President) and I traveled to
China in early November 2011 at the invitation of the Chinese
Society of Internal Medicine to speak at the society's annual
meeting in Xi'an. Our official activities in China were expanded by
additional invitations to speak at Peking Union Medical College in
Beijing and to visit other hospitals in both Beijing and Xi'an.
Because it was the first trip to China for both of us, we allowed
additional time to tour both Beijing and Xi'an and to travel to
Shanghai, and my wife accompanied us on the trip.
Upon arrival in Beijing on a Friday evening after a direct
flight from Chicago, we had an enjoyable introductory dinner with
several faculty members from Peking Union Medical College. We had
no official activities over the weekend, so we used the time to see
the sights of Beijing, including Tiananmen Square, the Forbidden
City, the Temple of Heaven, and the Summer Palace. We also went to
the Great Wall, which we accessed from Mutianyu, which is not far
Dr. Weinberger, medical resident Dr. Ma Ya, a faculty member
of Peking Union Medical College, and Dr. Hood in front of one of
the College's buildings.
We started our official activities on Monday by meeting with
several faculty and physician leaders at Peking Union Medical
College (PUMC), including the Vice President of the hospital, who
is an orthopedic surgeon. Our discussion centered around the
Chinese government's interest in providing better trained general
physicians to meet the health care needs of the community. Based on
this interest, PUMC would like to expand and improve its training
of general internists, and the faculty members were interested in
hearing about training models in the United States. We then took a
guided tour of a lovely exhibit presenting the history of PUMC,
followed by two sets of clinical teaching rounds on the wards of
PUMC - Virginia was on Nephrology rounds while I was on Pulmonary
rounds. The cases were presented in Chinese, but printed English
summaries had kindly been prepared for us. Later in the day, I gave
a lecture on trends and challenges in medical education in the
U.S., which was followed by questions and a discussion with the
attendees, who included faculty, residents, and medical
On Tuesday, we were taken to Peking University First Hospital,
another leading Beijing teaching hospital, which is not affiliated
with PUMC. We again met with a group of faculty members, including
educational leaders, and discussed medical education in the U.S.
and in China. Virginia was then taken on a tour of the Nephrology
service, while I was taken on a tour of the Pulmonary service,
including the intensive care unit. On Tuesday evening, Virginia
joined a group of about 20 medical students from PUMC who regularly
meet to discuss cases in English. She enjoyed discussing lupus
nephritis and was impressed by the students' enthusiasm.
Dr. Hood with students at Peking Union Medical
On Wednesday, we again spent time at PUMC, first meeting with
several faculty members, including Dr. Xuejun Zeng, Chief of the
Division of General Medicine and Vice Chair of the Department of
Medicine, who organized and served as the "point person" for much
of our trip. We then attended a clinical teaching conference at
which two interesting cases were presented for discussion. In the
afternoon, Virginia gave a well-received talk on professionalism,
which was followed by the hospital's formal Grand Rounds, where an
interesting case of pulmonary amyloidosis was extensively discussed
by faculty from a variety of disciplines.
We then flew from Beijing to Xi'an for the Chinese Society of
Internal Medicine meeting. We were most graciously hosted during
our stay in Xi'an by Dr. Dexin Zhang, a gastroenterologist based at
Xijing Hospital. Our first full day in Xi'an consisted of visiting
the most well-known attraction in Xi'an - the terracotta warriors.
On the second day in Xi'an, we attended the meeting of the Chinese
Society of Internal Medicine, where Virginia and I each gave the
same talks we had presented in Beijing, on medical professionalism
and on trends and challenges in medical education, respectively.
Although difficult to know how many physicians were at the meeting,
we estimated that approximately 500 physicians were at our talks.
We then were taken to Xijing GI Hospital, a 370 bed hospital that
is devoted exclusively to GI, pancreatic, and hepatobiliary
disease, but is part of a larger 3000 bed hospital (it's far from
the largest hospital in China, which we were told has approximately
10,000 beds!). That evening we were taken to a very festive dinner
for some of the meeting attendees. We had no official activities on
the next day, when we toured Xi'an, which had been an ancient
capital of China.
We concluded the trip by flying to Shanghai to see how "modern
China" has developed. We had no official activities in Shanghai, so
our time was spent touring around the city, which is stunning in so
many ways - the architecture, the beautiful Yu Garden, the
Confucian temple, and the Shanghai Museum were particular
highlights. The trip concluded with a direct flight from Shanghai
It was a wonderful trip, not only for what we accomplished and
the people we met, but also as a starting point for future
interactions and collaborations with our Chinese colleagues.
From left: Dr. Dexin Chang, Dr. Virginia Hood, Dr. Steven
Weinberger, and Dr. Kaichun Wu at Xijing Hospital in Xi'an
A 78-year-old woman who resides in a nursing home is seen for
management of her diabetes mellitus. The patient's blood glucose
log shows levels ranging between 40 and 400 mg/dL (2.2 and 22.2
mmol/L). She otherwise feels well. She has been on insulin for more
than 25 years after first taking oral agents for several years
following her initial diagnosis. The patient has hypothyroidism
treated with levothyroxine and remote history of Graves disease
treated with radioactive iodine. Her diabetes is currently treated
with neutral protamine Hagedorn (NPH) insulin, 25 units twice
daily; the dosage has been gradually increased over the past 3
The only pertinent finding on physical examination is her lean
body habitus (BMI of 19.3).
Results of routine laboratory studies are all within the normal
range. An anti-glutamic acid decarboxylase antibody titer is
Which of the following is the most likely diagnosis?
A. Late-onset autoimmune diabetes of adulthood
B. Maturity-onset diabetes of the young
C. Type 1 diabetes mellitus
D. Type 2 diabetes mellitus
Click here for the answer and critique.
Click here for more information.
Thursday, April 19, 2012
8:00 - 9:30 p.m.
HQ, Salons A-E
This reception is open to all international attendees and their
guests, as well as other attendees who are interested in meeting
with leaders from ACP and internal medicine societies from around
the world. Light hors d' oeuvres will be served.
Saturday, April 21, 2012
Faculty: Jorge Hidalgo, MD, FACP, FCCM, FCCP
This Meet the Professor course will discuss the historical
contributions of ancient Amerindian medicine to modern medicine. It
will combine not only history, much of which is little known to
many physicians, as well as fascinating medical/historical
This workshop is the fourth in a planned multi-year series
presented under the sponsorship of the International Council, on
"Contributions of Multiple Global Cultures to Modern Medicine".
Friday, April 20, 2012
Moderator: Jock Murray, MD, MACP
Panelists: Werner O. Bauer, MD, FACP, FRCP
Kesavan Kutty, MD, MACP
This panel of international faculty will address internal and
external pressures on professionalism that pose challenges to the
practicing physician and discuss strategies to maintain
professionalism in the face of challenges.
ACP has partnered with three major airlines to provide
additional discounts off lowest applicable airfares. Receive up to
5% off applicable classes of service for tickets purchased more
than 30 days prior to the meeting. Restrictions apply and not all
classes of service apply for the 5% discount. 5% off applicable
classes of service for tickets purchased prior to the meeting.
Click on "More Flight Options"
Enter promo code 7342BI
These discounts apply for travel 4/14/12-4/21/12 (New Orleans)
Some restrictions may apply. Service fees apply to ticketed
reservations. You may also call your own agency or the vendors
directly and refer to the following ID numbers.
Book early for the best rates on hotels in New Orleans during
Internal Medicine 2012. Great, wallet-friendly hotels for under
$200 available to only Internal Medicine 2012 attendees. Click
here for a complete list of hotels.
Receive a substantial registration discount for groups of 10 or
more. 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.
Please click here to download the
Group Registration Guidelines and Form.
pp = per person fee.
* Discount not applicable to the half-day Courses or to the
Ultrasound Course with a higher fee due to close faculty/student
interaction and special equipment.
Please submit completed registrations by January 28,
Director, Customer Service
190 N. Independence Mall West
Philadelphia, PA 19106
For further information, contact Pamela Carey at +1-215-351-2792
The 33rd Annual Meeting of the Peruvian Society of Internal
Medicine was held from October 27-30, 2011 in Lima, Peru. Dr.
William J. Hall, MACP, served as the ACP International Ambassador
to the meeting. Dr. Hall was hosted by the President of the
Society, Dr. Amador Carcelen Bustamante. The four-day conference
attracted around 1,000 internists and medical students from Peru
and neighboring countries.
Dr. Hall gave two plenary sessions, one entitled "Geriatrics
Update" and another session on "Successful Aging".
Dr. Hall dining with Peru's only ACP Master, Dr. Miguel
Dr. Nellen, ACP Governor, stands with ACP Ambassador, Dr.
The 34th National Congress of the Mexican College of Internal
Medicine was held from November 16-19, 2011 in Acapulco, Mexico.
Dr. Donna Sweet, MACP, was invited to serve as the ACP
International Ambassador to the meeting by Dr. Haiko Nellen Hummel,
FACP, Governor, ACP Mexico Chapter. Dr. Sweet spoke on two topics:
"High Value Cost-Conscious Health Care" and "HIV".
Around 1,600 physicians, residents, and medical students
attended the meeting. An ACP exhibit booth was present at this
Dr. Pei Ming Yang, PhD, FACP, President of the Taiwan
Society of Internal Medicine, presents a gift to ACP President Dr.
Virginia Hood at the meeting.
The 25th Annual Meeting of the Taiwan Society of Internal
Medicine was held November 26-27, 2011 in Taipei, Taiwan. Dr.
Virginia Hood, MBBS, MPH, FACP, ACP President, served as the ACP
International Ambassador to the meeting. About 8,000 physicians,
both generalists and subspecialists, from all over Taiwan attended
Dr. Hood gave a special lecture entitled "Can a physician refuse
to treat a patient: a framework for the obligation to care".
The current list of Future Worldwide Internal Medicine Meetings
is available here. Upcoming meetings will be taking place in India,
Panama, and Bangladesh.
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, 2011. They are listed by current location and may
have been credentialed through a different Chapter.
Iman Mohasseb, MD, FACP - Australia
Md Abdul Alim, MD, FACP - Rajshahi
Devendra Nath Sarkar, MD, FACP - Dhaka
Khalid H. Alghamdi, MD, FACP - London, ON
Zahi N. Touma, MD, FACP - Toronto, ON
Olayinka A. Adedayo, MD, FACP - Georgetown
Janet C. Zhang, MD, FACP - Shanghai
Nikolaos Tentolouris, MD, FACP - Athens
Dolland W. Noel, MD, FACP - Grenada
Ritesh Agarwal, MD, FACP - Chandigarh
Waseem M. Qureshi, MD, FACP - Srinigar
Lucky Aziza Bawazier, MD, FACP - Indonesia
Lorenzo Dagna, MD, FACP - Milano
Althea M. Aquart-Stewart, MD, FACP - Jamaica
Trevor S. Ferguson, MD, FACP - Liguanea
Akiko Matsumoto, MD, FACP - Japan
Takahiro Yamauchi, MD, FACP - Japan
Rami S. Farraj, MD, FACP - Amman
Victor Cordova-Pluma, MD, FACP - Mexico
Jose de Jesus Garcia Mendoza, MD, FACP - Mexico
Frank Ferro, MD, FACP - Panama
Enrique Jorge Mendoza, MD, FACP - Panama
Abed H. Al-Lehibi, MD, FACP - Riyadh
Mushira Abdulaziz Enani, MD, FACP - Riyadh
Nien Yue Koh, MD, FACP - Singapore
Gustavo J. Villasmil Prieto, MD, FACP - Caracas
United Arab Emirates
Halah Ibrahim Hassen, MD, FACP - Abu Dhabi
ACP Internist (formerly ACP
Observer) January 2012
ACP Hospitalist December
ACP International welcomes submissions from its readers. If you
would like to submit an article for consideration for the
newsletter, please send it to the ACP International Office mailbox
. Articles submitted for consideration should be formatted in a
Microsoft Word document and no longer than one page of 12-point
Times New Roman font. Articles about unique health issues routinely
treated in your country and humanitarian stories are
Answer: A, Late-onset autoimmune diabetes of
Educational Objective: Diagnose late-onset
autoimmune diabetes of adulthood.
Critique: This patient most likely has
late-onset autoimmune diabetes of adulthood (LADA). Diabetes
mellitus is categorized into several types. Most affected patients
have type 2 diabetes, and a minority (5% to 10%) have type 1
diabetes. Patients with type 2 diabetes are usually overweight, if
not frankly obese. Type 1 diabetes results from autoimmune
destruction of pancreatic beta cells and results in absolute
insulin deficiency, whereas type 2 is marked by insulin resistance
and relative insulin deficiency. Type 1 diabetes is classically
seen in younger patients, usually in children, teens, and young
adults. However, type 1 diabetes can be diagnosed at any age. When
diagnosed in older persons, especially those in whom hyperglycemia
was once controlled with oral agents, this form of diabetes is
referred to as LADA. In persons with LADA, beta cell destruction
over time leads to the requirement for insulin therapy, as in type
1 diabetes. LADA typically occurs in leaner persons after glycemic
control has become more labile and there is clear insulin
dependency. Autoimmune markers (anti-islet cell autoantibodies) are
present, including anti-glutamic acid decarboxylase antibody, the
detection of which can confirm the diagnosis.
Maturity-onset diabetes of the young is typically diagnosed in
adolescents or young adults and usually is marked by mild
hyperglycemia, often with a strong family history of diabetes.
Key Point: Diabetes mellitus in older, lean
patients with anti-islet cell autoantibodies is termed late-onset
autoimmune diabetes of adulthood.
Fourlanos S, Perry C, Stein MS, Stankovich J, Harrison LC,
Colman PG. A clinical screening tool identifies autoimmune diabetes
in adults. Diabetes Care. 2006;29(5):970-975. [PMID:16644622] - See