American Journal of Medicine最新文献

Cannabis products are widely accessible, yet adult presentations after unintentional ingestion of psychoactive Δ9-tetrahydrocannabinol (THC), synthetic cannabinoids, or adulterated cannabidiol (CBD) remain poorly described. This scoping review summarizes adult unintentional THC exposures among adults seeking medical care with confirmed ingestion, verified either by positive THC urine drug screens or detection of THC/synthetic cannabinoids in partially consumed food products, using five major databases (2023-2025). Of 370 manuscripts screened, 16 met criteria, reporting 84 adult cases (ages 18-94 years). Most involved THC-containing baked goods or candy. Common presenting symptoms included dizziness, dry mouth/mucous membranes, confusion, vision changes, paresthesia, nausea/vomiting, speech difficulties, anxiety, and somnolence. Hypertension, memory impairment, lethargy, incoordination, and tachycardia were frequent. Stroke was often the leading differential, with food poisoning commonly suspected. Most patients recovered within 24 h, though some reported lingering subjective symptoms (e.g., fatigue, anxiety). Clinicians should consider inadvertent cannabis ingestion in patients with stroke-like presentations lacking focal findings or with altered mental status plus gastrointestinal complaints, and ask about consumption of foods prepared by others, as well as use of purported CBD-only supplements.

Background: Giant cell arteritis (formerly Horton's disease) is an inflammatory large-vessel vasculitis of unknown etiology, primarily affecting individuals over 50 years of age, with a female predominance. Its clinical manifestations are heterogeneous and non-specific, making diagnosis challenging. Histological confirmation by temporal artery biopsy or alternatively 18F-FDG PET/CT when the biopsy isn't possible, remains the diagnostic gold standard.

Methods/discussion: We report a case highlighting the diagnostic complexity of this condition: a 68-year-old man with no significant medical history, regularly monitored through annual check-ups, who presented with new-onset arterial hypertension associated with persistent headaches. Blood pressure remained uncontrolled despite antihypertensive therapy. The patient subsequently developed significant general deterioration and a prolonged inflammatory syndrome. The diagnosis of Giant cell arteritis was ultimately confirmed through histology, CT angiography, and PET/CT imaging.

Conclusion: Giant cell arteritis does not always present with scalp paresthesia, headache, jaw claudication, or ocular involvement; refractory arterial hypertension associated with a deterioration in general condition should also raise suspicion, as illustrated by our case.

The continually evolving nature of evidence-based medicine requires clinicians to update their practice in response to new data. Integrating new research is essential for advancing clinical practice. To this aim, a panel of seven internists screened articles from seven high-impact internal medicine journals deemed most relevant to general outpatient care: New England Journal of Medicine, The Lancet, Annals of Internal Medicine, Journal of the American Medical Association (JAMA), JAMA Internal Medicine, British Medical Journal (BMJ), and Public Library of Science (PLoS) Medicine. The review also included curated summaries and evidence databases, including American College of Physicians Journal Club, NEJM Journal Watch, BMJ Evidence-Base Medicine, McMaster ACCESSSS/DynaMed Evidence Alerts, and Cochrane Reviews. Consensus was achieved using a modified Delphi process that emphasized outpatient relevance, impact on clinical practice, and overall quality of evidence. Related articles addressing the same clinical topics were evaluated together. Ultimately, seven practice-changing articles were included.