New ACP Webinars

Well-being Champion Webinar: Enhancing Well-being Through Organizational Change Lisa Rotenstein, MD March 26, 2021, 2:00–3:00 p.m. ET

In the News

“A Call to Action: Align Well-being and Antiracism Strategies” By Eileen Barrett, MD, MPH, MACP; N. Mariam Salas, MD; Charlene Dewey, MD, MEd, MACP; Jonathan Ripp, MD, MPH, ACP Member; and Susan Thompson Hingle, MD, MACP ACP Internist

From the Trenches

By Mark Linzer, MD, MACP, and Sara Poplau, Hennepin Healthcare, Minneapolis Coping With COVID: Early Data, Important Lessons

March 19, 2021

Emotional Support for Those Who Need It Most

Patients Before Paperwork

What are ACP's Legislative, Regulatory, and Advocacy Priorities for 2023? Join us for our next webinar! ACP's legislative, regulatory, and advocacy priorities are always evolving. Join us on March 23, 2023, at 8:00 p.m. ET, as Shari Erickson, MPH (ACP's Chief Advocacy Officer and Senior Vice President of Governmental Affairs and Public Policy) takes a deep dive into ACP's priorities for 2023 and the role they play in shaping health care. Following the presentation, there will be a live Q&A session. Please submit your questions in advance when registering.

Noteworthy Resources

Well-being Champion Training: Coaching Revisit your coaching curriculum for a refresher. This training explains coaching and the role you may decide to assume as an ACP Well-being Champion (WBC) peer coach. Even if you decide not to be a peer coach, the techniques you will learn in this training will help you succeed in your role as a WBC.

In the News

“I Cry and No One Cares”: Medscape Survey Shows Doctor Burnout, Depression Is Getting Worse by Anastassia Gliadkovskaya More than a third of doctors said they would rather not tell others about their depression, highlighting ongoing stigma for physicians seeking mental health support. Four in 10 believe people will think less of their professional abilities and fear the medical board or their employer will find out.

From the Trenches

What Does Well-being Mean to You Today? Supplement Resource to Coaching Practice by Kerri Palamara, MD, MACP Well-being Wheel Exercise Video We talk a lot about well-being, but it is often hard to define for others and for ourselves.

ACP Multimedia Education

Game Plan Refresh Series for Trained WBCs Marion McCrary, MD, FACP, and NC Well-being Champion (WBC), revisits strategies learned during your WBC training and new skills to grow your toolkit to support you and your colleagues. You Don't Need All of the Answers! Three Steps to Better Connect With a Colleague Who Needs You Watch Video

March 17, 2023

ACP Internal Medicine Meeting 2023 Well-being Activities and Career and Professional Development Opportunities

Laboratory or At-Home Sleep Studies for the Evaluation of Patients Suspected to Have Sleep Apnea

Dual Health Care System Use and Unsafe Medication Prescribing in Veterans With Dementia

Diagnosis and Management of Gout: Clinical Practice Guidelines From the American College of Physicians

Effect of a Structured Exercise Program on the Overall Burden of Major Mobility Disability Among Older Adults

Acupuncture With Electrical Stimulation as a Treatment for Severe Chronic Constipation

Variation in Assessments of Breast Density on Mammograms in Clinical Practice

Assessing the Risk for Diabetes in Patients With Unexpectedly Identified Tumors in the Adrenal Glands

Special Shoes for the Management of Knee Osteoarthritis Symptoms

Pioglitazone for Patients With Nonalcoholic Steatohepatitis and Prediabetes or Type 2 Diabetes

Tai Chi Versus Physical Therapy for Knee Osteoarthritis

Put words in our mouth

ACP launches business credit card

Article calls for vaccine policy that promotes health for all

Disparities in time on EHRs linked with burnout among women physicians, study suggests

MKSAP Quiz: Follow-up of incidental liver findings

Nirmatrelvir-ritonavir, remdesivir probably reduce hospitalizations in nonsevere COVID-19

Weight loss maintenance more successful with patient versus professional support

The importance of humanity in internal medicine

Semaglutide shortage over, counterfeits removed

I.M. Puzzled: June 2025

Stroke risk may be lower than expected in patients diagnosed with AF while admitted | ACP Hospitalist

Elevated troponin level at sepsis diagnosis did not predict in-hospital mortality | ACP Hospitalist

Correction to ‘Choices in C. diff Care’ | ACP Hospitalist

Bacterial infection unlikely in almost a third who got extended-spectrum antibiotics in ED | ACP Hospitalist

Take action on anaphylaxis | ACP Hospitalist

Take a quiz about the April 9 issue! | ACP Hospitalist

Poor communication involved in almost a quarter of patient safety incidents | ACP Hospitalist

Optimal medical therapy for HFrEF associated with lower 30-day readmissions | ACP Hospitalist

Intervention reduced antibiotic overuse for skin and soft-tissue infections | ACP Hospitalist

Choices in C. diff care | ACP Hospitalist

External Ophthalmoplegia and Nystagmus in a 64-Year-Old Man | Annals of Internal Medicine: Clinical Cases

A 64-year-old man with chronic alcoholism presented with disorientation. He was disoriented and displaying oculomotor dysfunction, including external ophthalmoplegia and nystagmus. Magnetic resonance imaging revealed high-intensity areas surrounding the aqueduct and third ventricle and within the medial thalamus and mammillary bodies on fluid-attenuated inversion recovery–weighted images, consistent with Wernicke encephalopathy. After treatment with 500 mg of thiamine thrice daily for 2 days, his ophthalmoplegia improved, although his nystagmus persisted. After continuation of 250 mg per day of thiamine for 5 days, he was discharged on day 8 without disorientation or ocular motor deficits.

An Unusual Case of Neurogenic Orthostatic Hypotension Without Parkinsonian Features | Annals of Internal Medicine: Clinical Cases

Orthostatic hypotension is a common cause of syncope, especially in the older adult population. While it is a commonly encountered issue as a cause of syncope, neurogenic orthostatic hypotension (nOH) is less common. Accurate diagnosis and management of neurogenic orthostatic hypotension is important especially when conservative measures fail. The condition of nOH is often seen in Parkinson disease or Parkinson plus syndromes. We present an unusual presentation of a patient with nOH who had no parkinsonian features but once started on norepinephrine agonism improved dramatically.

Rate–Pressure Product and Cardiac Cachexia in End-Stage Heart Failure | Annals of Internal Medicine: Clinical Cases

To address the effect of cardiac cachexia on the failing heart, we analyzed serial home-care monitoring of the rate–pressure product, as substitution of myocardial oxygen consumption, over 218 days in a 79-year-old man with a catecholamine-dependent end-stage dilated cardiomyopathy. At the end of his home-care visits, his body weight decreased to 37 kg from 55.2 kg (baseline). We found a linear reduction of the rate–pressure product accompanied by weight loss (r2 = 0.186; P = 0.0001), implying the progression of cardiac cachexia as a possible role in reducing myocardial oxygen consumption, which would mitigate energy deprivation of the failing heart.

Thymoma in an Older Woman Presenting as Bowel Obstruction | Annals of Internal Medicine: Clinical Cases

Thymomas are slow growing and rare tumors (<1% of all cancers) most commonly seen in the anterior mediastinum. These are often discovered incidentally on imaging and may cause clinical symptoms of myasthenia in up to 50% of the cases. Although thymomas can metastasize to the bowel, direct extension is extremely rare and only described in a few case reports. We present a case of a mediastinal thymoma extending into the abdomen and causing symptoms of partial bowel obstruction in an older woman who then had an excellent clinical response to proton beam radiation, contrary to the anticipated course.

A Case of Carfilzomib-Induced Atypical Hemolytic Uremic Syndrome | Annals of Internal Medicine: Clinical Cases

Atypical hemolytic uremic syndrome (aHUS) is a rare non-Shiga toxin thrombotic microangiopathy caused by uncontrolled activation of the alternative complement pathway. We present a 43-year-old man with a history of multiple myeloma receiving carfilzomib presenting with acute vomiting, diarrhea, and anuria. Laboratory results showed anemia, thrombocytopenia, and kidney failure. Additional evaluation led to a diagnosis of carfilzomib-induced thrombotic microangiopathy. Carfilzomib was withdrawn and ravulizumab was started, with improvements in platelet count and kidney function. Atypical hemolytic uremic syndrome is a rare adverse effect of carfilzomib and requires a high index of suspicion to ensure timely diagnosis and treatment.

Clinical Presentation and Diagnostic Work-up of Epiploic Appendagitis | Annals of Internal Medicine: Clinical Cases

Epiploic appendagitis is a rare condition caused by inflammation and necrosis of the epiploic appendages, which are small fat-filled structures around the colon that cushion it and help immune response. Although it is an exceedingly uncommon and underdiagnosed cause of acute abdominal pain, it mimics more serious intra-abdominal pathology that requires a thorough work-up. This case highlights the clinical presentation, work-up, and nonoperative management of a previously healthy 41-year-old man who presented with acute right lower-quadrant pain. Because of the challenges in identifying this condition and the limited research available, the goal of this report is to highlight a unique presentation of this disease.

Familial Case of Gastric Adenocarcinoma and Proximal Polyposis of the Stomach: A Long-Term Endoscopic Observation | Annals of Internal Medicine: Clinical Cases

We report multiple cases of gastric adenocarcinoma and proximal polyposis of the stomach (GAPPS), all within the same family. Esophagogastroduodenoscopy of a 29-year-old woman revealed a pedunculated large polyp, along with fundic gland polyposis. Endoscopic resection was performed on the large polyp, leading to the pathologic diagnosis of pyloric gland adenoma. A mutation in the promoter 1B region of the APC gene was found, leading to a diagnosis of GAPPS. GAPPS is a rare disease, and its pathogenesis remains unknown. In this case series, the clinical course of GAPPS is presented with detailed endoscopic findings during a long-term follow-up.

Recovery From Severe Heart Failure in a Patient With Primary Hyperoxaluria Type 1 After Treatment With Lumasiran, Pyridoxine, and Kidney Transplant | Annals of Internal Medicine: Clinical Cases

Combined liver and kidney transplant has long been the only therapeutic option for patients with primary hyperoxaluria type 1 (PH1) and advanced chronic kidney disease. The development of lumasiran, a liver-directed RNA interference therapy, has led to effective reduction of hepatic oxalate production in patients with PH1. Despite reports of single cases successfully treated with isolated kidney transplant and lumasiran therapy, data are still scarce. Here, we report the case of a patient with PH1, severe cardiomyopathy, and chronic kidney disease, whose cardiac function improved remarkably after receiving an isolated kidney transplant and therapy with lumasiran and pyridoxine.

Influenza-Induced Rhabdomyolysis in a Patient With Undiagnosed Light Chain Amyloidosis | Annals of Internal Medicine: Clinical Cases

This article explores a case of severe rhabdomyolysis in a 51-year-old woman with an influenza A infection. Investigating the cause of rhabdomyolysis is crucial to preventing recurrence. In this case, the patient was found to have underlying light chain amyloidosis with muscle involvement. When a patient presents with severe rhabdomyolysis, it is important to perform frequent physical examinations to assess for advanced muscle edema which can lead to compartment syndrome, as early diagnosis and intervention are paramount to salvaging affected limbs.

Macrocytic Anemia: A Presenting Feature of VEXAS Syndrome | Annals of Internal Medicine: Clinical Cases

VEXAS (Vacuoles, E1 enzyme, X-linked, Autoinflammatory, Somatic) syndrome is an X-linked multisystem inflammatory syndrome characterized by a combination of various clinical features, including myeloid dysplasia, sweet syndrome, relapsing polychondritis, polyarteritis nodosa, and giant cell arteritis. In this report, we present a patient who was initially evaluated for macrocytic anemia but subsequently developed additional clinical features, leading to the diagnosis of VEXAS syndrome based on genetic analysis.