In the News

White House Summit on Arts and Culture Earlier this year, the White House held the first ever summit on arts and culture in Washington, DC. "Music," said U.S. Surgeon General Dr. Vivek Murthy, "can, in a matter of seconds, make me feel better ... I've prescribed a lot of medicines as a doctor over the years. There are few I've seen that have that kind of extraordinary, instantaneous effect." Read here!

How We Show Up

By Hugo Davila Grijalva, MD, FACP

From the Trenches

Learn the importance of: "Conquering Imposter Syndrome" Read about how Dr. Kerry Palomara, ACP Well-being expert, uses physician peer coaching to alleviate imposter syndrome. Read here! "How We Show Up" By current Michigan Chapter WBC and Mindfulness-Based Stress Reduction teacher Dr. Hugo Davila.

July 19, 2024

Patients Before Paperwork

Patients Before Paperwork Update:

Noteworthy Resources

New! Group Coaching for ACP Well-being Champions

New ACP Webinars

Resident Well-being During the COVID-19 Pandemic Irene Alluen-Metzner, MD, FACP; Suja Mathew, MD, FACP; Benjamin Mba, MBBS, FACP Wednesday, July 22, 2020, 3:00–4:00 p.m. ET

In the News

“Doctors are Covid's First Historians,” The New York Times By Ron Suskind, Illustrations by Lilli Carré, June 12, 2020 Over 40 physicians from NewYork–Presbyterian and Massachusetts General Hospital recorded 10-minute conversations with colleagues discussing their experiences, fears, and hopes as they battle the COVID-19 pandemic.

From the Trenches

Moving Professionalism and Wellness Into the Formal Residency Curriculum By Arielle Berger, MD, ACP Well-being Champion, Ontario

The Consult Guys - CHADS, SHMADS: What's All This About Anticoagulation?

The Consult Guys - VTE: Is There Cancer?

Patient Outcomes After Bone Marrow Transplant

Testosterone Treatment in Adult Men With Age-Related Low Testosterone

Altered Risk for Cardiovascular Events With Changes in the Metabolic Syndrome Status

Colorectal Cancer Screening in Average-Risk Adults

The Effect of Technology-Based Coaching on Maintenance of Weight Loss

Rivaroxaban Versus Vitamin K Antagonist in Antiphospholipid Syndrome

High-Intensity or Low-Intensity Surveillance for Patients With Colorectal Tumors

Menopausal Estrogen-Alone Therapy and Health Outcomes in Women With and Without Bilateral Oophorectomy

New ACP position paper addresses ethics in long-term care

New ACP MKSAP CORE helps users demonstrate continuous learning

Stroke risk higher in Black women with history of gestational diabetes

MKSAP Quiz: Follow-up evaluation for thrombocytopenia

Surgical, medical options offered similar outcomes for women with urinary incontinence

Confirmatory testing for primary aldosteronism can misinform care

Put words in our mouth

Correction to “Drug Reactions a Risk with NOAC Treatment for Afib”

New ACP paper advises on how to be effective advocates through collective action

Opioid dose escalation, rapid tapering associated with all-cause mortality in older patients

Remote patient monitoring offered by almost half of U.S. hospitals in 2022 | ACP Hospitalist

Oral antibiotics may be suitable for more complex patients with infective endocarditis | ACP Hospitalist

Lateral positioning reduced hypoxemia in sedated patients, Chinese trial finds | ACP Hospitalist

Hot times | ACP Hospitalist

Take a quiz about the Aug. 13 issue! | ACP Hospitalist

Postdischarge intervention for sepsis patients had mixed results, trial finds | ACP Hospitalist

Diagnose dizziness | ACP Hospitalist

Dalbavancin similar to standard care for complicated S. aureus bacteremia | ACP Hospitalist

Continuing immunosuppressive drugs when sick didn't change risk of serious infection | ACP Hospitalist

Atrial natriuretic peptide levels may help predict readmission risk in HF | ACP Hospitalist

Janeway Lesions as a Manifestation of Aortic Graft Abscess | Annals of Internal Medicine: Clinical Cases

A 39-year-old man with history of intravenous drug use presented with fevers and back pain. Physical examination revealed multiple painless, small, hemorrhagic macules on the left plantar surface consistent with Janeway lesions. Janeway lesions were likely secondary to embolic sequelae of infected aortic graft without evidence of classical endocarditis, as vegetations were excluded on transesophageal echocardiogram.

Elderly Brothers With Fabry Disease Exhibiting Cardiac and Renal Manifestations | Annals of Internal Medicine: Clinical Cases

Fabry disease (FD) is an X-linked disorder resulting in α-galactosidase A activity deficiency. Late-onset FD, especially in elderly patients without classical symptoms, is difficult to diagnose, with manifestations that resemble natural aging. We report late-onset FD in elderly brothers who showed left ventricular hypertrophy (LVH) with arrythmia. Only the younger brother had chronic kidney disease, but kidney sections from both showed significant glycosphingolipid deposition. LVH is most frequent in elderly patients with FD, leading to an earlier diagnosis and treatment. FD should be considered in all patients with LVH, even at older age, given the presence of a late-onset variant.

Amyopathic Dermatomyositis Manifesting With Marked Unilateral Eyelid Swelling and Hyperpigmentation in a Darker Skin Tone | Annals of Internal Medicine: Clinical Cases

A 56-year-old man presented to the emergency department with unilateral eyelid swelling, a hyperpigmented rash, and no myositis. His physical examination showcases the variable presentation of classic dermatomyositis skin manifestations in darker skin. Dermatomyositis is an uncommon disease characterized by proximal muscle weakness and classic dermatologic manifestations. In amyopathic disease, the diagnosis relies on the identification of dermatologic findings, in which variation in manifestations can lead to delays in diagnosis and increased health disparities.

RS3PE: A Rheumatic Presentation of Lung Malignancy | Annals of Internal Medicine: Clinical Cases

We describe a previously well 56-year-old man who presented with symmetrical inflammatory polyarthralgia associated with bilateral lower limb swelling and left hand puffiness. He had noticed blood steaks in his productive cough for half a year but reported no constitutional symptoms. Inflammatory markers were elevated, whereas rheumatoid factor was negative. Imaging of the chest showed a mass in the right upper zone, which was confirmed via biopsy to be ALK-positive lung adenocarcinoma. The patient was diagnosed with paraneoplastic remitting seronegative symmetrical synovitis with pitting edema, representing one of the first descriptions of lung adenocarcinoma–associated RS3PE.

Cachexia and Diffuse “Fish-Scale” Skin | Annals of Internal Medicine: Clinical Cases

Ichthyosis is marked by dry, thickened, scaly skin. It may be genetic or acquired. Importantly, it may be a cutaneous manifestation of an underlying malignancy. Here, we present a striking case of paraneoplastic ichthyosis.

Massive Left Ventricular Aneurysm After Inferior Infarction | Annals of Internal Medicine: Clinical Cases

True ventricular aneurysm is a rare complication of myocardial infarction. After a 53-year-old man presented late with an inferior ST-segment elevation myocardial infarction, he was found to have a massive posterobasal left ventricular aneurysm. Cardiac magnetic resonance imaging volumetric analysis highlighted the hemodynamic significance of the aneurysm. As the result of persistent symptomatic heart failure, the patient underwent surgical resection of the aneurysm and placement of a pericardial patch with excellent results at follow-up.

Massive Empyema With Edwardsiella tarda in a Patient With Liver Cirrhosis | Annals of Internal Medicine: Clinical Cases

Although infection caused by Edwardsiella tarda is rare in humans, it can be fatal if contracted. A 78-year-old man with liver cirrhosis who ate raw fish on a regular basis was emergently admitted for treatment of septic shock. Computed tomography scan showed massive empyema in his right lung. The patient was diagnosed with septic shock with empyema caused by E tarda after a positive blood culture and drainage culture from the empyema. His condition improved with multidisciplinary therapy. However, the patient died 36 days after admission because of liver failure. We recommend that patients with liver cirrhosis should avoid raw fish.

Paraneoplastic Myositis in a Patient With Extrahepatic Cholangiocarcinoma: A Case Report | Annals of Internal Medicine: Clinical Cases

Paraneoplastic myositis associated with cholangiocarcinoma is an extremely rarely reported phenomenon. Here, we present a case of paraneoplastic myositis resulting in acute renal failure in a patient who presented with a pancreatic mass that was ultimately diagnosed as an extrahepatic cholangiocarcinoma. This case demonstrates that paraneoplastic myositis has the potential to cause severe complications and that initiation of glucocorticoid therapy may be an essential component of treatment of these patients.

Apathetic Thyrotoxicosis Presenting With New-Onset Pulmonary Hypertension | Annals of Internal Medicine: Clinical Cases

Apathetic thyrotoxicosis is a distinct clinical entity of hyperthyroidism that occurs in elderly patients. Manifestations include depression, weight loss, mild tachycardia, and symptoms of heart failure. Noteworthy is the absence of typical hyperkinetic motor symptoms. Pulmonary hypertension is an often-overlooked manifestation of thyrotoxicosis. Here, we present a case of a 67-year-old woman who presented to the clinic with complaints of dyspnea on exertion, orthopnea, leg edema, and 20-lb weight loss. Further work-up revealed pulmonary hypertension with thyrotoxicosis, without the typical sympathetic symptoms. After achieving a euthyroid state with methimazole therapy, she experienced resolution of her symptoms, and her pulmonary artery pressures normalized.

Mpox-Associated Pneumonia: A Case Report | Annals of Internal Medicine: Clinical Cases

Mpox classically presents with a prodrome of fevers and chills followed by a characteristic rash 3 to 4 days later, and self resolves within 2 to 4 weeks. We present a patient case of atypical mpox complicated by left lower lobe pneumonia, severe headaches, and photophobia in addition to the classic rash. These atypical features could play a role in guiding treatment with antiviral drugs such as tecovirimat.