Systems

The Effect of Bariatric Surgery on Incretin Hormones and Glucose Homeostasis

April 4, 2013
The Effect of Bariatric Surgery on Incretin Hormones and Glucose Homeostasis

By Michael Crist

Faculty Peer Reviewed

Until recently, little thought was given to the important role played by the duodenum, jejunum, and ileum in glucose homeostasis. The involvement of the gut in glucose regulation is mediated by the enteroinsular axis, which refers to the neural and hormonal signaling pathways that connect the gastrointestinal (GI) tract with pancreatic beta cells. These pathways are largely responsible for the increase in insulin that occurs during the postprandial period. In 1964 McIntyre and colleagues first reported the phenomenon of …

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White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

March 20, 2013
White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

By Lauren Foster

Faculty Peer Reviewed

Hypertension is a pervasive chronic disease affecting approximately 65 million adults in the United States, and a significant cause of morbidity and mortality . Antihypertensives are widely prescribed due to their effectiveness in lowering blood pressure, thereby reducing the risk of cardiovascular events. However, the phenomenon of the “white coat effect” may be a complicating factor in the diagnosis and management of hypertensive patients. It is well established that a considerable number of people experience an elevation of their …

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Anal cancer screening – A case for screening anal paps

January 24, 2013
Anal cancer screening – A case for screening anal paps

By Nelson Sanchez, MD

Faculty Peer Reviewed

Case:

A 56 year-old homosexual male presents to your clinic to ask whether or not he should have an anal Pap smear. The patient is HIV positive, has been on HAART for five years, and has no history of opportunistic infections. He denies any anal pain, bleeding or masses.

While efforts to improve knowledge about colorectal cancer in various communities continues to grow, awareness of and misconceptions about anal cancer remain. Over the past couple of years there …

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Promising New Hepatitis C Medications Raise Hopes, Questions

January 17, 2013
Promising New Hepatitis C Medications Raise Hopes, Questions

By Carl M. Gay, MD

Faculty Peer Reviewed

A healthy 61-year old man with a history of chronic genotype 1b hepatitis C virus infection of unknown duration arrives for his semiannual appointment in the Hepatology Clinic. The patient has previously been offered treatment with pegylated interferon and ribavirin, which he has declined on the basis of potential side effects and poor reported efficacy. He states that he has read that new treatment options for hepatitis C have recently become available…

Hepatitis C virus (HCV), first …

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Mystery Quiz-The Answer

January 10, 2013
Mystery Quiz-The Answer

Elizabeth Mulaikal MD, Vivian Hayashi MD, Robert Smith MD

The answer to the mystery quiz is pulmonary Mycobacterium kansasii infection. The patient’s clinical presentation of fevers and night sweats suggested an infectious process or B symptoms due to lymphoma. The initial chest radiograph (image 1) demonstrated a left hilar mass which was noted to be larger on a subsequent chest radiograph (images 2 and 4)) 1 month later. This increase in size over a short duration again suggested an infectious etiology. Importantly and a key …

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Mystery Quiz

December 21, 2012
Mystery Quiz

Elizabeth Mulaikal MD, Vivian Hayashi MD, Robert Smith MD

The patient is a 55 year old African American male with a 60 pack year history of tobacco use and AIDS,who presented with 1 month of intermittent fevers and weight loss. His most recent CD4 count and viral load were 2/cmm and 50,623 copies/mL, respectively. Prior opportunistic infections included pneumocystis pneumonia and thrush. He was previously homeless, but currently resides in a Single Room Occupancy Housing. Upon presentation he complained of occasional night sweats, but no …

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Kidney Stones and Climate Change

October 10, 2012
Kidney Stones and Climate Change

By Jeffrey Shyu, MD

Faculty Peer Reviewed

Climate change has been linked to a variety of adverse effects on human health, effects that are expected to worsen in the coming decades . For example, a heat wave in August 2003 resulted in nearly 15000 deaths in France, and the anticipated increase in average world temperatures is expected to lead to longer and more frequent heat waves that will disproportionately affect our more vulnerable populations. Infectious disease outbreaks, particularly vector-borne ones such as malaria, are expected …

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Olympics and Medicine By The Numbers

October 7, 2012
Olympics and Medicine By The Numbers

By Tracey Liebman

Faculty Peer Reviewed

The summer games may be over, but we’re still entertained by the 2012 Olympics! Here are a few medicine-related fun facts about the London Games.

Demographics of Summer 2012 Olympics:

10,500 athletes, 70,000+ volunteers, 20,000 media and journalists, 10+ million spectators

Medical care:

26 million dollars provided by the National Health Service (NHS) to build the state-of-the-art medical building in the Athletes’ Village for the Olympics

500 people expected to use the medical clinic each day …

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Morgellons: Real Disease or Delusion Turned Internet Meme?

October 3, 2012
Morgellons: Real Disease or Delusion Turned Internet Meme?

By Robert Mazgaj

Faculty Peer Reviewed

Morgellons disease is an “unexplained dermopathy” characterized by fibers emerging from skin lesions, and associated with various cutaneous sensations. Inspired by a curious medical condition reported by a 17th century English physician, Morgellons was actually named in 2002 by Mary Leitao, a layperson, to describe the mysterious set of symptoms reportedly suffered by her then 2-year-old son. Leitao then launched the not-for-profit Morgellons Research Foundation (MRF) along with a (no longer active) website, www.morgellons.org. MRF successfully petitioned members of …

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How to Get Your Patient a Kidney

September 28, 2012
How to Get Your Patient a Kidney

By Ilina Datkhaeva

Faculty Peer Reviewed

We give hope to patients with advanced kidney disease that a transplant will save them from their Monday, Wednesday, Friday trips to the dialysis unit. But how certain are we that they even qualify to be a recipient? And if they do, are they going to live long enough to get their new lease on life?

Kidney donation has received its fair share of publicity recently, from the allocation of organs to illegal immigrants to Good Samaritans starting a …

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From The Archives – Myths and Realities: Heart and Wine

September 27, 2012
From The Archives – Myths and Realities: Heart and Wine

Please enjoy this post from the archives dated August 26, 2010

By Aditya Mattoo, MD

Faculty Peer Reviewed

Not too long ago, a patient came to my clinic and said (I’m paraphrasing of course), “I never cared for alcohol, doctor, so I haven’t had much to drink since my college days. Maybe champagne or wine on the rare special occasion, but I keep hearing about how wine is good for your heart, so I am thinking I should start drinking regularly.” For years I have …

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What Is Andropause? Is Testosterone Supplementation the Answer in Older Men?

September 20, 2012
What Is Andropause?  Is Testosterone Supplementation the Answer in Older Men?

By Kylie Birnbaum

Faculty Peer Reviewed

Women have long bemoaned menopause and its physiological, psychological, and sexual effects. Fortunately, hormone replacement therapy has provided relief for symptomatic women. Less attention is paid to men, who also experience declines in their sex hormones. Decreased testosterone may explain many symptoms experienced by elderly men, such as poor sexual function and libido, decreased bone mineral density, fatigue, and decreased muscle mass and strength. Should physicians treat elderly men with testosterone replacement therapy?

Late-onset hypogonadism, or “andropause,” is the …

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