A Veteran Presenting With Fatigue and Weakness.

: A 65-year-old male veteran presented to the Veterans Affairs Boston Healthcare System (VABHS) emergency department with progressive fatigue, dyspnea on exertion, lightheadedness, and falls over the last month. New bilateral lower extremity numbness up to his knees developed in the week prior to admission and prompted him to seek care. Additional history included 2 episodes of transient loss of consciousness resulting in falls and a week of diarrhea, which had resolved.

Are Text Pages an Effective Nudge to Increase Attendance at Internal Medicine Morning Report Conferences? A Cluster Randomized Controlled Trial.

Background: Despite the importance of medical educational conferences, low attendance remains an issue. The utility of reminder text pages as a behavioral nudge to increase attendance is unknown. Our objective was to determine whether reminder text pages increase daily morning report attendance.

Establishing the safety of phenobarbital treatment of alcohol withdrawal syndrome on general medical wards: A retrospective cohort study.

Introduction: Concern about adverse effects from phenobarbital limits its use in treating alcohol withdrawal syndrome (AWS) on general medical wards. Benzodiazepines are the recommended treatment for inpatient management of AWS, yet a subset of patients have an inadequate response or experience complications of AWS despite treatment with benzodiazepines. Data supporting an alternative treatment are needed.

Alcohol-Related Hospitalizations During the Initial COVID-19 Lockdown in Massachusetts: An Interrupted Time-Series Analysis.

Background: The effect of initial COVID-19 pandemic-associated lockdowns on alcohol-related hospitalizations remains uncertain. This study compares alcohol-related hospitalizations at a US Department of Veterans Affairs (VA) system in Massachusetts before, during, and after the initial COVID-19 lockdown.

Methods: This study is an interrupted time-series analysis at the VA Boston Healthcare System.

Lung cancer screening provides an opportunity for early diagnosis and treatment of interstitial lung disease.

Interstitial lung abnormalities (ILA) can be incidentally detected in patients undergoing low-dose CT screening for lung cancer. In this retrospective study, we explore the downstream impact of ILA detection on interstitial lung disease (ILD) diagnosis and treatment. Using a targeted approach in a lung cancer screening programme, the rate of de novo ILD diagnosis was 1.

Transcatheter mitral valve intervention.

Mitral regurgitation is a common valvular heart disorder increasing with age. Many patients are ineligible for mitral valve surgery due to their age and other comorbidities. Left untreated, patients develop severe disease with a poor prognosis.

Clinical guideline highlights for the hospitalist: 2020 American Society of Addiction Medicine clinical practice guideline on alcohol withdrawal management.

The ASAM Clinical Practice Guideline on Alcohol Withdrawal Management RELEASE DATE: May 2020 PRIOR VERSION: 2004 American Society of Addiction Medicine guideline on management of alcohol withdrawal delirium DEVELOPER: American Society of Addiction Medicine FUNDING SOURCE: American Society of Addiction Medicine TARGET POPULATION: Adults hospitalized with alcohol withdrawal syndrome of any severity.

with (honey) along with adjuvant therapy in the management of trigger finger- A single case report.

Trigger finger (TF) mechanical ailment results from a stenotic A1 pulley that has lost its gliding surface, producing friction and nodular change in the tendon. This results in pain and tenderness at the site of the A1 pulley which further progresses into catching and then locking of the finger. A definite cure of TF in the current mainstream is the surgical release of the A1 pulley.

The Current State of Artificial Intelligence in Medical Imaging and Nuclear Medicine.

The last decade has seen a huge surge in interest surrounding artificial intelligence (AI). AI has been around since the 1950s, although technological limitations in the early days meant performance was initially inferior compared to humans. With rapid progression of algorithm design, growth of vast digital datasets and development of powerful computing power, AI now has the capability to outperform humans.

Exhaled Mycobacterium tuberculosis output and detection of subclinical disease by face-mask sampling: prospective observational studies.

Background: Tuberculosis remains a global health challenge, with early diagnosis key to its reduction. Face-mask sampling detects exhaled Mycobacterium tuberculosis. We aimed to investigate bacillary output from patients with pulmonary tuberculosis and to assess the potential of face-mask sampling as a diagnostic method in active case-finding.

A Multicenter Study Into Causes of Severe Acute Liver Injury.

The differential diagnosis of an increase in alanine aminotransferase (ALT) level and/or aspartate aminotransferase (AST) level of ≥1000 IU/L often is stated to include 3 main etiologies: ischemic hepatitis, acute viral hepatitis (typically hepatitis A and hepatitis B), and drug-induced (more specifically, acetaminophen/paracetamol) liver injury (DILI). Unfortunately, there are a paucity of studies examining the most common causes of acute liver injury (ALI) and those that have been published have been small, single-center, or examined less severe increases in ALT or AST levels. We conducted a multicenter study of all patients with an ALT and/or AST level ≥1000 IU/L.

A Mission for Graduate Medical Education at VA.

Chief medical residents from the 3 affiliate residency training programs at VA Boston Healthcare System developed a mission statement for the educational experience of all medical trainees rotating through VA medical centers.

Exercise Training Improves Ventilatory Efficiency in Patients With a Small Abdominal Aortic Aneurysm: A RANDOMIZED CONTROLLED STUDY.

Purpose: To investigate the effects of exercise training on ventilatory efficiency and physiological responses to submaximal exercise in subjects with small abdominal aortic aneurysm (AAA).

Methods: Sixty-five male patients (72.3 ± 7.

Delineating outcomes of patients with diffuse large b cell lymphoma using the national comprehensive cancer network-international prognostic index and positron emission tomography-defined remission status; a population-based analysis.

The recently devised National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) appears superior to the revised IPI (R-IPI) in delineating outcome in diffuse large B-cell lymphoma. We examined the outcome of a population-based cohort of 223 consecutive patients treated with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone) or R-CHOP-like immuno-chemotherapy between January 2005 and December 2011 by both the NCCN-IPI and R-IPI, and further stratified outcome by the achievement of both computerized tomography (CT) and positron emission tomography (PET)-CT complete remission (CR), with the latter reassessed using blinded central review by an independent nuclear medicine and radiology specialist. The NCCN-IPI was superior to the R-IPI in identifying patients at very high risk of systemic and/or central nervous system relapse.

Few-layer MoS2: a promising layered semiconductor.

Due to the recent expanding interest in two-dimensional layered materials, molybdenum disulfide (MoS2) has been receiving much research attention. Having an ultrathin layered structure and an appreciable direct band gap of 1.9 eV in the monolayer regime, few-layer MoS2 has good potential applications in nanoelectronics, optoelectronics, and flexible devices.

The role of single-photon emission computed tomography/computed tomography in localizing parathyroid adenoma.

With hybrid imaging playing an increasingly important role in nuclear medicine, this article reviews the literature on single-photon emission computed tomography/computed tomography (SPECT/CT) in parathyroid scintigraphy. An understanding of parathyroid and neck anatomy is important for accurate reporting of these scans, as this can have an impact on the surgical approach used. The contribution of SPECT/CT over and above SPECT alone is greatest in terms of localization, particularly for ectopic tumours.

Outbreak of influenza A (H3N2) variant virus infection among attendees of an agricultural fair, Pennsylvania, USA, 2011.

During August 2011, influenza A (H3N2) variant [A(H3N2)v] virus infection developed in a child who attended an agricultural fair in Pennsylvania, USA; the virus resulted from reassortment of a swine influenza virus with influenza A(H1N1)pdm09. We interviewed fair attendees and conducted a retrospective cohort study among members of an agricultural club who attended the fair. Probable and confirmed cases of A(H3N2)v virus infection were defined by serology and genomic sequencing results, respectively.