Systems

Spotlight: Subacute Endocarditis: The Great Masquerader

October 11, 2017
Spotlight: Subacute Endocarditis: The Great Masquerader

By  Helen Ma, MD

Peer Reviewed

Our new Spotlight series uses case vignettes to explore diagnosis, pathophysiology, and management of a wide variety of diseases seen in the outpatient and inpatient settings.  Articles in the Spotlight section contain clinical pearls that will be highlighted in the case discussion.  While the occasional zebra may appear, the goal of the series is to provide clinically relevant information, and each case has been selected specifically for the relevance of its learning points rather than its rarity. 

Learning objectives

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Life and Limb: Battlefield Medicine from WWII to Today

September 29, 2017
Life and Limb:  Battlefield Medicine from WWII to Today

By Eric Jeffrey Nisenbaum, MD

Peer Reviewed

Mr. O is a 93-year-old man with a past medical history notable for severe Alzheimer’s dementia and amputation of the left upper extremity secondary to wounds received in WWII who was brought in from his nursing home with fever and dyspnea for two days.  His physical exam was notable for inspiratory crackles at the right lung base.  His CBC was notable for an elevated WBC with left-shift and a chest x-ray revealing a right lower lobe infiltrate. He …

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Stem cells for heart failure: What is the evidence?

September 27, 2017
Stem cells for heart failure: What is the evidence?

By Maxine Wallis Stachel, MD

Peer Reviewed

The Scale of the Problem

Despite decades of rigorous data collection, drug research, patient education and evidence-based practice, ischemic heart disease (IHD) and congestive heart failure (CHF) remain among the most deadly diagnoses in America. The standardization of medical therapy and surgical revascularization have reduced morbidity and mortality, but these measures have not kept pace with the burden and cost of disease, which continue to expand as the population ages and more patients survive acute myocardial infarction. IHD …

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Spotlight: Pneumocystis Pneumonia in a Patient Without AIDS, A Clinical Vignette

September 20, 2017
Spotlight: Pneumocystis Pneumonia in a Patient Without AIDS, A Clinical Vignette

By Martin Fried, MD

Peer reviewed

Learning Objectives

Why does impaired cellular immunity increase the risk for Pneumocystis jiroveci Pneumonia (PJP)?  How do acquired humoral immune deficiencies, such as the use of rituximab, increase the risk for PJP? At what dose of chronic steroids use should patients be given prophylaxis for PJP?

Case Summary

The patient is a 35-year-old man with a history of psoriatic arthritis and complex regional pain syndrome on prednisone, methotrexate and abatacept who presented with two weeks of dyspnea on exertion …

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Spotlight: Hepatic Encephalopathy and TIPS: A Clinical Vignette

April 26, 2017
Spotlight: Hepatic Encephalopathy and TIPS: A Clinical Vignette

By Samantha Kass Newman, MD

Peer Reviewed

Today marks the first publication of the new Spotlight series in Clinical Correlations. This series uses case vignettes to explore diagnosis, pathophysiology, and management of a wide variety of diseases seen in the outpatient and inpatient settings.  Articles in the Spotlight section contain clinical pearls that will be highlighted in the case discussion.  While the occasional zebra may appear, the goal of the series is to provide clinically relevant information, and each case has been selected specifically for …

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How Reliable Is Hemoglobin A1c?

April 6, 2017
How Reliable Is Hemoglobin A1c?

By Alexa Yuen

Peer Reviewed 

According to the CDC, there are 22 million people with an established diagnosis of diabetes mellitus in the United States, but more frightening is that the rate of diabetes continues to rise both nationally and globally, with predictions that 7.7% of the world’s adult population will be afflicted with the disease in 2030., Preventing, monitoring, and managing this disease is of utmost importance in responding to the growing epidemic. The hemoglobin A1c (HbA1c) blood test has become a powerful tool …

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Gamechanger? Can Pioglitazone Reduce Cardiovascular Events After a Stroke? An Analysis of the IRIS Trial

January 19, 2017
Gamechanger?  Can Pioglitazone Reduce Cardiovascular Events After a Stroke?  An Analysis of the IRIS Trial

By Johanna Hase, MD

Peer Reviewed

Welcome to Gamechangers, a series that takes a critical look at the latest in medical literature to answer one important question: would the results of this article change my practice? Featuring thorough evidence-based review as well as expert commentary, our aim is for this series to help you decide if the results of a given study are, in fact, a gamechanger

A 64 year old woman with pre-diabetes, hyperlipidemia, and hypertension on aspirin, losartan and simvastatin, recently was diagnosed …

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Gamechanger? Is Spironolactone the Magic Bullet for Resistant Hypertension?

November 9, 2016
Gamechanger?  Is Spironolactone the Magic Bullet for Resistant Hypertension?

By Amar Parikh, MD

Peer Reviewed

Welcome to Gamechangers, a series that takes a critical look at the latest in medical literature to answer one important question: would the results of this article change my practice? Featuring thorough evidence-based review as well as expert commentary, our aim is for this series to help you decide if the results of a given study are, in fact, a gamechanger.

A 65 year-old Hispanic male with type 2 diabetes, hypertension, hyperlipidemia, and erectile dysfunction presents to clinic for

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The Rising Tide of Food Allergy

October 20, 2016
The Rising Tide of Food Allergy

By Kristina Cieslak, MD

Peer Reviewed

Food allergies affect approximately 8% of children and 5% of adults, with a steadily increasing prevalence .  Risk factors for the development of food allergy are numerous and include genetics, sex, and ethnicity . Indeed, children with a parent or sibling with peanut allergy are seven times more likely to develop a peanut allergy of their own, and peanut allergy demonstrates a 64% concordance rate among monozygotic twins as compared to 7% among dizygotic twins . The …

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Oxygen-Induced Hypercapnia in COPD: What is the Mechanism?

September 28, 2016
Oxygen-Induced Hypercapnia in COPD: What is the Mechanism?

By Jonathan Glatt

Peer Reviewed 

It was my first week on the wards as a third-year medical student, and I found myself huddled with the team in a busy corner of the Bellevue ED, listening to a man cough and wheeze his way through an interview. He was an elderly patient with an extensive smoking history–a lifetime of a destructive habit that had dilated and distorted his lungs beyond repair. He told us, between bouts of breathlessness, of worsening dyspnea and copious sputum production over …

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Little Knowledge, Large Problem: Lack of Nutrition and Obesity Education in Medical Curricula

September 23, 2016
Little Knowledge, Large Problem: Lack of Nutrition and Obesity Education in Medical Curricula

By Elissa Driggin

Peer Reviewed

At almost every single one of my medical school interviews, each interviewer, noting my college major in nutritional science, asked some variation of the question, “What should I be eating to stay healthy?” Each time, I was left unsure of whether or not this question was aimed to gauge my ability to hold a conversation in a stressful environment, articulate my thoughts in a logical manner, or fulfill some other mysterious goal of the infamous medical school interview process. Or, …

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Botox: Not Just for Wrinkles Anymore

July 28, 2016
Botox: Not Just for Wrinkles Anymore

Samantha Kass Newman, MD

Peer Reviewed

You can get a Botox injection almost anywhere these days. Internists, dermatologists, and even gynecologists have capitalized on an aging group of baby boomers who aren’t fans of their wrinkles. And it’s true that with an impressive safety profile, few contraindications, rapid effectiveness, and positive cash return for providers, botulinum toxin injections for cosmetic purposes can make everyone happy.

Botulinim toxin is produced by the anaerobic bacterium, Clostridium botulinum. This is the strongest toxin found in nature. When injected …

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