Systems

Should My Patient with a Solid Tumor be Anticoagulated in the Absence of Venous Thromboembolism?

September 8, 2011
Should My Patient with a Solid Tumor be Anticoagulated in the Absence of Venous Thromboembolism?

By David Altszuler, Class of 2012

Faculty Peer Reviewed

An empiric association between occult malignancy and thrombophlebitis has been recognized since Trousseau first reported the syndrome in 1865.  The mechanism by which cancer predisposes to thrombophilia has not been fully elucidated; however, it is now clear that this is a symbiotic relationship.  The second leading cause of death in hospitalized cancer patients (and a leading cause of death in ambulatory cancer patients) is venous thromboembolism.  There are algorithms to identify cancer patients at high risk …

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Should you Treat a COPD Exacerbation with Antibiotics?

September 3, 2011
Should you Treat a COPD Exacerbation with Antibiotics?

By: Aviva Regev

Mr. S is a 68-year old man with longstanding COPD and a 40-pack-year smoking history.  He presents to clinic with three days of increasing shortness of breath, and complains that he has been coughing up “more junk” than usual.  As I watch him spit a wad of chartreuse sputum into his tissue, I reach for the prescription pad and tell him he’ll need a week of antibiotics.  He wants to know why he can’t just go up on his inhaled medications instead …

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You Don’t Look Diabetic:Diabetes in Non-Obese South Asians–Is There a Molecular or Genetic Basis for Increased Insulin Resistance?

August 24, 2011
You Don’t Look Diabetic:Diabetes in Non-Obese South Asians–Is There a Molecular or Genetic Basis for Increased Insulin Resistance?

By Adelaide Hearst, MD

Faculty Peer Reviewed

Diabetes is a nationwide epidemic in the United States, affecting 23.6 million people, over 7% of the population. But all diabetics may not be created equal. In the US, Asians are 1.6 times more likely that non-Hispanic whites to have diabetes, even after adjusting for body-mass index (BMI), age, and sex. Asians have high rates of type 2 diabetes and coronary artery disease, and increased risk for metabolic syndrome compared to non-Hispanic whites.  Spend a day at Bellevue, …

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Subclinical Hypothyroidism: To Screen or Not to Screen?

August 17, 2011
Subclinical Hypothyroidism: To Screen or Not to Screen?

By Addie Peretz, MD

Faculty Peer Reviewed

Despite the ease of screening for hypothyroidism with hormone assays and the availability of thyroxine replacement therapy, no recommendations regarding routine screening for hypothyroidism in adults are universally accepted. The American Academy of Family Physicians and the American Association of Clinical Endocrinologists recommend periodic assessment of thyroid function in older women.  The American Thyroid Association advocates for more frequent earlier screening, recommending measurement of thyroid stimulating hormone (TSH) beginning at age 35 and every 5 years …

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The Treatment For Clostridium Difficile? Transplant!

July 29, 2011
The Treatment For Clostridium Difficile? Transplant!

By Andrea Mignatti , MD

Faculty Peer Reviewed

Among all the new medical therapies, this one will probably not be the most elegant or refined that you will read about. But it just may be one of the most unconventional ones you will come across.

From our experiences working on busy hospital wards, we know that Clostridium difficile colitis is an extremely serious infection that is becoming more prevalent due to the development of new hyper-virulent strains (toxinotype III BI/NAP1/027). It has been …

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Mental Health Considerations for Gay and Lesbian Patients

July 27, 2011
Mental Health Considerations for Gay and Lesbian Patients

By Benjamin Cox

Faculty Peer Reviewed

Gay men and lesbian women are members of a stigmatized minority group and evidence suggests that they may disproportionately utilize mental health services. This increased use of mental health services may be related to the concept of minority stress: that stigma, prejudice, discrimination, and violence create a hostile and stressful social environment that can contribute to mental health problems. Examples of external stressors that pose threats to mental health in gay and lesbian patients include verbal and physical violence, …

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Low Dose Vitamin K Supplementation and Anticoagulation Control

July 21, 2011
Low Dose Vitamin K Supplementation and Anticoagulation Control

By Joanna Becker

Faculty Peer Reviewed

Patients who are placed on long-term warfarin (Coumadin) therapy are sent home with a lengthy list of restrictions to minimize variations in warfarin efficacy. The agents that can alter warfarin levels can be divided into 2 categories: (1) those that interact with cytochrome P450, which metabolizes warfarin and (2) those that alter phytonadione (vitamin K) levels.  The majority of inter- and intra-individual warfarin dose variability is attributable to the agents in category 1 above, which include everything from antibiotics, …

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Systemic Lupus Erythematosus and Premature Coronary Artery Disease

July 14, 2011
Systemic Lupus Erythematosus and Premature Coronary Artery Disease

Please enjoy this post from the Clinical Correlations archives first posted June 17, 2009

Ishmeal  Bradley MD

Faculty Peer Reviewed

Ms. W is a 35 yo woman with a history of systemic lupus erythematosus diagnosed 10 years ago. Her only medications are hydroxychloroquine and prednisone for occasional disease flares. She is otherwise healthy. She has no known personal or family history of cardiac disease or stroke, but does smoke ½ pack of cigarettes per day. Currently, she denies any chest pain, shortness of breath, urinary …

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