Systems

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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Sex or Drugs: Why Do We See An Increased Incidence of Oropharyngeal Cancer?

July 13, 2016
Sex or Drugs: Why Do We See An Increased Incidence of Oropharyngeal Cancer?

By Tyler Litton, MD

Peer Reviewed

Oropharyngeal squamous cell carcinoma (OPSCC) is relatively rare but incidence has increased in the US over the past 40 years. Tonsillar cancer is the most common type of OPSCC followed by base of tongue cancer, which together account for 90% of all OPSCCs. The incidence of both tonsillar and base of tongue cancers individually have also increased in the US. OPSCC is more common in men than women and smoking and alcohol are well known risk factors for …

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Stroke 2.0: Novel methods of Detection, Selection and Intervention in Acute Cerebral Ischemia

June 29, 2016
Stroke 2.0: Novel methods of Detection, Selection and Intervention in Acute Cerebral Ischemia

By David Valentine, MD

Peer Reviewed

Stroke is among the costliest disorders in the world for both individuals and society. Every hour of an evolving stroke kills 120 million neurons, destroys 830 billion synapses and degrades 714 kilometers of myelinated fibers, aging the brain by 3.6 years in those 60 minutes1. It is the leading cause of adult disability in the USA, currently costing $70 billion a year2 with $2.2 trillion more projected over the next forty years3. The global burden is even higher.

Despite …

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The Brain’s Effect on the Heart After a Stroke

June 22, 2016
The Brain’s Effect on the Heart After a Stroke

By Rory Abrams, MD

Peer Reviewed 

The heart and brain are hopelessly intertwined. Their connection is greater than the tissues and sinews that physically tether them to the human body, and can be understood in three ways: 1) how the heart affects the brain, 2) how the brain affects the heart, and 3) how the heart and brain are both affected by various neuro-cardiac syndromes.  The heart’s effects on the brain are illustrated when there is hypoperfusion of the brain resulting in syncope, or when …

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Outpatient Rhythm Monitoring: Available Options and Diagnostic Yield

March 29, 2016
Outpatient Rhythm Monitoring: Available Options and Diagnostic Yield

By Iulia Giuroiu, MD

Peer Reviewed

A 70-year-old woman with hypertension, early dementia, and non-specific chest pain of unclear etiology presents with recurrent left-sided chest pain. Unfortunately, she is a poor historian; it appears that her chest pain is similar to past episodes. Prior workups, which included an echocardiogram, had been unremarkable. To confound matters further, the patient’s current pain appears to be reproducible when pressure is applied to her chest. She is admitted overnight for close observation. No electrocardiogram (ECG) changes are found and …

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PTH versus PTHrP — Small Differences, Big Implications

March 3, 2016
PTH versus PTHrP — Small Differences, Big Implications

Samantha Kass Newman, MD

Peer Reviewed 

A 48-year-old depressed male smoker with a bit of an alcohol problem presents to the emergency department with worsening fatigue, severe lower back pain, constipation, abdominal pain, and 4 days of coffee ground emesis.

This could be anything. Viral gastroenteritis? Perhaps. Food poisoning? Probably not. Upper GI bleed? Likely, given his alcohol use. You send off routine labs, and then are called for a critical value: his calcium is 13.8 mg/dL. The albumin is normal. Next, you check the …

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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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