J Intern Med Research Articles

Stemming Medicare Spending on Discarded Drugs—Waste Not, Want Not?

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal

Are acceptance and publication times longer in primary health care journals compared to internal medicine journals? A comparative study of 117 high-impact journals

Are acceptance and publication times longer in primary health care journals compared to internal medicine journals? A comparative study of 117 high-impact journals

Physicians as Owners and Agents—A Call for Further Study

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal

ODP542 Challenging Management of Fasting Hypoglycemia in a Patient With Pancreatic Neuroendocrine Tumor and Lupus Nephritis

Abstract Background Derangements of calcium metabolism are common in patients with cancer.1 Unlike hypercalcemia which is well-recognized, little is known about hypocalcemia of malignancy.2 In fact, there were only 2 studies published to date that investigated its incidence among cancer patients. 2,3 Clinical Case: A 40-year-old male consulted an ENT specialist for a 2×2 cm left parotid mass of 3 years duration. There was no fever, cough, night sweats or significant weight loss. Histological analysis of the mass revealed parotid gland adenocarcinoma. Tumor metastases to lung and spine were seen on PET CT scan. Consequently, he received 18 cycles of chemotherapy and 10 sessions of radiotherapy without surgery because of the advanced stage. He initially exhibited good response with the treatment. A year after, he developed shortness of breath, numbness of hands with seizure episode. Chest x-ray showed pleural effusion and osteoblastic changes while cranial CT scan revealed brain metastasis. Bone scintigraphy was evident for multiple osseous metastases. He underwent stereotactic brain surgery, and thoracentesis with pleural fluid analysis consistent with malignancy. Biochemical tests were remarkable for hypocalcemia (0.99, n>1.12 mmol/L, normomagnesemia (0.89, n>0.74 mmol/L), low vitamin D (11.6, n>30 ng/mL), elevated phosphate (1.73; n: <1.49 mg/dL), and elevated intact PTH which eventually dropped (157.7 to 9, n>15 pg/mL). Ultrasound of the neck revealed diffuse thyroid calcifications. Despite oral calcium supplementation (14.4 grams elemental calcium), calcium infusion (1.35 mg/kg/hour elemental calcium) and vitamin D supplementation (6000 IU cholecalciferol and 0.5 mg calcitriol daily), he remained hypocalcemic. His condition eventually worsened, and he succumbed to death in due course despite aggressive measures provided. Conclusion To our knowledge, this is the first case illustrating the therapeutic challenge in addressing an intractable hypocalcemia in the setting of an advanced parotid carcinoma in our country.Reference: (1)Carl Blomqvist. A Hospital Survey of Hypocalcemia in Patients with Malignant Disease. Acta Med Scand. 1986;220. (2) Schattner et al. Hypocalcaemia of Malignancy. The Netherlands Journal of Medicine. July 2016, Vol. 74, No. 6. (3) Goncalves. Hypocalcemia in cancer patients: An exploratory Study. Porto Biomed. J. (2019) 4: 4 Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

ODP652 Challenges in the Management of Hypocalcemia in a Patient with Advanced Stage of Parotid Gland Adenocarcinoma

Abstract Background Derangements of calcium metabolism are common in patients with cancer. 1 Unlike hypercalcemia which is well-recognized, little is known about hypocalcemia of malignancy. 2 In fact, there were only 2 studies published to date that investigated its incidence among cancer patients. 2,3 Clinical Case: A 40-year-old male consulted an ENT specialist for a 2×2 cm left parotid mass of 3 years duration. There was no fever, cough, night sweats or significant weight loss. Histological analysis of the mass revealed parotid gland adenocarcinoma. Tumor metastases to lung and spine were seen on PET CT scan. Consequently, he received 18 cycles of chemotherapy and 10 sessions of radiotherapy without surgery because of the advanced stage. He initially exhibited good response with the treatment. A year after,he developed shortness of breath, numbness of hands with seizure episode. Chest x-ray showed pleural effusion and osteoblastic changes while cranial CT scan revealed brain metastasis. Bone scintigraphywas evident for multiple osseous metastases. He underwent stereotactic brain surgery, and thoracentesis with pleural fluid analysis consistent with malignancy. Biochemical tests were remarkable for hypocalcemia (0.99, n>1.12 mmol/L, normomagnesemia (0.89, n>0.74 mmol/L), low vitamin D (11.6, n>30 ng/mL), elevated phosphate (1.73; n: <1.49 mg/dL), and elevated intact PTH which eventually dropped (157.7 to 9, n>15 pg/mL). Ultrasound of the neck revealed diffuse thyroid calcifications. Despite oral calcium supplementation (14.4 grams elemental calcium),calcium infusion (1.35 mg/kg/hour elemental calcium) and vitamin D supplementation (6000 IU cholecalciferol and 0.5 mg calcitriol daily), he remained hypocalcemic. His condition eventually worsened, and he succumbed to death in due course despite aggressive measures provided. Conclusion To our knowledge, this is the first case illustrating the therapeutic challenge in addressing an intractable hypocalcemia in the setting of an advanced parotid carcinoma inour country. Reference: (1)Carl Blomqvist. A Hospital Survey of Hypocalcemia in Patients with Malignant Disease. Acta Med Scand. 1986;220. (2) Schattner et al. Hypocalcaemia of Malignancy. The Netherlands Journal of Medicine. July 2016, Vol. 74, No. 6. (3) Goncalves. Hypocalcemia in cancer patients: An exploratory Study. Porto Biomed. J. (2019) 4: 4 Presentation: No date and time listed

The Price of Human and Veterinary Formulations of Common Medications—Price Discrimination and Innovation in Prescription Drug Markets

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal

Zones of Excess Mortality for Homeless Adults in the US—A Half Century Later

Our website uses cookies to enhance your experience. By continuing to use our site, or clicking "Continue," you are agreeing to our Cookie Policy | Continue JAMA Internal Medicine HomeNew OnlineCurrent IssueFor Authors Podcast Publications JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry (1919-1959) JN Learning / CMESubscribeJobsInstitutions / LibrariansReprints & Permissions Terms of Use | Privacy Policy | Accessibility Statement 2023 American Medical Association. All Rights Reserved Search All JAMA JAMA Network Open JAMA Cardiology JAMA Dermatology JAMA Forum Archive JAMA Health Forum JAMA Internal Medicine JAMA Neurology JAMA Oncology JAMA Ophthalmology JAMA Otolaryngology–Head & Neck Surgery JAMA Pediatrics JAMA Psychiatry JAMA Surgery Archives of Neurology & Psychiatry Input Search Term Sign In Individual Sign In Sign inCreate an Account Access through your institution Sign In Purchase Options: Buy this article Rent this article Subscribe to the JAMA Internal Medicine journal

Infective endocarditis with <em>Escherichia coli</em> secondary to urosepsis: a case report

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

The inner ‘aragalaya’ of a medical teacher: a reflective Q and A

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Home Blood Pressure Monitoring (HBPM): The way forward for Sri Lanka; a review article

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

SLCIM Picture Quiz

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Evaluation of anaemia in geriatric patients: a retrospective hospital-based study from Northern Sri Lanka

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Indications for hospital admission, prevalence of vascular and non-vascular complications and comorbidities among patients with diabetes mellitus admitted to a medical unit in a tertiary care hospital, Sri Lanka

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Doctor as an activist in the current crisis

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Internal Medicine in Sri Lanka: concepts, challenges, and prospects

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Maintaining universal healthcare and its sustainability in the Sri Lankan set up

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Strategies to overcome barriers to hypertension control in a resource-poor setting

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Subarachnoid haemorrhage as a late complication of infective endocarditis: a case report

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Key to Picture Quiz

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

Severe Metformin poisoning; Experience at a tertiary care hospital in Sri Lanka: a case series

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.