American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs

A Worm Hole: Liver Abscess in Ascariasis

A patient with an infection that is often asymptomatic developed an uncommon complication. The 60-year-old woman presented with fever and pain in the epigastrium and right hypochondrium, symptoms that had existed for the previous 5 days. On touch, she was clearly febrile. Her temperature was 38.6°C (101.5°F). Her blood pressure and pulse rate were within […]

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Effectiveness and Safety of Rivaroxaban Versus Warfarin in Frail Patients with Venous Thromboembolism

Frailty predicts poorer outcomes in patients receiving anticoagulation. We assessed the effectiveness and safety of rivaroxaban vs warfarin in frail patients experiencing venous thromboembolism. Methods Using US MarketScan claims data from January 2012-December 2016, we identified frail patients (using the Johns Hopkins Claims-Based Frailty Indicator score) who had ≥1 primary hospitalization/emergency department visit diagnosis codes […]

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Effective Immunization of Older Adults Against Seasonal Influenza

The 2017-2018 influenza season reminds us that it is important for health care professionals to be prepared for the annual onslaught of this contagious respiratory disease associated with potentially serious complications. Vaccination is by far the best method to prevent and control influenza, reducing illness, hospitalizations, and mortality. The highest rates of influenza-associated morbidity and […]

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close up of gloved hands filling a syringe

Emerging Trends in Pain Medication Management: Back to the Future: A Focus on Ketamine

  Providers face many challenges when faced with pain management. Pain is complex, difficult to understand and diagnose, and especially enigmatic to manage. The discovery of nonopioid agents for pain management has become particularly important considering the ongoing opioid epidemic. This review is focused on revisiting ketamine, an agent that has historically been used for […]

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Dr. Joseph S. Alpert

Socrates on Quality

Following several hours of vigorous exercise on a warm afternoon in the spring of 410 bce, Socrates converses with Asculepo, a young medical student attending the Hippocrates School of Medicine in Athens. Asculepo is telling Socrates about several recent lectures at the school on the subject of quality in healthcare. Socrates: A wonderful afternoon, Asculepo, perfect weather […]

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Geographic Variability in Liver Disease-Related Mortality Rates in the United States

Liver disease is an important cause of morbidity and mortality in the United States. Geographic variations in the burden of chronic liver disease may have significant impact on public health policies but have not been explored at the national level. The objective of this study is to examine interstate variability in liver disease mortality in […]

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Importance of Genetic Testing in the Diagnosis of Transthyretin Cardiac Amyloidosis

To the Editor: Systemic amyloidosis results from extracellular deposition of fibrillar material derived from aggregation of precursor proteins into insoluble beta-pleated sheets. The most frequently recognized types are due to prolonged inflammation, deposition of immunoglobulin light chains, and accumulation of transthyretin, a tetrameric protein synthesized in the liver. Transthyretin amyloidosis can occur owing to wild-type […]

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Hypertriglyceridemia-Induced Acute Pancreatitis with Normal Pancreatic Enzymes

To the Editor: The diagnosis of acute pancreatitis requires 2 of the following 3 features: 1) abdominal pain consistent with acute pancreatitis; 2) serum lipase activity (or amylase activity) at least 3 times greater than the upper limit of normal; and 3) characteristic imaging findings of acute pancreatitis.1 Although normal serum amylase levels have been reported […]

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Skin and Nasal Involvement: Look for Sarcoidosis!

  Sarcoidosis is a systemic, noncaseating, granulomatous disease affecting young adults between the ages of 25 and 40 years, most often of Black origin (35.5/100,000 vs 10.9 in the White population). Although the lower respiratory tract is affected in 90% of cases, ear, nose, and throat locations are very uncommon, with a prevalence varying between […]

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doctor uses tablet with patient

Diabetes Mellitus and Cardiogenic Shock Complicating Acute Myocardial Infarction

Diabetes mellitus (diabetes) increases the risk of acute myocardial infarction, which can result in cardiogenic shock. Data on the relation of diabetes and the occurrence and prognosis of cardiogenic shock postacute myocardial infarction are scant. Methods Among the National Inpatient Sample patients aged ≥18 years and hospitalized for acute myocardial infarction during the 2012-2014 period, […]

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