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Publisher: Elsevier   (Total: 3160 journals)

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Showing 1 - 200 of 3160 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 35, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 24, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 96, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 27, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 37, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 5)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 7)
Acta Astronautica     Hybrid Journal   (Followers: 421, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 28, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 2)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 10, SJR: 0.18, CiteScore: 1)
Acta Haematologica Polonica     Free   (Followers: 1, SJR: 0.128, CiteScore: 0)
Acta Histochemica     Hybrid Journal   (Followers: 3, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 276, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 3, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 1, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 27, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 6, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 14, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 17, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 8, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 167, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 8, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 15, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 28, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 10, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 11, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 14, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 33, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 4)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 13)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 28, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 10, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 12)
Advances in Digestive Medicine     Open Access   (Followers: 9)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 25)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 46, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 60, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 19, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 10, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 6, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 24, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 12, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 23)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 2, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 36, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 8, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 18, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 11, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 7, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 5)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 4, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 23)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 4)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 17, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 25, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 12)
Advances in Pharmacology     Full-text available via subscription   (Followers: 16, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 8, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 5)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 65)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 1, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 403, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 12, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 34, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 18)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 14)
Advances in Virus Research     Full-text available via subscription   (Followers: 5, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 48, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 359, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 11, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 464, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 17, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 42, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 57, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 6, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 11)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 1, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 10, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 10, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 52, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 4, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 4, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 6)
American Heart J.     Hybrid Journal   (Followers: 56, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 59, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 44, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 11)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 13, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 34, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 28, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 35, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 48)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 225, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 28, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 29, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 38, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 63, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 19, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 43, SJR: 1.512, CiteScore: 5)
Analytical Biochemistry     Hybrid Journal   (Followers: 188, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 12, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 13)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 23, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 204, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 5, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Journal Cover
American Journal of Medicine
Number of Followers: 48  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
Published by Elsevier Homepage  [3160 journals]
  • Parkinson's Disease and Parkinsonism
    • Abstract: Publication date: Available online 16 March 2019Source: The American Journal of MedicineAuthor(s): Michael T Hayes Parkinson's disease is a progressive neurodegenerative disease characterized by tremor and bradykinesia and is a common neurologic ailment. Male gender and advancing age are independent risk factors and, as the population ages, is taking an increasing toll on productivity and medical resources. There are number of other extrapyramidal conditions that can make the diagnosis challenging. Unlike other neurodegenerative diseases, idiopathic Parkinson's disease has effective treatments that mitigate symptoms. Medications can improve day-to-day function and, in cases where medication does not give a sustained benefit or has a significant side effects, treatments like deep brain stimulation result in improved quality of life.
       
  • America's Health Care System is Broken: What Went Wrong and How We Can Fix
           It. Part 2: Health Insurance
    • Abstract: Publication date: Available online 13 March 2019Source: The American Journal of MedicineAuthor(s): Edward P Hoffer Unlike most western democracies, health insurance in the United States is provided by a haphazard mix of employer-based plans, Medicare for those over 65 or on social security disability or chronic renal failure, Medicaid under varying state-dependent rules for some low-income recipients and no insurance for tens of millions. Administrative costs, which include both the direct costs of the insurers and the indirect costs imposed on physicians and hospitals, make up nearly 25% of our bloated national health care expenditures. This high cost adds no proven value to health care outcomes. Our current system of covering health care expenditures is both inefficient and unfair. Changes must be made.
       
  • Anticoagulation-Related Nephropathy: The most common diagnosis you've
           never heard of
    • Abstract: Publication date: Available online 13 March 2019Source: The American Journal of MedicineAuthor(s): Thomas Oliver, Brandon Ciaudelli, David A Cohen Anticoagulation-related nephropathy might just be the most common diagnosis you've never heard of. Formerly known as warfarin-induced nephropathy, until it was observed with numerous other anticoagulants and broadened to anticoagulation-related nephropathy. It is a potentially devastating disorder with serious and life-changing consequences if not recognized and diagnosed swiftly.As the clinician is faced with new acute renal failure, it is important to appreciate those factors that place patients at greater risk of anticoagulation-related nephropathy. Conditions such as underlying chronic kidney disease patients and supratherapeutic INR.Through greater understanding of this common, yet under-recognized condition, we become better equipped to diagnose and prognosticate potential patients. Currently, there are no specific guidelines to follow regarding anticoagulation-related nephropathy identification and management, however, it is an entity that is important to remember, especially given the number of patients requiring anticoagulation for numerous conditions.
       
  • Aspirin for the Primary Prevention of Cardiovascular Disease: Weighing Up
           the Evidence
    • Abstract: Publication date: Available online 12 March 2019Source: The American Journal of MedicineAuthor(s): Sean Murphy, Cian P. McCarthy, John W. McEvoy
       
  • Gene-based prescribing is here – are providers ready'
    • Abstract: Publication date: Available online 12 March 2019Source: The American Journal of MedicineAuthor(s): Leland E. Hull, Lisa Soleymani Lehmann, Julie A. Lynch
       
  • Cardiometabolic Medicine: A Call for a New Subspeciality Training Track in
           Internal Medicine
    • Abstract: Publication date: Available online 12 March 2019Source: The American Journal of MedicineAuthor(s): Robert H. Eckel, Michael J. Blaha
       
  • Type 2 Myocardial Infarction and Value-Based Programs: Cutting the Supply
           in the Absence of Demand
    • Abstract: Publication date: Available online 12 March 2019Source: The American Journal of MedicineAuthor(s): Cian P. McCarthy
       
  • Ranolazine, ACE Inhibitors, and Angiotensin Receptor Blockers
    • Abstract: Publication date: Available online 11 March 2019Source: The American Journal of MedicineAuthor(s): Thomas A. Marciniak, Victor Serebruany BackgroundRanolazine is an anti-angina agent with many metabolites creating the potential for off-target effects. FDA reviews sometimes contain clinically relevant data not found in other sources.MethodsWe reanalyzed data in an FDA review of the placebo-controlled MERLIN trial of ranolazine to display differences in adverse event rates graphically.ResultsRates of ACE inhibitor (ACEI) or angiotensin receptor blocker (ARB)-related adverse events (angioedema, dry cough, renal impairment, hypotension, anemia, and serum potassium> 5.5 mmol/L) were higher in patients receiving ranolazine and an ACEI or ARB. Rates of adverse events that should be decreased by ACEI/ARBs (hypokalemia, hypertension, and serum potassium
       
  • Beach Bummer: A Recurrent Pruritic Buttock Eruption Following Travel
    • Abstract: Publication date: Available online 11 March 2019Source: The American Journal of MedicineAuthor(s): Kristina Navrazhina, Brian P. Hibler, Cynthia M. Magro, Horatio F. Wildman
       
  • Left ventricular thrombus in patients after primary percutaneous coronary
           intervention for ST-elevation myocardial infarction: 1 year clinical
           outcomes
    • Abstract: Publication date: Available online 11 March 2019Source: The American Journal of MedicineAuthor(s): Alastair J. Moss, Anoop S.V. Shah, Eunice T. Zuling, Michael Freeman, David E. Newby, Philip D. Adamson, Nicholas L. Cruden BackgroundLeft ventricular thrombus formation is a complication of acute myocardial infarction.. However, the incidence and risk of systemic thromboembolism in the era of primary angioplasty for ST elevation myocardial infarction (STEMI) is unclear. This study aims to determine clinical outcomes in patients with STEMI treated with primary angioplasty and left ventricular thrombus at 1 year.MethodsPatients who underwent primary angioplasty for STEMI and had a transthoracic echocardiogram were recruited. The primary endpoint was a composite of all-cause mortality, stroke and systemic thromboembolism at one year. For the primary endpoint, the difference between the presence and absence of left ventricular thrombus was compared using a logistic regression, adjusting for minimisation variables including age, diabetes mellitus, hypertension and previous stroke.ResultsOf 2608 patients who underwent primary angioplasty for STEMI, 1645 (63%) patients had a transthoracic echocardiogram performed during the index hospital admission. Forty patients (2.4%) had evidence of left ventricular thrombus on transthoracic echocardiography. Patients with left ventricular thrombus were more likely to develop atrial fibrillation in the immediate post-infarction period (6 (15%) vs 87 (5.4%), p = 0.025). At 1 year, the primary endpoint occurred in 4 (10%) patients with LV thrombus and 146 (9.1%) who did not (logistic regression hazard ratio 0.79, 95% confidence interval 0.23–2.70).ConclusionsIn the contemporary era of mechanical reperfusion for STEMI, echocardiographic detection of left ventricular thrombus was observed in
       
  • Further Turns in the Conception and Regulation of Physician-Assisted Dying
           in the Netherlands
    • Abstract: Publication date: Available online 11 March 2019Source: The American Journal of MedicineAuthor(s):
       
  • A Bad Sign: Dermatomyositis with Interstitial Lung Disease
    • Abstract: Publication date: February 2019Source: The American Journal of Medicine, Volume 132, Issue 2Author(s): Siriwan Palawisuth, Kornphaka Kantikosum, Mattana Patiyasikunt, Thitiwat Sriprasart, Pravit Asawanonda, Pawinee Rerknimitr
       
  • Acute herbal therapy efficacy: a case report
    • Abstract: Publication date: Available online 9 March 2019Source: The American Journal of MedicineAuthor(s): Robert G. Stern
       
  • What Lurks Beneath: A Subaortic Membrane
    • Abstract: Publication date: Available online 9 March 2019Source: The American Journal of MedicineAuthor(s): Lily Chen, Aaron Schelegle, Jeong Choi, Ezra A. Amsterdam
       
  • Update in Outpatient General Internal Medicine: Practice-Changing Evidence
           Published in 2018
    • Abstract: Publication date: Available online 8 March 2019Source: The American Journal of MedicineAuthor(s): Majken T. Wingo, Jason H. Szostek, Karna K. Sundsted, Jason A. Post, Karen F. Mauck, Mark L. Wieland The expansive scope of general internal medicine makes it difficult to identify practice-changing medical literature. Clinical updates can be facilitated by synthesizing relevant articles and implications for practice. Six internal medicine physicians reviewed the titles and abstracts in the seven general internal medicine clinical outpatient journals with the highest impact factor and relevance to the internal medicine outpatient physician: New England Journal of Medicine (NEJM), Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA-Internal Medicine, British Medical Journal (BMJ), and Public Library of Science (PLoS) Medicine. The following collections of article synopses and databases were also reviewed: American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Based medicine, McMaster/DynaMed Evidence Alerts, and Cochrane Reviews. A modified Delphi method was used to gain consensus on articles based on clinical relevance to outpatient IM, potential impact on practice, and strength of evidence. Article qualities and importance were debated until consensus was reached. Clusters of articles pertinent to the same topic were considered together. In total, 7 practice-changing articles were included.
       
  • An Ominous Facial Droop
    • Abstract: Publication date: Available online 8 March 2019Source: The American Journal of MedicineAuthor(s): A.R. Sandre, A. Kapoor, J. Lu, E. Horner, A. Chakroborty, A. Goswami
       
  • The Medical Profession, Industry and Continuing Medical Education: Finding
           the Balance That's Right for Patients
    • Abstract: Publication date: Available online 8 March 2019Source: The American Journal of MedicineAuthor(s): Peter Kearney, Maarten Simoons, Lars Ryden, Paulus Kirchhof, Axel Pries, Colm O'Morain, Jeroen J. Bax Provision and participation in formal external continuing medical education (CME) is costly. Employer or state support of CME is the exception rather than the rule. The medical industry has supported both providers and consumers of educational activities, leading to concerns of commercial bias. Recent medical industry initiatives in Europe to improve the transparency of the relationship between industry and the profession, including the field of medical education, have had the paradoxical effect of the industry playing an increasingly direct role in the provision of physician education. Funding of medical professional society annual congresses has been directly and indirectly jeopardised. Acknowledging that there are areas of co-operation in the field of education between the medical profession and the medical industry from which both can benefit, we argue that medical education requires an objective approach that the primary fiduciary duty of medical industry companies precludes. Medical professional societies, as not-for-profit organisations whose core mission is the development and promotion of best practice, are best placed to guide and deliver medical education to their members.Clinical significance.This will be submitted off-line as discussed with the editor in chief. Dr. Alpert.•Maintaining knowledge and skills requires continuous and unbiased medical education•Accreditation systems have been devised to avoid bias in cases of industry support of continuing medical education (CME)Medical professional societies are central to provision of unbiased CME at international level•The collaboration between the medical professional societies and the medical industry in the field of education involves inevitable challenges as well as important opportunities•The future lies in agreeing roles and responsibilities and a controlled and transparent cooperation between the medical profession and industry
       
  • Iron supplementation improves cardiovascular outcomes in patients with
           heart failure
    • Abstract: Publication date: Available online 7 March 2019Source: The American Journal of MedicineAuthor(s): Xiang Zhou, Weiting Xu, Youjia Xu, Zhiyuan Qian BackgroundIron deficiency is prevalent in patients with heart failure. This meta-analysis was performed to evaluate the therapeutic effects of iron in patients with systolic heart failure and iron deficiency.MethodsWe searched PubMed, Embase, and Cochrane databases through March 2018 and included 10 randomised controlled trials involving 1404 heart failure patients who underwent iron or placebo treatment. Odds ratio (OR) and weighted mean differences (WMD) were calculated using fixed or random effects models.ResultsOur results showed that iron supplementation significantly reduced hospitalization for worsening heart failure (OR: 0.39, 95% CI: 0.19 to 0.80) and the combined endpoint of death and heart failure hospitalization (OR: 0.47, 95% CI: 0.32 to 0.69). In addition, iron treatment was found to improve New York Heart Association class, 6-min walk distance, left ventricular ejection fraction, and peak oxygen consumption. Iron therapy was also associated with improvements in Patient Global Assessment, Kansas City Cardiomyopathy Questionnaire score, European Quality of Life-5 Dimensions score, and Minnesota Living with Heart Failure Questionnaire score. Moreover, serum levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and C-reactive protein (CRP) were markedly decreased in patients with iron repletion compared with placebo treatment (WMD: − 332.48 pg/ml, 95% CI: -497.48 to − 167.47; WMD: -4.64 mg/L, 95% CI: -6.12 to − 3.17, respectively).ConclusionsOur meta-analysis suggests that iron therapy can reduce heart failure hospitalization, increase cardiac function, improve quality of life, and decrease serum levels of NT-proBNP and CRP in patients with heart failure.Clinical Significance◆Iron supplementation can reduce heart failure hospitalization but not all-cause mortality in patients with heart failure.◆Iron treatment can increase cardiac function and exercise capacity, and improve quality of life and prognosis in patients with heart failure.◆Iron repletion can decrease serum levels of N-terminal pro-B-type natriuretic peptide and C-reactive protein in patients with heart failure.
       
  • A Man with Right Lower Quadrant Abdominal Pain
    • Abstract: Publication date: Available online 7 March 2019Source: The American Journal of MedicineAuthor(s): Shum-Shin Lin, Ching-Yu Han, Chun-Yu Chen, Yu-Jang Su
       
  • Swollen hands and “fist sign” in acromegaly
    • Abstract: Publication date: Available online 7 March 2019Source: The American Journal of MedicineAuthor(s): Ko Harada, Kou Hasegawa, Fumio Otsuka
       
  • New Drug Approvals in 2018 – Another Record Year!
    • Abstract: Publication date: Available online 7 March 2019Source: The American Journal of MedicineAuthor(s): Alex M Ebied, Juri Na, Rhonda M Cooper-DeHoff In 2018, the US Food and Drug Administration approved 59 novel drugs. This all-time record was due primarily to the expedited review pathways. 43 of the 59 (73%) novel drug approvals were designated in an expedited review pathway, and 34 of the 59 (58%) were approved for treatment of rare diseases. A review of these novel drugs is summarized.Clinical Significance•This summary of novel drugs approved by the FDA during 2018 provides clinicians with pertinent prescribing information for each drug.•Clinicians may find this information in discussing these new drugs with their patients who may request them as part of their care.•This information may be useful as clinicians work with hospitals and other healthcare organizations that are considering addition of these drugs to their prescribing formularies.
       
  • An uncommon presentation of pancreatic carcinoma
    • Abstract: Publication date: Available online 7 March 2019Source: The American Journal of MedicineAuthor(s): Monica Greco, Simone Negrini, Chiara Schiavi, Francesca Giusti, Matteo Borro, Chiara Vassallo, Francesco Puppo, Giuseppe Murdaca
       
  • Inappropriate Communication During Internal Medicine Fellowship
           Recruitment: A Mixed-Methods Analysis
    • Abstract: Publication date: Available online 7 March 2019Source: The American Journal of MedicineAuthor(s): Christopher M. Williams, Richard L. Alweis, Alec O’Connor, Bhavin Dalal, Devesh Rai, Abdullah Abdullah, Richard Kopelman, Patricia Cornett, Michael O. Frank, Vera P. Luther, Elaine A. Muchmore
       
  • Maternal Implications of Breastfeeding – A Review for the Internist
    • Abstract: Publication date: Available online 7 March 2019Source: The American Journal of MedicineAuthor(s): Maryam Sattari, Janet R. Serwint, David M. Levine Breastfeeding seems to be a low-cost intervention that provides both short- and long-term health benefits for the breastfeeding woman. Interventions to support breastfeeding can increase its rate, exclusivity, and duration. Internists often have a longitudinal relationship with their patients and can be important partners with obstetricians and pediatricians in advocating for breastfeeding. To play their unique and critical role in breastfeeding promotion, internists need to be knowledgeable about breastfeeding and its maternal health benefits. In this paper, we will review the short- and long-term maternal health benefits of breastfeeding. We will also discuss special considerations in the care of breastfeeding women for the internist.Clinical Significance.Breastfeeding is a low-cost intervention that appears to provide both short- and long-term health benefits for the breastfeeding woman.Longer duration of breastfeeding appears to be associated with greater maternal benefits.There are only a limited number of maternal medical conditions, in which breastfeeding is contraindicated.There are only a limited number of medications and street drugs that are absolutely contraindicated while breastfeeding.
       
  • WAS LEONARDO DA VINCI DYSLEXIC'
    • Abstract: Publication date: Available online 7 March 2019Source: The American Journal of MedicineAuthor(s): Salvatore Mangione, Maestro
       
  • THE EFFECT OF VEGAN DIETS ON BLOOD PRESSURE IN ADULTS: A META-ANALYSIS OF
           RANDOMIZED, CONTROLLED TRIALS
    • Abstract: Publication date: Available online 6 March 2019Source: The American Journal of MedicineAuthor(s): Persio D. Lopez, Eder H. Cativo, Steven A. Atlas, Clive Rosendorff BackgroundVegan diets are increasing in popularity and have beneficial effects on glycemia and blood lipids, but the evidence is inconclusive regarding their effect on blood pressure. The purpose of this study was to review the effect of vegan diets on blood pressure in adults.MethodsWe searched MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov for records that compared a vegan diet to any less restrictive diet and reported pre- and post-intervention systolic and diastolic blood pressures. Two reviewers independently screened abstracts for randomized, controlled clinical trials in individuals ≥ 18 years of age and older. We used the PRISMA guidelines to select 11 clinical trials from 1673 records. Data synthesis was performed through a random-effects model.ResultsThe pooled data included 983 participants. Compared to less restrictive diets, a vegan diet did not result in a significant change in systolic (− 1.33 mmHg; 95% CI –3.50 to 0.84; p = 0.230) or diastolic (− 1.21 mmHg; 95% CI -3.06 to 0.65; p = 0.203) blood pressure. A pre-specified subgroup analysis of studies with baseline systolic blood pressure ≥ 130 mmHg revealed that a vegan diet resulted in a mean decrease in the systolic (− 4.10 mmHg; 95% CI -8.14 to − 0.06; p = 0.047) and diastolic (− 4.01 mmHg; 95% CI -5.97 to − 2.05; p = 0.000) blood pressures.ConclusionThe changes in blood pressure induced by a vegan diet without caloric restrictions are comparable to those induced by dietary approaches recommended by medical societies and portion-controlled diets.
       
  • Prescribing Statins to Reduce Cardiovascular Disease – Ten Common
           Misconceptions
    • Abstract: Publication date: Available online 6 March 2019Source: The American Journal of MedicineAuthor(s): David S. Schade, Lynda Shey, R. Philip Eaton
       
  • Etiological research using observational data, and net clinical benefit.
           Simplicity and practicality matter
    • Abstract: Publication date: Available online 6 March 2019Source: The American Journal of MedicineAuthor(s): Peter Brønnum Nielsen, Iain Buchan, Gregory Y.H. Lip
       
  • Confusion following Treatment of Ovarian Cancer
    • Abstract: Publication date: Available online 6 March 2019Source: The American Journal of MedicineAuthor(s): Beatriz Wills, Qihua Fan, Caitlin Alexander, Christopher R. Bailey, Allan C. Gelber
       
  • The Case for Being a Medical Conservative
    • Abstract: Publication date: Available online 6 March 2019Source: The American Journal of MedicineAuthor(s): John Mandrola, Adam Cifu, Vinay Prasad, Andrew Foy
       
  • Diagnostic Dilemma: A Unilateral Facial Rash with Eye Involvement
    • Abstract: Publication date: Available online 5 March 2019Source: The American Journal of MedicineAuthor(s): Kevin G. Buell, Silas P. Trumbo, Volker H. Haase
       
  • A Pictorial Essay of Immunotherapy: Complications that internists will
           see, whether they like it or not
    • Abstract: Publication date: Available online 5 March 2019Source: The American Journal of MedicineAuthor(s): Ashley Evens, George Cyriac, Daniel Jeong, Cyrillo Araujo, Kenneth Gage, Trevor Rose Immunotherapy agents for treatment of cancer have been investigated for decades, but effective agents have only recently been identified and are increasingly being used in multiple cancer types. There is growing recognition of adverse side effects in multiple organ systems mediated by dysregulation of the immune system, which can be exacerbated by co-morbidities often found in cancer patients such as chronic lung disease, diabetes, and hypertension. As a result, internists and other non-oncology clinicians are routinely encountering immunotherapy patients who present with a remarkably wide range of symptoms.Here, we present the radiographic manifestations of common side effects from immunotherapy agents. An accurate diagnosis is critical in these often complex clinical settings in which the consequences of the underlying cancer and other comorbidities must be distinguished from the variable manifestations of treatment toxicity.
       
  • Appropriateness of Cardiac Troponin Testing: Insights from the Use of
           TROPonin In Acute coronary syndromes (UTROPIA) study
    • Abstract: Publication date: Available online 5 March 2019Source: The American Journal of MedicineAuthor(s): Yader Sandoval, Ian L. Gunsolus, Stephen W. Smith, Anne Sexter, Sarah E. Thordsen, Michelle D. Carlson, Benjamin K. Johnson, Charles A. Bruen, Kenneth W. Dodd, Brian E. Driver, Katherine Jacoby, Sara A. Love, Johanna C. Moore, Nathaniel L. Scott, Karen Schulz, Fred S. Apple ObjectiveOur objective was to examine the appropriateness of cardiac troponin (cTn) testing among patients with cTn increases.MethodsPlanned secondary analysis of the Use of TROPonin In Acute coronary syndromes (UTROPIA, NCT02060760) observational cohort study. Appropriateness of cTn testing was adjudicated for emergency department patients with cTn increases> 99th percentile and analyzed using both contemporary and high-sensitivity (hs) cTnI assays according to sub-specialty, diagnoses, and symptoms.ResultsAppropriateness was determined from 1272 and 1078 adjudication forms completed for 497 and 422 patients with contemporary and hs-cTnI increases respectively. Appropriateness of cTnI testing across adjudication forms was 71.5% and 72.0% for cTnI and hs-cTnI respectively. Compared to emergency medicine physicians, cardiologists were less likely to classify cTnI orders as appropriate (cTnI: 79% vs. 56%, p 
       
  • Fever and rash in an adult: Varicella re-infection in conjunction with
           newly diagnosed chronic lymphocytic leukemia
    • Abstract: Publication date: Available online 5 March 2019Source: The American Journal of MedicineAuthor(s): Arpan Shah, Kanika Goel, Jeffery Uchin, Sai Krishna Patibandla, Zaw Min, Nitin Bhanot
       
  • Overlapping syndrome of systemic scleroderma and cryoglobulinemic
           vasculitis
    • Abstract: Publication date: Available online 2 March 2019Source: The American Journal of MedicineAuthor(s): Taro Horino, Kazu Hamada-Ode, Osamu Ichii, Yoshio Terada
       
  • Limp and Fever Leading to a Surprising Diagnosis
    • Abstract: Publication date: Available online 2 March 2019Source: The American Journal of MedicineAuthor(s): Liliana Andrade Chebli, Pedro Duarte Gaburri, Julio Maria Fonseca Chebli
       
  • Does use of Electronic Alerts for Systemic Inflammatory Response Syndrome
           (SIRS) to Identify Patients with Sepsis Improve Mortality'
    • Abstract: Publication date: Available online 2 March 2019Source: The American Journal of MedicineAuthor(s): Saranya Seetharaman, Christina Wilson, Mark Landrum, Sonia Qasba, Morgan Katz, Nicholas Ladikos, Jo Ellen Harris, Panagis Galiatsatos, David M. Yousem, Amy M. Knight, David B. Pearse, Renee Blanding, Richard Bennett, Noya Galai, Trish M. Perl, Geeta Sood PurposeThe objective of this study was to assess if earlier antibiotic administration in patients with Systemic Inflammatory Response Syndrome (SIRS) and evidence of organ dysfunction identified through electronic alerts improves patient mortality.MethodsThis is a retrospective observational cohort study of adult patients admitted across five acute care hospitals Mortality, Premier CareScience™ Analytics Expected Mortality Score, clinical and demographic variables were obtained through the electronic medical record and Premier (Premier Healthcare Solutions, Inc., Charlotte NC) reports. Patients with 2 SIRS criteria and organ dysfunction were identified through an automated alert. Univariate and multivariate logistic regression was performed.Results8146 patients with SIRS and organ dysfunction were identified through the electronic BPA. Overall 30-day mortality rate was 8.7%. There was no significant association between time to antibiotic administration from BPA alert and mortality (p = 0.21) after adjusting for factors that could influence mortality including age, heart rate, blood pressure, plasma lactate levels, creatinine, bilirubin levels, and the CareScience™ Predicted Mortality Risk Score. Female gender (OR 1.31 (95% CI 1.06–1.63)), and facility were also independently associated with mortality.ConclusionThe use of alerts in the electronic medical record may misclassify patients with SIRS as having sepsis. Time to antibiotic administration in patients meeting SIRS criteria and evidence of end-organ dysfunction through BPA alerts did not affect 30-day mortality rates across a health system. Patient severity of illness, gender and facility also independently predicted mortality. There were higher rates of antibiotic use and Clostridium difficile infection in patients with BPA alerts.
       
  • A Case of Catatonia Nearly Mistaken for Hepatic Encephalopathy
    • Abstract: Publication date: Available online 2 March 2019Source: The American Journal of MedicineAuthor(s): KG. Buell, SB. Kiser, Eduard E. Vasilevskis
       
  • Aspirin Use to Reduce the Risk of Sports-Related Cardiac Arrest in
           High-Risk Athletes
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Arthur J. Siegel
       
  • The Reply
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): James M. Rippe
       
  • 'Are We Ready to Practice Lifestyle Medicine'' The Point Is to Keep
           Within Bounds
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Vincent Baty, William Morris
       
  • Polypoidal Trachea: A Clinician's Predicament
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Pirabu Sakthivel, Kapil Sikka, Aanchal Kakkar, Sasikrishna Kavutharapu, Alok Thakar
       
  • Nodular Thyroid Dermopathy: Not a Hallmark of Graves Disease
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Mandeep Singla, Abhinav Gupta
       
  • Reactive Arthritis Caused by Haemophilus parainfluenzae in a
           Diabetic Patient
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Tomohiro Eguchi, Taro Horino, Eri Amano, Osamu Ichii, Yoshio Terada
       
  • Connecting the Dots—Acute Abdomen, ST Elevation, and a Consolidating
           Lung Mass
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Randol Kennedy, Percy Adonteng-Boateng
       
  • Drugs, the Thyroid, and the Heart: A Lethal Cocktail
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Andrew Jamieson
       
  • Malignant Pancreatic Insulinoma with Large Hepatic Metastasis
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Tariq A. Gojwari, Mohd Ilyas, Musaib Ahmad Dar, Aadil Hussain Malik, Mir Junaid Ahmad Kazimi
       
  • The Tradeoff of Cancer Drug Regulatory Policy: Faster Approvals for One
           Means Less Knowledge for Another
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Derrick Tao, Sally Schott, Vinay Prasad
       
  • Assessment and Treatment of Physician Speechlessness
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Michael W. Kahn
       
  • Personality Traits in Patients with Myocardial Infarction with
           Nonobstructive Coronary Arteries
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Daniella Nero, Stefan Agewall, Maria Daniel, Kenneth Caidahl, Olov Collste, Christina Ekenbäck, Mats Frick, Loghman Henareh, Tomas Jernberg, Karin Malmqvist, Karin Schenck-Gustafsson, Jonas Spaak, Peder Sörensson, Örjan Sundin, Shams Y-Hassan, Claes Hofman-Bang, Per Tornvall ObjectiveThe purpose of this study was to describe type A behavior pattern and trait anger in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) and compare them with patients with coronary heart disease and healthy controls. Type A behavior pattern and anger have been linked to coronary heart disease in previous studies. This is the first study to assess type A behavior pattern and trait anger in MINOCA patients.MethodsOne hundred MINOCA patients, consecutively recruited during 2007-2011 at 5 coronary care units in Stockholm, were matched for sex and age to 100 coronary heart disease patients and 100 healthy controls. All participants completed the Bortner Rating Scale to quantify type A behavior pattern and the Spielberger Trait Anger Scale to quantify anger 3 months after the acute event.ResultsMINOCA patients’ Bortner Rating Scale score was 70.9 ± 10.8 (mean ± SD) and Spielberger Trait Anger Scale score was 14 (12-17) (median; interquartile range). Coronary heart disease patients’ Bortner Rating Scale score was 70.5 ± 10.2 and Spielberger Trait Anger Scale score was 14 (12-17). Healthy controls’ Bortner Rating Scale score was 71.9 ± 9.1 and Spielberger Trait Anger Scale score was 13 (11-16).ConclusionWe found no significant differences in Bortner Rating Scale score and Spielberger Trait Anger Scale score among MINOCA, coronary heart disease patients, and healthy controls, regardless of whether total scores, subscales, or cutoffs were used to classify type A behavior pattern and trait anger. However, we cannot exclude the existence of an occasional episode of anger or mental stress in relation to the coronary event. This is the first study to assess type A behavior pattern and trait anger in patients with MINOCA, and future studies need to confirm the current findings before any firm conclusions can be made.
       
  • Serum Insulin and Cognitive Performance in Older Adults: A Longitudinal
           Study
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Babak Hooshmand, Minna Rusanen, Tiia Ngandu, Jaana Leiviskä, Shireen Sindi, Christine A.F. von Arnim, Peter Falkai, Hilkka Soininen, Jaakko Tuomilehto, Miia Kivipelto PurposeThe aim of this study was to examine the association of serum glucose, insulin, and insulin resistance with cognitive functioning 7 years later in a longitudinal population-based study of Finnish older adults.MethodsSerum glucose and insulin were measured at baseline in 269 dementia-free individuals aged 65-79 years, from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study. Insulin resistance was estimated with the homeostasis model assessment (HOMA-IR). Participants were reexamined 7 years later, and global cognition, episodic memory, executive functioning, verbal expression, and psychomotor speed were assessed, both at baseline and at follow-up. Multiple linear regression was used to investigate the associations with cognitive performance at follow-up, after adjusting for several potential confounders, including common vascular risk factors.ResultsIn the multivariable-adjusted linear regression models, no associations of insulin resistance with cognitive functioning were observed. After excluding 19 incident dementia cases, higher baseline HOMA-IR values were related to worse performance in global cognition (β [standard error (SE)] -.050 [0.02]; P = .043) and psychomotor speed (β [SE] -.064 [.03]; P = [.043]) 7 years later. Raised serum insulin levels were associated with lower scores on global cognition (β [SE] -.054 [.03]; P = .045) and tended to relate to poorer performance in psychomotor speed (β [SE] -.061 [.03]; P = .070).ConclusionsSerum insulin and insulin resistance may be independent predictors of cognitive performance 7 years later in elderly individuals without dementia. Randomized controlled trials are needed to determine this issue.
       
  • High-Sensitivity Cardiac Troponin I Levels in Normal and Hypertensive
           Pregnancy
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Jeganathan Ravichandran, Shu Yuan Woon, Yek Song Quek, Yee Chern Lim, Eliza Mohd Noor, Kumar Suresh, Ramakrishnan Vigneswaran, Vlad Vasile, Anoop Shah, Nicholas L. Mills, Jeganathan Sickan, Agim Beshiri, Allan S. Jaffe PurposeThe purpose of this study was to examine the association of circulating concentrations of high-sensitivity cardiac troponin I (hs-cTn) in the various trimesters of pregnancy in patients with and without hypertension.MethodsThis was a prospective cross-sectional study of pregnant and postnatal women aged between 18-35 years with no coexisting diseases. Serum samples were analysed for hs-TnI.ResultsA total of 880 women (mean age = 29.1 years [standard deviation = 5.1 years]) were recruited with 129 (14%), 207 (24%), and 416 (47%) patients in the first, second, and third trimesters, respectively. Ninety (10%) participants were recruited in the postnatal period. During pregnancy 28 (3%) patients were classified as having pregnancy-induced hypertension and 10 (1%) as preeclampsia. High-sensitivity cardiac troponin I was measurable in 546 (62%) participants with a median of 1 ng/L (range 0 to 783 ng/L). Troponin concentrations were above the 99th percentile in 19 (2%) individuals. Patients with pregnancy-induced hypertension and preeclampsia had higher concentrations of hs-TnI (median 11 ng/L [interquartile range (IQR) 6 to 22 ng/L] vs 12ng/L [IQR 3 to 98 ng/L] vs 1 ng/L [IQR 0 to 1 ng/L]). In logistic regression modeling hs-cTnI concentration remained an independent predictor of pregnancy-induced hypertension or preeclampsia in both unadjusted and adjusted models (odds ratio 9.3 [95% confidence interval 5.8 to 16.3] and 11.5 [95% confidence interval 6.3 to 24.1], respectively, per doubling of hs-TnI concentrations).ConclusionsCardiac troponin measured using a high-sensitivity assay is quantifiable in the majority of young pregnant women with 2% of individuals having concentration above the 99th percentile sex-specific threshold. Patients with pregnancy-induced hypertension or preeclampsia had higher cardiac troponin concentrations. Cardiac troponin was a strong independent predictor of pregnancy-induced hypertension or preeclampsia in pregnant and postnatal women.
       
  • Adherence and Outcomes with Urate-Lowering Therapy: A Site-Randomized
           Trial
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Ted R. Mikuls, T. Craig Cheetham, Gerald D. Levy, Nazia Rashid, Artak Kerimian, Kimberly J. Low, Brian W. Coburn, David T. Redden, Kenneth G. Saag, P. Jeffrey Foster, Lang Chen, Jeffrey R. Curtis PurposeThe purpose of this study was to test a pharmacist-led intervention to improve gout treatment adherence and outcomes.MethodsWe conducted a site-randomized trial (n=1463 patients) comparing a 1-year, pharmacist-led intervention to usual care in patients with gout initiating allopurinol. The intervention was delivered primarily through automated telephone technology. Co-primary outcomes were the proportion of patients adherent (proportion of days covered ≥0.8) and achieving a serum urate
       
  • Cannabis Legalization Does Not Influence Patient Compliance with Opioid
           Therapy
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Sheng-Ying Lo, Gabrielle N. Winston-McPherson, Amy J. Starosta, Mark D. Sullivan, Geoffrey S. Baird, Andrew N. Hoofnagle, Dina N. Greene BackgroundPrescription opioid use and opioid related deaths continue to increase nationwide. Several states have adopted legislation allowing for recreational use of cannabis. Little is known about how recreational cannabis laws impact compliance in chronic pain patients who have been prescribed opioid therapy. The goals of this study were to (1) retrospectively assess the effect of cannabis use on compliance with opioid therapy in a high-risk patient population and (2) determine the impact of legalization of recreational cannabis on patients prescribed therapeutic opioids.MethodsWe conducted a retrospective cohort study on results from a “high-risk” urine drug testing panel. Results from 1 year before and 1 year after initiation of recreational cannabis legislation were analyzed. This testing panel included qualitative assays for cannabinoids and 9 other common drugs of abuse in addition to a quantitative LC-MS/MS assay for 23 different opioids and metabolites. Opioid compliance was assigned by reviewing pathologists’ interpretations.ResultsIn the pre-legalization period, 1776 panels were performed, and in the post-legalization, 1648 panels were performed. An increase (6%) in the rate of positive cannabinoids screening results was observed after legalization of recreational cannabis; however, the overall compliance rate was consistent.ConclusionsThe results of this study suggest that legalization of recreational cannabis does not affect compliance rate in patients treated with opioid therapy for chronic pain.
       
  • Reinfarction in Patients with Myocardial Infarction with Nonobstructive
           Coronary Arteries (MINOCA): Coronary Findings and Prognosis
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Anna M. Nordenskjöld, Bo Lagerqvist, Tomasz Baron, Tomas Jernberg, Nermin Hadziosmanovic, Harmony R. Reynolds, Per Tornvall, Bertil Lindahl BackgroundMyocardial infarction (MI) with nonobstructive coronary arteries (MINOCA) is common. There are limited data on the mechanisms and prognosis for reinfarction in MINOCA patients.MethodsIn this observational study of MINOCA patients hospitalized in Sweden and registered in the SWEDEHEART registry between July 2003 and June 2013 and followed until December 2013, we identified 9092 unique patients with MINOCA of 199,163 MI admissions in total. The 570 (6.3%) MINOCA patients who were hospitalized due to a recurrent MI constituted the study group.ResultsThe mean age was 69.1 years and 59.1% were women. The median time to readmission was 17 months. A total of 340 patients underwent a new coronary angiography and 180 (53%) had no obstructive coronary artery disease (CAD) and 160 (47%) had obstructive CAD; 123 had 1-vessel, 26 had 2-vessel, 9 had 3-vessel disease, and 2 had left main together with 1-vessel disease. Male sex, diabetes, peripheral vascular disease, higher levels of creatinine, and ST elevation at presentation were more common in patients with MI with obstructive CAD than in patients with a recurrent MINOCA. Mortality during a median follow-up of 38 months was similar whether the reinfarction event was MINOCA or MI with obstructive CAD 13.9% vs 11.9% (P = .54).ConclusionsAbout half of patients with reinfarction after MINOCA who underwent coronary angiography had progression of coronary stenosis. Angiography should be strongly considered in patients with MI after MINOCA. Mortality associated with recurrent events was substantial, though there was no difference in mortality between those with or without significant CAD.
       
  • Bites that Spur the Blues: Maculae Ceruleae
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Cuong V. Nguyen, Jaime L. Kingsley-Loso
       
  • Follow the Beads: Fibromuscular Dysplasia
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Vy K. Ly, Reza Manesh, Kesav Raghavan, Rabih M. Geha
       
  • Behind the Curve: Late-Onset Axial Spondyloarthritis
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Qin Xiang Ng, Benjamin Hooi, Wei Chuan Tan, Garvi Pandya
       
  • Canakinumab: Promises and Future in Cardiometabolic Diseases and
           Malignancy
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Aneesh Dhorepatil, Somedeb Ball, Raktim K. Ghosh, Meera Kondapaneni, Carl J. Lavie Inflammation has proven in multiple studies to be responsible for the progression of cardiometabolic diseases and malignancies. The interleukin family has been critically associated with progression of atherosclerosis, insulin resistance, and various malignancies. Given the advent of pharmacologic interleukin-1 (IL-1) inhibition, this pathway can potentially be targeted to improve outcomes. In the recently concluded Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS) trial, investigators looked at the potential role of IL-1 (especially IL-1β) inhibition in halting the progression of atherosclerosis. In the subset analysis of the data from this trial, IL-1β inhibition with canakinumab was found to have beneficial effects in other cardiometabolic diseases characterized by inflammation, like diabetes, stroke, and chronic kidney disease, and also in patients with lung cancer. In this article, we will try to review the current literature on the role of canakinumab in the treatment of cardiometabolic diseases and malignancies.
       
  • Betrixaban: Safely Reducing Venous Thromboembolic Events with Extended
           Prophylaxis
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Paul P. Dobesh, Brian J. Trevarrow Although venous thromboembolism prophylaxis of acute medically ill patients is commonly employed, a percentage of high-risk patients still have venous thromboembolic events within 30 days of discharge. Research over the last several years has attempted to identify characteristics of these high-risk patients to facilitate provision of extended prophylaxis and venous thromboembolic event reduction; however, extended prophylaxis has been associated with a significant increase in the risk for major bleeding until recently. Betrixaban, a new oral direct Xa inhibitor with once-daily dosing and limited renal elimination, significantly reduces the risk of venous thromboembolism without increasing the risk for major bleeding. Consequently, betrixaban is the only anticoagulant approved by the Food and Drug Administration for preventing venous thromboembolism with extended prophylaxis in acute medically ill patients.
       
  • Spinal Emergencies in Primary Care Practice
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Jacob M. Babu, Shyam A. Patel, Mark A. Palumbo, Alan H. Daniels Atraumatic spinal emergencies often present a diagnostic and management dilemma for health care practitioners. Spinal epidural abscess, cauda equina syndrome, and spinal epidural hematoma are conditions that can insidiously present to outpatient medical offices, urgent care centers, and emergency departments. Unless a high level of clinical suspicion is maintained, these clinical entities may be initially misdiagnosed and mismanaged. Permanent neurologic sequela and even death can result if delays in appropriate treatment occur. A focused, critical review of 34 peer-reviewed articles was performed to identify current data about accurate diagnosis of spinal emergencies. This review highlights the key features of these 3 pathological entities with an emphasis on appropriate diagnostic strategy to intervene efficiently and minimize morbidity.
       
  • Sleep Disorders
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Milena K. Pavlova, Véronique Latreille Sleep disorders are frequent and can have serious consequences on patients’ health and quality of life. While some sleep disorders are more challenging to treat, most can be easily managed with adequate interventions. We review the main diagnostic features of 6 major sleep disorders (insomnia, circadian rhythm disorders, sleep-disordered breathing, hypersomnia/narcolepsy, parasomnias, and restless legs syndrome/periodic limb movement disorder) to aid medical practitioners in screening and treating sleep disorders as part of clinical practice.
       
  • Management of Acute Ischemic Stroke
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Yunyun Xiong, Bharti Manwani, Marc Fisher The treatment of acute ischemic stroke includes both intravenous (IV) thrombolysis and mechanical thrombectomy. Important advances regarding both treatment modalities have occurred recently that all physicians who see patients at risk for or who have had a stroke should be aware of. This review will focus on recent clinical trials of IV thrombolysis both positive and negative. Additionally, the results of a large number of early and late time window thrombectomy trials will be presented that demonstrate the remarkable efficacy of this treatment for appropriately selected patients.
       
  • Marijuana's Effects on Brain Structure and Function: What Do We Know and
           What Should We Do' A Brief Review and Commentary
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Richard D. deShazo, Sara B. Parker, Daniel Williams, John B. Ingram, Mahmoud Elsohly, Kathryn Rodenmeyer, Kyle McCullouch The recent US Food and Drug Administration approval of the marijuana constituent cannabidiol as safe and effective for treatment of 2 rare forms of epilepsy has raised hopes that others of the 500 chemicals in marijuana will be found to be therapeutic. However, the long-term consequences of street marijuana use are unclear, and recent studies raise red flags about its effects. Changes in brain maturation and intellectual function, including decreases in intelligence quotient, have been noted in chronic users and appear permanent in early users in most but not all studies. These studies suggest that at a minimum, regular marijuana use should be discouraged in individuals under the age of 21.
       
  • Transitional Care Interventions for Heart Failure: What Are the
           Mechanisms'
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): David R. Thompson, Chantal F. Ski, Alexander M. Clark
       
  • Wanted: Local Medical Experts/Champions to Prevent Gun Violence
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): James Webster
       
  • Burn Bright I: Reflections on the Burnout Epidemic (Part One of a Two-Part
           Series)
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Noshene Ranjbar, Mari Ricker
       
  • Asking How Our Patients Understand Addiction
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Helen E. Jack, Devin Oller, John Kelly, Jessica F. Magidson, Sarah E. Wakeman
       
  • Myocardial Infarction with Nonobstructive Coronary Arteries (MINOCA)
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Joseph S. Alpert, Rokas Serpytis, Pranas Serpytis, Qin M. Chen
       
  • Parental Leave in Graduate Medical Education: Recommendations for Reform
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Patricia Vassallo, Jennifer Jeremiah, Leanne Forman, Lauralee Dubois, Debra L. Simmons, Katherine Chretien, Alpesh Amin, David Coleman, Frances Collichio
       
  • Hall Pass
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Gregory E. Brisson
       
  • The Reply
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Jong Hyun Jhee, Seung Hyeok Han
       
  • Coffee Intake and Chronic Kidney Disease
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Tomoyuki Kawada
       
  • A Genetic Origin' Purpura Fulminans
    • Abstract: Publication date: March 2019Source: The American Journal of Medicine, Volume 132, Issue 3Author(s): Orly Avnery, Gili Kenet, Martin H. Ellis
       
  • A fateful miss - ground-level fall revealing occult cervical spinal
           stenosis
    • Abstract: Publication date: Available online 27 February 2019Source: The American Journal of MedicineAuthor(s): Ami Schattner, Yair Glick, Ina Dubin
       
  • Dyspnea and near syncope in a young female following delivery
    • Abstract: Publication date: Available online 27 February 2019Source: The American Journal of MedicineAuthor(s): Sugandhi Mahajan, Harsh Rawal, Elias Youssef, Sanjay Mehta
       
  • America's Health Care System is Broken: What Went Wrong and How We Can Fix
           It. Introduction to the Series
    • Abstract: Publication date: Available online 27 February 2019Source: The American Journal of MedicineAuthor(s): Edward P Hoffer Over the last half century, medical science has dramatically improved throughout the world. While costs have risen in all western countries as new technologies have been widely adopted, costs in the United States have risen much more than they have in any other country. Despite using fewer resources (numbers of physicians and nurses, hospital beds) than do peer countries, per capita spending on health care in the United States is double that in similar countries. The major driving force behind this difference is that we in the United States pay much more for the same products and services. There is no evidence that this increased spending gives better outcomes. Neither the general public nor doctors are happy with our current health care system. Subsequent articles will discuss the components of our system and how they are failing and how they can be improved.
       
  • Misconceptions and Facts about Beta-Blockers
    • Abstract: Publication date: Available online 25 February 2019Source: The American Journal of MedicineAuthor(s): Edgar Argulian, Sripal Bangalore, Franz H. Messerli Beta-blockers are commonly used medications, and they have been traditionally considered ‘cardioprotective’. Their clinical use appears to be more widespread than the available evidence base supporting their role in cardioprotection. Beta blockers counteract neurohumoral activation in heart failure with reduced ejection fraction and offer both symptomatic improvement and reduction in adverse events. On the other hand, use of beta-blockers in uncomplicated hypertension results in suboptimal outcomes compared to the established first-line antihypertensive agents. Providers at all levels should be familiar with common misconceptions regarding beta-blocker use in routine clinical practice.
       
  • “Endoscopic ultrasound first policy” in acute pancreatitis of
           presumed biliary origin
    • Abstract: Publication date: Available online 23 February 2019Source: The American Journal of MedicineAuthor(s): Vincent Zimmer
       
  • Advancing the Care of Severe Asthma: Differential Diagnosis,
           Multidisciplinary Management, and Patient Engagement
    • Abstract: Publication date: Available online 20 February 2019Source: The American Journal of MedicineAuthor(s): Jonathan Corren, Barbara P. Yawn
       
  • Injecting New Ideas Into Managing Type 2 Diabetes: Evolving Roles of GLP-1
           Receptor Agonists
    • Abstract: Publication date: Available online 16 February 2019Source: The American Journal of MedicineAuthor(s): John E. Anderson, John L. Leahy
       
  • New Approaches for Delirium: A Case for Robotic Pets
    • Abstract: Publication date: Available online 7 February 2019Source: The American Journal of MedicineAuthor(s): Joshua Schulman-Marcus, Sulagna Mookherjee, Lisa Rice, Radmila Lyubarova
       
  • Body Mass Index, Intensive Blood Pressure Management, and Cardiovascular
           Events in the Systolic Blood Pressure Intervention Trial (SPRINT)
    • Abstract: Publication date: Available online 2 February 2019Source: The American Journal of MedicineAuthor(s): Christina Stolzenburg Oxlund, Manan Pareek, Benjamin Schnack Brandt Rasmussen, Muthiah Vaduganathan, Tor Biering-Sørensen, Christina Byrne, Zaid Almarzooq, Michael Hecht Olsen, Deepak L. BhattABSTRACTBackgroundIt is unclear whether intensive blood pressure management is well-tolerated and affects risk uniformly across the body mass index (BMI) spectrum.MethodsThe randomized, controlled Systolic Blood Pressure Intervention Trial (SPRINT) included 9,361 individuals ≥50 years at high cardiovascular risk, without diabetes mellitus, and a systolic blood pressure 130-180 mmHg. Participants were randomized to intensive versus standard antihypertensive treatment and evaluated for the primary composite efficacy endpoint of acute coronary syndromes, stroke, heart failure, or cardiovascular death. The primary safety endpoint was serious adverse events. We used restricted cubic splines to determine the relationship between BMI, response to intensive blood pressure lowering, and clinical outcomes in SPRINT.ResultsBMI measurements could be calculated for 9,284 (99.2%) individuals. Mean BMI was similar between the two treatment groups (intensive group 29.9±5.8 kg/m2 vs. standard group 29.8± 5.7 kg/m2; P=0.39). Median follow-up was 3.3 years (range 0-4.8 years). BMI had a significant, J-shaped association with risk of all-cause mortality, stroke, and serious adverse events (P0.05 for all). Intensive blood pressure lowering reduced the primary efficacy endpoint and increased the primary safety endpoint compared with standard targets, consistently across the BMI spectrum (Pinteraction>0.05).ConclusionThe overall efficacy and safety of intensive blood pressure lowering did not appear to be modified by baseline BMI among high-risk older adults.Trial RegistrationSPRINT (Systolic Blood Pressure Intervention Trial); ClinicalTrials.gov Identifier: NCT01206062, https://clinicaltrials.gov/ct2/show/NCT01206062
       
  • Creating a culture of micro-affirmations to overcome gender-based
           micro-inequities in academic medicine
    • Abstract: Publication date: Available online 2 February 2019Source: The American Journal of MedicineAuthor(s): Rose L. Molina, Hope Ricciotti, Lucy Chie, Rebecca Luckett, Blair J. Wylie, Ebonie Woolcock, Jennifer Scott
       
  • The State of Ambulatory Undergraduate Internal Medicine Medical Education:
           Results of the 2016 Clerkship Directors in Internal Medicine Annual Survey
           
    • Abstract: Publication date: Available online 2 February 2019Source: The American Journal of MedicineAuthor(s): Amy W. Shaheen, Irene Alexandraki, Sara B. Fazio, Margaret C. Lo, Clifford D. Packer, Harish Jasti, Michael Kisielewski, Susan T. Hingle
       
  • Clinician's Guide to the Updated ABCs of Cardiovascular Disease
           Prevention: A Review Part 2
    • Abstract: Publication date: Available online 2 February 2019Source: The American Journal of MedicineAuthor(s): Kelly Arps, Vincent A. Pallazola, Rhanderson Cardoso, Joseph Meyer, Richard Jones, Jacqueline Latina, Ty J. Gluckman, Neil J. Stone, Roger S. Blumenthal, John W. McEvoyABSTRACTEfforts to better control risk factors for cardiovascular disease and prevent the development of subsequent cardiovascular events are crucial to maintaining healthy populations. In today's busy practice environment and with the overwhelming pace of new research findings, ensuring appropriate emphasis and implementation of evidence-based preventive cardiovascular care can be challenging. The ABCDEF approach to cardiovascular disease prevention is intended to improve dissemination of contemporary best practices and ease the implementation of comprehensive preventive strategies for clinicians. This review serves as a succinct yet authoritative overview for interested internists as well as for cardiologists not otherwise focused on cardiovascular disease prevention.The goal of this two-part series is to compile a state-of-the-art list of elements central to primary and secondary prevention of cardiovascular disease, using an ABCDEF checklist. In Part 2, we review new recommendations regarding lipid-modifying strategies, contemporary best practice for tobacco cessation, new evidence related to cardiovascular risk reduction in diabetes using novel therapies, ways to implement a heart-healthy diet, modern interventions to improve physical exercise, and how best to prevent the onset of heart failure.
       
  • Evidence Basis for a Point-of-Care Ultrasound Examination to Refine
           Referral for Outpatient Echocardiography
    • Abstract: Publication date: February 2019Source: The American Journal of Medicine, Volume 132, Issue 2Author(s): Paul J. Han, Ben T. Tsai, Julie W. Martin, William D. Keen, Jill Waalen, Bruce J. KimuraABSTRACTBackgroundFew data exist on the potential utility of a cardiac point-of-care ultrasound (POCUS) examination in the outpatient setting to assist diagnosis of significant cardiac disease.Using a retrospective sequential cohort design, we sought to derive and then validate a POCUS examination for cardiac application and model its potential use for prognostication and cost-effective echo referral.MethodsFor POCUS examination derivation, we reviewed 233 consecutive outpatient echo studies for 4 specific POCUS “signs” contained therein representing left ventricular systolic dysfunction, left atrial enlargement, inferior vena cava plethora, and lung apical B-lines. The corresponding formal echo reports were then queried for any significant abnormality. The optimal POCUS examination for identifying an abnormal echo was determined. We then reviewed 244 consecutive outpatient echo studies from another institution for associations between the optimal POCUS examination, clinical variables, and referral source with major adverse cardiac events and all-cause mortality in univariate and multivariate models. Assuming a referral model where the absence of POCUS signs or variables would negate initial echo referral, theoretical cost savings were expressed as a percentage in reduction of echo studies.ResultsIn the derivation cohort, the combination of two signs, denoting left atrial enlargement and inferior vena cava plethora resulted in the highest accuracy of 72% [95% CI: 65%, 78%] in detecting an abnormal echocardiogram. In the validation cohort, mortality at 5.5 years was 14.6% overall, 23% in patients with the left atrial enlargement sign (OR 3.5 [1.6, 7.6]), 25% with inferior vena cava plethora sign (OR 2.2 [0.8, 6.0]), and 8.0% (OR 0.3 [0.2, 0.7]) in those lacking both signs. After adjusting for age, both diabetes (OR 4.8 [2.0, 11.6]), and the left atrial enlargement sign (OR 2.4 [1.1, 5.4]) remained independently associated with mortality (p
       
  • Risk Estimation in Type 2 Myocardial Infarction and Myocardial Injury: The
           TARRACO Risk Score
    • Abstract: Publication date: February 2019Source: The American Journal of Medicine, Volume 132, Issue 2Author(s): German Cediel, Yader Sandoval, Anne Sexter, Anna Carrasquer, Maribel González-del-Hoyo, Gil Bonet, Carme Boqué, Karen Schulz, Stephen W. Smith, Antoni Bayes-Genis, Fred S. Apple, Alfredo BardajiABSTRACTBACKGROUNDDespite adverse prognoses of type 2 myocardial infarction and myocardial injury, an effective, practical risk stratification method remains an unmet clinical need. We sought to develop an efficient clinical bedside tool for estimating the risk of major adverse cardiovascular events at 180 days for this patient population.METHODSThe derivation cohort included patients with type 2 myocardial infarction or myocardial injury admitted to a tertiary hospital between 2012 and 2013 (n = 611). The primary outcome was a major adverse cardiovascular event (death or readmission for heart failure or myocardial infarction). The score included clinical variables significantly associated with the outcome. External validation was conducted using the UTROPIA cohort (n = 401).RESULTSThe TARRACO Score included cardiac troponin (cTn) concentrations and 5 independent clinical predictors of adverse cardiovascular events: age, hypertension, absence of chest pain, dyspnea, and anemia. The score exhibited good discriminative accuracy (area under the curve = 0.74; 95% CI, 0.70-0.79). Patients were classified into low-risk (score 0-6) and high-risk (score ≥7) categories. Major adverse cardiovascular events rates were 5 times more likely in high-risk patients compared with those at low risk (78.9 vs 15.4 events/100 patient-years, respectively; logrank P < .001). The external validation showed equivalent prognostic capacity (area under the curve=0.71, 0.65-0.78).CONCLUSIONA novel risk score based on bedside clinical variables and cTn concentrations allows risk stratification for death and cardiac-related rehospitalizations in patients with type 2 myocardial infarctions and myocardial injury. This score identifies patients at the highest risk of adverse events, a subset of patients who may benefit from close observation, medical intensification, or both.
       
  • Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute
           Coronary Syndrome Undergoing Percutaneous Coronary Intervention
    • Abstract: Publication date: February 2019Source: The American Journal of Medicine, Volume 132, Issue 2Author(s): Nuccia Morici, Stefano Savonitto, Luca A. Ferri, Daniele Grosseto, Irene Bossi, Paolo Sganzerla, Giovanni Tortorella, Michele Cacucci, Maurizio Ferrario, Gabriele Crimi, Ernesto Murena, Stefano Tondi, Anna Toso, Nicola Gandolfo, Amelia Ravera, Elena Corrada, Matteo Mariani, Leonardo Di Ascenzo, A. Sonia Petronio, Claudio Cavallini IntroductionAcute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far.MethodsRetrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke.ResultsOf 1443 ACS patients aged>75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P < .001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7).ConclusionsDespite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.
       
  • The Association Between Serum Calcium Levels and Short-Term Mortality in
           Patients with Chronic Heart Failure
    • Abstract: Publication date: February 2019Source: The American Journal of Medicine, Volume 132, Issue 2Author(s): Anne-Sofie Caroline Jensen, Christoffer Polcwiartek, Peter Søgaard, Rikke Nørmark Mortensen, Line Davidsen, Mette Aldahl, Matilde Alida Eriksen, Kristian Kragholm, Christian Torp-Pedersen, Steen Møller Hansen BackgroundPatients with chronic heart failure have vulnerable myocardial function and are susceptible to electrolyte disturbances. In these patients, diuretic treatment is frequently prescribed, though it is known to cause electrolyte disturbances. Therefore, we investigated the association between altered calcium homeostasis and the risk of all-cause mortality in chronic heart failure patients.MethodsFrom Danish national registries, we identified patients with chronic heart failure with a serum calcium measurement within a minimum 90 days after initiated treatment with both loop diuretics and angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Patients were divided into 3 groups according to serum calcium levels, and Cox regression was used to assess the mortality risk of 1.32 mmol/L (hypercalcemia) compared with 1.18 mmol/L–1.32 mmol/L (normocalcemia) as reference. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated.ResultsOf 2729 patients meeting the inclusion criteria, 32.6% had hypocalcemia, 63.1% normocalcemia, and 4.3% hypercalcemia. The highest mortality risk was present in early deaths (≤30 days), with a HR of 2.22 (95% CI; 1.74-2.82) in hypocalcemic patients and 1.67 (95% CI; 0.96-2.90) in hypercalcemic patients compared with normocalcemic patients. As for late deaths (>30 days), a HR of 1.52 (95% CI; 1.12-2.05) was found for hypocalcemic patients and a HR of 1.87 (95% CI; 1.03-3.41) for hypercalcemic patients compared with normocalcemic patients. In adjusted analyses, hypocalcemia and hypercalcemia remained associated with an increased mortality risk in both the short term (≤30 days) and longer term (>30 days).ConclusionAltered calcium homeostasis was associated with an increased short-term mortality risk. Almost one-third of all the heart failure patients suffered from hypocalcemia, having a poor prognosis.
       
  • Telltale T Waves
    • Abstract: Publication date: February 2019Source: The American Journal of Medicine, Volume 132, Issue 2Author(s): Nitin Kondamudi, Shah R. Ali, Amit Khera
       
  • The Reply
    • Abstract: Publication date: Available online 11 January 2019Source: The American Journal of MedicineAuthor(s): Prashant Rao, Adolph M. Hutter, Aaron L. Baggish
       
 
 
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