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...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.
Cannabis products are widely accessible, yet adult presentations after unintentional ingestion of psychoactive Δ9-tetrahydrocannabinol (THC), synthetic cannabinoids, or adulterated cannabidiol (CBD) remain poorly describ...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.
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...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.
PURPOSE: Chronic pain management remains a critical challenge despite policy efforts like Arizona's Prescription Monitoring Program. There is an ongoing need to enhance provider education in integrative, nonpharmacologic...PURPOSE: Chronic pain management remains a critical challenge despite policy efforts like Arizona's Prescription Monitoring Program. There is an ongoing need to enhance provider education in integrative, nonpharmacologic approaches to chronic pain.This study evaluated the impact of an Integrative Pain Management (IPM) program on healthcare providers' attitudes, confidence, and prescribing behaviors in chronic pain. METHOD: This pre-post study evaluated a six-hour, online IPM program for licensed Arizona providers. Outcomes included changes in provider attitudes and beliefs, confidence with IPM, and prescribing patterns for opioid and other controlled medications. Prescribing records linked by national provider identifier obtained from the Arizona Board of Pharmacy were used as well as validated surveys. Participants were recruited through state boards and professional organizations. RESULTS: Among 100 participants, most were female (76%), White (77%), and held Doctor of Medicine (48%) or Nurse Practitioner (24%) credentials. Significant improvements were found in attitudes toward chronic pain, pain-related beliefs, and medical knowledge (all P < .01), with no significant changes in prescribing patterns. Belief shifts included reduced negative stance toward pain patients (P < .001) and increased awareness of inadequate pain education (P = .032). Participating providers reported more frequent discussions on work-life balance (P = .019) and Ayurveda (P = .003). Pharmacy board data showed no significant prescribing changes over the one-year measurement period. CONCLUSIONS: The IPM course improved provider attitudes and engagement in whole-person care but did not affect prescribing behaviors, highlighting the need to pair education with system and policy changes for lasting impact.
Geertsema-Hoeve BC, Stam-Slob MC, Bijl M
… +17 more, Eikenboom J, Frijns CJM, Goekoop RJ, van den Hoogen LL, Huisman A, Jansen AJG, Kooiman J, Koopman JJE, de Leeuw K, Lely AT, van Mens TE, Middeldorp S, van der Molen RG, van de Ree MA, Urbanus RT, Westerink J, Limper M
In 2023, new ACR/EULAR classification criteria for research on the antiphospholipid syndrome (APS) were published. This Delphi consensus paper aims to examine the implications of these criteria and to update on recent di...In 2023, new ACR/EULAR classification criteria for research on the antiphospholipid syndrome (APS) were published. This Delphi consensus paper aims to examine the implications of these criteria and to update on recent diagnostic and therapeutic insights for APS in clinical practice. A panel of 19 Dutch experts participated in two survey rounds and a final discussion to achieve agreement. Consensus was defined as a median score of ≥7, indicating strong agreement, or a score of ≤3, indicating strong disagreement. 23 of 25 statements (92%) achieved consensus. The panel concluded that the new classification criteria improve risk stratification for research purposes but are not designed for clinical diagnosis. A significant proportion of patients with obstetric APS do not fulfil these research criteria. New is the emphasis on microvascular disease. Recognizing these lesser-known APS manifestations could facilitate earlier diagnosis and improve patient outcomes. Laboratory standardization remains a significant challenge. Current treatment recommendations favor vitamin K antagonists, but direct oral anticoagulants or antiplatelet therapy may be cautiously considered in selected low-risk patients.
Heterogeneity in disease pathogenesis persists despite advances in genomics and imaging because medicine measures biology while ignoring biography, the person's lived experiences that shape biological systems. Trauma, ch...Heterogeneity in disease pathogenesis persists despite advances in genomics and imaging because medicine measures biology while ignoring biography, the person's lived experiences that shape biological systems. Trauma, chronic stress, social isolation, and structural inequities create measurable shifts in immune, neural, and endocrine regulation, yet remain unmeasured in most research. Just as physics required dark matter to explain the behavior of galaxies that visible matter could not, medicine must integrate this biographical "dark matter" to explain disease pathogenesis. Mechanistic, patient-level analysis demands studying how biography becomes biology to explain disease risk and pathogenesis.
Migraine is a complex neurological disorder that affects over 1 billion individuals worldwide. While a growing number of migraine therapies have recently become available, migraine remains the leading cause of disability...Migraine is a complex neurological disorder that affects over 1 billion individuals worldwide. While a growing number of migraine therapies have recently become available, migraine remains the leading cause of disability among adults under the age of 50. The unmet burden of migraine is likely due to several elements. These include lifestyle factors such as stress, sleep, diet, and activity that, when compromised, can contribute to heightened migraine disability. Additionally, comorbidities involving the gastrointestinal, cardiovascular, and immunological systems can often worsen migraine disability. An integrative medicine approach has potential to synergistically address these elements while providing whole person migraine care. This model is especially imperative for pregnant, nursing, pediatric, or medication overuse migraine populations for whom non-pharmacologic and behavioral options are often the cornerstone of treatment. In this article, we review the Scripps model for providing multi-specialty integrative care for addressing migraine within a healthcare system. Part 1 of this article will provide an overview of migraine and updates on pharmacological and procedural care. Part 2 will review behavioral, complementary and neuromodulation care options.