Systems

Approach to a Patient with ‘Treatment Refractory’ Depression in The Medical Setting: Part 1

May 15, 2008
Approach to a Patient with ‘Treatment Refractory’ Depression in The Medical Setting: Part 1

Commentary by Brian Bronson, MD, Chief of Psychosomatic Medicine, VA New York Harbor, New York Campus 

Summary: Symptoms of depression in the medical setting may not respond to usual pharmacologic antidepressant treatment for a number of reasons. These may include an incorrect psychiatric diagnosis; failure to consider underlying medical causes of the symptoms; or insufficient antidepressant medication trial due to poor patient adherence, insufficient dose or length of trial. There is no consensus as to the definition of ‘treatment refractory’ depression. However, when…

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Meeting Perspectives: American College of Cardiology, Part 2

May 14, 2008
Meeting Perspectives: American College of Cardiology, Part 2

Commentary by Rob Donnino MD, NYU Division of Cardiology

The annual meeting of the ACC was held last month in Chicago. A good number of NYU faculty and fellows either presented at or attended the meetings. The cardiology fellows exhibited an impressive balance between exploring the Chicago nightlife and diligent attendance at the meetings. Several of the cardiology fellows presented some of the highlights of the ACC meeting at a recent journal club conference for the Cardiology Division. They are being summarized in a…

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Its okay to smoke…we’ll screen you

May 9, 2008
Its okay to smoke…we’ll screen you

Commentary by Shrujal Baxi MD, NYU Chief Resident

One of the first things you learn about critically analyzing a medical journal piece is to go to the end and see who sponsored the study. Corporate financing is known to have subtle effects on research which can lead to an unconscious bias. Disclosure of funding is paramount for a researcher in order to remain above reproach.

In a recent New York Times article, the impact of such relationships is investigated. In 2006, Dr.…

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Meeting Perspectives: American College of Cardiology, Part 1

May 8, 2008
Meeting Perspectives: American College of Cardiology, Part 1

Commentary by Rob Donnino MD, NYU Division of Cardiology

The annual meeting of the ACC was held last month in Chicago. A good number of NYU faculty and fellows either presented at or attended the meetings. The cardiology fellows exhibited an impressive balance between exploring the Chicago nightlife and diligent attendance at the meetings. Several of the cardiology fellows presented some of the highlights of the ACC meeting at a recent journal club conference for the Cardiology Division. They will be summarized in…

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Corticosteroids in Sepsis Now Less Stimulating

April 30, 2008
Corticosteroids in Sepsis Now Less Stimulating

Commentary by Joe Philip MD, PGY-2

CORTICUS was the long-awaited trial addressing the use of corticosteroids in sepsis that was published in the NEJM this past January. Months prior to the leading auther Charles Sprung publishing it, the Tisch and Bellevue intensive care units halted corticotropin stimulation testing. Corticosteroids have warranted much publicity since CORTICUS came out—and rightly so as practice across the country has changed because of it. The Survinig Sepsis Campaign has now downgraded the recommendation on the use of…

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Future Medicine: The Search for a New Anticoagulant

April 16, 2008
Future Medicine: The Search for a New Anticoagulant

Future Medicine is a new section of Clinical Correlations devoted to hot areas of research and development in various fields of medicine. In tihis series, we will highlight treatments in their infancy, from basic research opening up new targets for treatment, to following small molecules throughout their clinical investigation. We will also bring you the latest on technology and devices, as well as perspectives on drug discovery from a business point of view. Watch out – the future is just around the corner!

Commentary by Aaron Lord

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Grand Rounds: “ANCA-Associated Vasculitis: Update for Internists”

April 9, 2008
Grand Rounds: “ANCA-Associated Vasculitis: Update for Internists”

Commentary by Aditya Matoo MD, PGY-2

This week’s medicine grand rounds was given by Dr. Peter Merkel, M.D., M.P.H., Associate Professor of Medicine, Section of Rheumatology and Clinical Epidemiology Unit, Boston University School of Medicine and Director, Vasculitis Center, Boston University School of Medicine.

Dr. Merkel prefaced his discussion by highlighting the evolving movement among academics to change the name of Wegener’s Granulomatosis to an alternative given recent discoveries that Friedrich Wegener had willingly volunteered and actively participated in the Nazi movement…

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The Rational Clinical Examination: Does This Patient with Diabetes Have Osteomyelitis of the Lower Extremity?

March 28, 2008
The Rational Clinical Examination: Does This Patient with Diabetes Have Osteomyelitis of the Lower Extremity?

Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

The most recent installment in JAMA’s Rational Clinical Exam Series seeks to determine the accuracy of the history, physical exam, radiology and laboratory in making the diagnosis of osteomyelitis in diabetics. This is relevant given its frequency of occurrence and its cost and since the gold standard for diagnosis, namely a bone biopsy and culture, is less than optimal for a variety of reasons.

Less than 10% of the…

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Noninvasive Cardiac Imaging: Coronary CT Angiography

March 26, 2008
Noninvasive Cardiac Imaging: Coronary CT Angiography

Commentary by Matt LaBarbera MD, PGY-3 and Rob Donnino, MD Instructor of Medicine, Division of Cardiology

Coronary CT angiography (CCTA) is a noninvasive imaging modality which can be used to evaluate the anatomy of the coronary arteries. Unlike coronary artery calcium scoring, which utilizes noncontrast CT to assess atherosclerotic disease burden, CCTA allows direct visualization of the coronary artery wall and lumen with the administration of intravenous contrast. The degree of coronary luminal stenosis can be reliably estimated, as can the presence or absence…

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Class Act: Are beta-blockers really contraindicated for patients with a diagnosis of reactive airway disease?

March 21, 2008
Class Act: Are beta-blockers really contraindicated for patients with a diagnosis of reactive airway disease?

Commentary by Katherine Khvilivitzky, NYU Medical Student

Class act is a feature of Clinical Correlations written by NYU 3rd and 4th year medical students. These posts focus on evidenced based answers to clinical questions related to patients seen by our students in the clinics or on the wards. Prior to publication, each commentary is thoroughly reviewed for content by a faculty member.

In the past, reactive airway disease was considered to be a contraindication to administration of all beta-blockers including ophthalmic preparations.…

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A Brief Glance at the Relationship between Varicocele and Infertility

March 19, 2008
A Brief Glance at the Relationship between Varicocele and Infertility

Commentary by Melissa Freeman MD, PGY-2

A 30 year-old male resident presents to his primary care physician for a routine physical examination. A small, nontender left-sided scrotal mass is felt. The patient states that this asymptomatic mass has been present for one year and was evaluated by a prior physician who felt that further work-up was unnecessary. He is sent for a testicular ultrasound which reveals a grade II varicocele. His testosterone level was low and he later had a semen analysis which was abnormal.…

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Class Act: Is there clinical evidence for use of probiotics in the treatment of IBS?

March 12, 2008
Class Act: Is there clinical evidence for use of probiotics in the treatment of IBS?

Class act is a feature of Clinical Correlations written by NYU 3rd and 4th year medical students. These posts focus on evidenced based answers to clinical questions related to patients seen by our students in the clinics or on the wards. Prior to publication, each commentary is thoroughly reviewed for content by a faculty member.

Commentary by Alexander Jow, MSIII

Irritable bowel syndrome (IBS) is a poorly understood disorder, commonly encountered in clinical practice; IBS accounts for more than one-third of…

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