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Displaying 241 - 250 of 7608 in ACP Online

July 17, 2020

In these times of crisis, a community of well-being is increasingly important.

Patients Before Paperwork

The Centers for Medicare & Medicaid Services (CMS) recently posted additional FAQs for the Interoperability and Patient Access Final Rule. ACP was supportive of these efforts, as the FAQs are based on stakeholder feedback and provide current information about the policies included in the final rule.

Noteworthy Resources

Guidance Document: Actions and Activities that a Healthcare Organization Can Take to Support Its Physician Workforce Well-Being During COVID-19 and Beyond Prepared by the APA Committee on the Psychiatric Dimensions of Disaster, this guidance document provides practical measures that health care leaders and organizations can implement to sustainably support physician well-being.

In the News

Civility Saves Lives—The Impact and Importance of Civility in the Workplace By Joe Farmer and Penny Hurst On the Wards Blog, Australia

From the Trenches

Responding to Harassment and the Impact on Physician Wellness By Anne L. Becker, MD The elderly man approached me in the clinic hallway; pointed at my name badge; and said, “That says ‘Physician.’ You must have stolen that from someone!” As a woman physician, I am assumed to be not-a-doctor on a regular basis, and I felt a familiar swirling of emotions—confusion and disbelief, followed quickly by irritation and disgust—in response to his “joke.”

ACP Webinars

Back to Basics—Preventing Burnout, Building Trust, and Coping With the EMR Mark Linzer, MD, MACP, and Sara Poplau

July 16, 2021

January 18, 2019

Announcements Dear ACP Well-being Champions:

Patients Before Paperwork

Over the years, the federal government has prioritized initiatives to improve the electronic exchange of health information and ensure that a patient's health information follows the patient across the health care continuum. ACP has been supportive of these goals and believes improved interoperability across the entire health care continuum will ultimately help decrease a lot of existing burden. However, it is not feasible for physicians to expend the time and resources necessary to become compliant with the recent health information sharing regulations given the ongoing COVID-19 pandemic.

Noteworthy Resources

Bibliotherapy Virtual Book Club Join your ACP colleagues and friends for a virtual book club! In January, the club is reading Quackery: A Brief History of the Worst Ways to Cure Everything by Lydia Kang, MD and Nate Peterson, with a Zoom discussion on January 31, 2021, at 5 p.m. EST. Discover what we can learn from wild, comical, and dangerous medical treatments prescribed by doctors in the past.

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Displaying 241 - 250 of 500 in Annals of Internal Medicine: Clinical Cases

Navigating Through the Complications of Chronic Immunosuppression in Transplant Patients | Annals of Internal Medicine: Clinical Cases

The advent of organ transplantation has given hope to patients with end-stage organ failure. Allograft rejection is a transplant complication and remains a significant cause of transplant-related morbidity and mortality. Successful transplantation is achieved with immunosuppression, and the discovery of newer immunosuppressive agents has provided transplant physicians with more effective medications in preventing allograft rejection. On the flip side, long-term immunosuppression is fraught with complications such as predisposition to infections, malignancies, and cardiovascular diseases. The patient presented in the case report developed a transplant-related lymphoma many years after his kidney and pancreatic transplant. Primary care providers should be aware of these complications and educate their patients on measures to prevent some of them.

A Case of Neisseria sicca Bacteremia Due to Eculizumab Therapy | Annals of Internal Medicine: Clinical Cases

Eculizumab is a monoclonal antibody indicated for the treatment of complement-mediated disorders. Despite its utility, eculizumab increases risk for infection with Neisseria species, owing to membrane attack complex inhibition. Although this naturally evokes thought of infection with N meningitidis, other Neisseria species also benefit from membrane attack complex disruption. N sicca is a commensal organism that is typically considered nonpathogenic. Here, we describe a case of N sicca bacteremia in a patient receiving eculizumab for atypical hemolytic uremic syndrome and seek to elucidate limitations to current prophylactic recommendations for patients receiving anticomplement therapy.

Cryptococcal Meningoencephalitis in an HIV-Negative Host Infected With COVID-19: A Case Report | Annals of Internal Medicine: Clinical Cases

We report a rare case of cryptococcal infection in an immunocompetent adult who initially presented with altered sensorium and acute COVID-19 infection. The suspected diagnosis was encephalopathy due to pneumonia; however, the patient developed new neurologic deficits, warranting further investigation, which revealed cryptococcal meningoencephalitis. HIV testing was negative, but CD4 lymphocytopenia was seen, which resolved after treatment for both COVID-19 and cryptococcal meningoencephalitis. This case illustrates the importance of considering uncommon scenarios in which an opportunistic infection such as cryptococcal meningoencephalitis may present. It also demonstrates the need to frequently consider alternative diagnoses, particularly in the pandemic era.

Colitis Associated With Sevelamer Carbonate: A Case Report | Annals of Internal Medicine: Clinical Cases

Sevelamer carbonate is an anion-exchange, nonabsorbable resin that is commonly used to treat hyperphosphatemia in patients with advanced chronic kidney disease and end-stage renal disease. It is generally well-tolerated with only mild gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and constipation. There have been few case reports of gastrointestinal mucosal injury resulting from sevelamer crystal deposition. The severity of presentation varies from acute inflammation to polyp formation, necrosis, ulceration, and intestinal perforation. We report a 77-year-old woman with end-stage renal disease who was found to have mucosal injury from sevelamer crystal deposition resulting in colitis and ulceration.

A Case of Gigantic Unruptured Abdominal Aneurysm Successfully Treated With Endovascular Repair (EVAR) | Annals of Internal Medicine: Clinical Cases

Aortic aneurysms are focal dilations of more than 50% the normal aortic diameter; giant abdominal aortic aneurysms (AAAs) have diameters greater than or equal to 10 cm and are rare clinical entities. We present a case of an elderly man with an AAA with a 14.6-cm diameter, treated successfully with endovascular repair (EVAR). AAAs pose anatomical challenges for EVAR because of their narrow necks, extreme angulation, and dislocation of intra-abdominal organs. A literature review shows only 5 EVARs have been attempted for the repair of giant AAAs; 4 were successful. With the technical advancement and careful patient selection, successful EVAR of giant AAAs is possible.

Blastic Plasmacytoid Dendritic Cell Neoplasm Mimicking Erythema Nodosum: A Case Report | Annals of Internal Medicine: Clinical Cases

Blastic plasmacytoid dendritic cell neoplasm (BPDCN), previously known as blastic natural killer cell lymphoma, is a rare, difficult-to-diagnose, and aggressive hematologic malignancy. Skin lesions are the initial presentation of BPDCN in 64% to 77% of cases, characterized by brown to purple nodular or bruised macular lesions in solitary or multiple locations. Here, we report the case of a 57-year-old man who initially presented with refractory erythema nodosum symptoms, including fever, arthritis, and painful erythema, and was finally diagnosed with BPDCN after a second skin biopsy. This case illustrates that skin lesions caused by BPDCN mimic ordinary erythema nodosum.

Weakness and Paraparesis: A Common Presentation of the Rare Retrovirus HTLV | Annals of Internal Medicine: Clinical Cases

Limited knowledge exists about human T-lymphotropic virus and its many subtypes, various clinical presentations, devastating sequelae, and potential treatment options. In this case, a 62-year-old woman of Haitian descent presented with a constellation of generalized neurologic symptoms that progressed during an 8-month period and left her bedridden. Although no substantial treatment or cure currently exists, prompt diagnosis of human T-lymphotropic virus is crucial to initiate administration of steroids to both decrease the likelihood of clinical sequelae and help slow the progression of the disease.

Cold Agglutinin Disease–Associated Transient Ischemic Attack, Non-ST Elevation Myocardial Infarction, and Skin Necrosis: A Case Report | Annals of Internal Medicine: Clinical Cases

Cold agglutinin disease is a rare autoimmune hemolytic anemia that preferentially affects female patients and is more common in those older than 60 years. The pathophysiology involves IgM autoantibodies against erythrocytes in areas of the body at cooler temperatures, causing thrombosis and hemolysis. We present the case of a 66-year-old man who was found to have cold agglutinin disease and initially presented with altered mental status, stroke-like symptoms, and non-ST elevation myocardial infarction. Overnight, he also developed striking soft-tissue necrosis of his bilateral feet due to microvascular occlusion. His altered mentation and cardiac ischemia completely resolved; however, he eventually required bilateral phalangeal amputation.

Survival After Ruptured Spontaneous Hepatic Subcapsular Hematoma Following Heparin Initiation for Submassive Pulmonary Embolism | Annals of Internal Medicine: Clinical Cases

Hepatic subcapsular hematomas (HSHs) are rare outside the context of trauma, endoscopic retrograde cholangiopancreatography, and pregnancy. Ruptured HSHs present with abdominal pain and hypotension, with high mortality. We present the patient case of a 69-year-old man readmitted with deep venous thrombosis and pulmonary embolus after uncomplicated laparoscopic prostatectomy. Soon after receiving heparin, he experienced acute abdominal distention and right upper quadrant pain. A large ruptured subcapsular hematoma with focal active bleeding was identified and eventually controlled surgically. We highlight that HSHs can complicate anticoagulant therapy. Awareness and prompt intervention can be lifesaving.

Page Kidney From Ruptured Mycotic Pseudoaneurysm of Renal Artery: An Unusual Complication of Infective Endocarditis | Annals of Internal Medicine: Clinical Cases

Page kidney is an uncommon but potentially reversible cause of secondary hypertension characterized by external compressive force leading to renal hypoperfusion and elevated renin level. Renal artery mycotic aneurysms from infective endocarditis are exceedingly rare. The most feared complication is rupture, which can result in subcapsular hematoma and Page kidney. Early recognition and treatment are crucial to preserving renal function. Imaging and clinical findings aid diagnosis. Angiotensin-converting enzyme inhibitors are usually the first-line treatment of hypertension. Here, we present a rare patient case of ruptured mycotic pseudoaneurysm of the renal artery that complicated infective endocarditis and resulted in Page kidney.

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