Pub Date : 2026-03-03DOI: 10.1016/j.amjmed.2026.02.027
Malvinder S Parmar
{"title":"Nihilism versus Masterly Inactivity in Medicine: Reclaiming Therapeutic Restraint.","authors":"Malvinder S Parmar","doi":"10.1016/j.amjmed.2026.02.027","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.02.027","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147366841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-26DOI: 10.1016/j.amjmed.2025.11.016
Hui Yang , Isaac K.S. Ng MBBS, MRCP (UK), MMed (Int Med) , Christopher Thong MBBS, MRCP (UK), MMed (Int Med) , Kay Choong See MBBS, FRCP Edin, MHPE
Dyspnea is a common presenting symptom in clinical practice that has numerous causes. Beyond characterizing the time course and associated symptoms, the exacerbating and relieving factors of dyspnea including positional changes provide essential diagnostic clues. In this narrative review article, we describe the various forms of positional dyspnea including orthopnea, platypnea, trepopnea, and bendopnea, and provide a practical clinical approach to evaluation and management.
{"title":"Positional dyspnea: A brief review","authors":"Hui Yang , Isaac K.S. Ng MBBS, MRCP (UK), MMed (Int Med) , Christopher Thong MBBS, MRCP (UK), MMed (Int Med) , Kay Choong See MBBS, FRCP Edin, MHPE","doi":"10.1016/j.amjmed.2025.11.016","DOIUrl":"10.1016/j.amjmed.2025.11.016","url":null,"abstract":"<div><div>Dyspnea is a common presenting symptom in clinical practice that has numerous causes. Beyond characterizing the time course and associated symptoms, the exacerbating and relieving factors of dyspnea including positional changes provide essential diagnostic clues. In this narrative review article, we describe the various forms of positional dyspnea including orthopnea, platypnea, trepopnea, and bendopnea, and provide a practical clinical approach to evaluation and management.</div></div>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"139 3","pages":"Pages 287-298"},"PeriodicalIF":5.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-26DOI: 10.1016/j.amjmed.2025.11.022
Edward J. Goetzl MD, FACP
Mycobacteria tuberculosis (Mtb) infects millions yearly in many countries. Numerous multi-generational genetic factors have been identified that account for high host susceptibility to Mtb. Diagnostic tests based on quantification of interferon-γ generation by Mtb antigen-stimulated blood mononuclear leukocytes detect infection accurately and show far lower false-positive and false-negative results than Mtb antigen skin tests. Antibiotic resistance of Mtb has limited effective treatment. Now new tests for antibiotic resistance of Mtb based on genetic mutations characteristic of resistance to individual antibiotics report more accurately and rapidly than prior assays of resistance of cultured Mtb growth to antibiotics. The Bacillus Calmette-Guerin vaccine given to babies protects them against serious Mtb manifestations, such as Mtb meningitis, but does not prevent childhood or adult Mtb disease. Development of human Mtb vaccines has succeeded recently with antigens composed of mRNAs encoding Mtb polypeptides or recombinant peptides fused to proven adjuvant systems. Two of these vaccines have completed phase IIb or III trials and have prevented > 50% of individuals with inactive pulmonary Mtb from progressing to active disease over three years.
{"title":"Detection, treatment and prevention of tuberculosis","authors":"Edward J. Goetzl MD, FACP","doi":"10.1016/j.amjmed.2025.11.022","DOIUrl":"10.1016/j.amjmed.2025.11.022","url":null,"abstract":"<div><div><em>Mycobacteria tuberculosis</em> (Mtb) infects millions yearly in many countries. Numerous multi-generational genetic factors have been identified that account for high host susceptibility to Mtb. Diagnostic tests based on quantification of interferon-γ generation by Mtb antigen-stimulated blood mononuclear leukocytes detect infection accurately and show far lower false-positive and false-negative results than Mtb antigen skin tests. Antibiotic resistance of Mtb has limited effective treatment. Now new tests for antibiotic resistance of Mtb based on genetic mutations characteristic of resistance to individual antibiotics report more accurately and rapidly than prior assays of resistance of cultured Mtb growth to antibiotics. The Bacillus Calmette-Guerin vaccine given to babies protects them against serious Mtb manifestations, such as Mtb meningitis, but does not prevent childhood or adult Mtb disease. Development of human Mtb vaccines has succeeded recently with antigens composed of mRNAs encoding Mtb polypeptides or recombinant peptides fused to proven adjuvant systems. Two of these vaccines have completed phase IIb or III trials and have prevented > 50% of individuals with inactive pulmonary Mtb from progressing to active disease over three years.</div></div>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"139 3","pages":"Pages 283-286"},"PeriodicalIF":5.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145642474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-11-29DOI: 10.1016/j.amjmed.2025.11.024
Dor Atias MD, MPH , Yariv Gerber PhD , Tal Hasin MD , Uri Obolski PhD
Background
The Six-Minute Walk Test (6MWT) is a widely used, low-cost measure of functional capacity in heart failure patients. While baseline 6MWT distance is a known prognostic marker, the added value of serial assessments remains underexplored. This study examined whether serial 6MWT measurements and their temporal trajectories improve mortality prediction.
Methods
This retrospective cohort study included 1,114 patients with heart failure who underwent at least one 6MWT at Shaare Zedek Medical Center during 2014-2023. All-cause mortality was the primary outcome. Two modelling approaches were applied: 1) a Cox proportional hazards model using a single 6MWT assessment; and 2) a joint model incorporating repeated 6MWT assessments. Models were evaluated at baseline and after 12 months, for forward predictions of 36- and 60-month mortality, with performance assessed using the area under the curve (AUC) and Brier Score on data not used for model development.
Results
The joint models demonstrated superior predictive accuracy; in patients with ≥3 6MWTs, AUC improved by 0.116 (95% CI: 0.010-0.238) and Brier Score decreased by −0.032 (95% CI: −0.072, −0.003) at 36 months. In the joint model survival submodel, each 10-meter increase in 6MWT distance was associated with reduced mortality risk (HR=0.95, 95% CrI: 0.93-0.96), as was a 10-meter/year predicted improvement in slope (HR=0.86, 95% CrI: 0.80-0.97).
Conclusion
Serial 6MWT assessment offers prognostic value beyond a baseline measurement. Both absolute walking distance and improvement over time were independently associated with mortality. Modelling functional trajectories over time may improve mortality risk prediction and support personalized clinical management in heart failure.
{"title":"The prognostic value of serial six-minute walk testing for mortality prediction in heart failure patients","authors":"Dor Atias MD, MPH , Yariv Gerber PhD , Tal Hasin MD , Uri Obolski PhD","doi":"10.1016/j.amjmed.2025.11.024","DOIUrl":"10.1016/j.amjmed.2025.11.024","url":null,"abstract":"<div><h3>Background</h3><div>The Six-Minute Walk Test (6MWT) is a widely used, low-cost measure of functional capacity in heart failure patients. While baseline 6MWT distance is a known prognostic marker, the added value of serial assessments remains underexplored. This study examined whether serial 6MWT measurements and their temporal trajectories improve mortality prediction.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 1,114 patients with heart failure who underwent at least one 6MWT at Shaare Zedek Medical Center during 2014-2023. All-cause mortality was the primary outcome. Two modelling approaches were applied: 1) a Cox proportional hazards model using a single 6MWT assessment; and 2) a joint model incorporating repeated 6MWT assessments. Models were evaluated at baseline and after 12 months, for forward predictions of 36- and 60-month mortality, with performance assessed using the area under the curve (AUC) and Brier Score on data not used for model development.</div></div><div><h3>Results</h3><div>The joint models demonstrated superior predictive accuracy; in patients with ≥3 6MWTs, AUC improved by 0.116 (95% CI: 0.010-0.238) and Brier Score decreased by −0.032 (95% CI: −0.072, −0.003) at 36 months. In the joint model survival submodel, each 10-meter increase in 6MWT distance was associated with reduced mortality risk (HR=0.95, 95% CrI: 0.93-0.96), as was a 10-meter/year predicted improvement in slope (HR=0.86, 95% CrI: 0.80-0.97).</div></div><div><h3>Conclusion</h3><div>Serial 6MWT assessment offers prognostic value beyond a baseline measurement. Both absolute walking distance and improvement over time were independently associated with mortality. Modelling functional trajectories over time may improve mortality risk prediction and support personalized clinical management in heart failure.</div></div>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"139 3","pages":"Pages 341-349.e3"},"PeriodicalIF":5.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145649804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-08-30DOI: 10.1016/j.amjmed.2025.08.046
Josef Finsterer MD, PhD
{"title":"Recurrent polychondritis associated with rheumatoid arthritis and ataxia unresponsive to TNF-alpha blockers and JAK inhibitors","authors":"Josef Finsterer MD, PhD","doi":"10.1016/j.amjmed.2025.08.046","DOIUrl":"10.1016/j.amjmed.2025.08.046","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"139 3","pages":"Pages e85-e86"},"PeriodicalIF":5.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-25DOI: 10.1016/j.amjmed.2025.09.004
Muhammad Ajmal MD, FACC , Ayesha Javed MD , Michel T. Corban MD, FACC, FSCAI
{"title":"Cardiovascular care in rural America: challenges, insights, and strategies for meaningful improvement","authors":"Muhammad Ajmal MD, FACC , Ayesha Javed MD , Michel T. Corban MD, FACC, FSCAI","doi":"10.1016/j.amjmed.2025.09.004","DOIUrl":"10.1016/j.amjmed.2025.09.004","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":"139 3","pages":"Pages 250-252"},"PeriodicalIF":5.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145182387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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