Please enjoy this post from the archives, dated May 27, 2011
By Anthony Tolisano
Faculty Peer Reviewed
The sunlight forces its way into your eyes, stabbing at your cortex. Suddenly, a wave of nausea and diarrhea grips your stomach, threatening to evacuate its contents. You rush to the bathroom, tripping over the clothes that speckle your apartment. Your heart pounds inside your chest and your hands shake ever so subtly. Your mind is in a fog and the details of last night’s party are…
By Robert Mocharla, MD
Peer Reviewed
No. Sorry. Despite such reasonable excuses as – “I forgot my iPod”, “It’s pouring rain”, or “Game of Thrones is on” — an exhaustive literature search will not reveal a shred of evidence that you or most of your patients should skip daily exercise. However, a subset of your patients should indeed be skipping workouts regularly. The group referred to consists of endurance athletes (e.g. cyclists, swimmers, long-distance runners, competitive athletes). While this may not describe the majority of…
By Shivani K Patel, MD
Peer reviewed
A 61-year old male with chronic epigastric discomfort presented to the emergency room with severe abdominal pain radiating to his back. He had similarly presented and been hospitalized two weeks prior to this admission at an outside hospital, where he underwent endoscopic retrograde cholangiopancreatography (ERCP) with placement of a pancreatic duct stent. His pain initially improved, but quickly recurred after discharge. Admission labs showed only mild leukocytosis with slight elevation in serum lipase. Computed tomography (CT) of the…
Please enjoy this post from the archives dated May 25, 2011
By Santosh Vardhana
Faculty Peer Reviewed
Please review Part 1 of this article here.
Mr. M is a 63-year old man with a history of coronary artery disease and systolic congestive heart failure (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to the Adult Primary Care Center complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance. His vital signs on presentation are T 98.0˚F, P…
By Jung-Eun Ha
Peer Reviewed
Over the last few years major changes have occurred in the diagnosis and treatment of hepatitis C. In 2011 the U.S. Food and Drug Administration (FDA) approved a rapid finger stick antibody test for hepatitis C virus (HCV) infection . The FDA also approved the protease inhibitors telapravir (Incivek; Vertex Pharmaceuticals, Cambridge, Massachusetts; Johnson & Johnson, New Brunswick, New Jersey) and boceprevir (Victrelis; Merck, Whitehouse Station, New Jersey), for the treatment of genotype 1 hepatitis C . In August…
Zachary Elkin
Faculty Peer Reviewed
There are more than a million cases of herpes zoster (HZ) in the US annually . The incidence of HZ, or shingles, has been rising in the US since the 1990s . One third of all people in the US will get HZ, with the highest incidence in people aged 50 to 79 . As a result of the Shingles Prevention Study (SPS), the U.S. Food and Drug Administration (FDA) and Advisory Committee on Immunization Practices (ACIP) approved the Zostavax…
Please enjoy this post from the archives dated May 18, 2011
By Santosh Vardhana
Faculty Peer Reviewed
Mr. M is a 63-year-old man with a history of coronary artery disease and systolic CHF (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to Primary Care Clinic complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance. His vital signs on presentation are T 98.0º F, BP 122/76, HR 84 bpm. What are his therapeutic options?
A Race Against…
By Benjamin G. Wu
Peer Reviewed
The news of a large $675 million dollar settlement on concussions has headlined on both the sports news channels and in popular media during this 2013 National Football League (N.F.L.) season . Heralded as a victory mainly for the N.F.L., the settlement not only allows the league to avoid larger amounts in potential liability payments but also the public scrutiny of a discovery phase if a case were to move forward . In the wake of this settlement…
By Elizabeth Hammer, MD
Faculty Peer Reviewed
Renovascular hypertension, often caused by renal artery stenosis (RAS) due to atherosclerosis or fibromuscular dysplasia, is the most common potentially correctable cause of secondary hypertension. Although only approximately one percent of patients with hypertension have atherosclerotic renovascular disease (ARVD), the prevalence increases to 30-40% in patients with CAD, CHF, and PVD. Screening studies of asymptomatic populations in the United States demonstrate a disease prevalence of 7%, with an annual incidence of 0.5% per year in analyses of…
Please enjoy this post from the archives dated December 8, 2010
By Jon-Emile S Kenny
Faculty Peer Reviewed
A 65-year-old female with locally advanced rectal cancer is admitted to the ICU, hypotensive and febrile. Her PICC line is removed and blood cultures drawn. Fourty-eight hours later all cultures return ESBL Klebsiella with susceptibility only to polymyxin.
I sat on the venerable call-room couch staring mindlessly at the cluttered, nauseating walls repeating the word ‘polymyxin’ like an endless antimicrobial mantra. What strange dosing it has, and…
By Sherif Shoucri, MD
Yesterday, the American College of Cardiology and American Heart Association released new groundbreaking guidelines on the treatment of blood cholesterol. These recommendations, which officially drop LDL target levels for patients on statin therapy, will fundamentally alter the way most primary care physicians and cardiologists treat hyperlipidemia. After reviewing the available data on statins, the authors concluded that there was no evidence to support an LDL target of either 70 or 100. Rather, patients should be placed on either moderate-intensity (lowers…
By Gregory Katz, MD
Faculty Peer Reviewed
Everyday in clinic, we tell our patients to choose foods low in saturated fat. Because these foods raise plasma cholesterol, the thinking goes, they cause heart disease. Today, every major medical organization – from the American Heart Association to the Harvard School of Public Health to the USDA – recommends a diet low in saturated fat to prevent and treat heart disease. The fat-cholesterol-heart disease connection is so thoroughly integrated into both medicine and popular culture…
