Systems

Spotlight: A case of Metformin Associated Lactic Acidosis

May 11, 2018
Spotlight: A case of Metformin Associated Lactic Acidosis

By  Jasmine Nee and Martin Fried, MD

Peer Reviewed

LEARNING OBJECTIVES

1. What is metformin-associated lactic acidosis?
2. How does severe acidemia lead to acute kidney injury?
3. How do you treat metformin-associated lactic acidosis?

CASE SUMMARY

The patient is a 40-year-old man with alcohol dependence and type II diabetes who presented to the emergency department for alcohol intoxication. After arriving hemodynamically stable with reassuring labs, he become tachypneic, confused, and lethargic a few hours later. At this point, he admitted that he took “a …

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Insulin in a Pill: Barriers to Development of Oral Insulin

May 8, 2018
Insulin in a Pill: Barriers to Development of Oral Insulin

By Nicolas Gillingham

Peer Reviewed

Over 30 million Americans—9.4% of the population—live with diabetes, six million of whom are at least partially dependent on exogenous insulin. Insulin can be self-administered by subcutaneous injection, either classically via a syringe, an insulin pen, or using an insulin pump. However, patients with diabetes report that these daily injections can feel particularly burdensome, not to mention stigmatizing, when compared to oral medications like metformin, which is one reason why insulin carries a lower rate of adherence. What if our …

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Gamechanger? The Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients with Knee Osteoarthritis – A Randomized Clinical Trial

April 6, 2018
Gamechanger? The Effect of Intra-articular Triamcinolone vs Saline on Knee Cartilage Volume and Pain in Patients with Knee Osteoarthritis – A Randomized Clinical Trial

By Rebecca Lazarus, MD

Peer Reviewed

Why does this matter?
Osteoarthritis (OA) is a leading cause of disability in the United States and is the most common type of arthritis. The pathogenesis involves the progressive destruction of articular cartilage in a joint, which is accompanied by new bone formation and synovial proliferation. On a cellular level, this process is believed to involve mononuclear cells and pro-inflammatory mediators that promote synovitis, as well as the up-regulation of aggrecanases and collagenases that promote cartilage catabolism . Based …

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A Rare Complication of Diabetes: Diabetic Myonecrosis

March 29, 2018
A Rare Complication of Diabetes: Diabetic Myonecrosis

By Allison Harrington, MD

Peer Reviewed

Learning Objectives:

1) When should diabetic myonecrosis be suspected?

2) What are the diagnostic criteria for diabetic myonecrosis? What is the pathophysiology?

3) What is the management of diabetic myonecrosis? How can it be prevented?

A 41-year-old female with a past medical history of poorly controlled type I diabetes (hemoglobin A1C , 13%), a right lower extremity deep vein thrombosis (DVT) status post inferior vena cava filter placement in March 2017 presents with persistent weakness and left lower extremity …

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Is There Really a Link between Asthma and Reflux?

February 27, 2018
Is There Really a Link between Asthma and Reflux?

By Scott Statman, MD

Peer Reviewed

There is little doubt that an association between asthma and gastroesophageal reflux disease (GERD) exists. However clinicians have debated the nature of this relationship for decades. Asthma and GERD are among the most common disorders encountered by physicians, with prevalence in the general population estimated at 8%1 and 10 to 20%2 respectively. Studies have shown that up to 80% of asthmatics have symptomatic GERD3 and that people with GERD are nearly1.2 times more likely to have asthma.4  This may …

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Food for Thought

February 9, 2018
Food for Thought

By Hannah Kopinski
Peer Reviewed

Diabetes, hypertension, and hyperlipidemia. One would be hard pressed to find an adult primary care physician in the United States who would not list these three chronic medical conditions as the metaphorical bread and butter of his or her practice. Bread and butter in this case is, however, not just a metaphor. The single most important driver of these conditions and the complications that arise from them (myocardial infarction, stroke, renal failure, just to name a few) is poor diet. …

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NSAIDs: Are They All the Same?

February 1, 2018
NSAIDs: Are They All the Same?

By Vishal Shah, MD

Peer Reviewed

Nonsteroidal antiinflammatory drugs (NSAIDs) are a heterogenous group of non-opioid analgesics and anti-inflammatory agents. Their use is ubiquitous, from treating a simple tension headache to a sprained ankle. NSAIDs are available over the counter and in prescription form.

NSAID use in the United States is rising; from 2005 to 2010, prescriptions for NSAIDs increased by 41%.1 These numbers will continue to rise with the increasing population age and subsequent demand for analgesics to treat conditions related to increasing age …

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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 …

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