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Displaying 151 - 160 of 7509 in ACP Online

How to Create a Clinician Wellness Committee

Creating a wellness committee is a concrete first step an organization can take to foster a culture of clinician wellness. Clinician well-being is not only critical to enhancing patient safety, but plays an important role in recruiting and retaining physicians. Stress in the medical workplace is generated by:

Financial Well-being Program | Professional Fulfillment | ACP

ACP is helping physicians plan with tools to secure financial well-being. Topics include paying off student debt, retirement savings, & every life event in between.

Design Your Own Well-being Program

Explore these tools to create a well-being program tailored to any organization’s needs and budget.

Advocacy Toolkit: Modernizing License and Credentialing Applications to Not Stigmatize Mental Health

Published 9/30/24

Well-being Champion Celebration Event

Well-being Champion Celebration Event PowerPoint Slides

WBC and Leadership

Uncertainty

Time Management Strategies

Taking Care of Ourselves

Storytelling for Advocacy

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Displaying 151 - 160 of 500 in Annals of Internal Medicine: Clinical Cases

A Case of Heavy Chain Neuronal Intermediate Filament Autoimmune Encephalitis | Annals of Internal Medicine: Clinical Cases

A 66-year-old woman presented with 2 days of confusion, poor balance, and a recent ground level fall. She exhibited lower extremity weakness, urinary retention, and upper extremity resting tremor with cogwheel rigidity. Extensive work-up for electrolyte, infectious, and rheumatologic pathologies was unremarkable, and she was ultimately found to have heavy chain neuronal intermediate filament (NIF-H) antibodies in the cerebrospinal fluid, supporting a diagnosis of NIF autoimmune encephalitis (AE). An increased awareness of AE and a high index of suspicion are key to prompt diagnosis and treatment. If diagnosed, cancer screening is recommended, because AE can be a paraneoplastic process.

Acute Rheumatic Fever Presenting With Isolated Myocarditis and Right Coronary Artery Occlusion | Annals of Internal Medicine: Clinical Cases

Acute rheumatic fever (ARF) traditionally presents with carditis, usually involving valvulitis. This case report describes a 22-year-old man with an atypical ARF presentation: isolated myocarditis and coronary artery occlusion. He presented with chest pain and signs of cardiogenic shock. Initial electrocardiogram and elevated cardiac biomarkers led to a diagnosis of acute myocardial infarction due to 100% right coronary artery occlusion, which was managed with wire-based thrombus removal. Further work-up revealed elevated antistreptolysin-O titers and cardiac magnetic resonance imaging consistent with myocarditis. This case highlights an occurrence of such an unusual presentation of ARF.

Bouveret Syndrome: Excavating a Unique Geode-Like Gallstone With White Crystal Inner Core From Duodenum | Annals of Internal Medicine: Clinical Cases

Bouveret syndrome is a rare complication of cholelithiasis where a gallstone creates a cholecystoduodenal fistula resulting in gastric outlet obstruction. We present a case of a 66-year-old man with Bouveret syndrome with unique stone characteristics, which was successfully extracted using electrohydraulic lithotripsy during endoscopic retrograde cholangiopancreatography. The stone had an unusual appearance of a white crystal inner core surrounded by a dark brown covering resembling a geode.

Isolated Right Ventricular Myocardial Infarction Due to Coronary Artery Embolism | Annals of Internal Medicine: Clinical Cases

We report a rare case of isolated right ventricular myocardial infarction (RVMI) due to coronary artery embolism in a 64-year-old man. Emergent coronary angiography revealed a normal dominant left coronary artery and a nondominant right coronary artery with proximal occlusion. Thrombus aspiration achieved complete recanalization, and no additional procedures, such as ballooning or stenting, were performed. Intravascular ultrasound, thallium/pyrophosphate dual scintigraphy, cardiac magnetic resonance imaging, and pathologic findings established the diagnosis of isolated RVMI due to coronary artery embolism.

Pneumocystis Pneumonia and Hypercalcemia: An Underrecognized and Atypical Feature of a Common Opportunistic Infection | Annals of Internal Medicine: Clinical Cases

Pneumocystis pneumonia (PCP) is a common opportunistic infection that presents as acute hypoxemic respiratory failure with fever and respiratory distress in immunocompromised patients. However, the diagnosis of PCP can be difficult to confirm, emphasizing the importance of recognizing atypical features of infection. This article describes three cases of PCP presenting with parathyroid hormone–independent hypercalcemia in patients receiving immunosuppressive medications for autoimmune conditions. These patients did not meet established criteria for prophylaxis before presentation. In each case, patients’ hypercalcemia resolved with empirical treatment of PCP. These cases affirm the relationship between PCP and hypercalcemia in patients without obvious risk factors.

Pathology-Proven Cerebral Amyloid Angiopathy in a Patient With Spontaneous Intracerebral Hemorrhage | Annals of Internal Medicine: Clinical Cases

Cerebral amyloid angiopathy (CAA)–related intracerebral hemorrhage (ICH) accounts for 20% of spontaneous ICH. Results of brain magnetic resonance imaging (MRI) support the clinical diagnosis of suspected CAA and help predict future ICH. Here, we report an interesting case in which the MRI brain imaging demonstrated a left temporal ICH with no underlying mass and no evidence suggestive of amyloid angiopathy. Surgical evacuation of the hemorrhage was performed and histology was consistent with CAA. This case is noteworthy because the diagnosis of CAA was unsuspected owing to the absence of MRI brain findings as per Boston criteria 2.0.

Polyarticular Septic Arthritis From Streptococcus pneumoniae Infection in an Immunocompetent Adult: A Case Report | Annals of Internal Medicine: Clinical Cases

Polyarticular septic arthritis is a condition with significant morbidity and mortality that is rarely seen in immunocompetent adults. We report a case of a 73-year-old man presenting with a 2-day history of polyarthralgia involving bilateral shoulders, elbows, wrists, knees, and ankles with rigours and chills, initially treated as reactive arthritis and subsequently found to have Streptococcus pneumoniae bacteremia. Bilateral knee aspirations were performed for worsening arthritis despite antibiotics, revealing polyarticular septic arthritis that required bilateral arthroscopic washouts. This case illustrates the diagnostic challenges surrounding polyarticular septic arthritis and emphasizes the importance of timely recognition and treatment.

Hepatic Myelopathy: A Rare Complication of Chronic Liver Failure Treated Conservatively Without Liver Transplantation | Annals of Internal Medicine: Clinical Cases

Hepatic myelopathy (HM) diagnosis requires the exclusion of other causes of spastic paraparesis and typically presents in the setting of recurrent hepatic encephalopathy. Pathophysiology involves toxin accumulation, particularly ammonia, leading to astrocyte swelling and demyelination of the corticospinal tract. While nonpyramidal symptoms can be reversible with treatment, spastic paraparesis may not always respond. Liver transplant is considered a definitive treatment, but outcomes vary. Early intervention and monitoring of ammonia levels in patients with known portosystemic shunts may reduce irreversible HM cases. Recognizing HM in patients with spastic paraparesis and liver disease is crucial for timely intervention and potentially reversing symptoms.

Pneumocystis jirovecii Pneumonia Following Initiation of 15 mg Prednisone Daily | Annals of Internal Medicine: Clinical Cases

A 74-year-old man with chronic obstructive pulmonary disease presented with acute dyspnea and rapidly progressed to hypoxic respiratory failure requiring high levels of noninvasive mechanical ventilation. Three months prior, he was administered prednisone, 15 mg daily for polymyalgia rheumatica. He was subsequently found to have Pneumocystis jirovecii pneumonia, an uncommon infection in the absence of severe immunosuppressive conditions or steroid doses greater than or equal to 20 mg, prednisone daily. The initiation of Pneumocystis jirovecii pneumonia prophylaxis at lower steroid doses is controversial but should be considered in patients with multiple risk factors.

Infective Endocarditis Caused by Fusobacterium nucleatum and Slackia exigua Secondary to Poor Oral Health | Annals of Internal Medicine: Clinical Cases

Infective endocarditis caused by anaerobes may be underrecognized. Here, we report a case of polymicrobial anaerobic infective endocarditis secondary to poor oral health. A 79-year-old man presented with fever, trismus, and a painful swollen jaw. Evaluation revealed pulmonary septic embolism, osteomyelitis, and vegetation on the mitral valve. Fusobacterium nucleatum and Slackia exigua were identified in blood cultures. He was diagnosed with infective endocarditis and was successfully treated with antimicrobials. This highlights the importance of promptly identifying systemic infections even in apparent odontogenic infections. Clinicians should be aware of severe infections caused by oral anaerobes and the importance of maintaining oral health.

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