Systems

From The Archives: Creatine Kinase: How Much is Too Much?

October 24, 2013

Please enjoy this post from the archives dated November 3, 2010

By Jon-Emile Kenny, MD

Faculty Peer Reviewed

A 37-year-old man, with no past medical history and taking finasteride for male pattern baldness, is admitted to Medicine with profound lower extremity weakness after a weekend of performing multiple quadriceps exercises. His measured creatine phosphokinase (CPK) is over 35,000 IU/liter. I wonder to myself, what is the risk to his kidneys and can I mitigate the damage?

Rhabdomyolysis means destruction of striated muscle. Physical manifestations range from…

Generation A(dderall)

October 17, 2013

By Michael Weinstock

Faculty Peer Reviewed

Neurocognitive enhancement with mixed amphetamine salts (MAS) has grown commonplace in academic settings. Over 34% of college students at a large public university reported using MAS as a study aid at least once in their life . Other researchers have found prevalence rates ranging from 13.7% lifetime use at another large public university to 55% lifetime use among fraternity members at a large public university . Abuse and misuse of stimulants does not stop after four years of college,…

Is there a Non-Invasive Method to Diagnose Cirrhosis/Hepatic Fibrosis?

October 11, 2013

By Becky Naoulou, MD

Faculty Peer Reviewed

Clinical Question:

You are asked to see a 45 year-old male with a medical history significant for untreated hepatitis C (HCV RNA 5,000,000 copies/mL, genotype 1a). He presents complaining of worsening fatigue and weakness for several months. Labs are remarkable for mildly elevated transaminases, low albumin, and an elevated INR. The patient is very worried because he has heard that hepatitis C can cause liver cancer and asks you if there is a non-invasive screening test for liver…

Barriers to Translating Evidence into Clinical Care: the Zoster Vaccine

October 10, 2013

By 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…

Decoding the APOL1 Kidney

September 25, 2013

By Areeba Sadiq

Faculty Peer Reviewed

African American patients have a higher risk of developing end-stage renal disease (ESRD) than their Caucasian counterparts . If over the age of 70, that risk is 3 times higher. If between the ages of 60-69, the risk is 8 times higher. And, if between 30 and 39, African American patients are an astounding 11 times more likely to develop ESRD . Why are African Americans more likely to develop ESRD? What is different about the African American kidney?…

The DLO: Does FFP Correct INR?

September 20, 2013

By Nicole A Lamparello, MD

Faculty Peer Reviewed

Page from the hematology laboratory: critical lab value; INR 1.9. Liver biopsy scheduled for tomorrow. What is a knowledgeable physician practicing evidence-based medicine to do?

Fresh frozen plasma (FFP) is the liquid, acellular component of blood. FFP contains water, electrolytes, and the majority of the coagulation proteins . It is frequently transfused to patients with an elevated prothrombin time (PT), a measure of the activity of the common coagulation pathway (involving factors X, V, prothrombin and fibrinogen)…

Diagnostic Dilemma-Poststreptococcal Reactive Arthritis in a Pregnant Woman

September 18, 2013

By Bryan Stierman and Todd Cutler, MD

Faculty Peer Reviewed

Case Presentation

A 35-year-old Hispanic woman presented to the emergency room with severe joint pain and swelling for one week.

The patient had a history of hypothyroidism and hepatitis C which was treated with interferon therapy two years prior. She was recently discovered to be pregnant and, at the time of presentation, was in her tenth week of pregnancy. Three weeks prior to admission she developed a sore throat. She saw an outside care provider…

Does Running Cause Knee Osteoarthritis?

September 14, 2013

By Karin Katz, MD

Faculty Peer Reviewed

Post-summer is here. Despite the heat and what feels like 100% humidity, the East River Path is packed with runners. No amount of car fumes pouring onto the path could stop those in training. Others are circling the 6-mile-loop around Central Park. Or, if you are bored of running the typical routes, for a few Saturdays, Park Avenue will be shut down for automobile traffic. New Yorkers love to run (well, some do). And while unforeseen circumstances…

An Evaluation of Basic Running Techniques: A Guide for Health Practitioners and the Novice Runner

September 11, 2013

By Austin Peters, MD

Faculty Peer Reviewed

Introduction

Running injuries are common, afflicting greater than two-thirds of frequent runners each year. Despite the abundance of available resources, there are no clear guidelines to extend to patients on the subject of proper running technique in order to avoid repeat or worsening injuries. Though specialized intervention may be in order for more severe cases, novice runners and those who have not been active in the sport for some time may benefit from basic instructional advice. The purpose…

Confocal Microscopy To Noninvasively Detect Skin Cancer: An Emerging Technology To Avoid Unnecessary Skin Biopsy

September 6, 2013

By Brian Park

Faculty Peer Reviewed

Skin cancer is the most common type of cancer worldwide. In the United States, the incidence is rising, with over two million people diagnosed each year . More cases of skin cancer are diagnosed each year than breast, prostate, lung, and colon cancer combined. The lifetime risk of developing skin cancer is estimated to be 20% . Although nonmelanoma skin cancer is rarely fatal and associated with a very low mortality rate, melanoma can be highly fatal. Approximately 76,000…

Down-And-Out With Diabetes: Caring For The Homeless Diabetic Patient

August 23, 2013

By Sara Gallant

Faculty Peer Reviewed

Each year in the US, an estimated 2.3–3.5 million individuals are homeless . Homelessness has a complicated association with poor health. People at risk for losing their home tend to have heavier disease burdens. In New York City, 6.3% of a subset of newly homeless people had diabetes mellitus, compared to 1.9% of the same age group in the general US population . In return, homelessness poses unique challenges to receiving and adhering to treatment for diabetes. The rewards…

From The Archives: Does Heyde Syndrome Exist?

August 8, 2013

Please enjoy this post from the Archives dated September 29, 2010

By Lara Dunn, MD

Faculty Peer Reviewed

In 1958, EC Heyde published 10 cases of aortic stenosis (AS) and arteriovenous malformations (AVMs) of the gastrointestinal tract in the New England Journal of Medicine . Thus, the association between aortic stenosis and intestinal angiodysplasia became known as Heyde Syndrome. Yet the existence of this syndrome has been controversial.

Contrasting conclusions have been obtained by studies conducted to evaluate this association. In a prospective study, Bhutani…

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Clinical Correlations

Systems

From The Archives: Creatine Kinase: How Much is Too Much?

Generation A(dderall)

Is there a Non-Invasive Method to Diagnose Cirrhosis/Hepatic Fibrosis?

Barriers to Translating Evidence into Clinical Care: the Zoster Vaccine

Decoding the APOL1 Kidney

The DLO: Does FFP Correct INR?

Diagnostic Dilemma-Poststreptococcal Reactive Arthritis in a Pregnant Woman

Does Running Cause Knee Osteoarthritis?

An Evaluation of Basic Running Techniques: A Guide for Health Practitioners and the Novice Runner

Confocal Microscopy To Noninvasively Detect Skin Cancer: An Emerging Technology To Avoid Unnecessary Skin Biopsy

Down-And-Out With Diabetes: Caring For The Homeless Diabetic Patient

From The Archives: Does Heyde Syndrome Exist?

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