Systems

Are Dentists Really Causing Infective Endocarditis?

August 29, 2012
Are Dentists Really Causing Infective Endocarditis?

By Jeffrey Krutoy, DDS

Faculty Peer Reviewed

Bacterial infective endocarditis is a potentially devastating disease, and while it may be an easy tradition to blame the dentist, recent research and new guidelines from the American Heart Association (AHA) indicate that it may not be so simple.

Infective endocarditis (IE), while relatively uncommon (with yearly incidence rates ranging from 2 to 6 cases per 100,000 people), results in high rates of morbidity and mortality even when treated. For this reason, physicians have emphasized the importance…

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Should We Measure Apolipoproteins to Evaluate Coronary Heart Disease Risk?

August 24, 2012
Should We Measure Apolipoproteins to Evaluate Coronary Heart Disease Risk?

By Navya Nair, MD

Faculty Peer Reviewed

Coronary heart disease (CHD) is the major cause of mortality worldwide. Lipoproteins play a major role in the development of this disease. Current guidelines advocate that low-density lipoprotein (LDL) cholesterol should be the primary target for lipid lowering therapy. However, there is a growing literature on the atherogenic potential of apolipoprotein B (apo B)-containing lipoproteins and the protective effect of apolipoprotein A-one (apo AI)-containing lipoproteins. Many studies suggest that these apolipoproteins be used as markers to evaluate risk…

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From The Archives: The Role of Serologic Testing in the Diagnosis of Celiac Disease

August 23, 2012
From The Archives: The Role of Serologic Testing in the Diagnosis of Celiac Disease

Please enjoy this post from the archives dated, August 18, 2010

By Todd Cutler

Faculty Peer Reviewed

A 31-year-old woman presents to the clinic with chronic fatigue. She was diagnosed with iron  deficiency anemia when she was 25 years old and has since taken oral contraceptives to limit bleeding during menstruation which she describes as minimal. She has a family history significant for an older brother with celiac disease. She is thin and her exam is significant for conjunctival pallor. Her laboratory findings are

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Does Stress Cause Stress Ulcers? The Etiology and Pathophysiology of Stress Ulcers

August 22, 2012
Does Stress Cause Stress Ulcers? The Etiology and Pathophysiology of Stress Ulcers

Sara-Megumi Naylor, MD

Faculty Peer Reviewed

When Warren and Marshall were awarded the Nobel Prize in Physiology or Medicine in 2005 for their work on Helicobacter pylori and peptic ulcer disease , a long-standing controversy concerning the major cause of peptic ulcers was settled. They are not due to the reasons—spicy food, excessive coffee consumption, poor sleep, a stressful lifestyle—that we have heard from relatives and perhaps believed over the years. It is now well accepted that the leading causes of peptic ulcers are infection…

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Omega-3 Fatty Acids and Atherosclerosis

August 17, 2012
Omega-3 Fatty Acids and Atherosclerosis

By Michael Malone

Faculty Peer Reviewed

Omega-3 long chain polyunsaturated fatty acids (PUFAs) have been popularized in recent years as beneficial nutrients with cardioprotective effects. Omega-3 PUFAs are so named because of a double bond between the 3rd and 4th carbon of the polycarbon chain. They are “poly-unsaturated” with hydrogen atoms, as their carbon chains contain multiple double bonds. Three omega-3 long chain PUFAs are typically discussed in the context of medical therapy, the first being alpha-linolenic acid (ALA). ALA is an essential precursor omega-3…

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Xopenex: Is it worth the money?

August 16, 2012
Xopenex: Is it worth the money?

By Han Na Kim

Faculty Peer Reviewed

Case:

The patient is a 50-year-old woman with history of steroid-dependent, severe, persistent asthma since childhood and coronary artery disease who presented with dyspnea and URI symptoms admitted for management of asthma exacerbation. Patient received nebulized albuterol treatment every two to four hours, and on hospital day two, patient developed persistent sinus tachycardia to heart rate of 120s believed to be secondary to albuterol therapy. Given her tachycardia, would it be safer to prescribe levalbuterol rather than…

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Should I Consider Antibiotics in My Patient with Irritable Bowel Syndrome?

July 26, 2012
Should I Consider Antibiotics in My Patient with Irritable Bowel Syndrome?

By Jason Chalifoux

Faculty Peer Review

The story of a patient with multiple office visits due to uncontrolled abdominal pain, bloating and diarrhea/constipation is common among primary care doctors and gastroenterologists. The workup is often extensive and rules out many etiologies. After discovering no metabolic, inflammatory, or anatomic pathology, physicians use the Rome III criteria to diagnose irritable bowel syndrome (IBS). IBS is a functional bowel disorder that is diagnosed by symptoms of recurrent abdominal pain or discomfort for at least 3 days per month…

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Bystander CPR: How Much Does It Help?

July 18, 2012
Bystander CPR: How Much Does It Help?

By Andrew L. Weinstein

Faculty Peer Reviewed

You have just completed a certification course in basic life support and are competent at performing cardiopulmonary resuscitation (CPR) using chest compressions, a CPR mask, a bag-valve mask with impedance threshold device, and an automated external defibrillator (AED), all interventions recommended by the American Heart Association (AHA) to improve circulation following a sudden cardiac arrest. On your way home from the training center you see a man collapse and rush over to find him unresponsive, not breathing, and…

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Mystery Quiz- The Answer

June 29, 2012

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The answer to the mystery quiz is thymoma associated with myasthenia gravis. The clue to the case is the intermittent dysphagia and chewing difficulty. If one considers myasthenia in the differential, then an otherwise grossly normal appearing chest radiograph may be viewed more closely, with attention directed to the upper, anterior mediastinum. The chest radiograph shows the ascending aorta (image 3, arrow); on the lateral film, the retrosternal space, which normally contains air, appears…

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Mystery Quiz

June 19, 2012
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The patient is a 61 year old man admitted to the psychiatry service for depression. During the hospitalization the patient reported a three year history of dysphagia and occasional right sided chest pain not clearly associated with exertion. He first noted difficulty chewing and swallowing turkey on Thanksgiving Day. The symptoms were intermittent thereafter and involved solid foods but not liquids. His chewing and swallowing difficulty abated for a year but returned one year…

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Gout: A Disease of the Blessed or a Blessing in Disguise?

June 8, 2012
Gout: A Disease of the Blessed or a Blessing in Disguise?

By Krithiga Sekar

Faculty Peer Reviewed

“The patient goes to bed and sleeps quietly until about two in the morning when he is awakened by a pain which usually seizes the great toe, but sometimes the heel, the calf of the leg or the ankle… so exquisitely painful as not to endure the weight of the clothes nor the shaking of the room from a person walking briskly therein.”

—Thomas Sydenham  (1683)

Gout, an excruciatingly painful but relatively benign form of arthritis in the…

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American College of Cardiology 2012

May 29, 2012
American College of Cardiology 2012

By Steven Sedlis, MD

The 2012 Scientific Sessions of the American College of Cardiology were held from March 24-27, 2012 in Chicago. This is always a great city for a conference —terrific restaurants, museums and parks—it almost makes you feel as though you are in New York. The McCormick Place Convention Center is another attraction—it is well laid out and easy to navigate. It allows participants to freely move from session to session spending time on what interests them most. The ACC meetings are also…

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