Systems

Is Personalized Medicine Really the Cure? Looking Through the Lens of Breast Cancer

May 3, 2013

By Jessica Billig

Faculty Peer Reviewed

Although millions of dollars are spent towards cancer research every year, progress toward a cure is less than ideal. Last year the New York Times posted a piece about the burgeoning improvements on the genomic front that could lead to a new approach to cancer treatment. “The promise is that low-cost gene sequencing will lead to a new era of personalized medicine, yielding new approaches for treating cancers and other serious diseases” . Through genomic technology, physicians will be able…

Preserving Residual Renal Function

May 1, 2013

By Jerome Lowenstein, MD

Faculty Peer Reviewed

Two questions that often arise concerning the administration of radio-contrast in patients with advanced renal disease, receiving hemodialysis or peritoneal dialysis, reveal what appear to be widespread and important misconceptions.

The first misconception is that in end-stage renal disease, glomerular filtration is absent or minimal and the removal of wastes (“uremic toxins”) is accomplished only by peritoneal or hemodialysis Most patients who reach the advanced stages of renal disease requiring hemodialysis or peritoneal dialysis are not oliguric and…

Have a Cow? How Recent Studies on Red Meat Consumption Apply to Clinical Practice

April 12, 2013

By Tyler R. McClintock

Faculty Peer Reviewed

“Red Meat Kills.” “Red Meat a Ticket to Early Grave.” “A Hot Dog a Day Raises Risk of Dying.” Such were the headlines circulating in popular press last year when the Annals of Internal Medicine released details of an upcoming article out of Frank Hu’s research group at the Harvard School of Public Health . Analyzing long-term prospective data from two large cohort studies, researchers found that individuals who ate a serving of unprocessed red meat each day…

The Effect of Bariatric Surgery on Incretin Hormones and Glucose Homeostasis

April 4, 2013

By Michael Crist

Faculty Peer Reviewed

Until recently, little thought was given to the important role played by the duodenum, jejunum, and ileum in glucose homeostasis. The involvement of the gut in glucose regulation is mediated by the enteroinsular axis, which refers to the neural and hormonal signaling pathways that connect the gastrointestinal (GI) tract with pancreatic beta cells. These pathways are largely responsible for the increase in insulin that occurs during the postprandial period. In 1964 McIntyre and colleagues first reported the phenomenon…

White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

March 20, 2013

By Lauren Foster

Faculty Peer Reviewed

Hypertension is a pervasive chronic disease affecting approximately 65 million adults in the United States, and a significant cause of morbidity and mortality . Antihypertensives are widely prescribed due to their effectiveness in lowering blood pressure, thereby reducing the risk of cardiovascular events. However, the phenomenon of the “white coat effect” may be a complicating factor in the diagnosis and management of hypertensive patients. It is well established that a considerable number of people experience an elevation of their…

Anal cancer screening – A case for screening anal paps

January 24, 2013

By Nelson Sanchez, MD

Faculty Peer Reviewed

Case:

A 56 year-old homosexual male presents to your clinic to ask whether or not he should have an anal Pap smear. The patient is HIV positive, has been on HAART for five years, and has no history of opportunistic infections. He denies any anal pain, bleeding or masses.

While efforts to improve knowledge about colorectal cancer in various communities continues to grow, awareness of and misconceptions about anal cancer remain. Over the past couple of years there…

Promising New Hepatitis C Medications Raise Hopes, Questions

January 17, 2013

By Carl M. Gay, MD

Faculty Peer Reviewed

A healthy 61-year old man with a history of chronic genotype 1b hepatitis C virus infection of unknown duration arrives for his semiannual appointment in the Hepatology Clinic. The patient has previously been offered treatment with pegylated interferon and ribavirin, which he has declined on the basis of potential side effects and poor reported efficacy. He states that he has read that new treatment options for hepatitis C have recently become available…

Hepatitis C virus (HCV), first…

Kidney Stones and Climate Change

October 10, 2012

By Jeffrey Shyu, MD

Faculty Peer Reviewed

Climate change has been linked to a variety of adverse effects on human health, effects that are expected to worsen in the coming decades . For example, a heat wave in August 2003 resulted in nearly 15000 deaths in France, and the anticipated increase in average world temperatures is expected to lead to longer and more frequent heat waves that will disproportionately affect our more vulnerable populations. Infectious disease outbreaks, particularly vector-borne ones such as malaria, are expected…

Morgellons: Real Disease or Delusion Turned Internet Meme?

October 3, 2012

By Robert Mazgaj

Faculty Peer Reviewed

Morgellons disease is an “unexplained dermopathy” characterized by fibers emerging from skin lesions, and associated with various cutaneous sensations. Inspired by a curious medical condition reported by a 17th century English physician, Morgellons was actually named in 2002 by Mary Leitao, a layperson, to describe the mysterious set of symptoms reportedly suffered by her then 2-year-old son. Leitao then launched the not-for-profit Morgellons Research Foundation (MRF) along with a (no longer active) website, www.morgellons.org. MRF successfully petitioned members of…

What Is Andropause? Is Testosterone Supplementation the Answer in Older Men?

September 20, 2012

By Kylie Birnbaum

Faculty Peer Reviewed

Women have long bemoaned menopause and its physiological, psychological, and sexual effects. Fortunately, hormone replacement therapy has provided relief for symptomatic women. Less attention is paid to men, who also experience declines in their sex hormones. Decreased testosterone may explain many symptoms experienced by elderly men, such as poor sexual function and libido, decreased bone mineral density, fatigue, and decreased muscle mass and strength. Should physicians treat elderly men with testosterone replacement therapy?

Late-onset hypogonadism, or “andropause,” is the…

From The Archives: The Role of Serologic Testing in the Diagnosis of Celiac Disease

August 23, 2012

Please enjoy this post from the archives dated, August 18, 2010

By Todd Cutler

Faculty Peer Reviewed

A 31-year-old woman presents to the clinic with chronic fatigue. She was diagnosed with iron deficiency anemia when she was 25 years old and has since taken oral contraceptives to limit bleeding during menstruation which she describes as minimal. She has a family history significant for an older brother with celiac disease. She is thin and her exam is significant for conjunctival pallor. Her laboratory findings are…

Omega-3 Fatty Acids and Atherosclerosis

August 17, 2012

By Michael Malone

Faculty Peer Reviewed

Omega-3 long chain polyunsaturated fatty acids (PUFAs) have been popularized in recent years as beneficial nutrients with cardioprotective effects. Omega-3 PUFAs are so named because of a double bond between the 3rd and 4th carbon of the polycarbon chain. They are “poly-unsaturated” with hydrogen atoms, as their carbon chains contain multiple double bonds. Three omega-3 long chain PUFAs are typically discussed in the context of medical therapy, the first being alpha-linolenic acid (ALA). ALA is an essential precursor omega-3…

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Clinical Correlations

Systems

Is Personalized Medicine Really the Cure? Looking Through the Lens of Breast Cancer

Preserving Residual Renal Function

Have a Cow? How Recent Studies on Red Meat Consumption Apply to Clinical Practice

The Effect of Bariatric Surgery on Incretin Hormones and Glucose Homeostasis

White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

Anal cancer screening – A case for screening anal paps

Promising New Hepatitis C Medications Raise Hopes, Questions

Kidney Stones and Climate Change

Morgellons: Real Disease or Delusion Turned Internet Meme?

What Is Andropause? Is Testosterone Supplementation the Answer in Older Men?

From The Archives: The Role of Serologic Testing in the Diagnosis of Celiac Disease

Omega-3 Fatty Acids and Atherosclerosis

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