American Journal of Medicine, internal medicine, medicine, health, healthy lifestyles, cancer, heart disease, drugs
Dr. Joseph S. Alpert

Divisions, Departments, and the 2018 Red Sox Baseball Team: Qualities of Leadership That Lead to Success

I am a converted Red Sox baseball fan. I grew up in New Haven, Conn, and was an ardent New York Yankees fan growing up. However, during my many years living in Massachusetts, as well as having numerous contacts with players for the Red Sox at the University of Massachusetts Medical Center, I became a […]

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Outcomes of Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

Acute 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. Methods […]

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Concomitant Use of Direct Oral Anticoagulants with Antiplatelet Agents and the Risk of Major Bleeding in Patients with Nonvalvular Atrial Fibrillation

Patients with nonvalvular atrial fibrillation commonly have comorbidities requiring concurrent use of oral anticoagulants and antiplatelets. There are no real-world data on the comparative safety of concomitant antithrombotic treatments in the era of direct oral anticoagulant (DOACs). Thus, we compared the incidence of intracranial hemorrhage, gastrointestinal bleeding, and other major bleeding between concomitant DOAC-antiplatelet use […]

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Pheidippides’ sudden cardiac death in the Atheneum in 490 B.C. after declaring victory over the invading Persian army on the Plains of Marathon (by anonymous).

Unforseeing one! Yes, he fought on Marathon day: So, when Persia was dust, all cried “To Akropolis! Run, Pheidippides, one race more. Till in Athens he broke, ‘Rejoice, we conquer!” Joy in his blood bursting his heart, he died—the bliss! ‘Pheidippides’ by Robert Browning, 1879.

Aspirin to Prevent Sudden Cardiac Death in Athletes with High Coronary Artery Calcium Scores

While proficient cardiac resuscitation has improved survival following cardiac arrest during road races in Japan, this accomplishment does not address coronary artery disease as the underlying cause of an increasing frequency of cardiac arrest in middle-aged men during marathons and ironman triathlons in the United States since the year 2000. Based on the high prevalence […]

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Should Patients Infected with Borrelia burgdorferi No Longer Be Referred to as Having Lyme Disease?

In 1977, a seminal paper described what was subsequently called Lyme arthritis.1 The name ‘Lyme’ originated from the initial investigation of the disease that was conducted in the Connecticut towns of Lyme, Old Lyme, and East Haddam.1 As more of the clinical manifestations of this illness were discovered, the condition became referred to as Lyme disease.2, 3, 4 In 1983, the […]

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Medical Tourists: Incoming and Outgoing

Patients who travel to another country to seek health care are referred to as medical tourists. The term arose because many Americans seek less expensive elective surgical, dental, or cosmetic procedures while vacationing abroad.1 Of course, US hospitals and physicians have also long cared for medical tourists from other countries. Now, many medical tourists are going […]

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Chest radiograph demonstrating 2 bilateral cavitating pulmonary infiltrates (A) and chest radiograph 9 months later demonstrating complete resolution of the infiltrates after immunosuppressive therapy (B).

Granulomatosis with Polyangiitis Presenting as Hypophysitis

A 20-year-old healthy woman presented to a local hospital with 3 months of headaches and fatigue and 3 weeks of intermittent fevers to 40°C. Physical examination was normal. White blood cell count was 6.1 × 109/L, hemoglobin 10 g/dL, sodium 153 mmol/L, and creatinine 0.80 mg/dL. Magnetic resonance imaging demonstrated a 2.1 × 1.8 × 0.9-cm cystic sellar lesion. Hormone testing […]

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Doppler assessment by transesophageal echocardiogram of severe mitral stenosis.

Diagnostic and Management Dilemma: Massive Hemoptysis from Severe Mitral Stenosis

Severe hemoptysis in a critically ill patient must prompt rapid development of a broad differential. We present an unusual case that presented a diagnostic and management dilemma. A 55-year-old man presented to the Emergency Department with dyspnea and hemoptysis. He was hemodynamically unstable, requiring intubation and pressor support. Assessment On examination, he was afebrile and […]

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Hemoglobin A1c trend before and after proprotein convertase subtilisin/kexin 9 inhibitor (PCSK9I) therapy. Hemoglobin A1c values prior to PCSK9I therapy were in the range of 6.4% to 7.3%. After initiation of therapy, they slowly trended up, eventually doubled, and then improved after discontinuation of the medication.

Doubling of Hemoglobin A1c on PCSK9 Inhibitor Therapy

A 70-year-old man with history of cerebrovascular accident, hyperlipidemia, and type 2 diabetes mellitus presented with polyuria, polydipsia, and weight loss. Severe hyperglycemia (serum glucose, 585 mg/dL) was present on admission. No precipitating factors were identified. Initial laboratory findings were also notable for elevated aspartate aminotransferase (703 IU/L) and alanine aminotransferase (779 IU/L). Diabetes mellitus, […]

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