Systems

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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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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