Systems

Could Metformin be the First Anti-Aging Drug?

February 11, 2016
Could Metformin be the First Anti-Aging Drug?

By Amy Shen Tang, MD

Peer Reviewed

“I would pay you if you took it away from me. I’d try to buy it back,” said Irving Kahn, the late Wall Street investment advisor when asked if he would ever retire from work . Mr. Kahn, who founded Kahn Brothers Group, Inc. with his sons more than 40 years ago, took an active role as chair of his company until his passing last winter at the ripe age of 109 years. Kahn and his siblings all …

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The Persistent HIV Crisis: HIV Prevalence Among Black Men Who Have Sex With Men (MSM)

February 3, 2016
The Persistent HIV Crisis: HIV Prevalence Among Black Men Who Have Sex With Men (MSM)

By Ofole Mgbako, MD

Peer Reviewed

In July 2010, the much-anticipated “National HIV/AIDS Strategy for the United States” was released to the public. In its introduction, the president declared, “Our Nation is at a crossroads…unless we take bold actions, we face a new era of rising infections, greater challenges in serving people living with HIV, and higher health care costs” . Indeed, the incidence of HIV infection in the U.S. has fallen dramatically over the last few decades, from initially 130,000 new infections annually in …

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Is It Time to Reconsider Who Should Get Metformin?

December 11, 2015
Is It Time to Reconsider Who Should Get Metformin?

By Lauren Strazzulla

Current FDA guidelines for the use of metformin stipulate that it not be prescribed to those with an elevated creatinine (at or above 1.5 mg/dL for men and 1.4 mg/dL for women). It is also contraindicated in patients with heart failure requiring pharmacologic treatment, and people over age 80, unless their creatinine demonstrates that renal function is not reduced. These guidelines are in place to prevent lactic acidosis, an understandably feared complication of metformin. However, metformin is, by consensus, the initial drug …

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Are We Overusing Proton Pump Inhibitors?

November 13, 2015
Are We Overusing Proton Pump Inhibitors?

By Shimwoo Lee
Peer Reviewed
Case: A 31-year-old man with poorly controlled type 2 diabetes was hospitalized for community-acquired pneumonia. His home medications included esomeprazole. When asked why he was receiving this medication, the patient said it was first started during his prior hospitalization for “ulcer prevention” eight months ago and that he had continued to take it since. He denied any history of upper gastrointestinal symptoms. Esomeprazole was tapered off during this admission. When being discharged after successful treatment of his pneumonia, he was …

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HDL Quantity, Necessary But Not Sufficient For Cardioprotection

September 30, 2015
HDL Quantity, Necessary But Not Sufficient For Cardioprotection

By Kerrilynn Carney, MD

Peer Reviewed

Coronary heart disease remains the leading cause of death globally despite the use of statin therapy. Although major statin studies suggest an average 31% reduction in relative risk of coronary events, a residual risk of 69% remains to be addressed. (1) The search for a medical therapy to ameliorate residual risk has become the holy grail of cardiologists and pharmaceutical companies alike. While high-density lipoprotein cholesterol levels (HDL) independently predict cardiovascular disease risk, interventions to raise circulating HDL levels …

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The Great Marijuana Debate – Effects on Psychosis and Cognition

August 13, 2015
The Great Marijuana Debate – Effects on Psychosis and Cognition

By Kristina Cieslak, MD

Peer Reviewed 

The heavily debated gradual decriminalization and legalization of marijuana will likely result in easier access for all ages. An informed debate has been stymied, however, by a lack of prospective data examining the various long-term effects of marijuana use on the brain, particularly among adolescents who use it heavily. This year, the National Institute on Drug Abuse (NIDA) initiated the “National Longitudinal Study of the Neurodevelopmental Consequences of Substance Use.” This study will follow a large cohort of children …

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The Role of Fish Oil in Arrhythmia Prevention

July 29, 2015
The Role of Fish Oil in Arrhythmia Prevention

By Steven Bolger

Peer Reviewed

Omega-3 fatty acids were first identified as a potential agent to prevent and treat cardiovascular disease through several epidemiologic studies of the Greenlandic Inuit in the 1970s suggesting that high consumption of fish oil was associated with a decreased risk of cardiovascular disease . Fish oil contains two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), that have been shown to be beneficial in treating hypertriglyceridemia and in the secondary prevention of cardiac events .

The GISSI-Prevenzione trial, …

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UV Nail Lamps and Cancer: A Correlation?

July 24, 2015
UV Nail Lamps and Cancer: A Correlation?

By Jennifer Ng, MD

Peer Reviewed 

Beauty and suffering are often thought to be intertwined.  It is hard to have your cake and eat it too.  In the quest for beauty, women (and men) have subjected themselves to toxic and potentially deadly practices, such as applying lead-based cosmetics to whiten their faces historically , or more recently, going to tanning beds and/or laying out in the sun for prolonged periods to get a “healthy glow.”  As we have become increasingly health-conscious and vigilant, more and …

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A Primer on CRP and Cardiovascular Risk

July 22, 2015
A Primer on CRP and Cardiovascular Risk

Cindy Fei, MD

Peer Reviewed

A 63-year-old woman with hypertension presents to your clinic for routine follow-up. She came across an online article regarding C-reactive protein and its purported link to heart disease, and she asks you whether she should be tested for it. She is an otherwise asymptomatic non-smoker without a family history of heart disease. Her only medication is hydrochlorothiazide. Her blood pressure measured in the office is 128/81 mmHg, her low-density lipoprotein is 110 mg/dL, and her high-density lipoprotein is 54 mg/dL. …

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Diagnostic Challenges in Latent Tuberculosis Infection: A Brief Review of Available Tests and their Appropriate Use

July 15, 2015
Diagnostic Challenges in Latent Tuberculosis Infection: A Brief Review of Available Tests and their Appropriate Use

By: Miguel A. Saldivar, MD

Peer Reviewed 

“Indeterminate.” Many clinicians have expressed frustration when reading this word on a Quantiferon-TB Gold test result. The obligate follow-up question is: what is the next best step? Repeat the Quantiferon? Ignore it altogether and perform a Tuberculin Skin Test (TST) instead? Even worse, what happens when both tests are performed with discordant results? In order to answer some of these questions, this article begins with a very brief overview of Mycobacterium tuberculosis (TB) infection epidemiology. This is followed …

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Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate

July 10, 2015
Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate

By Shannon Chiu, MD

Peer Reviewed

The annual incidence of infective endocarditis (IE) is estimated to be 3 to 9 cases per 100,000 persons in developed countries . Neurologic complications are the most severe and frequent extracardiac complications of IE, affecting 15-20% of patients . They consist of 1) ischemic infarction secondary to septic emboli from the valvular vegetation, which can eventually undergo hemorrhagic transformation; 2) focal vasculitis/cerebritis from septic emboli obstructing the vascular lumen, which can then develop into brain abscess or meningoencephalitis; 3) …

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Microbiome Blues in E

April 1, 2015
Microbiome Blues in E

By M tanner

Many  bacteria live in and on me—I’ve always known that. But when I learned that bacteria make up 90% of the cells in my body, it made me feel so sucio, so unclean.

I went through my day, realizing for the first time that I am entertaining 100 trillion houseguests who never go home. And who lack all sense of decorum. I know that, technically speaking, bacteria are asexual. But then I read: “one special type of pilus found in ‘male’ strains …

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