Breaking News

FDA Approves Sale of Prescription Placebo

December 8, 2006

Believe it or not…Have a great weekend.Smile

Outbreak: Toxic Tacos

December 7, 2006

Update 12/12/06  Download new NY DOH Alert

Several Taco Bell restaurants in our area have been shut down recently due to an outbreak of E. Coli O157:H7.  At least 22 people are infected, and most are under age 18.  Interestingly, at least 2 Taco Bell employees have been found to carry the bacteria but are asymptomatic.

The vector is usually undercooked infected meat.  Symptoms usually present within 3-4 days of ingestion. The department of health has issued a warning to physicians to consider this diagnosis if a patient presents with bloody diarrhea or hemolytic-uremic syndrome (HUS).

Read more »

Pfizer Shutting Lights on ILLUMINATE Study

December 4, 2006

Low HDL is a well known independent risk factor for atherosclerotic disease.  As a result, there have been several attempts to develop medications to raise HDL.  Specific targets include the inhibition of cholesteryl ester transfer protein, which plays an essential role in HDL metabolism by facilitating the transfer of cholesterol esters from HDL cholesterol to apolipoprotein B-containing lipoproteins.

Pfizer created just that drug.  Known as Torcetrapib, it was seen as a promising therapeutic to increase HDL and potentially use in combination with Lipitor. Drug execs were hopeful that Torcetrapib would be another money maker for Pfizer especially in light of the fact that they will lose their patent on Lipitor in 2010.  But in a recent phase 3 clinical trial, known as the Investigation of Lipid Level Management to Understand its IMpact IN ATherosclerotic Events (ILLUMINATE), it seemed to increase blood pressure; there also appeared to be a larger number of deaths in the drug combination arm.  So the decision was made to halt the trial dashing the high hopes that investigators had around the country for the drug.  Ultimately, the loss of Torcetrapib will likely amount to millions of dollars in lost revenue as well as cost many their jobs. 

 

 

Links

New York Times Article

NEJM original article on Torcetrapib

 

Smerd, R. Pfizer Shutting Lights on Illuminate Study, NYU Clinical Correlations Vol 3 #5 December 4, 2006.

 

Welcome to Clinical Correlations

November 27, 2006
Welcome to the official launch of the NYU Internal Medicine Residency Program’s Blog- Clinical Correlations.  We hope this site becomes a part of your daily routine.  Each weekday we will be posting compelling medical content including:

1. clinical cases with difficult management questions answered by faculty members

2. breaking news that should be on everyone’s radar

3. quick journal article reviews with commentary from housestaff/expert faculty

4. morning report teaching points from all 3 hospitals

5. reviews of national meetings by attendees

6. links to other excellent medical sites

7. lecture slides from r3 lectures, core conferences

Have a look around.  We’ve been piloting the site for the last few weeks so there’s already plenty of content. We’re always looking for help so if you’re interested contact any of the members of the steering committee listed on the About page. We’re especially interested in any clinical questions you have about your patients that we will forward to our faculty for a response.  Thanks.

NYU’s Dr. Hochman Releases OAT Results

November 16, 2006

                          Hochman JS et al. for the Occluded Artery Trial Investigators. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med 2006 Nov 14; 355.

Reperfusion via thrombolytics or PCI in patients with acute STEMI has been shown to reduce mortality and maximize myocardial salvage.  It has been less clear whether patients with late presentations of MI are afforded the same benefits.  Though there was no official consensus, late revascularization of the infarct vessel was frequently employed.  At the AHA meeting yesterday, Dr Hochman presented the results of the The Occluded Artery Trial (OAT) and provided the medical community with a definitive answer about how to manage these patients. 

Read more »

Tamiflu Patients Need Monitoring

November 14, 2006

Over 100 cases have been reported to the FDA involving the use of Tamiflu and the development of hallucinations, delerium and other unusual behavior mainly in Japanese children.  From the Chicago Tribune article "Health officials have been sensitive about taking any action that might dissuade people from taking Tamiflu, since the drug could play an important role in an outbreak of bird flu."

Read more about it in the Chicago Tribune and FDA websites…here are the links:

FDA announcement

Chicago Tribune Story

Google to Replace Physicians?

November 13, 2006

So someone has finally done an official “study” of what most of us were already aware of.  Online at the BMJ is a study proving Google’s diagnostic ability.  The researchers took 3-5 terms from case reports from the NEJM, fed them into google and then looked at the links that were referenced.  58% (15/26)  of the time the correct diagnosis was found in the links retrieved by google (CI 38-77%).  You can debate whether this is truly research, however we’re getting closer and closer to the day you and I become irrelevant…scary eh?

 

Improving Stroke Recovery-The EXCITE Trial

November 9, 2006

The EXCITE trial was the lead article in last week’s JAMA. It looks at a 2 week program of contstraint induced movement therapy vs. usual care in patients suffering a cva within the previous 3-9 months. Pt’s in the treatment arm wore a restraining mitt on the less-affected hand and engaged in tasks/behaviors with the hemiplegic hand. This group was compared to a control group with usual care. Measures of performance time and motor function ability all showed clinically relevant improvements that persisted out to 1 year.

Commentary By Rob Staudinger, M.D. Program Director, NYU Neurology Residency, Associate Chief of Neurology at the Veterans Affairs NYHHS.

Stroke is the leading cause of disability in the US. Currently used rehabilitation treatments generally are based on empirical approaches rather than validated therapies. The EXCITE (Extremity Constraint Induced Therapy Evaluation) trial is interesting in several ways. It is the first multisite randomized study to demonstrate the efficacy of a rehabilitative intervention. It included patients who had the first stroke in the previous 3-9 months and therefore suggests that more recovery after a stroke is possible than we currently teach. The study included only patients with limited disability and it remains to be seen if this approach, based on the concept of neuronal plasticity, holds promise for more severely affected patients.

Wolf SL, et al “Effect of Constraint-Induced Movement Therapy on Upper Extremity Function 3 to 9 Months After Stroke: The EXCITE Randomized Clinical Trial” JAMA 2006; 296 (17): 2095-2104.

Statins and CHF

November 3, 2006
This week’s JAMA has an enormous study that looks at chf patients and the use of statins. Data from ~25,000 patients with chf were analyzed for use of statin in the 120 days prior to the initial chf diagnosis. Mortality risk was significantly lower for statin users than nonusers (hazard ratio 0.79), as was hospitalization (hr 0.80). Findings did not change by etiology of chf or whether the patient had cad. The press is taking this study to mean all patients with chf should be on statins. However the observational nature of this study and the difficulty distinguishing the effect of the statin, vs. the effect of overall better care (statin being a surrogate marker for better care/better physician) make this study far from definitive. Oh and yes it was funded by industry…that being said prospective randomized studies should settle this issue.

Headlines: Salmonella Outbreak

November 2, 2006
The CDC and the FDA announced yesterday that they are investigating an outbreak of Salmonella typhimurium illness that has affected at least 171 people in 19 states. Symptoms include fever and nonbloody diarrhea. The outbreak seems to be subsiding and they are still unclear as to the source suspecting tomatoes or letuce. No deaths as of yet, 11 patients hosptialized. Cases have been seen in Arkansas, Connecticut, Georgia, Indiana, Kentucky, Maine, Massachusetts, Michigan, Minnesota, North Carolina, New Hampshire, Ohio, Pennsylvania, Rhode Island, Tennessee, Virginia, Vermont, Washington, and Wisconsin. No New York cases yet, but those of you in the er should be on the lookout and report any suspicious cases to the DOH. CDC announcement Salmonella from Uptodate (subsciption required)