Systems

How to interpret troponins in renal disease?

October 21, 2009

Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities. Troponin I levels drawn at 0, 6, and 12 hours after initial presentation are …

It’s Lyme Season: How Should You Manage the Tick-bitten Patient?

October 14, 2009

Joshua Allen-Dicker

Faculty peer reviewed

A healthy 42-year old patient presents to your office after a day of hiking with his family in Upstate New York. This morning in the shower he found a “big black tick” on his right leg. He is currently asymptomatic and wants to know what his risk of Lyme disease is.

For New York City physicians, the end of summer and beginning of fall herald a spike in cases of Lyme Disease. Each year in the United States, over 19,000 …

Medicine by the Numbers

October 9, 2009

Chris Tully MD

Faculty peer reviewed

What is the number of patients needed to prophylax to prevent an episode of venous thromboembolism in a hospitalized medical patient?

The use of prophylactic anticoagulation for venous thromboembolism (VTE) is considered standard of care in the inpatient medical setting in order to prevent deep venous thrombosis (DVT) and fatal and nonfatal pulmonary embolism (PE). While a majority of the knowledge stems of post-surgical patients, there has been an increasing volume of research emphasizing and illustrating the benefit in …

What is Wellens’ Syndrome?

October 7, 2009

Erin Ducharme MD

Faculty peer reviewed

Wellens’ syndrome refers to a pattern of ECG signs occurring during chest-pain free periods in patients with unstable angina, heralding critical, proximal left anterior descending artery (LAD) stenosis . The eponym honors Dr. Hein J.J. Wellens who first described this ECG phenomenon in 1982. Wellens and colleagues identified a subgroup of patients with unstable angina who demonstrated a pattern of inverted precordial T-waves which strongly correlated with early large anterior myocardial infarction (MI) and a poor prognosis . In …

Sleep, Memory, and Medical Students

October 2, 2009

Megan Mulligan

Faculty peer reviewed by Dr. David Rapoport

The role of sleep in memory formation is an intriguing topic that has garnered widespread interest among researchers in recent years. The subject has seen a doubling in the number of publications every decade, yet the mechanism by which memories are formed remains elusive. There is little debate that sleep is important for memory, which begs the question: What does the role of sleep in memory imply for the infamously sleep-deprived medical trainee? This brief review …

When Should You Obtain a Renal Biopsy? Indications, Risks, Follow-up and Value

September 30, 2009

Frederick Gandolfo MD

Faculty peer reviewed

At a recent conference on renal transplantation, the importance of early renal biopsy for the diagnosis of acute rejection was emphasized. As busy practitioners of general internal medicine, we rarely have the opportunity to learn the details of a subspecialty procedure such as renal biopsy. However, knowing the details of these procedures is important in providing care for these specific patients. What are the indications, risks, and follow-up care required for the renal biopsy patient? In the native kidney …

The Forgotten Influenza of 1918: When a Strong Immune System Becomes a Weakness

September 23, 2009

Emily Breidbart

Faculty peer reviewed

As the threat of the swine flu surfaced in early 2009, doctors and the media referenced the influenza of 1918. Also known as the Spanish flu, this pandemic spread to nearly every part of the world and killed more humans than any other disease in a similar period in known history. According to an epidemiological study done in 2002, this unusually virulent strain of influenza A, subtype H1N1, is said to have killed approximately 50 million people worldwide. At least …

Diseases 2.0: Rheumatoid Arthritis

September 18, 2009

Diseases 2.0 – Bringing you the latest updates on disease pathophysiology and treatment

Rachana Jani MD

Faculty peer reviewed

Rheumatoid arthritis is a well-recognized but enigmatic disease afflicting the lives of thousands of individuals each year. The mysterious nature of RA has become increasingly uncovered as research has mapped various pathways of cytokine production and interleukin activation. However, in practice, we use clinical criteria to diagnose RA and evaluate the effectiveness of these new therapies.Though soon to be updated, the American College of Rheumatology (ACR) …

The Utility of GlycoMark ™: 1,5 Anhydroglucitol as a Marker for Glycemic Control

September 16, 2009

David R. Friedmann MD

Faculty Peer Reviewed

Hemoglobin A1 (Hb A1c) is the standard method for monitoring diabetic patients’ long-term glycemic control by indicating average blood glucose levels over a period of two months, or half of the average life span of red blood cells. A new biochemical marker GlycoMarkTM is a test that measures serum levels of 1,5-anhydroglucitol (1,5-AG), a monosaccharide derived from ingestion of food, slightly different in structure from glucose. The test has been available in Japan since the early 1990s but …

PrimeCuts: This Week in the Journals

September 14, 2009

Michael Ford MD

Faculty Peer Reviewed

Last spring, The New York Times published a series of articles that examined the status of “the War on Cancer,” initiated some 40 years ago by then president Richard Nixon. The halting pace of this war was made more poignant with the recent death of Senator Edward M. Kennedy, who had championed the effort from its inception. Certainly, much has been learned about cancer in the intervening decades, but while other illnesses saw dramatic improvement in outcome (since 1950, …

Wheal and Flare: Chronic Urticaria Revisited

September 9, 2009

Erin Ducharme MD

Faculty peer reviewed by Rardi Feigenbaum MD

Urticaria is a common cutaneous disorder characterized by transient edematous plaques resulting from acute dermal edema and surrounding erythema. Roughly 20% of the general population will manifest urticaria at some point in their lives, qualifying it as a condition caregivers should be able to recognize and treat. When the unsightly wheal and flare reaction combined with periods of intense pruritis persists for greater than six weeks without an identifiable causative agent, the condition is referred …

Myths and Realities: Ginger Ale in Treating Nausea and Vomiting

September 3, 2009

Chau Che MD

Faculty peer reviewed

Despite the numerous medications available for the treatment of nausea and vomiting, some patients and doctors insist that ginger ale will alleviate gastrointestinal symptoms. As early as the first century AD, the Greek physician Dioscorides praised ginger root because it “gently stimulates the gut and is profitable for the stomach” (4). During the 16th century, the physician Lonicerus similarly wrote, “Ginger does good for a bad stomach” (4). Ginger has long medicinal roots in both India and China and …

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Systems

How to interpret troponins in renal disease?

It’s Lyme Season: How Should You Manage the Tick-bitten Patient?

Medicine by the Numbers

What is Wellens’ Syndrome?

Sleep, Memory, and Medical Students

When Should You Obtain a Renal Biopsy? Indications, Risks, Follow-up and Value

The Forgotten Influenza of 1918: When a Strong Immune System Becomes a Weakness

Diseases 2.0: Rheumatoid Arthritis

The Utility of GlycoMark ™: 1,5 Anhydroglucitol as a Marker for Glycemic Control

PrimeCuts: This Week in the Journals

Wheal and Flare: Chronic Urticaria Revisited

Myths and Realities: Ginger Ale in Treating Nausea and Vomiting

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