Systems

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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Diabetic Foot Ulcers: Pathogenesis and Prevention

March 19, 2015
Diabetic Foot Ulcers: Pathogenesis and Prevention

By Shilpa Mukunda, MD

Peer Reviewed

On my first day on inpatient medicine at the VA Hospital, Mr. P came in with an oozing foot ulcer. Mr. P, a 60-year-old man with a 30 pack-year smoking history, poorly controlled diabetes, peripheral vascular disease, and chronic renal disease, had already had toes amputated. He knew all too well the routine of what would happen now with his newest ulcer. After two weeks of IV antibiotics and waiting for operating room time, Mr. P eventually had his …

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Ethical Considerations in the Use of Cordons Sanitaires

February 19, 2015
Ethical Considerations in the Use of Cordons Sanitaires

By Rachel Kaplan Hoffmann, M.D., M.S.Ed., and Keith Hoffmann, J.D.

Peer Reviewed

On December 6, 2013, a two-year-old boy living in southeastern Guinea became the first victim of the latest epidemic of Ebola Virus Disease (EVD). Since the death of Patient Zero, EVD has spread throughout West Africa, becoming the largest outbreak of the deadly virus ever . In its most recent report (2/18/15), the World Health Organization (WHO) reported over 20,000 cases of EVD, with over 9,000 reported deaths , but the actual number …

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Shifting Paradigms in Cancer: Vaccines

January 22, 2015
Shifting Paradigms in Cancer: Vaccines

Joshua Horton

Peer Reviewed

We are not winning the war against cancer, if war is even an appropriate metaphor. When Richard Nixon signed the National Cancer Act into effect in 1971, many predicted that cancer would be a thing of the past within 5 years. It was likened to polio, smallpox, and other long-since-forgotten scourges of mankind; with appropriate funding and research, surely cancer, too, would vanish. With that act in 1971, the National Cancer Institute received a budget of $200 million, a figure that …

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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 by …

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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 minor …

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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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