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The most comprehensive meeting in Internal Medicine.
April 11-13, 2019
Internal Medicine Meeting 2019
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I'd never felt conflict on so many intellectual levels before. I
didn't want my patient to die, or suffer. I didn't want the
minutiae of the law to keep me from doing what was right or to let
me do something I felt was wrong. I didn't want to burden our
health care system with futile procedures, and I didn't want to
lose my heart. The way I was thinking finally hit me—I was
focused too much on what I didn't want because I was afraid of the
consequences. I needed to figure out what I did want.
I visited a hospital in a small city where the wards
consisted of two large rooms full of hospital beds, one room for
men and the other for women. In these wards, there were no concerns
of Health Insurance Portability and Accountability Act violations
and no thoughts toward maintaining patient privacy. The patients in
these shared wards, in beds just 3 feet apart from each other, had
conditions ranging from pneumonia to dehydration to post-op
recovery. The maternity ward was another large, open room filled
with a mixture of women in labor and new moms who had recently
delivered in the separate, sterile delivery room.
Dr. Ashish Parikh has lived in many diverse places in his life,
including Calcutta; Mumbai, Tallahassee, Los Angeles, and New
Orleans, Louisiana. However, out of all of the places that he has
lived, Dr. Parikh feels the most at home in Livingston, New Jersey,
where he is the Director of the internal medicine residency program
at Saint Barnabas Medical Center. The son of a scientific
researcher, Dr. Parikh and his family moved often. His father
passed along his love of science to Dr. Parikh and inspired him to
pursue a career in medicine. "My father often reminded us that we
should always do more to help people and to go beyond what is
expected of us." While in high school, Dr. Parikh was accepted into
the prestigious Honors Program in Medicine Education at the
University of Miami in Florida, a dual-degree program that allowed
him to receive a both a Bachelor of Science and a Doctor of
Medicine. After completing medical school, Dr. Parikh did his
residency and internship at Miriam Hospital, which is associated
with Brown University in Providence, Rhode Island, where he
received "The Best Teaching Resident Award" two years in a row.
The IMIG at the Paul L. Foster School of Medicine assist the El
Paso County Medical Society with their production of the public
television program The El Paso Physician. This monthly
program provides health information to the community on a wide
variety of topics presented by a panel of local physicians and
Are international experiences valued in a residency application?
What types of international experiences do program directors prefer
to see from an applicant (clinical work abroad, medical courses in
other languages, medical mission trips, etc)? How does an
international experience contribute to a candidate´s overall
From March 26 to 28 the Supreme Court heard oral arguments in
the case against several key elements of the health care reform
law, the Affordable Care Act. The three days of arguments covered
the constitutionality of both the "individual mandate" and Medicaid
expansion that are included in the law. The court is expected to
issue a decision in the case sometime in June.
Felty's Syndrome (FS) is classically defined as a triad of
rheumatoid arthritis, splenomegaly, and neutropenia, and is found
in 1-3% of patients with rheumatoid arthritis. First described in
1924 there are new definitions and concurrent debate over therapy.
There are no randomized control trials on treatment of Felty's
syndrome; current goals of treatment focus on increasing the
neutrophil count, preventing infections, addressing the
splenomegaly, and/or treatment of rheumatoid arthritis
Endocrinology is the diagnosis and care of disorders of the
endocrine system. The principle endocrine problems include goiter,
thyroid nodules, thyroid dysfunction, diabetes mellitus, hyper- and
hypocalcemia, adrenal cortex dysfunction, endocrine hypertension,
gonadal disorders, disorders of sodium and water balance,
manifestations of pituitary disorders, disorders of bone
metabolism, and hyperlipidemia. While not strictly an endocrine
disorder, obesity is considered part of the spectrum of
endocrinology because it often enters into the differential
diagnosis of endocrine disease and is a major element in the
management of type 2 diabetes. Prevention focuses on the
complications of obesity, diabetes, hyperlipidemias, thyroid
disease, and the iatrogenic effects of glucocorticoids.
Diabetic ketoacidosis (DKA), the complication of diabetes
mellitus that causes the greatest risk for death, is characterized
by hyperglycemia and metabolic acidosis due to the accumulation of
ketones from the breakdown of free fatty acids. Treatment requires
hospitalization to correct hyperglycemia as well as serious volume
depletion and electrolyte abnormalities. DKA occurs primarily in
patients with type 1 diabetes mellitus but can also occur in those
with type 2 diabetes. In a multicenter study of nearly 15 000
children and adolescents, DKA was the initial presentation of type
1 diabetes for 21.1%, and this proportion did not change
substantially from 1997 to 2007 (1).
In the Clinic is a monthly feature in Annals of Internal
Medicine that focuses on practical management of patients with
common clinical conditions. It offers evidence-based answers to
frequently asked questions about screening, prevention, diagnosis,
therapy, and patient education and provides physicians with tools
to improve the quality of care. Many internal medicine clerkship
directors recommend this series of articles for students on the
internal medicine ambulatory rotation.
devices offer advantages, challenges
Internists are piecing together technology to improve their
practice management, but too many pieces are more of a puzzle than
a picture. All the new devices ultimately need to lead to better
care, the experts urge.
Matters: Decisional conflict: Balancing risks, benefits for each
A 73-year-old man struggles with the decision to consider
anticoagulation for atrial fibrillation, a "decisional conflict"
that affects many trying to balance risks and rewards of medical
treatments. Doctors should help the patients choose, but then abide
by that decision.
of Care: Take the C-TraIn: Hospital-funded transitions-of-care
program targets underserved patients
Oregon Health & Science University helped improve transitions
by paying community clinics to serve as medical homes for
Clostridium difficile infections on the increase
In 2010 I predicted that Clostridium difficile would become a
household name. C. diff. is a bacterium that infects the colon
causing severe, sometimes life-threatening, diarrhea. C. diff
infection is frequently a complication of antibiotic use.
Antibiotics can kill the normal bacteria in the colon and establish
an opportunity for C. diff to proliferate. After a course of
antibiotics, a person can remain susceptible for a few months, and
subsequent exposure to C. diff, usually in a health care setting,
can lead to infection.