Breaking News

Measles Alert!

February 20, 2008
Measles Alert!

Commentary by Rosemary Adamson MD, PGY-2

Be on the look-out for measles! New York City’s Department of Health and Mental Hygiene (DOHMH) issued a measles alert at the end of last November because there were 5 confirmed cases of measles being imported from abroad in 2007 to NYC. The DOHMH wished to raise healthcare provider awareness of measles, especially in travelers. Coming from the UK, this alert is close to my heart, as Britain has been battling with reduced uptake of the MMR vaccine and consequent…

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A New Path for the ACCORD (The Action to Control Cardiovascular Risk in Diabetes) trial: Does Being Sweeter Save Lives?

February 8, 2008
A New Path for the ACCORD (The Action to Control Cardiovascular Risk in Diabetes) trial: Does Being Sweeter Save Lives?

Commentary by Melissa Freeman MD, Endocrinology Section Editor

The ACCORD trial is an ongoing 5-year, North American, randomized study that began in 2001 to evaluate potential interventions to decrease cardiovascular (CV) events in adults living with DM2.  The trial enrolled 10,251 adults, aged 40- 82, with DM2 for 10 or more years, and a history of CV disease or two CV risk factors in addition to DM2. All participants were randomized at enrollment into intensive versus standard glucose control. In addition, participants were…

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Breaking News: A Disappointment for Zetia

January 15, 2008
Breaking News: A Disappointment for Zetia

Commentary by Alana Choy-Shan MD, NYU Chief Resident

The highly anticipated results of the ENHANCE trial will likely be presented at the American College of Cardiology meeting in March, but the preliminary results already have everyone talking. ENHANCE was a multinational, double-blind randomized controlled trial sponsored by Merck and Schering-Plough (the manufacturers of the combination ezetimibe/simvastatin pill). A total of 720 patients who were heterozygotes for Familial Hypercholesterolemia were randomized to treatment with either ezetimibe/simvastatin 10/80mg or simvastatin 80mg. The primary endpoint was change in…

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Breaking News: FDA Issues New Warnings for Haldol

September 21, 2007
Breaking News: FDA Issues New Warnings for Haldol

Commentary by Helen Kourlas, PharmD

On September 17th 2007, the FDA issued an advisory warning healthcare professionals to avoid the use of higher than recommended doses of haloperidol, marketed as Haldol, Haldol Decanoate and Haldol Lactate. In addition to this warning, the FDA also emphasized that the injectable form of haloperidol is only approved to be administered as an intramuscular injection. Common off – label intravenous administration of haloperidol has led to numerous case reports of QT prolongation, Torsades de Piontes (TdP) and sudden death.…

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Recent Legionella Outbreak in the Bronx

September 20, 2007
Recent Legionella Outbreak in the Bronx

Commentary by Elizabeth Hackett MD, PGY-3

On July 25th, 2007, the NYC Department of Health released an advisory requesting that all New York City physicians maintain a high index of suspicion for Legionnaires’ disease in patients presenting with community acquired pneumonia. This advisory was prompted by 27 cases of Legionella pneumonia reported in the Parkchester neighborhood of the Bronx during the fall of 2006 (zip code 10462 ). This cluster of cases represented an increase in incidence of the disease to 16.6 cases/100,000 in the…

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FDA Black Box Warning on Gadolinium

May 24, 2007

Back in December we reported on the FDA cautioning practioners about the use of gadolinium (an mri contrast agent) in patients with chronic kidney disease.  The FDA is now requesting a black box warning  stating “that patients with severe kidney insufficiency who receive gadolinium-based agents are at risk for developing a debilitating, and a potentially fatal disease known as nephrogenic systemic fibrosis (NSF). In addition, it would state that patients just before or just after liver transplantation, or those with chronic liver disease, are also at risk…

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The HPV vaccine: Recommended in the U.S., but required in Virginia

May 8, 2007
The HPV vaccine: Recommended in the U.S., but required in Virginia

Commentary By: Marshall Fordyce, PGY-3

Now that the dust has settled in Texas and Virginia, let’s clarify the role of the human papilloma virus (HPV) vaccine in our clinics. An excellent article in last week’s JAMA by its Editor-In-Chief, Dr. Catherine DeAngelis, and Lawrence Gostin, JD, highlights how the recent push for compulsory vaccination – a significant step beyond CDC recommendations – defied precedent and threatened public confidence in our national vaccine policy. Now, after the tussle of aggressive pharmaceutical lobbying and the public outcry…

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Don’t Pass the Olives…

April 18, 2007
Don’t Pass the Olives…

This week, olives from several different companies were found to contain Clostridium Botulinum. No cases of botulism have been reported to date, but this is an opportunity to review the pertinent clinical findings.

Botulism is caused by exposure to the botulinum neurotoxin in clostridium botulinum. There are eight toxin strains identified, 4 are known to cause disease in humans. The toxin is produced only in an anaerobic environment, so bottled or canned food products are a good source of infection. Food may smell…

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Meeting Perspectives: The 2007 American College of Cardiology Scientific Session

April 5, 2007
Meeting Perspectives: The 2007 American College of Cardiology Scientific Session

Commentary By: Steven Sedlis, MD Associate Professor of Medicine, Chief, Division of Cardiology Manhattan Veterans Administration Medical Center

The 56th annual scientific session of the American College of Cardiology was held in New Orleans on March 24-27.  The site of the meeting had been selected before hurricane Katrina; the ACC re-affirmed its commitment last year when the devastation caused by the storm was still fresh and when future prospects for southern Louisiana were still uncertain. The ACC meeting was by far the largest…

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First Direct Renin Inhibitor Approved for Hypertension

March 29, 2007
First Direct Renin Inhibitor Approved for Hypertension

Commentary By: Josh Olstein, PGY-3

Earlier this month the FDA approved Tekturna (aliskiren) the first drug in a novel class of antihypertensives that work by directly inhibiting renin. While Novartis has yet to release pricing information, don’t expect to see this new addition on the Bellevue or VA formulary any time soon.

The idea of treating hypertension by blocking the actions of renin has been toyed with by pharmaceutical companies for over twenty years with little success. Aliskiren is the first agent…

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The COURAGE Trial: PCI is not superior to medical therapy in patients with stable coronary disease

March 27, 2007
The COURAGE Trial:  PCI is not superior to medical therapy in patients with stable coronary disease

Commentary by Cara Litvin, PGY-3

The results of one of the more remarkable studies from the meeting of the American College of Cardiology were presented on Monday, along with the simultaneous early publishing of the study online in the New England Journal of Medicine. As a result the study results captured a front page article in today’s New York Times.

The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial was a randomized trial involving 2287 patients with stable but significant coronary artery disease…

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Conflicts of Interest

March 21, 2007
Conflicts of Interest

The debate about the ethically questionable relationship between physicians and the pharmaceutical industry opened up again this morning on the front page of the New York Times. Although the article is heavy on interview and anecdote and a little short on evidence, it is difficult to avoid casting a critical eye on this relationship. The impetus for the article is the new laws in a handful of states requiring drug makers to disclose all payments made to doctors. These laws have made public previously…

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