March 15, 2019

Announcements Volunteers Needed at Internal Medicine Meeting 2019 Volunteer opportunities (We need you!)

June 21, 2019

WBCs in Their Community: Promoting Positive Working and Learning Environments

Patients Before Paperwork

Recently Proposed Changes to Race and Ethnicity Standards Will Have Important Impact on Research and Data Collection The Office of Management and Budget is proposing an update to the Race and Ethnicity Statistical Standards to expand the number of categories and make them more specific. View Here!

Noteworthy Resources

Team-Based Care Toolkit ACP has developed this toolkit to share best practices and real-life examples of successful team-based clinical care models that include internal medicine physicians working with nurse practitioners, physician assistants, and other members of the clinical care team. This toolkit includes resources to help foster productive and purposeful internal medicine teams. View here!

In the News

You're Not Alone in Feeling Lonely By Dr. Vivek Murthy, U.S. Surgeon General Loneliness is an experience so many of us have. But what's surprising is how loneliness impacts both our mental and physical health. To mark the release of a groundbreaking new Surgeon General's advisory on loneliness and social connection, Dr. Murthy answers the most common questions he's asked about loneliness. He also shares some of the surprising science around the positive health effects of social connection. This episode is one worth sharing with a friend.

From the Trenches

WBCs in Their Community: Promoting Positive Working and Learning Environments Puerto Rico WBC Melba Feliciano, MD, FACP, and her team in action. Check out photos from well-being activities at their chapter and in the community. Photo story here! Loneliness & Belonging By Kerri Palamara, MD, MACP

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 the Answers! 3 Steps to Better Connect With a Colleague Who Needs You Watch Video

July 21, 2023

Professional Fulfillment Zone

Congratulations to this year's winners from the abstract competition in the category of Physician Well-being and Professional Fulfillment at the 2024 ACP Internal Medicine Meeting held in Boston, Massachusetts, this past April.

Management of Chronic Insomnia Disorder in Adults: A Clinical Practice Guideline From the American College of Physicians

Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: Recommendations From the U.S. Preventive Services Task Force

Trying to Quit Cigarette Smoking by Cutting Down or Stopping Abruptly

Physical Fitness During Adolescence and Long-Term Risk for Type 2 Diabetes Mellitus

Oral Prednisolone in the Treatment of Acute Gout

Medicine and Nonmedicine Options for the Treatment of Adults With Major Depressive Disorder

Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention

Mechanical Symptoms and Arthroscopic Partial Meniscectomy in Patients With Degenerative Meniscus Tear

Hematuria as a Marker of Occult Urinary Tract Cancer

Screening for Depression in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Optimizing clinical reasoning during the diagnostic process

MKSAP Quiz: 5-day history of hair loss

Perioperative practices often mired in inertia

‘LEGO’ of the idea you can't be ‘the Special’

Latest updates on ACP's priorities, initiatives

Internal Medicine Meeting 2025 swings into New Orleans

How to remove an allergy label

Global Forum seeks solutions to workforce challenges

Gender-affirming care amid political turmoil

For early career IMGs, community is key

Beta-lactams noninferior to fluoroquinolones, trim-sulfa for uncomplicated gram-negative bacteremia | ACP Hospitalist

Thoracentesis didn't improve outcomes in heart failure with pleural effusion | ACP Hospitalist

Take a quiz about the April 2 issue! | ACP Hospitalist

Parenteral, enteral, and malnutrition in the hospital | ACP Hospitalist

New studies highlight importance of intervening on OUD during hospitalization | ACP Hospitalist

Invasive group A strep incidence up sharply in the U.S. over last decade | ACP Hospitalist

First national practice standards for hospital at home developed | ACP Hospitalist

Beefing up on BCNE | ACP Hospitalist

Take a quiz about the March 26 issue! | ACP Hospitalist

Hospitalizations common among patients with substance use disorder | ACP Hospitalist

A Rapidly Progressing Infectious Nephropathology: What to Do? | Annals of Internal Medicine: Clinical Cases

We encountered a previously healthy 32-year-old woman who developed generalized malaise and was found to have rapidly worsening infectious symptoms, which progressed to septic shock and metabolic encephalopathy. Her diagnosis was initially made with computed tomography of the abdomen and confirmed by renal biopsy, revealing a case of renal malakoplakia. We discuss current knowledge in the epidemiology and pathophysiology of this rare condition and offer a case-based diagnostic and management strategy that led to a successful clinical outcome.

A Case of Calcinosis Cutis in a Patient With Sjögren Syndrome | Annals of Internal Medicine: Clinical Cases

Calcinosis cutis is a challenging, debilitating condition that often is observed in patients with systemic sclerosis or dermatomyositis. However, it is rarely documented in cases of Sjögren syndrome, with only 6 previous cases reported in the medical literature. In this article, we report the case of a 56-year-old woman with a known diagnosis of Sjögren syndrome who presented with calcinosis cutis of the digits.

Thumbprint Abdominal Retiform Purpura: Opportunity for Immediate Recognition of Disseminated Strongyloidiasis | Annals of Internal Medicine: Clinical Cases

Disseminated strongyloidiasis is characterized by the dissemination of the Strongyloides stercoralis nematode beyond the skin, gastrointestinal, and pulmonary organ systems, which comprise the life cycle of the parasite. Corticosteroids are a known risk factor for disseminated strongyloidiasis, which carries a high mortality risk. When disseminated, the disease can be reliably identified by the cutaneous skin eruption of retiform purpura, which resemble “thumbprints” on the abdomen and periumbilical region. Therefore, recognition of this skin finding should prompt immediate initiation of therapy with ivermectin even prior to direct confirmation of the species.

An Unusual Case of Adrenal Hemorrhage | Annals of Internal Medicine: Clinical Cases

Adrenal hemorrhage is an uncommon diagnosis, with nonspecific clinical findings. It can present with elevated blood pressure and arrhythmia in the setting of elevated catecholamine levels. Although overproduction from an adrenal mass such as pheochromocytomas is typically suspected, severe physiologic stress is also associated with increased catecholamine release. This report details a case of acute clinical deterioration and biochemical evidence of marked excess of catecholamines in a patient with unilateral adrenal hemorrhage. Initial suspicion was high for a hemorrhagic pheochromocytoma. However, follow-up evaluation revealed resolution of the hemorrhagic collection, evidence of an adrenal mass, and normalization of catecholamine levels.

Adult-Onset Ornithine Transcarbamylase Deficiency in a 51-Year-Old Man Who Presented With Fatal Hyperammonemic Encephalopathy | Annals of Internal Medicine: Clinical Cases

Typical male patients with ornithine transcarbamylase deficiency present in their early years with lethargy, seizure, and coma from hyperammonemia. An adult-onset phenotype, with sudden severe hyperammonemia emerging in otherwise-healthy men, has been increasingly recognized. We describe a characteristic clinical course in a 51-year-old Chinese man who developed fatal hyperammonemia after receiving systemic corticosteroid for Bell's palsy. The genetic sequencing detected a novel missense variant NM_000531.6:c.642C>A (p.His214Gln) in the OTC gene. Inherited urea cycle disorders should be suspected in unexplained hyperammonemia at all ages with aggressive treatment initiated promptly before a diagnosis is confirmed.

Recurrent Abdominal Aortic Aneurysm After Aortoiliac Endograft Stent Placement | Annals of Internal Medicine: Clinical Cases

We report a case of a 59-year-old man with multiple comorbid conditions who had endovascular aortic repair for an abdominal aortic aneurysm (AAA). Despite the procedure's initial success, the patient later presented with recurrent AAA as the result of an enlarged aneurysmal sac and a 90-degree angle kink at the midportion of the endograft stent, necessitating emergent open surgery. This case underscores the challenges in managing AAA post endovascular aortic repair and the potential for serious complications. Our experience highlights the importance of close surveillance and prompt intervention for optimal patient outcomes.

Lung Herniation as a Complication of Chronic Obstructive Pulmonary Disease | Annals of Internal Medicine: Clinical Cases

Lung herniation is a rare complication of chronic obstructive pulmonary disease. This case describes a patient with a history of chronic obstructive pulmonary disease and laryngeal and thyroid carcinoma treated with total laryngectomy who presented with dysphagia, nasal regurgitation, and shortness of breath. Computed tomography imaging confirmed severe emphysema with herniation of the right lung apex through the thoracic inlet. Although this complication is uncommon, providers should recognize its presenting symptoms, especially in patients with risk factors.

Intravascular Large B-Cell Lymphoma: A Case of Negative Biopsies and Hemophagocytic Lymphohistiocytosis | Annals of Internal Medicine: Clinical Cases

Intravascular large B-cell lymphoma (IVLBCL) is a rare lymphoma characterized by highly variable symptoms and intravascular spread. The disease is subclassified into 3 variants according to symptomatology and epidemiology. Diagnosis is often challenging, requiring a high index of suspicion in conjunction with targeted biopsies. We present a case of a White patient with the hemophagocytic “Asian” variant of IVLBCL. Repeated biopsies and reevaluation of pathology were required to make the diagnosis. Our case identifies strategies to augment the diagnostic yield when traditional workup is negative. It also calls into question the characterization of disease variants by geography.

Diffuse Podocytopathy Associated With Semaglutide | Annals of Internal Medicine: Clinical Cases

We present 3 cases of biopsy-proven minimal change disease occurring in close temporal association with semaglutide (glucagon-like peptide 1 receptor agonists) exposure. The observed diffuse podocytopathy was associated with de novo formation of antinephrin antibodies in 2 of the 3 cases. All patients experienced complete remission shortly after discontinuing semaglutide and undergoing immunosuppressive therapy, which included either steroids or a combination of tacrolimus and rituximab. Although further research is needed to establish causality, this report highlights a new association of which prescribers need to be aware, particularly as the use of glucagon-like peptide 1 receptor agonists continues to expand.

Visceral Leishmaniasis During Pregnancy: A Case Report | Annals of Internal Medicine: Clinical Cases

Visceral leishmaniasis is a life-threatening disease endemic in tropical and subtropical regions and in the Mediterranean basin. Two species (Leishmania infantum/chagasi and Leishmania donovani) with different host reservoirs are responsible for visceral disease. The infection is usually transmitted by phlebotomine sandflies, whereas vertical and blood transfusion transmission is rarely observed. We report a 35-year-old Italian pregnant woman in the 26th gestational week presenting with progressive fatigue, intermittent fever, and pancytopenia who finally was diagnosed with visceral leishmaniasis. She had treatment with liposomal amphotericin B and delivered at week 38 a baby small for gestational age. The newborn had a positive Leishmania serology that turned negative at 6 months of age.