Pub Date : 2026-01-24DOI: 10.1016/j.amjmed.2026.01.023
Ji Mei May Wong, Niraj Punjya, Tahir Mahmood, Saul Schaefer
{"title":"Spodick's Sign: A Helpful Clue in Asymptomatic Pericarditis.","authors":"Ji Mei May Wong, Niraj Punjya, Tahir Mahmood, Saul Schaefer","doi":"10.1016/j.amjmed.2026.01.023","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.01.023","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054788","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 : 2026-01-24DOI: 10.1016/j.amjmed.2026.01.013
Raya Nahlawi, Zoha Majeed, Issam Motairek, Trejeeve Martyn, Paulino Alvarez, Wael A Jaber, Moises Auron
Renin-angiotensin-aldosterone system (RAAS) antagonists are essential in managing heart failure, hypertension, chronic kidney disease, and atherosclerotic cardiovascular disease. However, their perioperative use remains controversial due to concerns about intraoperative hypotension and vasoplegia. This review offers an updated synthesis of guideline recommendations, mechanistic insights, and clinical trial evidence, including POISE-3, STOP-OR-NOT, and SPACE, along with a practical decision-making framework for internists. We examine the physiological basis for holding or continuing RAAS antagonists amidst anesthetic interactions, fluid shifts, and cardiovascular risks. Evidence indicates that continuing RAAS antagonists until the day of surgery may raise the risk of intraoperative hypotension but does not consistently worsen major postoperative outcomes. Discontinuation might be suitable for patients with low cardiovascular risk or those undergoing high-risk procedures. We also discuss when and how to resume therapy, incorporate biomarkers like NT-proBNP for risk stratification, and explore emerging approaches such as ARNIs and pharmacogenomics. This review advocates for an individualized, evidence-based approach to RAAS management across surgical contexts.
{"title":"Renin-Angiotensin-Aldosterone System (RAAS) Antagonists in the Perioperative Setting: An Updated Review.","authors":"Raya Nahlawi, Zoha Majeed, Issam Motairek, Trejeeve Martyn, Paulino Alvarez, Wael A Jaber, Moises Auron","doi":"10.1016/j.amjmed.2026.01.013","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.01.013","url":null,"abstract":"<p><p>Renin-angiotensin-aldosterone system (RAAS) antagonists are essential in managing heart failure, hypertension, chronic kidney disease, and atherosclerotic cardiovascular disease. However, their perioperative use remains controversial due to concerns about intraoperative hypotension and vasoplegia. This review offers an updated synthesis of guideline recommendations, mechanistic insights, and clinical trial evidence, including POISE-3, STOP-OR-NOT, and SPACE, along with a practical decision-making framework for internists. We examine the physiological basis for holding or continuing RAAS antagonists amidst anesthetic interactions, fluid shifts, and cardiovascular risks. Evidence indicates that continuing RAAS antagonists until the day of surgery may raise the risk of intraoperative hypotension but does not consistently worsen major postoperative outcomes. Discontinuation might be suitable for patients with low cardiovascular risk or those undergoing high-risk procedures. We also discuss when and how to resume therapy, incorporate biomarkers like NT-proBNP for risk stratification, and explore emerging approaches such as ARNIs and pharmacogenomics. This review advocates for an individualized, evidence-based approach to RAAS management across surgical contexts.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054856","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 : 2026-01-24DOI: 10.1016/j.amjmed.2026.01.014
Tolulope Popoola, Ikeotunye Royal Chinyere
{"title":"Fitness Gone too Far: Cardioembolic Stroke and Type B Dissection in a Powerlifter.","authors":"Tolulope Popoola, Ikeotunye Royal Chinyere","doi":"10.1016/j.amjmed.2026.01.014","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.01.014","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054791","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 : 2026-01-24DOI: 10.1016/j.amjmed.2026.01.031
Grace Lt Tung, Wilson Gw Goh, Isaac Ks Ng, Sai Meng Tham
{"title":"Cholera Without the Runs: Vibrio cholerae Bacteremia in a City-State.","authors":"Grace Lt Tung, Wilson Gw Goh, Isaac Ks Ng, Sai Meng Tham","doi":"10.1016/j.amjmed.2026.01.031","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.01.031","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054681","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 : 2026-01-24DOI: 10.1016/j.amjmed.2026.01.033
Mindy J Fain, Karl Eric De Jonge
{"title":"Reflections on Medicare Open Enrollment: Be Wary of Medicare Dis-Advantage Plans.","authors":"Mindy J Fain, Karl Eric De Jonge","doi":"10.1016/j.amjmed.2026.01.033","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.01.033","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054825","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 : 2026-01-24DOI: 10.1016/j.amjmed.2026.01.029
Vanessa Tze Hui Heng, Thiagarajah A L Thyagarajan Ravi, Desmond Boon Seng Teo
{"title":"More than Meets the Eye: Sjögren's Syndrome Presenting as Hypokalemic Myopathy Secondary to Distal Renal Tubular Acidosis.","authors":"Vanessa Tze Hui Heng, Thiagarajah A L Thyagarajan Ravi, Desmond Boon Seng Teo","doi":"10.1016/j.amjmed.2026.01.029","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.01.029","url":null,"abstract":"","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054861","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 : 2026-01-24DOI: 10.1016/j.amjmed.2026.01.012
Yanna Willett, Chengwu Yang, John Dunn, Katerina Benson, Kevin Sajan, Allison Ferris, Tim Dye, Charles H Hennekens
Objective: Concerns have been raised about many deleterious consequences of ultra processed food; however, data are sparse about risks of cardiovascular disease. This research explores whether United States adults who consume the highest amounts of ultra processed foods have increased risks of cardiovascular disease.
Methods: Large, random sample of the most recently published National Health and Nutrition Examination Survey from 2021 to 2023. Percentage of total daily energy intake derived from UPFs were categorized into quartiles based on the sample distribution using the widely accepted and validated NOVA classification system. Cardiovascular disease was defined as myocardial infarction or stroke. Logistic regression models were used to estimate crude and adjusted relative risks as effect measures and 95% confidence intervals to test for statistical significance. Covariates included age, gender, race, ethnicity, poverty-to-income ratio, and cigarette smoking.
Results: The mean age was 55 years, 55.9% were women, and mean ultra processed food intake was 26.1% of total energy. In adjusted analyses, individuals in the highest quartile compared with those in the lowest, had a statistically significant higher risk of CVD (relative risk= 1.47; 95% confidence interval = 1.06-2.04; p = 0.02).
Conclusions: Adults who consumed the highest amounts of ultra processed foods had a statistically significant 47% increased risk of cardiovascular disease. Large scale randomized trials are needed, but in the meantime, health care providers should advise patients to decrease consumption of ultra processed foods in addition to adopting other therapeutic lifestyle changes and adjunctive drug therapies of proven benefit.
{"title":"Consumption of Ultra-Processed Foods and Increased Risks of Cardiovascular Disease in U.S. Adults.","authors":"Yanna Willett, Chengwu Yang, John Dunn, Katerina Benson, Kevin Sajan, Allison Ferris, Tim Dye, Charles H Hennekens","doi":"10.1016/j.amjmed.2026.01.012","DOIUrl":"https://doi.org/10.1016/j.amjmed.2026.01.012","url":null,"abstract":"<p><strong>Objective: </strong>Concerns have been raised about many deleterious consequences of ultra processed food; however, data are sparse about risks of cardiovascular disease. This research explores whether United States adults who consume the highest amounts of ultra processed foods have increased risks of cardiovascular disease.</p><p><strong>Methods: </strong>Large, random sample of the most recently published National Health and Nutrition Examination Survey from 2021 to 2023. Percentage of total daily energy intake derived from UPFs were categorized into quartiles based on the sample distribution using the widely accepted and validated NOVA classification system. Cardiovascular disease was defined as myocardial infarction or stroke. Logistic regression models were used to estimate crude and adjusted relative risks as effect measures and 95% confidence intervals to test for statistical significance. Covariates included age, gender, race, ethnicity, poverty-to-income ratio, and cigarette smoking.</p><p><strong>Results: </strong>The mean age was 55 years, 55.9% were women, and mean ultra processed food intake was 26.1% of total energy. In adjusted analyses, individuals in the highest quartile compared with those in the lowest, had a statistically significant higher risk of CVD (relative risk= 1.47; 95% confidence interval = 1.06-2.04; p = 0.02).</p><p><strong>Conclusions: </strong>Adults who consumed the highest amounts of ultra processed foods had a statistically significant 47% increased risk of cardiovascular disease. Large scale randomized trials are needed, but in the meantime, health care providers should advise patients to decrease consumption of ultra processed foods in addition to adopting other therapeutic lifestyle changes and adjunctive drug therapies of proven benefit.</p>","PeriodicalId":50807,"journal":{"name":"American Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2026-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146054749","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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