Systems

Mechanisms of Angiotensin Blockade in the Management of Diabetic Nephropathy

December 11, 2014
Mechanisms of Angiotensin Blockade in the Management of Diabetic Nephropathy

By Miguel A. Saldivar, MD

Peer Reviewed 

When a patient with diabetes comes into a clinic or hospital, it is not uncommon to hear the question, “Is he/she on an angiotensin-converting-enzyme (ACE) inhibitor (ACEI) or an angiotensin-receptor blocker (ARB)?” Most clinicians know the mantra: ACEIs are renoprotective in diabetes. Most are aware that clinical studies dating back to the 1990s have indeed shown the protective effects of ACEIs, such as captopril, against renal function deterioration in diabetes . Most are even aware that there are…

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Unraveling The Mysteries of Prinzmetal’s Angina: What Is It And How Do We Diagnose It?

October 8, 2014
Unraveling The Mysteries of Prinzmetal’s Angina: What Is It And How Do We Diagnose It?

By Anjali Varma Desai, MD

Peer Reviewed

Mr. Q is a 55-year-old male smoker who presents with recurrent chest pain in the mornings over the past several months. The patient reports being awakened from sleep at approximately 5:00 a.m. each morning with the same diffuse chest “pressure.” The pain typically lasts on the order of minutes, resolves, and then recurs at five-minute intervals in the same fashion for a total duration of two hours. The pain always occurs at rest and is never precipitated…

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Are Health Care Providers PrEPared?

September 24, 2014
Are Health Care Providers PrEPared?

By Nathan King

Faculty Reviewed

Doctors are known to be some of the worst patients, and from personal experience I predict that medical students are not too far behind. That’s why when I finally found the time to take a proactive step in maintaining my good health, the last thing I hoped to run into were barriers, but that’s exactly what I hit. To my surprise, it was not at the hands of insurance companies, overbooked doctors, or the general bureaucracy of the medical system;…

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To Inject, or Not to Inject: Using the Pneumococcal Vaccinations Effectively

September 19, 2014
To Inject, or Not to Inject: Using the Pneumococcal Vaccinations Effectively

By Luke O’Donnell, MD

Peer reviewed

Once formidable diseases, pneumonia, bacteremia, and meningitis are all now considered “bread-and-butter” internal medicine. Streptococcus pneumoniae is one of the major pathogens in these processes, causing 500,000 cases of pneumonia, 50,000 cases of bacteremia, and 3,000 cases of bacterial meningitis in the United States annually, with case fatality rates of 5-7%, 20%, and 30%, respectively .

Efforts to vaccinate against this gram-positive diplococcus started in mining sites near Johannesburg, South Africa around the turn of the last century…

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From the Bellevue Wards: Wellens’ Syndrome Revisited

September 18, 2014
From the Bellevue Wards: Wellens’ Syndrome Revisited

By Matthew Shou Lun Lee, MD

Peer Reviewed

Clinical Questions

-How common are elevated cardiac enzymes during Wellens’ syndrome?

-Can the EKG changes in Wellens’ syndrome be found with other causes?

Background

This post represents a follow-up to the 2009 article in Clinical Correlations by Dr. Erin Ducharme .

Wellens’ syndrome refers to a distinctive combination of clinical and EKG findings in unstable angina associated with high-grade lesions of the left anterior descending artery (LAD) . Initially described in 1982, the criteria has undergone…

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Chimeras Could Bridge the Gap Between Treatment and Cure Or Are They Your Silent and Deadly Twin?

August 8, 2014
Chimeras Could Bridge the Gap Between Treatment and Cure Or Are They Your Silent and Deadly Twin?

By Pritha Subramanyam

Peer Reviewed

Mrs. CS is a 66-year-old Indian female who presents for a cardiology follow-up. The patient has a history of mitral regurgitation secondary to rheumatic fever she experienced as a child. As a teenager, her condition was diagnosed when she frequently became short of breath while playing sports in school. She was in good health until 24 years ago, when an acute episode of dyspnea while climbing stairs sent her to the emergency room. Her native mitral valve was found to…

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Vit-a-minute: Are Supplements Worth It?

July 11, 2014
Vit-a-minute: Are Supplements Worth It?

By Aditya K. Sreenivasan

Peer Reviewed

The Huffington Post recently publicized a large study on the health habits of doctors. The study, a survey done by Medscape with 31,399 participants, revealed that more than half of doctors take some form of dietary supplement. The most common form of supplement taken was a multivitamin . With the way doctors find themselves in constant discussions about “evidence based medicine” these days, we can assume that there are solid data showing that multivitamins are beneficial to long-term health.…

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Inhaled insulin: An Elusive Revolution in Diabetes Management.

June 19, 2014
Inhaled insulin: An Elusive Revolution in Diabetes Management.

By Reed Magleby, MD

Peer Reviewed

For many with type II diabetes, initiation of insulin therapy represents a devastating progression of their disease. Patients who are dependent on insulin require constant blood sugar monitoring, adherence to strict dosing algorithms, and up to 4 self-administered injections every day. According to a 2010 survey of non-insulin adherent diabetic patients, both “injection phobia” and inconvenience were found to be important barriers to initiation of insulin therapy. . In response to these concerns, less invasive administration techniques such as…

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Proton Pump Inhibitors: Acid Suppression with a Nutritional Cost

June 13, 2014
Proton Pump Inhibitors: Acid Suppression with a Nutritional Cost

By Dana Zalkin

Peer Reviewed

In the late 1970s evidence began to emerge that a newly discovered pump, a H+/K+ ATPase in the gastric mucosa, was the final step in the process of acid secretion . With this discovery, further research demonstrated the ability to reduce gastric acid secretion by inhibiting these proton pumps . We now have drugs that do just that: the proton pump inhibitors (PPIs). Proton pump inhibitors have been used since 1989 to treat acid-related gastrointestinal disorders as well as in…

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Caffeine and the Risk of Atrial Fibrillation

June 6, 2014
Caffeine and the Risk of Atrial Fibrillation

By Joshua Michael Lader, MD

Peer Reviewed

As physicians, we are frequently asked to weigh-in on dinnertime discussions about topics that, despite their relevance to everyday life, were never formally addressed in our medical training. For example, at a recent family gathering the conversation turned to a 78 year-old uncle who was recently diagnosed with atrial fibrillation. While this uncle had longstanding and likely poorly controlled hypertension, he would also typically drink 4 to 5 cups of coffee between breakfast and lunch. The debate then…

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Are Probiotics Effective In Preventing Clostridium Difficile Associated Diarrhea?

May 30, 2014
Are Probiotics Effective In Preventing Clostridium Difficile Associated Diarrhea?

By Theresa Sumberac, MD

Peer Reviewed

Antibiotic associated diarrhea is a common complication of antibiotic therapy, occurring in 5% to 39% of all patients receiving treatment. Nearly one third of these cases are attributed to the gram –positive spore forming rod, Clostridium difficile . A primary Clostridium difficile associated diarrhea (CDAD) is estimated to add $2871 to $4846 to in hospital costs while a recurrent infection is estimated to cost $13,655 to $18,067 . The emergence of the hyper-virulent NAP1/B1/027 strain of C. difficile together…

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Gay Men, Barebacking and the New Little Blue Pill: The awkward interface of medicine and gay sex.

May 23, 2014
Gay Men, Barebacking and the New Little Blue Pill: The awkward interface of medicine and gay sex.

By Richard E. Greene, MD

Peer Reviewed

In July of 2012, the FDA approved the use of Tenofovir-Emtricitabine (Truvada, a single blue pill) daily as Pre-Exposure Prophylaxis (PrEP) in men with persistent risk for contracting HIV infection. The idea of PrEP has ignited a firestorm of concern among healthcare providers about how, when and in whom to use PrEP, if at all. Indeed, some believe that PrEP will usher in a new era of drug resistant new infections with HIV, or encourage men on…

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