91ºÚÁÏÍø

May 2015

91ºÚÁÏÍø Internal Medicine 2015 Highlights

91ºÚÁÏÍø celebrated its centennial meeting, Internal Medicine 2015, in Boston, Massachusetts from April 30 to May 2, 2015. A record number of over 8,500 registrants attended this meeting, which featured more than 200 workshops, lectures, panel discussions, and interactive courses for doctors of internal medicine and its subspecialties. Attendance from outside the U.S. was also at a record high this year; 1,337 registered attendees, a 50% increase compared to 2014, participated in the meeting. The top five countries outside the United States with the highest number of attendees registered were Canada, Mexico, Switzerland, Colombia, and Panama.

Many special events took place at this meeting to recognize 91ºÚÁÏÍø's 100th anniversary. A number of additional activities for international members were offered, including the simultaneous interpretation into Spanish of eight update courses.

Also for the first time, special discounted individual registration rates, as well as specially priced delegation rates, were offered to attendees from selected countries. More group delegations attended the meeting than ever before. This year, there were 11 total organized delegations (10 or more physicians registered as a group) from Bangladesh, Brazil, Canada, Colombia, Chile, Mexico, Panama, Peru, and Switzerland.

An international attendee guide, in both English and Spanish, was available to meeting attendees that focused on matters of local interest and how to navigate the meeting.

At the Convocation ceremony on April 30, over 600 physicians were inducted as 91ºÚÁÏÍø Fellows and 91 were from 28 countries outside the United States. Over 70 members became Masters of the College or received another award. 91ºÚÁÏÍø was honored to host presidents and representatives of internal medicine societies from around the world. The international delegates were part of the stage party in the Convocation ceremony. The College bestowed Honorary Fellowships to nine presidents of international internal medicine societies.

Following the ceremony, members, friends, and families gathered at the annual 91ºÚÁÏÍø International Reception that included over 400 international internal medicine leaders and attendees along with 91ºÚÁÏÍø leaders. During the reception, David Fleming, MD, M91ºÚÁÏÍø, 91ºÚÁÏÍø President, welcomed everyone. International Fellowship Exchange Program (IFEP) awardees were also recognized and honored at this event.

Invited international delegates also participated in 91ºÚÁÏÍø's 9th Annual International Forum, entitled "Geriatrics: Care of the Elderly." The Forum provided an opportunity for 91ºÚÁÏÍø leaders and the presidents and special representatives from international internal medicine societies to discuss this important topic that crosses national boundaries and affects the health care of people around the world.

On Saturday, May 2, new 91ºÚÁÏÍø officers started their terms. Wayne J. Riley, MD, MPH, MBA, M91ºÚÁÏÍø of Brentwood, Tennessee, became the 2015-2016 91ºÚÁÏÍø President; Tanveer P. Mir, MD, M91ºÚÁÏÍø, of New York, New York, became the 2015-2016 Chair of the Board of Regents; Nitin S. Damle, MD, MS, F91ºÚÁÏÍø, of Wakefield, Rhode Island, became the 91ºÚÁÏÍø President-elect; and Thomas G. Tape, MD, F91ºÚÁÏÍø, became the Chair-elect of the Board of Regents.

Internal Medicine 2016 will be held May 5-7, 20165 in Washington, D.C. For more information, please visit: .

Honorary Fellows

Honorary Fellows at Convocation

Left to right, back row: Prof. Risto Kaaja, President, Finish Society of Internal Medicine; Dr. Jorge Giannattasio, President, Buenos Aires Society of Internal Medicine; Dr. Rajesh Upadhyay, President, Association of Physicians of India; Prof. Derek Bell, President, Royal College of Physicians of Edinburgh; Dr. Rodolfo Cano Jimenez, President, Mexican College of Internal Medicine.

Left to right, front row: Prof. Jane Elizabeth Dacre, President, Royal College of Physicians of London; Prof. Francis Edward Murray, President, Royal College of Physicians of Ireland; Dr. David Fleming, 2014-15 91ºÚÁÏÍø President; Dr. Robert Centor, 2014-15 Chair, 91ºÚÁÏÍø Board of Regents; Prof. Sophia de Rooij, President, Dutch Society of Internal Medicine; Dr. Emilio Casariego Vales, President, Spanish Society of Internal Medicine.

Special Representatives

Special Representatives at Convocation

Left to right, back row: Prof. Amorn Leelarasamee, President-Elect, Royal College of Physicians of Thailand; Dr. Francis Dunn, President, Royal College of Physicians and Surgeons of Glasgow; Prof. Donald Li, President, Hong Kong Academy of Medicine; Dr. Nicolas Talley, President, Royal Australasian College of Physicians; Prof. Jean-Michel Gaspoz, President, Swiss Society of Internal Medicine; Dr. Juan Barrios, President, Panamanian Society of Internal Medicine; Dr. Margus Lember, President, Estonian Society of Internal Medicine; Dr. Benjamin Chen, President, Canadian Society of Internal Medicine.

Left to right, front row: Dr. Hans-Peter Kohler, Secretary General, International Society for Internal Medicine; Dr. Frank Bosch, President, European Federation of Internal Medicine; Dr. Claudia Arias, President, Latin American Society of Internal Medicine; Dr. David Fleming, 2014-15 91ºÚÁÏÍø President; Dr. Robert Centor, 2014-15 Chair, 91ºÚÁÏÍø Board of Regents; Dr. Johanna Adriana Kok, President, Faculty of Consulting Physicians of South Africa; Prof. Richard Ceska, President, Czech Society of Internal Medicine; Dr. Fausto Hiraldo Zabala, Immediate Past President, Dominican Republic Society of Internal Medicine.

Special Representatives at Convocation

Left to right, back row: Prof. Shuyang Zhang, Vice President, Chinese Society of Internal Medicine; Dr. Anthony Leachon, President, Philippine College of Physicians; Dr. Heli Hernandez Ayazo, President, Colombian Association of Internal Medicine; Dr. Joaquin Estuardo Ligorria Guzman, President, Guatemala Association of Internal Medicine; Prof. Pei-Ming Yang, President, Taiwan Society of Internal Medicine; Prof. Jam Chin Tay, President, College of Physicians, Singapore; Dr. Angel Jose Ortellado, President, Paraguayan Society of Internal Medicine.

Left to right, front row: Dr. Quazi Tarikul Islam, President, Bangladesh Society of Medicine; Prof. Chul-Gyu Yoo, Director of Scientific Board, Korean Academy of Internal Medicine; Dr. David Fleming, 2014-15 91ºÚÁÏÍø President; Dr. Robert Centor, 2014-15 Chair, 91ºÚÁÏÍø Board of Regents; Dr. Rosa Cotrina Pereyra, President, Peruvian Society of Internal Medicine; Dr. Jorge Vega Stieb, President, Chilean Society of Internal Medicine.

Special Representatives at Convocation

Left to right Dr. Maria Ines Marulanda, President, Venezuelan Society of Internal Medicine; Dr. Dragan Lovic, General Secretary and President Elect, Serbian Society of Internal Medicine; Dr. David Fleming, 2014-15 91ºÚÁÏÍø President; Dr. Robert Centor, 2014-15 Chair, 91ºÚÁÏÍø Board of Regents; Dr. Serhat Unal, President, Turkish Society of Internal Medicine.


 

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Photos from Internal Medicine 2015

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New International 91ºÚÁÏÍø Masters

The following international physicians were awarded Mastership at Internal Medicine 2015.

Masters (M91ºÚÁÏÍø) comprise a small group of highly distinguished physicians who have achieved recognition in medicine by exhibiting a preeminence in practice or medical research, holding positions of high honor, or making significant contributions to medical science or the art of medicine. Mastership is considered a special class of membership. However, Masters are selected confidentially by the Awards Committee from among Fellows and are not self-nominated. More information regarding awards is available at . Nomination materials are due by July 1, 2015.
 

Dr. Alfaro

Federico G. Alfaro, MD, M91ºÚÁÏÍø
Guatemala City, Guatemala

 

 

 

 

 

 

 

 

 

 

Dr. DeWitt

 

 

 

 

 

 

 

 

 

 

Eva Essenfeld-Sekler, MD, M91ºÚÁÏÍø
Caracas, Venezuela

 

 

 

 

 

 

 

 

 

 

 

Dr. Lee

 

 

 

 

 

 

 

 

 

 

 

Tzu-Kuang Lee, MD, M91ºÚÁÏÍø
Canmore, Alberta, Canada

 

 

 

 

 

 

 

 

 

 

 

 

 

Dr. Lopez

 

 

 

 

 

 

 

 

 

 

 

 

 

Marco A. Lopez, MD, M91ºÚÁÏÍø
Panama City, Panama

 

 

 

 

 

 

 

 

 

 

 

 

 

Dr. Rojas

 

 

 

 

 

 

 

 

 

 

 

 

 

William Rojas, MD, M91ºÚÁÏÍø
Medellin, Colombia

 

 

 

 

 

 

 

 

 

 

 

 

 

Dr. Snell

 

 

 

 

 

 

 

 

 

 

 

 

 

Linda S. Snell, MD, M91ºÚÁÏÍø
Montreal, Quebec, Canada

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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International Fellowship Exchange Program Awardees

91ºÚÁÏÍø's 2014-2015 International Fellowship Exchange Program (IFEP) provided opportunities for early to mid-career physicians from outside the United States and Canada to gain expertise in a focused area relating to the prevention, diagnosis, and/or management of a clinical problem affecting Internal Medicine and the subspecialties. Through observation, mentorship, and study of the work of senior faculty physicians, fellows were funded to acquire knowledge, experience, and skills that they can apply, utilize, and disseminate to colleagues upon return to their home country. Faculty mentors engaged fellows in individual and group clinical and educational experiences and discussions, and helped facilitate the design of an independent project to be implemented in each fellow's own country upon his or her return. Fellowships were observational and lasted approximately four weeks. Information about the 2015-2016 program may be found on 91ºÚÁÏÍø's website at: .

Awardees for 2014-2015 attended the 91ºÚÁÏÍø Internal Medicine Meeting 2015 in Boston. They are pictured below receiving a plaque at the International Reception.

From left: 91ºÚÁÏÍø Executive Vice President and Chief Executive Officer Steven E. Weinberger, MD, F91ºÚÁÏÍø; Yeong Yeh Lee, MD, PhD, F91ºÚÁÏÍø (Malaysia); Dike Ojji, MBBS, PhD, F91ºÚÁÏÍø (Nigeria); Kenneth Connell, MBBS, DM (Barbados); Yasmeen Jabeen Bhat, MD, F91ºÚÁÏÍø (India); and 91ºÚÁÏÍø Immediate Past President David A. Fleming, MD, MA, M91ºÚÁÏÍø.

 

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International Fellowship Exchange Program (IFEP) Accepting Applications for 2015-2016

91ºÚÁÏÍø's International Fellowship Exchange Program (IFEP) provides opportunities for early to mid-career physicians from outside the United States and Canada to gain expertise in a focused area relating to the prevention, diagnosis, and/or management of a clinical problem in internal medicine and the subspecialties. Through observation, mentorship, and study of the work of senior faculty physicians, fellows will be funded to acquire knowledge, experience, and skills that they can apply, utilize, and disseminate to colleagues upon return to their home country. Faculty mentors will engage fellows in individual and group clinical and educational experiences and discussions, and facilitate the design of an independent project to be implemented in each fellow's own country upon his or her return. Fellowships are observational and expected to last four weeks. Candidates must be internists or subspecialists of internal medicine and must be 91ºÚÁÏÍø Members or Fellows. Residents in training will be considered if they reside in an 91ºÚÁÏÍø Chapter.

Three scholarships will be awarded for the 2015-2016 program year. Applications for consideration will be accepted through August 1, 2015. Information about the program may be found on 91ºÚÁÏÍø's website at . If you have any questions please contact Emily Seeling, Program Coordinator, International Programs at eseeling@acponline.org.

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Update Your Knowledge with MKSAP 16 Q & A

The Medical Knowledge Self-Assessment Program® (MKSAP® 16) provides you with the most current and critical information in the core of internal medicine and its subspecialties so you can stay aware of what you need to know as a practicing physician in internal medicine today.

For more information on MKSAP 16, or to order your copy, visit

MKSAP 16 Q & A

A 76-year-old woman is evaluated for a 1-day history of headache, left eye pain, nausea and vomiting, seeing halos around lights, and decreased visual acuity of the left eye. She has type 2 diabetes mellitus, hypertension, and atrial fibrillation. Medications are metformin, digoxin, metoprolol, hydrochlorothiazide, and warfarin.

On physical examination, temperature is 36.8 °C (98.2 °F), blood pressure is 148/88 mm Hg, pulse rate is 104/min, and respiration rate is 16/min. Visual acuity wearing glasses is 20/40 (right eye) and 20/100 (left eye). The left eye has conjunctival erythema. The right pupil is reactive to light, the left pupil is sluggish and constricts in response to light from 6 mm to 4 mm. On palpation of the ocular globe, the left globe feels firm as compared with the right.

Which of the following is the most likely diagnosis?

A. Acute angle-closure glaucoma
B. Central retinal artery occlusion
C. Ocular migraine
D. Temporal arteritis

Click here for the answer and critique.

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91ºÚÁÏÍø In The Clinic

Deep Venous Thrombosis

In the Clinic is a monthly feature in Annals of Internal Medicine introduced in January 2007 that focuses on practical management of patients with common clinical conditions. It offers evidence-based answers to frequently asked questions about screening, prevention, diagnosis, therapy, and patient education and provides physicians with tools to improve the quality of care.

This issue of In The Clinic provides a clinical overview of deep venous thrombosis, focusing on prevention, diagnosis, treatment, and patient information. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (91ºÚÁÏÍø), including 91ºÚÁÏÍø Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the 91ºÚÁÏÍø's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from 91ºÚÁÏÍø Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult , , and other resources referenced in each issue of In the Clinic.

To read this issue of In The Clinic, please click . All 91ºÚÁÏÍø members have full access to this content.

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Internal Medicine: Global Perspectives

91ºÚÁÏÍø's International History: an interview featuring
Virginia L. Hood, MBBS, MPH, FR91ºÚÁÏÍø, M91ºÚÁÏÍø and Jose A. Rodriguez-Portales, MD, M91ºÚÁÏÍø

 

Part II

 

 

For part I of this interview, .

 

In this special edition of 91ºÚÁÏÍø Global Perspectives, we meet the physician authors of "The American College of Physicians as an International Organization," a chapter from 91ºÚÁÏÍø's recently published 100th anniversary book, entitled: Serving our Patients and Profession: A Centennial History of the American College of Physicians (1915-2015).

Dr. Virginia Hood's and Dr. Jose Rodriguez-Portales's literary contributions to 91ºÚÁÏÍø's international history required extensive research and collaboration. Here, in Part I of this interview, they share some of the discoveries and insights gained from that experience. The second half of the interview will appear in the May issue of 91ºÚÁÏÍø International.

Dr. Virginia Hood is an internist and nephrologist from Burlington, Vermont. She is a Professor of Medicine at University of Vermont College of Medicine and an attending physician at University of Vermont Medical Center (UVMC). She is certified in internal medicine and nephrology. Dr. Hood is a past President of 91ºÚÁÏÍø, a former 91ºÚÁÏÍø Regent, and Governor of the 91ºÚÁÏÍø Vermont Chapter.

Dr. Jose Rodriguez-Portales has had a distinguished career in internal medicine as a teacher, scholar, and highly respected endocrinologist. He has contributed greatly to organizations promoting excellence and professionalism in internal medicine in Chile. Dr. Rodriguez-Portales is a former 91ºÚÁÏÍø Regent and Governor of the 91ºÚÁÏÍø Chile Chapter.

Dr. Hood, left, and Dr. Rodriguez-Portales

 

 

 

 

 

 

 

 

 

 

 

 

What are the most important factors to help facilitate 91ºÚÁÏÍø's growth internationally?

 

 

 

 

 

 

 

 

 

 

 

 

Dr. Rodriguez-Portales: In countries with Chapters, the Governor plays a key role. It is important to have him/her participate in the BOG's Fall meeting, in the Annual Session and in as many committees as possible, to familiarize him/her with the College and its organization and to experience the collegiality of membership. Having internalized this, the Governor will be more prone to become an active recruiter and promoter of the 91ºÚÁÏÍø in his/her region.

In countries without Chapters, contacts with the local Internal Medicine societies can help disseminate news about the 91ºÚÁÏÍø and its benefits. As the history of the 91ºÚÁÏÍø shows, personal contact between 91ºÚÁÏÍø and local leaders can be very beneficial. In a more structured and professional way, the International Office is keen to find ways of expanding the 91ºÚÁÏÍø internationally.

Dr. Hood: We must continually engage with interested physicians and organizations from other countries, listen to their viewpoints and learn from them, co-sponsor meetings, encourage physician visits to international chapters and be hospitable to all who visit US. Those of us who have travelled to other countries on behalf of 91ºÚÁÏÍø have been "blown away" by the hospitality we have been afforded. We must support all efforts to enable chapters to form and grow.

What do you think the 91ºÚÁÏÍø should do to help reinforce its positive image among international physicians, especially internists?

Dr. Rodriguez-Portales: Two actions would help in this respect: one, to continue to partner with organizations that can provide funds to bring foreign physicians for short stays in academic centers in the United States. This is the way the initial seeds of the College were sowed in many countries in Latin America, and continues to be an attractive feature for those who belong or want to belong to the College.

Two, to have a third party promote the products and services of the College abroad. Self-promotion is not as effective as someone else saying that 91ºÚÁÏÍø's products and services are good. Also, prices could vary according to the economic condition of the specific country.

Dr. Hood: 91ºÚÁÏÍø must continue to be seen as a leader in education and innovation, be a place where members can participate in mainstream medicine, and be proud to identify itself as an inclusive group of international internal medicine physicians in which international members can feel appreciated and welcome. The programs, products and services must be applicable, affordable and available to members in all countries.

91ºÚÁÏÍø must maintain the ethical and professionalism standards that have been the bedrock of College activities and policy for the past 100 years. This is essential for our members both here and in other countries but also for our standing as a professional society that strives to improve health care systems and promote excellence in the practice of medicine no matter where the need is.

How do you think the College should evolve as an international organization in the next 25 years to best serve its members?

Dr. Rodriguez-Portales: During the past 30 years an awareness of the 91ºÚÁÏÍø as an international organization has been gradually increasing among College leaders. A substantial part of the membership are IMG's and international physicians, and this has been reflected in the composition both of the BOG and the BOR. A strong International Office has also played a very important role in promoting this awareness.

Unless an unexpected catastrophe occurs, the next 25 years may bring an intensification and deepening of globalization, allowing large populations to gain access to higher levels of education, including medicine, together with an ever growing improvement in information technologies and communications.

This is especially true in certain parts of the world such as China, India, and Southeast Asia. New 91ºÚÁÏÍø Chapters are being established in that area and my feeling is that that is where the 91ºÚÁÏÍø's efforts should be directed in the near future; of course, without abandoning Latin America where the first international chapters arose, and Africa where the struggle against disease is most intensely fought.

Dr. Hood: We must continue to evaluate how we serve our members both here and in other countries so as to make needed changes while strengthening and conserving existing valued activities. We must encourage more collaboration and input from the world wide internal medicine community while understanding the real economic and cultural barriers that exist.

We must also realize our capacity to provide not just medical educational materials but also policy and programs that promote professionalism, ethics and high-value, cost-conscious care - challenges all physicians and countries face as they struggle to provide quality patient care in an atmosphere of limited resources.

Globalization and electronic connectedness can provide the opportunities to include physicians with different values and cultures who are eager to participate. Having Chapters from many countries and cultures will significantly enrich the outlook of the College and its importance as an integrated American-world society of internal medicine.

What do you think 91ºÚÁÏÍø's most important legacy will be internationally?

Dr. Rodriguez-Portales: The 91ºÚÁÏÍø must be seen by the world as the premier provider of high quality continuing medical education, a source of helpful and innovative educational resources and standards of medical care, and also as a promoter of the importance of the face-to-face interaction between patient and doctor and the values of compassion, professionalism, proficiency and respect for human life that have been a characteristic of internal medicine from time immemorial.

Dr. Hood: An organization that faithfully and consistently celebrates and promotes the shared core values of excellence and professionalism in the practice of medicine embracing physicians from all over the world.

Last comment for readers:

Dr. Rodriguez-Portales: I would like to encourage all 91ºÚÁÏÍø members to read about the 91ºÚÁÏÍø's history so that they may be aware of how their organization has come to be what it is, so that they may feel proud of belonging to it.

Dr. Hood: During my tenure with 91ºÚÁÏÍø, it has been an amazing and rewarding personal experience for me to meet, work with and learn from the many remarkable 91ºÚÁÏÍø members on 6 continents that I have encountered. Many thanks to all of you for what you have contributed to the College.

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91ºÚÁÏÍø Leaders on the Road: Thailand

David A. Fleming, MD, M91ºÚÁÏÍø, 91ºÚÁÏÍø Immediate Past President
1st 91ºÚÁÏÍø Southeast Asian Chapter Meeting & 2nd AFIM Meeting in Conjunction with the 31st Annual Meeting of the Royal College of Physicians of Thailand (RCPT)
March 26-28, 2015

 

I had the distinct honor of representing 91ºÚÁÏÍø at the 31st annual meeting of the Royal College of Physicians of Thailand (RCPT) March 26-28, 2015 in Bangkok. This was a particularly memorable conference because it was held in conjunction with the first annual meeting of the Southeast Asian Chapter of 91ºÚÁÏÍø and the second annual meeting of the ASEAN Federation of Internal Medicine (AFIM). Of the 4,000 or so internists in Thailand, nearly 2,000 attended along with many others from around the Pacific Rim, including Australia/New Zealand, Philippines, China, Japan, Bali, Singapore, and Vietnam, amongst others. For the first time, the RCPT annual meeting was held in Bangkok. The Bangkok Convention Centre at Centralworld served as the beautiful venue for this meeting. The theme of this year's conference was "Medicine Beyond Frontiers: Towards a Healthier AEC" and each session was well attended. And as I have experienced everywhere, it seems, it was mostly a very young and enthusiastic croud of trainees and young physicians who occupied the halls and lecture rooms.

 

This trip was a wonderful opportunity to network with colleagues and friends of different cultures, belief systems, and traditions. Our hosts in Thailand were incredibly warm, engaging, and caring during our stay there - they took good care of us. As I have discovered here and in my travels to other parts of the world, the numerous rich scientific and socioeconomic discussions offered at this meeting are very similar to those I have heard around the world: work force concerns of having the right number and distribution of internists; how to address the mounting disease burden of a growing and aging population; emerging public health threats; updates on the latest in medical science; and much more. "Revalidation" (the same as MOC in the United States) and how to ensure competency was a major theme and they were very interested in what 91ºÚÁÏÍø is doing about MOC and our relationship with the American Board of Internal Medicine (ABIM). This was one of my presentations, sharing the podium with the former president of the revalidation board in the UK, Sir Peter Rubin. MOC and/or Revalidation continues to be a concern for internists around the globe and all eyes are on the U.S. as to where things are going and what they can learn from the challenges we are presently facing.

My international trips serve to remind me that 91ºÚÁÏÍø is a "citizen of the world" and that we have many colleagues from other countries who not only value what we value in the US but also value 91ºÚÁÏÍø immensly for the opportunities of professional development, scholarship, and leadership that we offer. Our world partners are strong and future opportunity for growth and development internationally is immense.

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Future Worldwide Internal Medicine Meetings

A complete list of Future Worldwide Internal Medicine Meetings is available here.

Save the date! The 14th European Congress of Internal Medicine will be held in Moscow, Russia from October 14-16, 2015. ECIM 2015 is a scientific Congress during which new research is being presented and discussed among scientists and practitioners from Europe and the rest of the world.

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Highlights from 91ºÚÁÏÍø Internist and
91ºÚÁÏÍø Hospitalist

91ºÚÁÏÍø Internist April/May 2015


  • Doctors continue to be frustrated by their patients' chronic pain problems, due to a lack of evidence on opioids' long-term effectiveness and strong evidence of potential harms.
     

  • Increasing awareness of the harmful effects of under- and overnutrition can in turn increase nutritional assessments in primary care.
     

  • Aspirin's long-standing role in cardiovascular health does not resolve its precise benefit in terms of cardiovascular prevention, specifically in patients who haven't had a myocardial infarction or stroke.
     

91ºÚÁÏÍø Hospitalist March/April/May 2015


  • Sepsis strategies studied and debated.
     

  • Antiretroviral therapy is less complex than it used to be, but errors are still common.
     

  • Strategies to achieve a timely discharge.
     

  • Communication may be helpful to patients' recovery.
     
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MKSAP 16 Answer & Critique

Answer: A, Acute angle-closure glaucoma

Educational Objective: Diagnose acute angle-closure glaucoma.

Critique: This patient most likely has acute angle-closure glaucoma. Angle-closure glaucoma is characterized by narrowing or closure of the anterior chamber angle, which impedes the trabecular drainage system in the anterior chamber, resulting in elevated intraocular pressure and damage to the optic nerve. Acute angle-closure glaucoma is an ophthalmologic emergency. Symptoms depend upon the rapidity of the elevation of intraocular pressure. Typical history of acute angle-closure glaucoma may include seeing halos around lights, severe unilateral eye pain, headache, and nausea and vomiting. Occasionally, patients may present with only nausea and vomiting and be mistaken as having cardiac or abdominal pathology. Physical examination may show conjunctival erythema; a sluggish or nonreactive, mid-range dilated pupil; corneal cloudiness; and, on funduscopic examination, cupping of the optic nerve. Treatment in this case would be immediate referral to an ophthalmologist or emergency department for initiation of topical Î’-adrenergic antagonists and pilocarpine and carbonic anhydrase inhibitors.

Central retinal artery occlusion (CRAO) classically presents in a 50- to 70-year-old patient as a painless, abrupt loss of vision that occurs in the early morning hours-usually between midnight and 6 AM and, second most commonly, between 6 AM and noon. It results from an embolic or thrombotic event in the ophthalmic artery. Although this patient is at risk for CRAO owing to her atrial fibrillation, CRAO would not cause red eye, a firm globe, ocular pain, nausea, or vomiting.

Ocular migraine, also known as retinal migraine, typically occurs in persons with a family history or personal history of migraine, which this patient does not have. Symptoms include flashing lights, scintillating scotomas, visual blurring, and even total unilateral vision loss. Patients with ocular migraine tend to be younger than 40 years, making this diagnosis highly unlikely in this 76-year-old patient.

Temporal arteritis should be considered in patients older than 50 years presenting with a severe new headache. Visual loss in temporal arteritis is painless, however, and would not cause a red eye, nausea, or vomiting.

Key Point: Acute angle-closure glaucoma is characterized by severe unilateral eye pain, headache, nausea and vomiting, and seeing halos around lights; physical examination findings include conjunctival erythema; a sluggish or nonreactive, mid-range dilated pupil; corneal cloudiness; and cupping of the optic nerve.

Bibliography:

Magauran B. Conditions requiring emergency ophthalmologic consultation. Emerg Med Clin North Am. 2008;26(1):233-238. [PMID: 18249265]

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