Systems

Age Is Just a Number: Combating Muscle Loss in The Elderly

December 14, 2017
Age Is Just a Number: Combating Muscle Loss in The Elderly

By Carl Preiksaitis

Peer Reviewed

The term “sarcopenia” was introduced in 1989 to characterize the loss of muscle mass that occurs as a consequence of advancing age.1 Use of the term has since grown to include the loss of muscular function experienced in older adults. The prevalence of sarcopenia is estimated to be approximately 29% in community-dwelling older adults and 33% in individuals living in long-term care institutions. Sarcopenia is linked to increased morbidity and mortality from physical disability, increased falls and fractures, decreased quality …

Read more »

Core IM podcast: 5 Pearls on Iron Deficiency Anemia

November 15, 2017

Listen to 5 Pearls segment of Iron Deficiency Anemia! By Dr. Cary Blum MD, Marty Fried MD and Shreya P. Trivedi MD; Illustration by Mike Natter MD

Time Stamps:

  1.  Should patients be screened for iron deficiency? If so, who and how often? (1:40)
  2.  What are the indications for diagnostic endoscopy in iron deficient patients? (3:23)
  3. How should you advice patients to take oral iron? What is optimal dosing? (5:53)
  4.  In which patients would you consider IV iron? What are the risks? (11:41)
  5.  Throwback Question: What is a medication overuse HA? (14:44)

Read more »

Is Potassium Supplementation Beneficial in Hospitalized Patients?

October 25, 2017
Is Potassium Supplementation Beneficial in Hospitalized Patients?

By Sara Stream, MD

Peer Reviewed

As resident physicians, we are taught to supplement serum potassium to a goal level of 4.0 mEq/L in all hospitalized patients. While the dangers of severe potassium abnormalities are well established, the benefit of routine potassium supplementation of normal serum levels in the general hospitalized population is unclear.

Potassium is predominantly an intracellular ion with 98% of total body potassium located in the intracellular space. The accepted reference range for serum potassium levels is 3.5 to 5.0 mEq/L. The …

Read more »

Core IM Podcast: 5 pearls on Headaches

October 18, 2017

Listen to CORE IM’s first 5 Pearls segment on Headaches!

Time Stamps

  1.   What are the indications for imaging for HA? (1:36)
  2.   What is your approach to abortive therapy for migraines? (4:45)
  3.   How do you diagnose medication overuse HA? (6:41)
  4.  What is your approach to migraine prophylaxis? (8:29)
  5. What are some evidence based nonpharmacological therapies for migraines?  (10:42)

Read more »

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

Read more »

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 …

Read more »

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 …

Read more »

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 …

Read more »