Clinical Information Search
Search Results for "low back pain"
- Online Learning Center (4)
- Policy Library (448)
- Performance Measures (2)
- Annals of Internal Medicine (1899)
- Annals of Internal Medicine: Clinical Cases (85)
- IM Matters (105)
- ACP Hospitalist (289)
- ACP Diabetes Monthly (27)
- ACP Gastroenterology Monthly (31)
Displaying 51 - 60 of 448 in Policy Library
Displaying 51 - 60 of 1899 in Annals of Internal Medicine
These Annals of Internal Medicine results only contain recent articles.
- Visit annals.org to search all content back to 1927.
- View Annals of Internal Medicine CME by topic here.
Should We Screen for Coronary Heart Disease in Asymptomatic Persons?: Grand Rounds Discussion From Beth Israel Deaconess Medical Center: Annals of Internal Medicine: Vol 164, No 7
In March 2015, the American College of Physicians (ACP) released a clinical guideline on the value of screening for coronary heart disease (CHD) in asymptomatic persons. The guideline authors found that results of screening studies are unlikely to change patient management or the intensity of risk factor reduction strategies. Most events occur in patients who are at low to intermediate risk for CHD; and in low-risk asymptomatic patients, percutaneous coronary intervention in “screen-positive” patients does not improve outcomes and creates unnecessary risks. As a result, the ACP recommended against screening for asymptomatic patients who are at low risk for CHD. Instead, it recommended a focus on proven strategies, such as treatment of hypertension and hypercholesterolemia, to reduce risk in appropriately selected asymptomatic persons. Two discussants weigh the evidence for and against screening for CHD in asymptomatic patients with varying degrees of risk and provide recommendations for a specific patient who is uncertain whether to proceed to screening.
Reporting of Sex Effects by Systematic Reviews on Interventions for Depression, Diabetes, and Chronic Pain
Systematic reviews (SRs) have the potential to contribute uniquely to the evaluation of sex and gender differences (termed “sex effects”). This article describes the reporting of sex effects by SRs on interventions for depression, type 2 diabetes mellitus, and chronic pain conditions (chronic low back pain, knee osteoarthritis, and fibromyalgia). It includes SRs published since 1 October 2009 that evaluate medications, behavioral interventions, exercise, quality improvement, and some condition-specific treatments. The reporting of sex effects by primary randomized, controlled trials is also examined. Of 313 eligible SRs (86 for depression, 159 for type 2 diabetes mellitus, and 68 for chronic pain), few (n = 29) reported sex effects. Most SRs reporting sex effects used metaregression, whereas 9 SRs used subgroup analysis or individual-patient data meta-analysis. The proportion of SRs reporting the sex distribution of primary studies varied from a low of 31% (n = 8) for low back pain to a high of 68% (n = 23) for fibromyalgia. Primary randomized, controlled trials also infrequently reported sex effects, and most lacked an adequate sample size to examine them. Therefore, all SRs should report the proportion of women enrolled in primary studies and evaluate sex effects using appropriate methods whenever power is adequate.
Displaying 51 - 60 of 85 in Annals of Internal Medicine: Clinical Cases
Multisystem Inflammatory Syndrome After Mild COVID-19 Infection in a Fully Vaccinated Adult | Annals of Internal Medicine: Clinical Cases
Multisystem inflammatory syndrome in adults (MIS-A) is a rare and severe complication of SARS-CoV-2 infection that is more common in children than adults. It is often underdiagnosed by physicians because of the heterogeneity of symptoms, overlapping comorbid conditions, and a lack of comprehensive work-up. Here, we present a patient case of MIS-A after mild COVID-19 infection in a fully vaccinated adult. The goal of this case is to describe the presentation of MIS-A in adults and review the associated laboratory results that can guide early diagnosis and management to improve outcomes.
Alanine Aminotransferase Deficiency in a Patient With Hyperferritinemia, Steatosis Hepatis, and Hepatosplenomegaly | Annals of Internal Medicine: Clinical Cases
The glutamate pyruvate transaminase enzyme, also called alanine aminotransferase (ALT), plays an important role in gluconeogenesis and amino acid metabolism. It catalyzes the reversible transamination of L-alanine and α-ketoglutarate to pyruvate and L-glutamate. ALT is mostly located in the liver but is also present in other organs like kidney, heart, skeletal muscle, pancreas, and spleen. ALT deficiency was reported in a case of hepatitis B and hepatitis C infection, whereas complete absence of ALT, to our knowledge, has only been reported in 1 case of acute liver failure.
Autopsy Case of Colonic Plasmablastic Lymphoma Exhibiting Unique Endoscopic Phenotypic Changes During Ulcerative Colitis Therapy | Annals of Internal Medicine: Clinical Cases
Plasmablastic lymphoma (PBL), a rare and aggressive CD20-negative B-cell lymphoma, has been increasingly recognized in individuals who are HIV-negative and who are also immunosuppressed. To our knowledge, we report the first autopsy case of a 74-year-old woman with ulcerative colitis (UC) who developed colonic PBL under immunosuppressive therapy. Serial colonoscopies demonstrated a morphologic transformation from serpiginous ulcers to elevated lesions. The patient ultimately died because of carcinomatous lymphangitis. Autopsy showed widespread metastases and numerous flat elevated lesions with lobulations throughout the colon. This case demonstrates a unique endoscopic phenotypic transition in colonic PBL, suggesting the importance of careful monitoring for timely diagnosis in immunosuppressed UC patients.
Digoxin-Like Toxicity After Tejocote Root and Yellow Oleander Ingestion: The Hidden Dangers of Herbal Supplements | Annals of Internal Medicine: Clinical Cases
Tejocote root (Crataegus mexicana) is a common herbal supplement used for weight loss and to induce bowel movements. In recent years, there has been an increase in the number of cases of digoxin-like toxicity associated with consumption of tejocote root, and substitution of tejocote root with yellow oleander. We present a case of excess tejocote ingestion to induce a bowel movement that resulted in subsequent gastrointestinal upset and cardiac arrhythmia. This report highlights the potential risks associated with the consumption of tejocote root, particularly due to suspected inclusion of yellow oleander after a Food and Drug Administration–issued warning of several supplements.
A Case of Dacrystic Seizure in a 72-Year-Old Man | Annals of Internal Medicine: Clinical Cases
Dacrystic seizures are rare, stereotyped episodes of ictal crying. We describe a 72-year-old man with recurrent crying spells, initially attributed to orthostatic hypotension with psychogenic episodes. Electroencephalography monitoring captured interictal left frontal spikes and diffuse background slowing. Magnetic resonance imaging demonstrated a prominent left mesial temporal lesion, though no episodes were identified in the 24-hour monitoring period. The patient was treated with levetiracetam and reported significantly fewer events at home. Clinical response confirms the diagnosis. This case highlights the diagnostic challenge of emotional seizure semiologies and the critical role of multidisciplinary evaluation, particularly for hospitalists encountering atypical neurologic presentations.
Fever of Unknown Origin Due to Legionella dumoffii Bioprosthetic Aortic Valve Endocarditis | Annals of Internal Medicine: Clinical Cases
Legionella dumoffii is a rare human pathogen but has been known to cause infective endocarditis. The diagnosis is challenging as this bacterium is difficult to grow in standard culture media. We present a case of a patient with fever of unknown origin (FUO) who was diagnosed with L dumoffii bioprosthetic aortic valve endocarditis using metagenomic next-generation sequencing. After identification of this pathogen and targeted antibiotic treatment, the patient experienced complete resolution of symptoms. Legionella dumoffii infective endocarditis should be considered in patients with FUO and prosthetic heart valves.
Chronic Q Fever Masquerading as Granulomatous Disease: A Diagnostic Challenge | Annals of Internal Medicine: Clinical Cases
Chronic Q fever, caused by Coxiella burnetii, can mimic sarcoidosis and cause diagnostic delays. We report a 45-year-old Iranian man with hypertrophic obstructive cardiomyopathy with implantable cardioverter defibrillator placement, found to have splenomegaly and thrombocytopenia, later developing fatigue, night sweats, weight loss, polyarthralgia, and persistent cytopenia. Lymphoma was initially suspected, but biopsies showed rare noncaseating granulomas. Sarcoidosis was considered. However, symptoms persisted despite corticosteroids. An infectious disease work-up confirmed chronic Q fever. This case underscores the need to include Q fever in the differential of unexplained granulomatous disease, particularly when atypical for sarcoidosis or refractory to immunosuppression.
Acute Polyarthritis With a Finger Wound: Rat Bite Fever From Streptobacillus moniliformis | Annals of Internal Medicine: Clinical Cases
Rat bite fever is a rare cause of acute polyarthritis. Without clinical suspicion, it can be a difficult diagnosis to make, as the bacterium Streptobacillus moniliformis is challenging to culture. This case discusses the course of a patient with significant autoimmune history who was treated with steroids until a synovial fluid culture grew S moniliformis. Once diagnosed, it was determined she owned 4 rats and sustained a bite 3 days before symptom onset. She improved with intravenous antibiotics. Although rare, this diagnosis can be quickly explored with a detailed history of living conditions, occupation, and contact with animals.
Rapid Diagnosis of Capnocytophaga Infection Made by Peripheral Blood Smear | Annals of Internal Medicine: Clinical Cases
Dog bites causing local infection are common but seldom lead to life-threatening complications. We present a case of a 52-year-old woman who presented with septic shock and multiorgan failure after sustaining a dog bite. At presentation, she was in multiorgan failure with a necrotic bite wound on her finger and a petechial rash on her face, arms, and legs. Abdominal imaging revealed asplenia. Her peripheral smear showed rod-like inclusions within neutrophils, consistent with intracellular bacilli. A diagnosis of Capnocytophaga infection was made. She was started on broad-spectrum antibiotics, including piperacillin–tazobactam, and made a full recovery.