Systems

Nothing QT (Cute) about it: rethinking the use of the QT interval to evaluate risk of drug induced arrhythmias

April 27, 2012
Nothing QT (Cute) about it: rethinking the use of the QT interval to evaluate risk of drug induced arrhythmias

By Aneesh Bapat, MD

Faculty Peer Reviewed

Perhaps it’s the French name, the curvaceous appearance on electrocardiogram (EKG), or its elusive and mysterious nature, but Torsades des pointes, a polymorphic ventricular arrhythmia, is certainly the sexiest of all ventricular arrhythmias. Very few physicians and scientists can explain its origin in an early afterdepolarization (EAD), and fewer still can explain its “twisting of the points” morphology on EKG. Despite its rare occurrence (only 761 cases reported to the WHO Drug Monitoring Center between 1983 and 1999)1,…

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From The Archives: How Does Alcohol Cause Cardiomyopathy?

April 19, 2012
From The Archives: How Does Alcohol Cause Cardiomyopathy?

Please enjoy this post from the archives dated November 4, 2009

Charles Levine

Faculty peer reviewed

Excessive consumption of ethanol (EtOH) has many deleterious effects on the human body. The heart is a target of damage from EtOH consumption, as chronic consumption of EtOH leads to decreased cardiac function and structural heart disease, including dilated cardiomyopathy.(1) The exact mechanism by which EtOH exerts its deleterious effects on the heart remains poorly understood and is an area of active…

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A Study of Cultural Complications in the Management of Diabetes

April 18, 2012
A Study of Cultural Complications in the Management of Diabetes

By Kimberly Jean Atiyeh

Faculty Peer Reviewed

Ms. KS is a 49- year-old Bangladeshi woman with a history of diabetes mellitus and non-adherence to medical treatment or follow up, who was reluctantly brought to the Bellevue ER by her family for nausea, vomiting, and fevers for one day. Her most recent hospitalization was 9 months prior for epigastric discomfort in the setting of uncontrolled diabetes with a hemoglobin A1C of 12.4%. On arrival, her physical exam was significant for tachypnea, tachycardia, and dry mucus membranes.…

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RTS,S/AS01: Is This The Beginning Of The End Of Malaria?

April 12, 2012
RTS,S/AS01: Is This The Beginning Of The End Of Malaria?

By Nicole Sunseri

Faculty Peer Reviewed

In Africa, there lurks a stealthy and powerful beast. Is it a lion, a black mamba, or a crocodile? No, it is the Anopheles mosquito. Although less than the size of a paperclip, these insects inflict an incapacitating blow, inoculating their larger human prey with Plasmodium spp., the parasites responsible for malaria. According to the World Health Organization, the worldwide incidence of malaria infection in 2009 was 225 million cases with a death toll of 781,000 Most of these…

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Use it or Lose it- Do cognitive leisure activities protect against the development of Alzheimer’s?

March 30, 2012
Use it or Lose it- Do cognitive leisure activities protect against the development of Alzheimer’s?

By Courtney Cunningham, MD

Faculty Peer Reviewed

As the world population ages, enormous resources will be required to adequately care for persons suffering from Alzheimer’s disease. The disease is the fifth leading cause of death for adults aged 65 years and older, and is estimated to affect 1 in 8 persons in this age group. Despite recent advances, the cause of Alzheimer’s disease is not well understood. The FDA-approved medications in common use—donepezil (Aricept), galantamine (Razadyne), rivastigmine (Exelon), and memantine (Namenda)–help to manage symptoms; however…

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Should Physicians Offer The HPV Vaccine To Men And Boys?

March 23, 2012
Should Physicians Offer The HPV Vaccine To Men And Boys?

By Kevin Burns

Faculty Peer Reviewed

On December 22, 2010, the US Food and Drug Administration (FDA) approved the quadrivalent human papillomavirus (HPV) vaccine (Gardasil; Merck, Whitehouse Station, New Jersey) for prevention of anal cancer and anal intraepithelial neoplasia (AIN) for males and females 9 to 26 years old. HPV is the most common sexually transmitted infection in the United States and the high-risk subtypes 16 and 18 are linked to development of cervical, vaginal, vulvar, anal, penile, and oropharyngeal malignancies. The FDA-approved uses for…

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Challenges in the Treatment of TB and HIV Co-Infection

March 16, 2012
Challenges in the Treatment of TB and HIV Co-Infection

By Santosh Vardhana, MD/PhD

Faculty Peer Reviewed

Ms. T is a 32- year-old woman with no past medical history who presents with a three month history of productive cough, shortness of breath, and a twenty pound weight loss. On review of systems, she also reports night sweats. On physical exam, she is cachectic. Pulmonary exam reveals dry bibasilar inspiratory crackles. Rapid HIV test is positive, and CD4 count returns at 46. Chest X-ray reveals bilateral increased interstitial markings at the lung bases as well as…

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From The Archives: How to interpret troponins in renal disease?

March 15, 2012
From The Archives: How to interpret troponins in renal disease?

Please enjoy this post from the archives first posted on October 21, 2009.

By Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities.…

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Does the BCG Vaccine Really Work?

March 14, 2012
Does the BCG Vaccine Really Work?

By Mitchell Kim

Faculty Peer Reviewed

Mycobacterium tuberculosis, an acid-fast bacillus, is the causative agent of tuberculosis (TB), an infection that causes significant morbidity and mortality worldwide. A highly contagious infection, TB is spread by aerosolized pulmonary droplet nuclei containing the infective organism. Most infections manifest as pulmonary disease, but TB is also known to cause meningitis, vertebral osteomyelitis, and other systemic diseases through hematogenous dissemination. In 2009, there were an estimated 9.4 million incident and 14 million prevalent cases of TB worldwide, with a…

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Is There a Long-Term Mortality Benefit From Bariatric Surgery?

March 8, 2012
Is There a Long-Term Mortality Benefit From Bariatric Surgery?

By Marc O’Donnell

Faculty Peer Reviewed

Obesity is defined as a body mass index (BMI) of ?30 kg/m2. The rate of obesity in the United States has skyrocketed over the last several decades, becoming a disease of epidemic proportions. According to the Centers for Disease Control and Prevention, in 2009, 32 states had a prevalence of obesity of ?25%, while 9 of these states had a prevalence of ?30%. It has been estimated that the economic costs of treating obesity and its complications, including type…

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FROM THE ARCHIVES: How Do You Diagnose Polymyalgia Rheumatica?

March 1, 2012
FROM THE ARCHIVES: How Do You Diagnose Polymyalgia Rheumatica?

Please enjoy this post from the archives dated August 12, 2009

By Eve Wadsworth MD

Faculty Peer Reviewed

Polymyalgia rheumatica (PMR) is a condition that resembles several different disorders including osteoarthritis and can be difficult to diagnose. In addition to osteoarthritis, PMR can resemble conditions as diverse as depression, fibromyalgia, myopathic drug reactions, and malignancy. PMR, however, can be associated with dangerous consequences, namely blindness, and is responsive to well-established treatment regimens. As such, familiarity with PMR’s presentation and its unique features is critical so…

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Cardiac Murmur Websites: An Internet Review of Common Cardiac Auscultation Websites

February 29, 2012
Cardiac Murmur Websites: An Internet Review of Common Cardiac Auscultation Websites

By Rachel Bond, MD

Faculty Peer Reviewed

In the field of medicine including the art of physical diagnosis, there is nothing more nerve provoking then having to master the art of cardiac auscultation. Imagine the concern of medical students, residents, internists and freshly starting cardiologists all alike who are asked by patients time and time again, “does my heart sound okay?!” With the advancement in technology and the rapid surge of echocardiogram usage, the use of a stethoscope has not been very provocative. However, being…

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