Systems

When Minutes Matter: Why Do Patients Wait to Seek Treatment Following a Stroke or Heart Attack?

March 3, 2010
When Minutes Matter: Why Do Patients Wait to Seek Treatment Following a Stroke or Heart Attack?

Laurel Geraghty

Faculty peer reviewed

Both stroke and heart attack require rapid treatment following the onset of symptoms to minimize morbidity and mortality, but few patients seek help in a timely manner. Only about half of patients with acute myocardial infarction (AMI) or stroke arrive to the emergency department within four hours of the onset of symptoms.,,, Every 30-minute delay in treatment following AMI increases one-year mortality by 7.5%, and almost half of the 167,000 annual stroke deaths in this country occur before the patient …

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What Should We Know About Bedbugs?

February 18, 2010
What Should We Know About Bedbugs?

Jia Huang

Faculty peer reviewed

A 46 year-old Asian female presented with recurrent pruritic erythematous papules in a partially linear pattern over her forearms, face, and trunk. Each papule measured about 3/4 inch in diameter. The eruption first appeared two to three weeks ago and simultaneously appeared over these areas. She denies using any new skin products or taking any new medication. Travel history is positive for a recent trip to Los Angeles. Bedbugs were suspected and the patient was prescribed oral diphenhydramine and topical …

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Zinc Cold Remedies: Are They Safe and Effective–Who Nose?

February 11, 2010
Zinc Cold Remedies: Are They Safe and Effective–Who Nose?

Amanda Benkoff

Faculty peer reviewed

Each year doctors are presented with the dilemma of the common cold. Adults in the U.S. experience an average of 3 colds per year, and children up to 8-10, resulting in over 500 million colds annually.(1) Patients often visit the doctor with cold symptoms requesting antibiotics. Since the etiology of the common cold is viral, antibiotic therapy is ineffective and inappropriate, and only contributes to bacterial antibiotic resistance. More than 200 viruses can cause the common cold, including rhinoviruses, coronaviruses, …

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Oldies but Goodies: How should you approach a low titer +RPR?

February 5, 2010
Oldies but Goodies: How should you approach a low titer +RPR?

Please enjoy a post from the Clinical Correlations Archives, first posted November 28, 2006…

45 year old male with a history of Hepatitis B ( Hep B Surf Ag + but Hep B E Ab+ and E Ag – and DNA viral load was not sent) and syphilis treated in the past. He has RPRs in the past that were 1:1 for years and then negative x 2 a year apart, the last being over two years ago. He had labs drawn last week and …

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Dix-Hallpike Positive, No Red Flags, Now What?

January 23, 2010
Dix-Hallpike Positive, No Red Flags, Now What?

The Proper Diagnosis and Treatment of Benign Paroxysmal Positional Vertigo

Carly Oboudiyat

Faculty peer reviewed

You finally have the “dizzy” patient whose eyes actually beat torsionally upwards when you do that silly maneuver you have done countless times to no avail. Hallelujah, you think, a positive Dix-Hallpike sign, reassuring you that you have a case of benign paroxysmal positional vertigo (BPPV). But now what? Do you try that other acrobatic maneuver to reposition the canaliths in the posterior canal, or should you give meclizine?

Benign …

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Chief of Service Rounds: Should You Always Stop Anticoagulating a Bleeding Patient?

January 20, 2010
Chief of Service Rounds: Should You Always Stop Anticoagulating a Bleeding Patient?

Chief-of-service rounds is a new feature of Clinical Correlations.  Here we summarize Bellevue Hospital’s Chief of Service Rounds moderated by the Chief of Medicine, Nate Link, MD.  This multidisciplinary bimonthly conference focuses on a case that presents a diagnostic or treatment challenge.  A clinical question is posed at the end of the case and then answered using the principles of evidence based medicine.

Daria Crittenden , MD

Moderator: Nate Link, MD Associate Professor of Medicine, . GI consultant:  Gerry Villanueva, MD Clinical Assistant Professor of …

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How Do You Advise the Balding Patient?

January 13, 2010
How Do You Advise the Balding Patient?

Sagar Mungekar

Faculty Peer Reviewed

The incidence of male pattern hair loss can reach almost 100% in some ethnic groups.1, 2 While treatment of the condition is usually deferred to dermatologists, it is often the primary care physician (PCP) who is first approached for advice. Several medical and surgical treatments exist for male pattern hair loss. Herbal supplements and products on infomercials make cursory non-FDA-approved claims of hair growth. Minoxidil, once developed for hypertension, is available over the counter as a scalp treatment. Finasteride and …

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Some gleanings from the meeting of the Infectious Diseases Society of America (IDSA) in Philadelphia, October 29-November 1. 2009

January 6, 2010
Some gleanings from the meeting of the Infectious Diseases Society of America (IDSA) in Philadelphia, October 29-November 1. 2009

Neal H. Steigbigel, M.D.

The recent IDSA meeting reviewed many important and interesting findings.  Topics spanned a wide array of subjects, many of which are of importance and interest to all physicians.  These subjects included:

HIV/AID- increasing support for starting HAART earlier Influenza-details regarding pathogenesis, epidemiology, clinical presentation and treatment for the H1N1 2009 Influenza pandemic infections Updates regarding  pyogenic bacterial meningitis and Group A streptococcus necrotizing fasciitis Management information regarding the all too common hospital-associated multiple drug resistant gram-negative bacillary infections (especially, P. aeruginosa…

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Tailoring Colon Cancer Screening

December 19, 2009
Tailoring Colon Cancer Screening

Guidelines for Colorectal Cancer Screening and the Recent Evidence Behind Them

 Nazia Hasan, MD MPH

Faculty peer reviewed

For most residents, screening for colorectal cancer (CRC) may seem as established as that for breast and cervical cancer. In reality, the use of CRC screening has only recently approached that of screening for those other malignancies. We have seen recently changes to the CRC screening guidelines last published by The American College of Gastroenterology in 2000. The updated screening guidelines for colorectal cancer became available in …

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Meeting Perspectives: American Heart Association Scientific Sessions 2009

December 16, 2009
Meeting Perspectives: American Heart Association Scientific Sessions 2009

Steven Sedlis, MD

 

The annual scientific session of the American Heart Association (AHA) was held in Orlando on November 14-18 2009. It felt like a ghost town. I ran into Ira Schulman, my medicine resident at Bellevue when I was a third year medical student; we looked at one another and simultaneously blurted out “where is everybody?” Well Ira remains my role model and hero and it goes to show that although attendance at major medical meetings may wax and wane, the impact of a …

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Tailoring Colon Cancer Screening

December 11, 2009
Tailoring Colon Cancer Screening

Guidelines for Colorectal Cancer Screening and the Recent Evidence Behind Them

 Nazia Hasan, MD MPH

Faculty peer reviewed

For most residents, screening for colorectal cancer (CRC) may seem as established as that for breast and cervical cancer. In reality, the use of CRC screening has only recently approached that of screening for those other malignancies. We have seen recently changes to the CRC screening guidelines last published by The American College of Gastroenterology in 2000. The updated screening guidelines for colorectal cancer became available in …

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Prostate Cancer Screening: Where Do We Stand Now?

December 9, 2009
Prostate Cancer Screening: Where Do We Stand Now?

Annery Garcia

Prostate cancer is the second most common cancer in western men and the second leading cause of cancer-related deaths in men in the U.S.1 In 2007 approximately 218,890 men were diagnosed with prostate cancer, and it is expected that one out of six men will receive the diagnosis in their lifetime.2 Although considered to be a slow-growing tumor, the American Cancer Society estimated that in 2008 186,330 new cases of prostate cancer would be diagnosed, and 26,000 men will die from prostate cancer.3 …

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