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Many essays, books, and even movies have centered on the theme of doctor as patient. As an academic internist diagnosed with breast cancer in 2016, I could appreciate the profound impact it had on me personally and on my patient interactions and practice style. What was rather unexpected was the additional transformation of my clinical teaching. In the educator role, I noticed my priorities shifting and approach changing, whether it was as course director in the medical school or preceptor in resident clinic or attending on the inpatient service.

Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors such as age or hypertension. Critical appraisal of studies evaluating the association between atrial fibrillation and dementia in stroke-free patients reveals that several suffer from methodological issues, such as not including silent stroke or anticoagulation therapy in multivariate analyses.

Beta-blockers in high target doses are recommended for heart failure with reduced ejection fraction (HFrEF) but not for preserved ejection fraction (HFpEF). Treatment benefits are often more pronounced in high-risk subgroups, and patients with HFpEF with heart rate ≥70 beats per minute have emerged as such a high-risk subgroup. We examined the associations of high-dose beta-blocker use with outcomes in these patients.

Background: Older patients with heart failure with preserved ejection fraction have severe exercise intolerance. Vitamin D may play a role in cardiovascular and skeletal muscle function, and may therefore be implicated in exercise intolerance in heart failure with preserved ejection fraction. However, there are few data on vitamin D status and its relationship to exercise capacity in heart failure with preserved ejection fraction patients.Methods: Plasma 25-hydroxyvitamin D (25[OH]D) and exercise capacity (peak oxygen consumption, [VO2], 6-minute walk distance) were measured in 112 older heart failure with preserved ejection fraction patients (mean ± SD age = 70 ± 8 years) and 37 healthy age-matched controls.

Sleep duration has been shown to be associated with all-cause mortality; however, its relationship with cause-specific fatal events remains uncertain. We examined the relationship between sleep duration and risk of fatal coronary heart disease, sudden cardiac death, cancer-related death, and all-cause mortality.

Cardiovascular health has been proven to be associated with major cardiometabolic diseases. However, little is known of associations between cardiovascular health and nonalcoholic fatty liver disease.

Patients with motor neuron diseases may present to primary care clinic or may be initially encountered in the inpatient setting. Timely diagnosis of these conditions is a key factor in early intervention and therapy, and accuracy of diagnosis is of extreme importance, in particular for amyotrophic lateral sclerosis with its poor prognosis. The aim of this review article is to provide a clinical and diagnostic framework for the diagnosis and evaluation of motor neuron disease for primary care physicians.

The patient had long grappled with a disease attributed to toxin exposure after the World Trade Center attack on September 11, 2001. Years later, a biopsy specimen offered a different possible explanation for his signs and symptoms.

Phenomena known as cognitive biases, when applied to the details of a patient’s medical history, evidently steered the first attempts at diagnosis in the wrong direction. A 60-year-old man presented after 6 weeks of progressively worsening fevers, weight loss, malaise, night sweats, and confusion. Originally, the fevers were intermittent and low grade at 37.7°C (99.9°F). In the 2 weeks prior to presentation, they occurred daily, with temperatures rising to 39°C (102°F). The patient also reported mild headaches, a dry cough, and palpable lymphadenopathy in his axilla and neck.

In 1881, Henrik Ibsen’s play Ghosts shocked the theatrical world by bringing to center stage the taboo topic of venereal disease. A major character in the drama, Oswald Alving, age 26, suffers from neurosyphilis. Oswald’s headaches and neck stiffness (“like a tight iron band squeezing me from my neck up”1) indicate chronic meningitis. His difficulty concentrating (“I couldn’t focus any of my thoughts”1) and inability to work suggest the meningoencephalitis of general paresis. And, in the play’s tragic climax, Oswald suffers a devastating, catastrophic neurologic deterioration on stage with altered mental status and an unresponsiveness that leaves him permanently an invalid (“Oswald appears to crumple inwardly in the chair; all his muscles loosen; the expression leaves his face; and his eyes stare blankly”1).