Subjects -> MEDICAL SCIENCES (Total: 8359 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (210 journals)
    - ANAESTHESIOLOGY (119 journals)
    - CARDIOVASCULAR DISEASES (329 journals)
    - CHIROPRACTIC, HOMEOPATHY, OSTEOPATHY (21 journals)
    - COMMUNICABLE DISEASES, EPIDEMIOLOGY (228 journals)
    - DENTISTRY (288 journals)
    - DERMATOLOGY AND VENEREOLOGY (162 journals)
    - EMERGENCY AND INTENSIVE CRITICAL CARE (119 journals)
    - ENDOCRINOLOGY (148 journals)
    - FORENSIC SCIENCES (41 journals)
    - GASTROENTEROLOGY AND HEPATOLOGY (182 journals)
    - GERONTOLOGY AND GERIATRICS (132 journals)
    - HEMATOLOGY (153 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (164 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (98 journals)
    - MEDICAL GENETICS (58 journals)
    - MEDICAL SCIENCES (2268 journals)
    - NURSES AND NURSING (356 journals)
    - OBSTETRICS AND GYNECOLOGY (202 journals)
    - ONCOLOGY (377 journals)
    - OPHTHALMOLOGY AND OPTOMETRY (136 journals)
    - ORTHOPEDICS AND TRAUMATOLOGY (164 journals)
    - OTORHINOLARYNGOLOGY (80 journals)
    - PATHOLOGY (96 journals)
    - PEDIATRICS (270 journals)
    - PHYSICAL MEDICINE AND REHABILITATION (152 journals)
    - PSYCHIATRY AND NEUROLOGY (813 journals)
    - RADIOLOGY AND NUCLEAR MEDICINE (190 journals)
    - RESPIRATORY DISEASES (102 journals)
    - RHEUMATOLOGY (76 journals)
    - SPORTS MEDICINE (78 journals)
    - SURGERY (393 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (150 journals)

MEDICAL SCIENCES (2268 journals)                  1 2 3 4 5 6 7 8 | Last

Showing 1 - 200 of 3562 Journals sorted alphabetically
16 de Abril     Open Access   (Followers: 1)
3D Printing in Medicine     Open Access   (Followers: 4)
4 open     Open Access  
AADE in Practice     Hybrid Journal   (Followers: 6)
ABCS Health Sciences     Open Access   (Followers: 8)
Abia State University Medical Students' Association Journal     Full-text available via subscription   (Followers: 2)
AboutOpen     Open Access  
ACIMED     Open Access   (Followers: 1)
ACS Medicinal Chemistry Letters     Hybrid Journal   (Followers: 48)
Acta Bio Medica     Full-text available via subscription   (Followers: 2)
Acta Bioethica     Open Access  
Acta Bioquimica Clinica Latinoamericana     Open Access   (Followers: 1)
Acta Científica Estudiantil     Open Access  
Acta Facultatis Medicae Naissensis     Open Access   (Followers: 1)
Acta Herediana     Open Access  
Acta Informatica Medica     Open Access  
Acta Medica (Hradec Králové)     Open Access  
Acta Medica Bulgarica     Open Access  
Acta Medica Colombiana     Open Access   (Followers: 1)
Acta Médica Costarricense     Open Access   (Followers: 2)
Acta Medica Indonesiana     Open Access  
Acta Medica International     Open Access  
Acta medica Lituanica     Open Access  
Acta Medica Marisiensis     Open Access  
Acta Medica Martiniana     Open Access  
Acta Medica Nagasakiensia     Open Access   (Followers: 1)
Acta Medica Peruana     Open Access   (Followers: 2)
Acta Médica Portuguesa     Open Access  
Acta Medica Saliniana     Open Access  
Acta Scientiarum. Health Sciences     Open Access   (Followers: 2)
Acupuncture & Electro-Therapeutics Research     Full-text available via subscription   (Followers: 6)
Acupuncture and Natural Medicine     Open Access  
Addiction Science & Clinical Practice     Open Access   (Followers: 8)
Addictive Behaviors Reports     Open Access   (Followers: 9)
Adıyaman Üniversitesi Sağlık Bilimleri Dergisi / Health Sciences Journal of Adıyaman University     Open Access   (Followers: 1)
Adnan Menderes Üniversitesi Sağlık Bilimleri Fakültesi Dergisi     Open Access   (Followers: 1)
Advanced Biomedical Research     Open Access  
Advanced Health Care Technologies     Open Access   (Followers: 8)
Advanced Science, Engineering and Medicine     Partially Free   (Followers: 8)
Advanced Therapeutics     Hybrid Journal   (Followers: 1)
Advances in Bioscience and Clinical Medicine     Open Access   (Followers: 7)
Advances in Cell and Gene Therapy     Hybrid Journal   (Followers: 1)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26)
Advances in Life Course Research     Hybrid Journal   (Followers: 9)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Medical Education and Practice     Open Access   (Followers: 32)
Advances in Medical Ethics     Open Access   (Followers: 1)
Advances in Medical Research     Open Access   (Followers: 1)
Advances in Medical Sciences     Hybrid Journal   (Followers: 9)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Medicine     Open Access   (Followers: 3)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5)
Advances in Molecular Oncology     Open Access   (Followers: 2)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7)
Advances in Parkinson's Disease     Open Access  
Advances in Phytomedicine     Full-text available via subscription  
Advances in Preventive Medicine     Open Access   (Followers: 6)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20)
Advances in Regenerative Medicine     Open Access   (Followers: 3)
Advances in Skeletal Muscle Function Assessment     Open Access  
Advances in Therapy     Hybrid Journal   (Followers: 5)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6)
Advances in Wound Care     Hybrid Journal   (Followers: 12)
Aerospace Medicine and Human Performance     Full-text available via subscription   (Followers: 13)
African Health Sciences     Open Access   (Followers: 3)
African Journal of Biomedical Research     Open Access   (Followers: 1)
African Journal of Clinical and Experimental Microbiology     Open Access   (Followers: 4)
African Journal of Laboratory Medicine     Open Access   (Followers: 2)
African Journal of Medical and Health Sciences     Open Access   (Followers: 3)
African Journal of Thoracic and Critical Care Medicine     Open Access  
African Journal of Trauma     Open Access   (Followers: 1)
Afrimedic Journal     Open Access   (Followers: 2)
Aggiornamenti CIO     Hybrid Journal   (Followers: 1)
AIDS Research and Human Retroviruses     Hybrid Journal   (Followers: 9)
AJOB Empirical Bioethics     Hybrid Journal   (Followers: 3)
AJSP: Reviews & Reports     Hybrid Journal  
Aktuelle Ernährungsmedizin     Hybrid Journal   (Followers: 4)
Al-Azhar Assiut Medical Journal     Open Access   (Followers: 2)
ALERTA : Revista Científica del Instituto Nacional de Salud     Open Access  
Alexandria Journal of Medicine     Open Access   (Followers: 1)
Allgemeine Homöopathische Zeitung     Hybrid Journal   (Followers: 3)
Alpha Omegan     Full-text available via subscription  
ALTEX : Alternatives to Animal Experimentation     Open Access   (Followers: 2)
Althea Medical Journal     Open Access   (Followers: 2)
American Journal of Biomedical Engineering     Open Access   (Followers: 15)
American Journal of Biomedical Research     Open Access   (Followers: 2)
American Journal of Biomedicine     Full-text available via subscription   (Followers: 7)
American Journal of Chinese Medicine, The     Hybrid Journal   (Followers: 4)
American Journal of Clinical Medicine Research     Open Access   (Followers: 8)
American Journal of Family Therapy     Hybrid Journal   (Followers: 10)
American Journal of Law & Medicine     Full-text available via subscription   (Followers: 11)
American Journal of Lifestyle Medicine     Hybrid Journal   (Followers: 5)
American Journal of Managed Care     Full-text available via subscription   (Followers: 12)
American Journal of Medical Case Reports     Open Access   (Followers: 1)
American Journal of Medical Sciences and Medicine     Open Access   (Followers: 4)
American Journal of Medicine     Hybrid Journal   (Followers: 50)
American Journal of Medicine and Medical Sciences     Open Access   (Followers: 1)
American Journal of Medicine Studies     Open Access   (Followers: 2)
American Journal of Medicine Supplements     Full-text available via subscription   (Followers: 3)
American Journal of the Medical Sciences     Hybrid Journal   (Followers: 12)
American Journal on Addictions     Hybrid Journal   (Followers: 10)
American medical news     Free   (Followers: 3)
American Medical Writers Association Journal     Full-text available via subscription   (Followers: 6)
Amyloid: The Journal of Protein Folding Disorders     Hybrid Journal   (Followers: 5)
Anales de la Facultad de Medicina     Open Access  
Anales de la Facultad de Medicina, Universidad de la República, Uruguay     Open Access  
Anales del Sistema Sanitario de Navarra     Open Access   (Followers: 1)
Analgesia & Resuscitation : Current Research     Hybrid Journal   (Followers: 6)
Anatolian Clinic the Journal of Medical Sciences     Open Access  
Anatomica Medical Journal     Open Access  
Anatomical Science International     Hybrid Journal   (Followers: 3)
Anatomical Sciences Education     Hybrid Journal   (Followers: 1)
Anatomy     Open Access   (Followers: 2)
Anatomy Research International     Open Access   (Followers: 3)
Angewandte Schmerztherapie und Palliativmedizin     Hybrid Journal  
Angiogenesis     Hybrid Journal   (Followers: 3)
Ankara Medical Journal     Open Access   (Followers: 2)
Ankara Üniversitesi Tıp Fakültesi Mecmuası     Open Access  
Annales de Pathologie     Full-text available via subscription  
Annales des Sciences de la Santé     Open Access  
Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale     Full-text available via subscription   (Followers: 3)
Annals of African Medicine     Open Access   (Followers: 2)
Annals of Anatomy - Anatomischer Anzeiger     Hybrid Journal   (Followers: 3)
Annals of Bioanthropology     Open Access   (Followers: 5)
Annals of Biomedical Engineering     Hybrid Journal   (Followers: 19)
Annals of Biomedical Sciences     Full-text available via subscription   (Followers: 4)
Annals of Clinical Hypertension     Open Access  
Annals of Clinical Microbiology and Antimicrobials     Open Access   (Followers: 14)
Annals of Family Medicine     Open Access   (Followers: 14)
Annals of Health Research     Open Access   (Followers: 1)
Annals of Ibadan Postgraduate Medicine     Open Access  
Annals of Medical and Health Sciences Research     Open Access   (Followers: 7)
Annals of Medicine     Hybrid Journal   (Followers: 12)
Annals of Medicine and Surgery     Open Access   (Followers: 7)
Annals of Microbiology     Hybrid Journal   (Followers: 13)
Annals of Nigerian Medicine     Open Access   (Followers: 1)
Annals of Rehabilitation Medicine     Open Access  
Annals of Saudi Medicine     Open Access  
Annals of the New York Academy of Sciences     Hybrid Journal   (Followers: 5)
Annals of The Royal College of Surgeons of England     Full-text available via subscription   (Followers: 3)
Annual Reports in Medicinal Chemistry     Full-text available via subscription   (Followers: 7)
Annual Reports on NMR Spectroscopy     Full-text available via subscription   (Followers: 5)
Annual Review of Medicine     Full-text available via subscription   (Followers: 17)
Anthropological Review     Open Access   (Followers: 24)
Anthropologie et santé     Open Access   (Followers: 5)
Antibiotics     Open Access   (Followers: 9)
Antibodies     Open Access   (Followers: 2)
Antibody Technology Journal     Open Access   (Followers: 1)
Antibody Therapeutics     Open Access  
Anuradhapura Medical Journal     Open Access  
Anwer Khan Modern Medical College Journal     Open Access   (Followers: 2)
Apmis     Hybrid Journal   (Followers: 1)
Apparence(s)     Open Access   (Followers: 1)
Applied Clinical Informatics     Hybrid Journal   (Followers: 4)
Applied Clinical Research, Clinical Trials and Regulatory Affairs     Hybrid Journal   (Followers: 2)
Applied Medical Informatics     Open Access   (Followers: 13)
Arab Journal of Nephrology and Transplantation     Open Access   (Followers: 1)
Archive of Clinical Medicine     Open Access   (Followers: 1)
Archive of Community Health     Open Access   (Followers: 1)
Archives Medical Review Journal / Arşiv Kaynak Tarama Dergisi     Open Access  
Archives of Asthma, Allergy and Immunology     Open Access  
Archives of Medical and Biomedical Research     Open Access   (Followers: 3)
Archives of Medical Laboratory Sciences     Open Access   (Followers: 1)
Archives of Medicine and Health Sciences     Open Access   (Followers: 4)
Archives of Medicine and Surgery     Open Access  
Archives of Trauma Research     Open Access   (Followers: 3)
Archivos de Medicina (Manizales)     Open Access  
ArgoSpine News & Journal     Hybrid Journal  
Arquivos Brasileiros de Oftalmologia     Open Access   (Followers: 1)
Arquivos de Ciências da Saúde     Open Access  
Arquivos de Medicina     Open Access  
Ars Medica : Revista de Ciencias Médicas     Open Access  
ARS Medica Tomitana     Open Access   (Followers: 1)
Art Therapy: Journal of the American Art Therapy Association     Hybrid Journal   (Followers: 17)
Arterial Hypertension     Open Access   (Followers: 1)
Artificial Intelligence in Medicine     Hybrid Journal   (Followers: 18)
Artificial Organs     Hybrid Journal   (Followers: 1)
ASHA Leader     Open Access   (Followers: 1)
Asia Pacific Family Medicine Journal     Open Access   (Followers: 1)
Asia Pacific Journal of Clinical Nutrition     Full-text available via subscription   (Followers: 12)
Asia Pacific Journal of Clinical Trials : Nervous System Diseases     Open Access  
Asian Bioethics Review     Full-text available via subscription   (Followers: 3)
Asian Biomedicine     Open Access   (Followers: 2)
Asian Journal of Cell Biology     Open Access   (Followers: 6)
Asian Journal of Health     Open Access   (Followers: 3)
Asian Journal of Medical and Biological Research     Open Access   (Followers: 4)
Asian Journal of Medical and Pharmaceutical Researches     Open Access   (Followers: 2)
Asian Journal of Medical Sciences     Open Access   (Followers: 2)
Asian Journal of Medicine and Health     Open Access   (Followers: 1)
Asian Journal of Research in Medical and Pharmaceutical Sciences     Open Access   (Followers: 1)
Asian Journal of Scientific Research     Open Access   (Followers: 3)
Asian Journal of Transfusion Science     Open Access   (Followers: 1)
Asian Medicine     Hybrid Journal   (Followers: 5)
Asian Pacific Journal of Cancer Prevention     Open Access  
ASPIRATOR : Journal of Vector-borne Disease Studies     Open Access  
Astrocyte     Open Access  
Atención Familiar     Open Access  
Atención Primaria     Open Access   (Followers: 1)
Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche     Open Access  

        1 2 3 4 5 6 7 8 | Last

Similar Journals
Journal Cover
American Journal of Medicine
Number of Followers: 50  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
Published by Elsevier Homepage  [3147 journals]
  • Systemic treatment with glucocorticoids is associated with incident
           hypoglycemia and mortality: A historical prospective analysis
    • Abstract: Publication date: Available online 23 January 2020Source: The American Journal of MedicineAuthor(s): Israel Khanimov, Mona Boaz, Mordechai Shimonov, Julio Wainstein, Eyal LeibovitzAbstractPurposeTo examine whether the increased glycemic variability associated with systemic glucocorticoid treatment is also associated with increased incidence of hypoglycemia.MethodsIn this retrospective analysis were included all patients discharged from internal medicine units between 2010 and 2013. Patients were assigned to 3 groups: Group 1: No steroids were prescribed. Group 2: Topical or inhaled steroids with no systemic treatment. Group 3: Systemic steroids were prescribed, with or without topical or inhaled treatment.ResultsA total of 45,272 patients were included in the study. Patients in Group 3 had significantly higher rates of hypoglycemia (10.9%) compared to patients in Group 2 (7.4%), and patients in Group 1 (7.3%). Patients with diabetes mellitus had higher rates of hypoglycemia compared to patients without diabetes mellitus (14.3% vs. 4.9%), but exhibited similar trends in response to steroid treatment. Multivariate analysis showed that systemic steroids were associated with increased risk for hypoglycemia (OR 1.513, 95% CI 1.311- 1.746, p
       
  • Newer Insights Into Takotsubo Cardiomyopathy
    • Abstract: Publication date: Available online 23 January 2020Source: The American Journal of MedicineAuthor(s): Kamal Kant Sahu, Ajay Kumar Mishra, Amos Lal
       
  • Financial Incentives for Smoking Cessation in Hospitalized Patients: A
           Randomized Clinical Trial
    • Abstract: Publication date: Available online 23 January 2020Source: The American Journal of MedicineAuthor(s): Joseph A. Ladapo, Chi-Hong Tseng, Scott E. ShermanABSTRACTBackground-Financial incentives for smoking cessation and use of evidence-based therapy may increase quit rates and reduce health and economic disparities.Methods-We randomized a low-income population of 182 hospitalized patients (mean age 58 years, 45% with high school education or less) to enhanced usual care, which included hospital-directed cessation care and Quitline referral, or enhanced usual care plus financial incentives. All patients received enhanced usual care, while participants randomized to the financial incentives group were also eligible to receive up to $550 for participation in Quitline counseling ($50), participation in a community-based cessation program ($50), use of pharmacotherapy ($50), and biochemically-confirmed smoking cessation at 2 months ($150) and 6 months ($250). Primary outcome was biochemically-confirmed smoking cessation at 6 months after hospital discharge.Results-Total mean payment was $84 (SD=$133) in the incentive group. The 6-month rate of biochemically-confirmed smoking cessation was 19.6% in the incentive group and 8.9% in the enhanced usual care group (odds ratio, 2.56; 95% CI, 0.84 to 7.83, P=0.10). Participants in the incentive group had higher rates of nicotine replacement therapy use (57.3% versus 31.3%, P=0.002). Financial incentives did not improve subjective social status but did increase financial stress.Conclusions-Rates of bioconfirmed smoking cessation were higher among hospitalized patients randomized to financial incentives compared to usual care alone, but the difference was not significant. Considering the frequency of low payouts and the importance of assistance for successful quitting, future studies should explore the effectiveness of financial incentives sufficiently large to overcome barriers to evidence-based therapy.
       
  • Opportunities and Challenges of Disruptive Innovation in Medicine using
           Artificial Intelligence
    • Abstract: Publication date: Available online 22 January 2020Source: The American Journal of MedicineAuthor(s): Rinku Skaria, Pratik Satam, Zain Khalpey
       
  • Trigeminal Trophic Syndrome: A Cause of Dysesthesia and Persistent Facial
           Ulceration
    • Abstract: Publication date: Available online 22 January 2020Source: The American Journal of MedicineAuthor(s): Ashlee Margheim, Robert Spaulding, Courtney R. Schadt
       
  • The Passing of a Mentor
    • Abstract: Publication date: Available online 21 January 2020Source: The American Journal of MedicineAuthor(s): Stuart R. Chipkin, Terri L. Paul
       
  • The Undiagnosed Patient in Christina's World
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Aleksandar Radonjic
       
  • Fetal Hypertension
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Yan Qiu Wang, Hui Juan Zhang, MJ Quinn
       
  • The Reply
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Joseph S. Alpert
       
  • Death by Powerpoint
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Norman J. Temple
       
  • The Reply
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Vida Abedi, Ramin Zand
       
  • Artificial Intelligence in Medical Education
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Tushar Garg,
       
  • The Reply
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Vida Abedi, Ramin Zand
       
  • To the Horizon: The Brink of an AI Revolution in Prostate Cancer'
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Joseph M. Norris, Asif Raza
       
  • The Reply
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Melina Stüssi-Helbling, Mattia Arrigo, Lars C. Huber
       
  • Illuminating Gestalt in Diagnosing Acute Pulmonary Embolism
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Jayshil J. Patel, Paul A. Bergl
       
  • What Are the Parameters That Should Inform Gestalt as a Clinical Decision
           Strategy for Pulmonary Embolism'
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Oscar M.P. Jolobe
       
  • The Reply
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Edward P. Hoffer
       
  • One Way to Fix the Broken Health System Is to Fix the Broken Medical
           Liability System
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Edward Volpintesta
       
  • China’s Health Care System: Something is Wrong and How We Can Fix It
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): GuanYang Kang, HuiQing Zhang
       
  • DRESS Masquerading as Acute Cholecystitis
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Adinia Santosa, Sam Shiyao Yang, Nisha Suyien Chandran
       
  • Half and Half Nails
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Shashank Singh, Mandy Sue Silver, Monika Aleksandra Gasiorek, Abhilash Koratala
       
  • Pseudohyperkalemia in Chronic Lymphocytic Leukemia
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Alon Bnaya, Rosa Ruchlemer, Eyal Itzkowitz, Ezra Gabbay, Linda Shavit
       
  • Recurrent Pericarditis as an Initial Presentation of Rheumatoid Arthritis
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Georges El Hasbani, Basel K. Masri, Abdallah G Rebeiz, Imad Uthman
       
  • Splenic Vein Thrombosis—Caught in the Middle
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Ami Schattner, Yair Glick
       
  • Cushing’s Disease in a Patient with MEN 2B Syndrome
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Ivan Kruljac, Nina Dabelić, Domagoj Marjan, Kristina Blaslov, Božidar Perić, Gorana Mirošević, Davor Vagić, Milan Vrkljan
       
  • Misdiagnosis of Liver Abscess Resulting From Misunderstood Culture Results
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Kai Uehara, Yukinori Harada
       
  • Rapid Diagnosis of Infective Endocarditis Using Pocket-Sized Ultrasound
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Dan Haberman, Meital Zikry, Natasha Kozak, Jacob George, Sara Shimoni
       
  • Meta-Analysis of Transcatheter Aortic Valve Replacement in Low-Risk
           Patients
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Babikir Kheiri, Mohammed Osman, Ahmed Bakhit, Qais Radaideh, Mahmoud Barbarawi, Yazan Zayed, Harsh Golwala, Firas Zahr, Gregg W. Stone, Deepak L. BhattAbstractPurposeThis study evaluated the efficacy and safety of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement (SAVR) in low surgical risk patients.MethodsAn electronic database search was conducted for randomized controlled trials (RCTs). We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model.ResultsFive RCTs were identified with a total of 3,072 patients (mean age 74.5 ± 6.1 and 64.8% male). Compared with SAVR, TAVR was associated with a significantly reduced rate of death or disabling stroke (HR = 0.52; 95% CI = 0.27-0.99; P = .049), atrial-fibrillation (HR = 0.28; 95% CI = 0.18-0.46; P < .01), and post-procedure bleeding (HR = 0.38; 95% CI = 0.31-0.46; P < .01), along with a significantly improved quality-of-life at 1-year. However, TAVR was associated with significantly increased rates of paravalvular leak (HR = 4.09; 95% CI = 1.92-8.69; P < .01) and pacemaker insertion (HR = 2.81; 95% CI = 1.85-4.28; P < .01) compared with SAVR.ConclusionAmong older low-risk patients with severe aortic stenosis, TAVR is associated with a lower rate of death or disabling stroke compared with SAVR. Transcatheter aortic valve replacement is also associated with improved quality-of-life, reduced bleeding and atrial fibrillation, but higher paravalvular leak and pacemaker implantation rates.
       
  • Early Effects of Starting Doses of Enalapril in Patients with Chronic
           Heart Failure in the SOLVD Treatment Trial
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Phillip H. Lam, Milton Packer, Gregg C. Fonarow, Charles Faselis, Richard M. Allman, Charity J. Morgan, Steven N. Singh, Bertram Pitt, Ali AhmedAbstractBackgroundIn the Studies of Left Ventricular Dysfunction (SOLVD) treatment trial, similar clinical benefits were observed between starting doses of enalapril and the target dose achieved by postrandomization up-titration. In our current analysis, protecting the randomization, we examined the early effects of starting doses of enalapril.MethodsThere were 2569 patients with mild-to-moderate chronic heart failure with reduced ejection fraction (ejection fraction ≤ 35%) randomized to receive starting doses (5-10 mg/day) of placebo (n = 1284) or enalapril (n = 1285). At day 14, both study drugs were blindly up-titrated to the target dose (20 mg/day). Overall, 96% (2458/2569) of the patients returned for dose up-titration, which was achieved in 59% (1444/2458), 48% (696/1444) of whom were in the enalapril group. Hazard ratios (HRs) and 95% confidence intervals (CIs) for outcomes in the enalapril group were estimated.ResultsHRs (95% CIs) for all-cause mortality, heart failure hospitalization, and the combined endpoint of heart failure hospitalization or all-cause mortality at 14 days after randomization were 0.80 (0.32-2.03), 0.63 (0.35-1.12), and 0.65 (0.39-1.06), respectively. Corresponding HRs (95% CIs) at 30 days were 0.82 (0.41-1.67), 0.43 (0.27-0.68), and 0.43 (0.27-0.68), respectively. The magnitude of these early effects of starting doses of enalapril is similar to its previously reported long-term effects at the target dose.ConclusionThese data suggest that in stable ambulatory patients with heart failure with reduced ejection fraction, the magnitude of the early effect of starting doses of enalapril is similar to that observed during longer-term therapy with the target doses of the drug.
       
  • The Case for Using Human Insulin
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Mayer B. Davidson
       
  • The Undiagnosed Diseases Network as a Tool for Graduate Medical Education
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Aaron W. Aday, Joel B. Krier, J. Carl Pallais, Elizabeth L. Fieg, Calum A. MacRae, Joseph Loscalzo, Members of the UDN
       
  • An Appeal from the American Lyme Disease Foundation
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Phillip J. Baker
       
  • Routine Microbiologic Studies of Pleural Fluid Specimens in Cancer
           Patients
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Marshall Bailey, Georgie Eapen, David Ost, Roberto F. Casal, Carlos Jimenez, Saumil Datar, Sofia Molina, Lara Bashoura, Saadia A. Faiz, Diwakar D. Balachandran, Vickie R. Shannon, Ajay Sheshadri, Horiana B. GrosuAbstractBackgroundPatients who have pleural effusions typically undergo thoracentesis with examination of pleural fluid in their initial assessment. However, limited data are available on the diagnostic yield of pleural fluid bacterial cultures and fungal and acid-fast bacilli (AFB) smear and cultures in patients with cancer.MethodsWe performed a retrospective cohort study of consecutive patients who had new onset pleural effusions and underwent an initial thoracentesis. The primary outcome was diagnostic yield of pleural fluid bacterial cultures and fungal and AFB smear and cultures.ResultsOf 1637 patients, 1547 (94%) had evidence of active malignancy and 1359 (83%) had evidence of metastatic disease. Of the 1637 patients, 542 (33%) had high clinical suspicion of pneumonia within 14 days prior to thoracentesis. Only 14 patients (1.1%) had positive pleural fluid bacterial cultures, and only 6 of these positive cultures met the criteria for true pleural space infection.ConclusionsThe incidence of positive results from pleural fluid bacterial, fungal, and AFB in cancer populations is very low. Unless there is a suspicion for infection, microbiological analysis should be ordered selectively.
       
  • Adult Life-Course Trajectories of Lung Function and the Development of
           Emphysema: The CARDIA Lung Study
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): George R. Washko, Laura A. Colangelo, Raul San José Estépar, Samuel Y. Ash, Surya P. Bhatt, Yuka Okajima, Kiang Liu, David R. Jacobs, Carlos Iribarren, Bharat Thyagarajan, Cora E. Lewis, Rajesh Kumar, MeiLan K. Han, Mark T. Dransfield, Mercedes R. Carnethon, Ravi KalhanAbstractBackgroundPeak lung function and rate of decline predict future airflow obstruction and nonrespiratory comorbid conditions. Associations between lung function trajectories and emphysema have not been explored.MethodsUsing data from the population-based CARDIA Study, we sought to describe the prevalence of visually ascertained emphysema at multiple time points and contextualize its development based upon participant’s adult life course measures of lung function. There were 3171 men and women enrolled at a mean age of 25 years, who underwent serial spirometric examinations through a mean age of 55 years. Trajectories for the change in percent-predicted forced expiratory volume in one second (FEV1) were determined by fitting a mixture model via maximum likelihood. Emphysema was visually identified on computed tomographic scans and its prevalence reported at mean ages of 40, 45, and 50 years.ResultsWe identified 5 trajectories describing peak and change in FEV1: “Preserved Ideal,” “Preserved Good,” “Preserved Impaired,” “Worsening,” and “Persistently Poor.” Ever smokers comprised part of all 5 trajectories. The prevalence of emphysema was 1.7% (n = 46; mean age of 40 years), 2.5% (n = 67; mean age of 45 years), and 7.1% (n = 189; mean age of 50 years). Of those with emphysema at a mean age of 50 years, 18.0% were never smokers. Worsening and poor lung health trajectories were associated with increased odds of future emphysema independent of chronic tobacco smoke exposure (odds ratio 5.06; confidence interval, 1.84-13.96; odds ratio 4.85; confidence interval, 1.43-16.44).ConclusionsLower peak and accelerated decline in FEV1 are risk factors for future emphysema independent of smoking status.
       
  • Us, Too. Sexual Harassment Within Academic Medicine in the United States
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Linda H. Pololi, Robert T. Brennan, Janet T. Civian, Sandra Shea, Emma Brennan-Wydra, Arthur T. EvansAbstractPurposeWe report on the extent of sexual harassment among residents and examine its relationship to specialty and program year and effects.MethodsUsing the C–Change Resident Survey, we surveyed residents in 34 internal medicine, pediatrics, and general surgery programs in 14 academic medical centers (AMCs). A total of 1708 residents completed the survey (70% response-rate); 51% (n = 879) were women. Respondents reported unwanted sexual comments, attention, or advances by a superior or colleagues within the last 2 years. Measures of vitality and ethical or moral distress were included in the surveys.ResultsRates of sexual harassment reported by women differed across the 34 programs, with an interquartile range of 0%-11%. Residents in pediatrics had the lowest frequencies of sexual harassment (mean 2%, 95% confidence interval [CI] 0%, 4%). Residents in internal medicine had higher rates of sexual harassment (mean 7%, 95% CI 1%, 25%). Residents in surgery had the highest rates (mean 12%, 95% CI 2%, 33%). Sexual harassment was associated with lower levels of vitality and higher ethical or moral distress (both, P
       
  • Risk of Cardiovascular Events in Patients With Type 2 Diabetes and
           Metabolic Dyslipidemia Without Prevalent Atherosclerotic Cardiovascular
           Disease
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Jamal S. Rana, Jennifer Y. Liu, Howard H. Moffet, Robert J. Sanchez, Irfan Khan, Andrew J. KarterAbstractBackgroundThe relationship between achieved low-density lipoprotein cholesterol (LDL-C) levels and risk of incident atherosclerotic cardiovascular disease events among patients with diabetes and metabolic dyslipidemia has not been well described.MethodsWe conducted an observational cohort study of statin-treated adults (ages 21–90 years) with type 2 diabetes without established atherosclerotic cardiovascular disease (as of January 1, 2006) who had metabolic dyslipidemia (elevated triglycerides ≥ 150 mg/dL and low high-density lipoprotein cholesterol,
       
  • Ovarian Vein Thrombosis in an Elderly Female with Pyelonephritis
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Katherine Bruening, Sarah Laper, James Pile
       
  • Connective Tissue is the Issue: Relapsing Polychondritis
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Vivek K. Murthy, Andrea Fava
       
  • Glycogenic Hepatopathy Causing Elevated Lactic Acid and Liver Enzymes
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Jessica A. Regan, Bryan Golubski, Elizabeth B. Gilbert, Brian Sullivan, Shannon J. McCall, Suchita S. Sata
       
  • A Curious Case of Endocarditis and Liver Abscess in a Previously Healthy
           Man
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Nicholas Volpe, Sean Connolly, Baljash Cheema, Michael Angarone
       
  • Propensity Score Matching: The ‘Devil is in the Details’ Where More
           May Be Hidden than You Know
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): James A. ReiffelABSTRACTPropensity score matching has been used with increasing frequency in the analyses of non-prespecified subgroups of randomized clinical trials, and in retrospective analyses of clinical trial data sets, registries, observational studies, electronic medical record analyses, and more. The method attempts to adjust post hoc for recognized unbalanced factors at baseline such that the data once analyzed will hopefully approximate or indicate what a prospective randomized data set—the “gold standard” for comparing two or more therapies—would have shown. However, for practical limitations, propensity score matching cannot assess and balance all the factors that come into play in the clinical management of patients and that may be present in the circumstances of the study. Thus, propensity score matching analyses may omit, due to nonrecognition, the effects of several clinically important but not considered factors that can affect the outcomes of the analyses being reported, causing them to possibly be misleading, or hypothesis-generating at best. This review discusses this issue, using several specific examples, and is targeted at clinicians to make them aware of the limitations of such analyses when they apply their results to patients in their care.
       
  • Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction in
           Patients With Nonalcoholic Fatty Liver Disease
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Milton PackerAbstractThe most common causes of chronic liver disease in the developed world—nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH)—are the hepatic manifestations of an insulin-resistant state that is linked to visceral adiposity and systemic inflammation. NAFLD and NASH lead to an expansion of epicardial adipose tissue and the release of proinflammatory adipocytokines that cause microcirculatory dysfunction and fibrosis of the adjoining myocardium, resulting in atrial fibrillation as well as heart failure with a preserved ejection fraction (HFpEF). Inflammatory changes in the left atrium lead to electroanatomical remodeling; thus, NAFLD and NASH markedly increase the risk of atrial fibrillation. Simultaneously, patients with NAFLD or NASH commonly show diastolic dysfunction or latent HFpEF. Interventions include 1) weight loss by caloric restriction, bariatric surgery, or intensive exercise, and 2) drugs that ameliorate fat-mediated inflammation in both the liver and heart (eg, statins, metformin, sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and pioglitazone). Patients with NAFLD or NASH commonly have an inflammation-related atrial and ventricular myopathy, which may contribute to symptoms and long-term outcomes.
       
  • An Evidence-Based Review of Elevated Blood Pressure for the Inpatient
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Bryan Stanistreet, Joseph A. Nicholas, John D. BisognanoAbstractElevated blood pressure is common in patients who are hospitalized. There are no guidelines and few recommendations to help inpatient providers manage patients with elevated blood pressure. There are no normal reported values for blood pressure in the inpatient and recording circumstances often widely vary. Many factors may influence blood pressure such as pain, anxiety, malaise, nicotine withdrawal, or withholding home medications. This review of available literature suggests potential harm and little to no potential benefit in treating asymptomatic patients with elevated blood pressure. This review also found no evidence that asymptomatic elevated blood pressure progresses to lead to end-organ damage. However, there are clear instances of hypertensive emergency where treatment is indicated. Conscientious adjustment of an anti-hypertensive regimen should be undertaken during episode of elevated blood pressure associated with end-organ damage.
       
  • Physician Stress and Burnout
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Scott W. YatesAbstractTens (or hundreds) of thousands of Americans die each year as a result of preventable medical errors. Changes in the practice and business of medicine have caused some to question whether burnout among physicians and other healthcare providers may adversely affect patient outcomes. A clear consensus supports the contention that burnout affects patients, albeit with low-quality objective data. The psychological and physical impact on physicians and other providers is quite clear, however, and the impact on the physician workforce (where large shortages are projected) is yet another cause for concern. We have all heard the airplane safety announcement remind us to “Please put on your own oxygen mask first before assisting others.” Unfortunately, like many airline passengers (very few of whom use oxygen masks correctly when they are needed), physicians often do not recognize symptoms of burnout or depression, and even less often do they seek help. We detail the causes and consequences of physician burnout and propose solutions to increase physician work satisfaction.
       
  • On the Pearls and Perils of Sub-Subspecialization
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Ohad Oren, Bernard J. Gersh, Deepak L. Bhatt
       
  • Should Routine Screening for Coronary Artery Disease Be Recommended' A
           Comparison With Routine Screening for Colon Cancer
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): David S. Schade, Sanjeev Arora, R. Philip Eaton
       
  • A Possible and Simple Response to Physician Burnout
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Joseph S. Alpert
       
  • Oath to Self-Care and Well-Being
    • Abstract: Publication date: February 2020Source: The American Journal of Medicine, Volume 133, Issue 2Author(s): Mukta Panda, Kevin E. O'Brien, Margaret C. Lo
       
  • Growing Mismatch Between Evidence Generation and Implementation in Heart
           Failure
    • Abstract: Publication date: Available online 17 January 2020Source: The American Journal of MedicineAuthor(s): Ankeet S. Bhatt, Muthiah Vaduganathan, Javed Butler
       
  • Lung MRI as a potential complementary diagnostic tool for early COPD
    • Abstract: Publication date: Available online 16 January 2020Source: The American Journal of MedicineAuthor(s): Francesca Polverino, Erik B. Hysinger, Nishant Gupta, Matt Willmering, Tod Olin, Steven H. Abman, Jason C WoodsAbstractMany knowledge gaps in the nature of early Chronic Obstructive Pulmonary Disease (COPD) still exist, mainly because COPD has always been considered a disease of the elderly. Little attention has been paid to the pathologic changes in the lungs of young adults with risk factors for COPD, such as bronchopulmonary dysplasia. One major limitation is the current lack of non-invasive ways to sensitively measure and/or image functional declines from subjects who are at risk for COPD but haven't yet developed more significant clinical symptoms of the disease.  We report the use of lung magnetic resonance (MRI) with hyperpolarized gas in the identification of lung abnormalities in a patient with bronchopulmonary dysplasia with underlying chronic airflow limitation, who meets the spirometry criteria for early-onset COPD. In the post-surfactant era, where more young-adults will be spirometrically diagnosed with COPD, patients should be classified not only on the basis of their airflow limitation, but also on lung abnormalities identified with safe, comprehensive imaging technologies which allow regular, longitudinal follow up.
       
  • The Primary Cares Initiative: Value-Based Redesign of Primary
           Care
    • Abstract: Publication date: Available online 15 January 2020Source: The American Journal of MedicineAuthor(s): Haley E. Bliss, Paul George, Eli Y. Adashi
       
  • Empathy in medicine: What it is, and how much we really need it
    • Abstract: Publication date: Available online 15 January 2020Source: The American Journal of MedicineAuthor(s): Jean DecetyAbstractIt is acknowledged that empathy plays a critical role in the physician-patient relationship and has a positive impact on health outcomes. However, as the field of empathy expands, the lack of conceptual coherence challenges advances in medicine. In fact, in some cases there is little added theoretical or clinical value in applying the all-encompassing term of empathy in medical setting, which is by nature multidimensional, interpersonal and modulated by the context. Functional neuroimaging studies of health professionals, designed to examine patterns of brain activation in response to empathy-eliciting situations bring theoretical clarity to the neurocognitive mechanisms that underlie interpersonal sensitivity, emotional empathy, cognitive empathy, and caring. These components are relatively independent, but often interact and are deeply interwoven in the fabric of the brain. Nevertheless, it seems clear from this review that cultivating empathic concern or compassion in today's medicine is more important than other aspects of empathy, like vicariously experiencing and introspecting about patients' emotions. Specific neurobiological mechanisms explain the benefit to patients of their physicians’ perceived empathy.
       
  • INTERPRETERS IN HEALTHCARE: A CONCISE REVIEW for Clinicians
    • Abstract: Publication date: Available online 11 January 2020Source: The American Journal of MedicineAuthor(s): Mary J. Kasten, Anthony C. Berman, Amanda B. Ebright, Jay D. Mitchell, Onelis Quirindongo-CedenoAbstractHealth care providers are frequently faced with the challenge of caring for patients who have limited English proficiency. These patients experience challenges accessing healthcare and are at higher risk of receiving suboptimal healthcare than native English speakers. Healthcare interpreters are crucial partners to help break down communication barriers and prevent these patients from facing health care disparities. Many providers lack the skill-set and knowledge that are vital to successful collaboration with an interpreter. The objective of this article is to address a number of questions surrounding the use of healthcare interpreters and to provide concrete suggestions which will enable providers to best serve their patients.
       
  • Spurious Low Serum Bicarbonate Level due to Severe Hypertriglyceridemia
           – A Clinical Challenge
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of MedicineAuthor(s): Ali Pardis Dana, Amir Kazory
       
  • An Unusual Cause of Productive Cough with Yellow Sputum
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of MedicineAuthor(s): Sho Kitagawa, Keiya OkamuraWe declare that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere. There are no conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its outcome. We obtained informed consent from the patient. The manuscript has been read and approved by all named authors. S. Kitagawa diagnosed the case and wrote the manuscript, and is the article guarantor. K. Okamura contributed to and edited the final manuscript.
       
  • A Review of Antibiotic-Tolerant Persisters and Their Relevance to
           Post-Treatment Lyme Disease Symptoms
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of MedicineAuthor(s): Phillip J. BakerAbstractSeveral well-controlled clinical trials have shown that prolonged antibiotic therapy has no benefit in relieving post-treatment Lyme disease symptoms. However, some insist that such symptoms are due to a persistent Borrelia burgdorferi infection requiring prolonged antibiotic therapy to resolve. This unproven view is bolstered by the results of in vitro where small numbers of viable B. burgdorferi can be detected after treatment with antibiotic. The results described in the present work suggest that the presence of persisters can best be explained by classic biochemical kinetics and that there are alternative explanations for this phenomenon that appears to have no clinical significance.
       
  • Beware of Perianal Pain: Fournier's Gangrene
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of MedicineAuthor(s): Teiko Kawahigashi, Takashi Kawabe, Hirokazu Iijima, Mutsuo Takagi, Yuma Suno, Tomohiro Noda, Kazunao Watanabe
       
  • Bilateral Adrenal Hemorrhage Secondary to Heparin-induced Thrombocytopenia
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of MedicineAuthor(s): Bryan E-Xin Tan
       
  • Cardiorespiratory Fitness, Body-Mass Index, and Markers of Insulin
           Resistance in Apparently Healthy Women and Men
    • Abstract: Publication date: Available online 9 January 2020Source: The American Journal of MedicineAuthor(s): Shoa L. Clarke, Gerald M. Reaven, David Leonard, Carolyn E. Barlow, William L. Haskell, Benjamin L. Willis, Laura DeFina, Joshua W. Knowles, David J. MaronAbstractBackgroundInsulin resistance may be present in healthy adults and is associated poor health outcomes. Obesity is a risk factor for insulin resistance, but most obese adults do not have insulin resistance. Fitness may be protective, but the association between fitness, weight, and insulin resistance has not been studied in a large population of healthy adults.MethodsA cross-sectional analysis of cardiorespiratory fitness, body-mass index, and markers of insulin resistance was performed. Study participants were enrolled at the Cooper Clinic (Dallas, Texas). The analysis included 19,263 women and 48,433 men with no history of diabetes or cardiovascular disease. Cardiorespiratory fitness was measured using exercise treadmill testing. Impaired fasting glucose (100-125 mg/dL) and elevated fasting triglycerides (≥150 mg/dL) were used as a markers of insulin resistance.ResultsAmong normal weight individuals, poor fitness was associated with a 2.2 (1.4-3.6; p=0.001) fold higher odds of insulin resistance in women and a 2.8 (2.1-3.6; p
       
  • Acute pancreatitis after a meatless burger in Familial Chylomicronemia
           Syndrome
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of MedicineAuthor(s): Jonida Haxhi, Josiah Bote, Paul D. Thompson
       
  • Beware ketoacidosis with SGLT2 inhibitors in latent autoimmune diabetes
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of MedicineAuthor(s): Brendan J. Nolan, Suresh Varadarajan, Spiros Fourlanos, Sandra L. NeohAbstractBackgroundSodium-glucose co-transporter-2 (SGLT2) inhibitors are increasingly used for the treatment of type 2 diabetes but have been associated with ketoacidosis.Methods/ResultsWe report a case series of three patients with latent autoimmune diabetes who presented with ketoacidosis, including one case with normal blood glucose levels, in the context of SGLT2 inhibitor use.ConclusionsSGLT2 inhibitors should only be used with caution and close clinical monitoring in patients with latent autoimmune diabetes. A clinical risk score permits targeted autoantibody testing and should be undertaken prior to commencement of SGLT2 inhibitors and/or cessation of insulin.
       
  • Hepatitis C virus-associated cryoglobulinemic vasculitis
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of MedicineAuthor(s): Taro Horino, Osamu Ichii, Satoshi Inotani, Tatsuki Matsumoto, Yoshio Terada
       
  • Disseminated Blastomycosis Presenting as Obstructive Renal Mass Treated
           with Fluconazole
    • Abstract: Publication date: Available online 8 January 2020Source: The American Journal of MedicineAuthor(s): Zachary A. Yetmar, Edison Cano Cevallos, Bobbi Pritt, Daniel C. DeSimone
       
  • Electrolyte Derangements when Ectopic Cushing's Is Included in Dual
           Paraneoplastic Syndrome
    • Abstract: Publication date: Available online 7 January 2020Source: The American Journal of MedicineAuthor(s): Oscar M.P. Jolobe
       
  • Make Scientific Reading Great and More Meaningful Again: Reappraisal of
           the TraditionalP Value in Modern-Day Clinical Research and Practice
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Hawa O. Abu, Robert J. Goldberg
       
  • On Hoping
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Frances C. Hessel
       
  • Scleritis and Endophthalmitis Due to Streptococcus pyogenes
           Infective Endocarditis
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Hayato Mitaka, Tessa Gomez, David C. Perlman
       
  • A Report of Antibiotic-Treated, Blood-Culture Negative MRSA Septic
           Arthritis of the Temporomandibular Joint Preceding MRSA Epidural Abscess
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Claire Baniel, Tabassum A. Kennedy, David J. Ciske
       
  • Central Poststroke Pain with Wallenberg Syndrome
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Junki Mizumoto
       
  • Reversible Hippocratic Fingers in a Patient with Pneumonia
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Matthias Diebold, Sabine Kuster, Michael Osthoff
       
  • The Dark Side of Iron
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Valentina Pietra, Selene Degrassi, Tanja Fusi-Schmidhauser
       
  • Atrial Flutter with Underlying Left Atrial Myxoma
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Eamon P. McCarron, Aoibhinn Clinton, Brian Herron, Mark Jones, Shiva Sreenivasan, Monica Monaghan
       
  • Varicella-Zoster Virus Vasculopathy Leading to Multi-Focal Stroke in an
           Immunocompromised Patient
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Sae K. Jang, Natalia E. Castillo Almeida, Randall Ambroz, Walter Wilson
       
  • Infection of Aortic Endograft Caused by Coccidioidomycosis
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): James Bardwell, Jessica August, Sumaya Farran, Catalin Florita, Fariba Donovan, Tirdad T. Zangeneh
       
  • Productive Cytomegalovirus Infection Is Associated With Impaired
           Endothelial Function in ST-Elevation Myocardial Infarction
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Anna Lebedeva, Elena Maryukhnich, Jean-Charles Grivel, Elena Vasilieva, Leonid Margolis, Alexander ShpektorAbstractBackgroundAn association between productive cytomegalovirus infection and atherosclerosis was shown recently in several trials, including a previous study of ours. However, the mechanism involved in this association is still under investigation. Here, we addressed the interaction between productive cytomegalovirus infection and endothelial function in patients with ST-elevation myocardial infarction (STEMI).MethodsWe analyzed the presence of cytomegaloviral DNA in plasma and endothelial function in 33 patients with STEMI and 33 volunteers without cardiovascular diseases, using real-time polymerase chain reaction (PCR) and a noninvasive test of flow-mediated dilation.ResultsBoth the frequency of presence and the load of cytomegaloviral DNA were higher in plasma of patients with STEMI than those in controls. This difference was independent of other cardiovascular risk factors (7.38 [1.36-40.07]; P = 0.02). The results of the flow-mediated dilation test were lower in patients in STEMI than in controls (5.0% [2.65%-3.09%] vs 12. %5 [7.5%-15.15%]; P = 0.004) and correlated negatively with the cytomegaloviral DNA load (Spearman R = −0.407; P = 0.019) independently of other cardiovascular risk factors.ConclusionsProductive cytomegalovirus infection in patients with STEMI correlated negatively with endothelial function independently of other cardiovascular risk factors. The impact of cytomegalovirus on endothelial function may explain the role of cytomegalovirus in cardiovascular prognosis.
       
  • Relation of Kidney Function Decline and NT-proBNP With Risk of Mortality
           and Readmission in Acute Decompensated Heart Failure
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Wendy McCallum, Hocine Tighiouart, Michael S. Kiernan, Gordon S. Huggins, Mark J. SarnakAbstractBackgroundAcute declines in kidney function occur in approximately 20%-30% of patients with acute decompensated heart failure, but its significance is unclear, and the importance of its context is not known. This study aimed to determine the prognostic value of a decline in kidney function in the context of decongestion among patients admitted with acute decompensated heart failure.MethodsUsing data from patients enrolled in the Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome Study (CARRESS) and Diuretic Optimization Strategies Evaluation (DOSE) trials, we used multivariable Cox regression models to evaluate the association between decline in estimated glomerular filtration rate (eGFR) and change in N-terminal pro-b-type natriuretic peptide (NT-proBNP) with a composite outcome of death and rehospitalization, as well as testing for an interaction between the two.ResultsAmong 435 patients, in-hospital decline in eGFR was not significantly associated with death and rehospitalization (hazard ratio [HR] = 0.89 per 30% decline, 95% confidence interval [CI] 0.74, 1.07), whereas decline in NT-proBNP was associated with lower risk (HR = 0.69 per halving, 95% CI 0.58, 0.83). There was a significant interaction (P = 0.002 unadjusted; P = 0.03 adjusted) between decline in eGFR and change in NT-proBNP where a decline in eGFR was associated with better outcomes when NT-proBNP declined (HR = 0.78 per 30% decline in eGFR, 95% CI 0.61, 0.99), but not when NT-proBNP increased (HR = 0.99, 95% CI 0.76, 1.30).ConclusionsDecline in kidney function during therapy for acute decompensated heart failure is associated with improved outcomes as long as NT-proBNP levels are decreasing as well, suggesting that incorporation of congestion biomarkers may aid clinical interpretation of eGFR declines.
       
  • Clinical Practice Update on Infectious Endocarditis
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Sami El-Dalati, Daniel Cronin, Michael Shea, Richard Weinberg, James Riddell, Laraine Washer, Emily Shuman, James Burke, Sadhana Murali, Christopher Fagan, Twisha Patel, Kirra Ressler, George Michael DeebAbstractInfectious endocarditis is a highly morbid disease with approximately 43,000 cases per year in the United States. The modified Duke Criteria have poor sensitivity; however, advances in diagnostic imaging provide new tools for clinicians to make what can be an elusive diagnosis. There are a number of risk stratification calculators that can help guide providers in medical and surgical management. Patients who inject drugs pose unique challenges for the health care system as their addiction, which is often untreated, can lead to recurrent infections after valve replacement. There is a need to increase access to medication-assisted treatment for opioid use disorders in this population. Recent studies suggest that oral and depo antibiotics may be viable alternatives to conventional intravenous therapy. Additionally, shorter courses of antibiotic therapy are potentially equally efficacious in patients who are surgically managed. Given the complexities involved with their care, patients with endocarditis are best managed by multidisciplinary teams.
       
  • Pulmonary Manifestations of Inflammatory Bowel Disease
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Annie Massart, Daniel P. HuntAbstractPulmonary manifestations of inflammatory bowel disease are increasingly recognized in patients with ulcerative colitis and Crohn’s disease. Most commonly, incidental abnormalities are noted on chest imaging or pulmonary function tests. Although clinically significant pulmonary disease is less common, it can carry significant morbidity for patients. We review the presenting symptoms, workup, and management for several of the more common forms of inflammatory bowel disease-related pulmonary disease. Increased awareness of the spectrum of extraintestinal inflammatory bowel disease will help providers more readily recognize this phenomenon in their own patients and more comprehensively address the protean sequelae of inflammatory bowel disease.
       
  • Salt, No Salt, or Less Salt for Patients With Heart Failure'
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Muhammad Shahzeb Khan, Daniel W. Jones, Javed ButlerAbstractRestricting dietary sodium is a common recommendation given by clinicians to patients with heart failure and is one supported by current guidelines. However, the quality of evidence for this recommendation is suboptimal, and there is no consensus on the optimal level of sodium intake. Though excessive sodium intake is associated with left ventricular hypertrophy and hypertension, recent data have suggested that very low sodium intake is paradoxically associated with worse outcomes for patients with heart failure. This is possibly explained by the association between low sodium intake and activation of the sympathetic and renin-angiotensin-aldosterone systems. Nevertheless, sodium restriction is routinely recommended and remains a cornerstone of heart failure and blood pressure therapy. In this review we discuss the pros and cons of sodium restriction for patients with heart failure from the current literature.
       
  • Scientific Authors in a Changing World of Scholarly Communication: What
           Does the Future Hold'
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Gyorgy Baffy, Michele M. Burns, Beatrice Hoffmann, Subha Ramani, Sunil Sabharwal, Jonathan F. Borus, Susan Pories, Stuart F. Quan, Julie R. IngelfingerAbstractScholarly communication in science, technology, and medicine has been organized around journal-based scientific publishing for the past 350 years. Scientific publishing has unique business models and includes stakeholders with conflicting interests—publishers, funders, libraries, and scholars who create, curate, and consume the literature. Massive growth and change in scholarly communication, coinciding with digitalization, have amplified stresses inherent in traditional scientific publishing, as evidenced by overwhelmed editors and reviewers, increased retraction rates, emergence of pseudo-journals, strained library budgets, and debates about the metrics of academic recognition for scholarly achievements. Simultaneously, several open access models are gaining traction and online technologies offer opportunities to augment traditional tasks of scientific publishing, develop integrated discovery services, and establish global and equitable scholarly communication through crowdsourcing, software development, big data management, and machine learning. These rapidly evolving developments raise financial, legal, and ethical dilemmas that require solutions, while successful strategies are difficult to predict. Key challenges and trends are reviewed from the authors’ perspective about how to engage the scholarly community in this multifaceted process.
       
  • Successful Implementation of Healthful Nutrition Initiatives into
           Hospitals
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Monica Aggarwal, Ariel Grady, Daya Desai, Katrina Hartog, Lilian Correa, Robert J. Ostfeld, Andrew M. Freeman, Michelle McMacken, Eugenia Gianos, Koushik Reddy, Columbus Batiste, Christopher Wenger, Ron Blankstein, Kim Williams, Kathleen Allen, Rebecca M. Seifried, Karen Aspry, Neal D. BarnardAbstractPoor dietary quality is a leading contributor to mortality in the United States, and to most cardiovascular risk factors. By providing education on lifestyle changes and, specifically, dietary changes, hospitals have the opportunity to use the patient experience as a “teachable moment.” The food options provided to inpatients and outpatients can be a paradigm for patients to follow upon discharge from the hospital. There are hospitals in the United States that are showcasing novel ways to increase awareness of optimal dietary patterns and can serve as a model for hospitals nationwide.
       
  • Is Long-Standing Atrial Fibrillation a Biomarker of or Contributor to the
           Symptoms or Progression of Chronic Heart Failure'
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Milton Packer
       
  • Writing Wrongs
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Vinay Guduguntla, Tessa Adzemovic, Vineet Chopra
       
  • The Internist’s Role in Ending the HIV Epidemic in the United States
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Lori E Fantry, Elizabeth Connick
       
  • Extended Thromboprophylaxis for Medical Patients
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): James E. Dalen, Paul D. Stein, Jennifer L. Plitt, Neha Jaswal, Joseph S. Alpert
       
  • Lost in the Haze: The Physician’s Role in Cannabinoid Prescribing
           and Advising
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Bree Johnston, Todd W. Vanderah
       
  • Consistency of Direct-to-Consumer Genetic Testing Results Among Identical
           Twins
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Anne M. Huml, Catherine Sullivan, Maria Figueroa, Karen Scott, Ashwini R. SehgalAbstractBackgroundThe purpose of this study was to evaluate the consistency of 3 commonly used direct-to-consumer genetic testing kits. Genetic testing kits are widely marketed by several companies but the consistency of their results is unclear. Because identical twins share the same DNA, their genetic testing results should provide insight into test consistency.MethodsForty-two identical twins (21 pairs) provided samples for 3 testing companies. Outcomes were concordance of ancestry results when twin pairs were tested by the same company and the same participant was tested by different companies. Concordance of 8 self-reported traits with 23andMe genetic analyses were also examined.ResultsConcordance of ancestry results when twin pairs were tested by the same company was high, with mean percentage agreement ranging from 94.5% to 99.2%. Concordance of ancestry results when participants were tested by 2 different companies was lower, with mean percentage agreement ranging from 52.7% to 84.1%. Concordance of trait results was variable, ranging from 34.1% for deep sleep and detached earlobes to 90.2% for cleft chin.ConclusionThe consistency of consumer genetic testing is high for ancestry results within companies but lower and more variable for ancestry results across companies and for specific traits. These results raise questions about the usefulness of such testing.
       
  • Twenty Common Mistakes Made in Daily Clinical Practice
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): William H. Frishman, Joseph S. Alpert
       
  • #StoptheRobbery: How Residency Training Programs Can Help
    • Abstract: Publication date: January 2020Source: The American Journal of Medicine, Volume 133, Issue 1Author(s): Kruti J. Yagnik, Ashleigh Wright, Zareen Zaidi
       
  • Limitations of Electrocardiography for Detecting Left Ventricular
           Hypertrophy or Concentric Remodeling in Athletes
    • Abstract: Publication date: Available online 15 November 2019Source: The American Journal of MedicineAuthor(s): Kristofer Hedman, Kegan J Moneghetti, David Hsu, Jeffrey W Christle, Alessandro Patti, Euan Ashley, David Hadley, Francois Haddad, Victor FroelicherAbstractBackgroundElectrocardiography (ECG) is used to screen for left ventricular hypertrophy (LVH), but common ECG-LVH criteria have been found less effective in athletes. The purpose of this study was to comprehensively evaluate the value of ECG for identifying athletes with LVH or a concentric cardiac phenotype.MethodsA retrospective analysis of 196 male Division I college athletes routinely screened with ECG and echocardiography within the Stanford Athletic Cardiovascular Screening Program was performed. Left-ventricular mass and volume were determined using echocardiography. LVH was defined as left ventricular mass (LVM)> 102 g/m²; a concentric cardiac phenotype as LVM-to-volume (M/V) ≥ 1.05 g/mL. Twelve-lead electrocardiograms including high-resolution time intervals and QRS voltages were obtained. Thirty-seven previously published ECG-LVH criteria were applied, of which the majority have never been evaluated in athletes. C-statistics, including area under the receiver operating curve (AUC) and likelihood ratios were calculated.ResultsECG lead voltages were poorly associated with LVM (r = 0.18-0.30) and M/V (r = 0.15-0.25). The proportion of athletes with ECG-LVH was 0%-74% across criteria, with sensitivity and specificity ranging between 0% and 91% and 27% and 99.5%, respectively. The average AUC of the criteria in identifying the 11 athletes with LVH was 0.57 (95% confidence interval [CI] 0.56-0.59), and the average AUC for identifying the 8 athletes with a concentric phenotype was 0.59 (95% CI 0.56-0.62).ConclusionThe diagnostic capacity of all ECG-LVH criteria were inadequate and, therefore, not clinically useful in screening for LVH or a concentric phenotype in athletes. This is probably due to the weak association between LVM and ECG voltage.
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 3.229.142.175
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-