November 18, 2022

Well-being Champion Resources That Facilitate Networking and Interventions

Patients Before Paperwork

New ACP Toolkit Empowers Members to Lobby for Prior Authorization Reform Members can use the toolkit to learn about the policy landscape and take action to help advocate for reform at the state and federal levels. View Here! Keep Up to Date:

Noteworthy Resources

Chapter Collaborations (ACP LeaderNet Access Required) This resource is to assist you in working with your chapter's leadership to reflect on where your chapter is, where it would like to elevate to, and how a strategic collaboration could help you achieve that vision.

In the News

Addressing Patient Bias Toward Health Care Workers: Recommendations for Medical CentersBy Kimani Paul-Emile, JD, PhD; Jeffrey M. Critchfield, MD; Margaret Wheeler, MS, MD; Shalila de Bourmont, BS; and Alicia Fernandez, MDThis article offers guidance to organizations on devising effective policies that meet the needs of medical centers, patients, and health care workers across services and roles, including physicians, nurses, and trainees.

From the Trenches

Congratulations! ACP Award for Outstanding Contributions to Improving Well-being and Professional Fulfillment in Internal Medicine Mukta Panda, MD, MACP Chattanooga, Tennessee WBC Emeritus

ACP Multimedia Education

Well-being Champion Training: Data This module explains gathering and analyzing well-being data, followed by discussion and example interventions you can consider. View Here (Must be logged in to ACP Online to access.)

November 17, 2023

Professional Fulfillment Zone

Want to take your WBC training to the next level?

Patients Before Paperwork

Advocacy in Action ACP Updates Its Climate Change and Health Toolkit The American College of Physicians is renewing its call to members to help mitigate the effects of climate change and educate others on how to do the same. Click below to download the toolkit. View here!

Noteworthy Resources for Well-being

ACP: Design Your Own Well-being Program Explore these tools to create a well-being program tailored to any organization's needs and budget. View here!

Continuous Glucose Monitoring in Patients With Type 2 Diabetes

Different Effects of Screening on Prostate Cancer Death in Two Trials

Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults

Is Coffee Consumption Associated With Lower Risk for Death?

Whole-Genome Sequencing in Primary Care

Yoga, Physical Therapy, or Education for Chronic Low Back Pain

Treatment of Low Bone Density or Osteoporosis to Prevent Fracture

Prevalence of Elevated Cardiovascular Risks in Young Adults

Cardiometabolic Abnormalities Among Normal-Weight Persons From Five Racial/Ethnic Groups in the United States

Relationship Between Weight History and Risk for Death

Guidance issued on providing high-value, low-carbon care

MKSAP Quiz: Progressive head tremor

Screening for breast, colorectal cancer rebounded after COVID-19

For bacterial vaginosis, concurrent male partner treatment lowers recurrence rates

Vote for your favorite entry

Physician visits decreased from 2010 to 2021, study finds

Patients with disabilities report feeling disrespect from health care professionals

MKSAP Quiz: Evaluation in the ED for hematemesis

Longer counseling improved tobacco abstinence in older patients screened for lung cancer

New guidance issued on acute coronary syndromes

Craving continuity | ACP Hospitalist

Bartonella quintana endocarditis presenting as heart failure | ACP Hospitalist

Age at first HF hospitalization varies by race, ethnicity | ACP Hospitalist

The aquatic hospitalist | ACP Hospitalist

Take a quiz about the Aug. 20 issue! | ACP Hospitalist

Risk score predicts contrast-associated AKI before CT | ACP Hospitalist

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

Drug-Induced Interstitial Lung Disease From PARP Inhibitors (Olaparib and Niraparib) for Ovarian Cancer | Annals of Internal Medicine: Clinical Cases

Poly (ADP-ribose) polymerase (PARP) inhibitors are approved for the treatment of several types of cancers. We report a case of an 80-year-old Japanese woman who developed drug-induced interstitial lung disease (ILD) during treatment with PARP inhibitors (olaparib and niraparib) for ovarian cancer. Bronchoalveolar lavage revealed elevated lymphocytes and eosinophils with no pathogens or malignant cells. After treatment with prednisolone, PARP inhibitor–induced ILD improved. This patient case suggests that PARP inhibitor–induced ILD may be caused by allergic processes with cross-reactivity between PARP inhibitors. Therefore, although further studies are required, switching to another PARP inhibitor in patients with PARP inhibitor–induced ILD should be carefully considered.

Reversible Improvement of Arterial Stenosis and Wall Thickness in Takayasu Arteritis Through Treatment With Tocilizumab | Annals of Internal Medicine: Clinical Cases

Early diagnosis and initiation of treatment in Takayasu arteritis (TA) is important to prevent irreversible arterial changes. A 39-year-old female was diagnosed with active TA. Subcutaneous administration of tocilizumab (162 mg/week) was initiated in combination with prednisolone (30 mg/d). After 21 months, the carotid arterial stenosis and wall thickness had normalized with only slight plaque on echocardiography. After 23 months, computed tomography showed normalization of the overall aortic stenosis and wall thickness. The prednisolone dosage could be reduced to 2 mg/d without relapse for >2 years. Early combination treatment of TA with tocilizumab prevented and normalized vascular stenosis and wall thickness.

Abdominal Pain, Conjunctival Icterus, and Melena in a Man With Recent Endocarditis | Annals of Internal Medicine: Clinical Cases

Gastrointestinal bleeding is a common clinical entity associated with substantial morbidity and mortality. Upper gastrointestinal hemorrhage in particular requires swift recognition and management, and additionally engenders a broad differential diagnosis. Although rare, hemobilia, bleeding from or into the biliary tract, is an important diagnosis to consider at the bedside because of its unique risk factors, as well as diagnostic and therapeutic considerations. Here, we describe the clinical presentation of a man with hemobilia, highlighting key contemporary risk factors, diagnostic modalities, and therapeutic interventions.

Brownish-Yellow Layering on Skin—an Unusual Manifestation of Cutaneous Aspergillosis in a Heart Transplant Recipient | Annals of Internal Medicine: Clinical Cases

An unusual cutaneous manifestation of aspergillosis in an immunocompromised patient in which Aspergillus terreus grew on the necrotic skin, creating a brownish-yellow layer of fungal growth, is reported.

A Rare Case of Kleine–Levin Syndrome Following COVID-19 | Annals of Internal Medicine: Clinical Cases

A wide variety of neuropsychiatric manifestations have been reported with COVID-19. We present a case of a 45-year-old man who developed significant hypersomnia and hypersexual thoughts following COVID-19 illness. Further evaluation did not reveal any other infection, structural brain disease, or stroke, leading us to consider Kleine–Levin syndrome as a diagnosis of exclusion. However, a confirmed diagnosis of this syndrome cannot be made on initial presentation, and its formal diagnosis requires recurrence of symptoms. Although relapses of this syndrome are known to be triggered by viral illnesses, no primary occurrences have been reported with COVID-19 to date.

Opsoclonus-Myoclonus Syndrome Possibly Associated With Mumps Infection | Annals of Internal Medicine: Clinical Cases

Opsoclonus-myoclonus syndrome (OMS) is an infrequent yet serious neurologic entity related to neoplastic, infectious, toxic, and metabolic diseases. In recent years, OMS associated with multiple infections have been reported. In contrast to neoplastic and autoimmune etiologies, OMS from infectious diseases occurs in younger patients and has a favorable outcome. Though the data are limited, the use of corticosteroids and immunotherapy remain the treatments of choice for the management of OMS symptoms. We present a patient case of OMS possibility associated with mumps virus in an immunocompetent young adult who was successfully treated with steroids.

Plasma Cell Myeloma With Lymphoplasmacytic Morphology and Negative CD138 Expression: Case Report and Differential Diagnosis | Annals of Internal Medicine: Clinical Cases

Plasma cell neoplasms may have variable morphologic and immunophenotypic features. This patient case demonstrates a rare presentation of plasma cell myeloma with negative CD138 expression and lymphoplasmacytic morphology. In this report, we discuss the possible differential diagnosis and highlight the importance of a comprehensive diagnostic approach including flow cytometry, immunohistochemistry, and molecular studies to arrive at the correct diagnosis.

Recurrent Cryptogenic Stroke in a Young Woman: Congenital Thrombotic Thrombocytopenic Purpura Unmasked | Annals of Internal Medicine: Clinical Cases

Cryptogenic stroke of undetermined cause should warrant an exhaustive neurologic and cardiovascular workup. If no cause is identified, additional investigations should be individualized on the basis of clinical history and objective findings. Herein, we present the case of a young patient with a personal and family history of cryptogenic stroke who was investigated for thrombophilia. Transient thrombocytopenia and peripheral blood schistocytes led to an eventual diagnosis of congenital thrombotic thrombocytopenic purpura, which is characterized by vaso-occlusive end-organ complications. The diagnosis is confirmed by undetectable ADAMTS13 (a disintegrin and metalloproteinase with thrombospondin type 1 motifs, member 13) activity.

Cutaneous Scrotal Metastasis Secondary to Primary Prostate Adenocarcinoma Responding to Immunotherapy | Annals of Internal Medicine: Clinical Cases

This case demonstrates the aggressive progression of prostate adenocarcinoma, failing 3 treatment regimens. Although the patient initially responded to treatments, he developed cutaneous metastasis. Genomic tumor analysis of scrotal tissue confirmed targetable molecular mutations. Treatment with systemic immunotherapy was initiated with complete resolution of disease. This case reveals the rare metastasis of prostate adenocarcinoma to the scrotum with advanced refractory cancer and the successful response to immunotherapy. It illustrates the importance of tumor genomic testing in advanced refractory prostate cancer.

Lymphomatoid Granulomatosis Presents With Nodal and Bone Marrow Invasion: A Case Report and Literature Review | Annals of Internal Medicine: Clinical Cases

Lymphomatoid granulomatosis (LYG) is a rare lymphoproliferative disease driven by Epstein-Barr virus (EBV) infection. It is characterized by pulmonary involvement; however, nodal and bone marrow invasion are very rare. Tissue biopsy is the cornerstone of diagnosis. To our knowledge, this is the first case of LYG presenting with nodal, spleen, and bone marrow invasion on initial work-up. Imaging suggested nodal and marrow site invasion along with classical lung lesions. Biopsy and immunoprofile confirmed EBV+ B-cell lymphoma, which is diagnostic of LYG grade 3. The patient responded to chemotherapy for this high-grade disease.