Systems

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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Breaking News: The Downfall of the PSA

May 23, 2012
Breaking News: The Downfall of the PSA

The United States Preventive Services Task Force stands their ground in this week’s Annals of Internal Medicine and recommends against the routine use of the PSA as a screening tool for prostate cancer. This Class D recommendation is grounded in data that suggests a “very small” mortality benefit at the risk of significant over-diagnosis and unnecessary treatment. The PSA should still be used to follow response to treatment in those already diagnosed with prostate cancer. This recommendation has already set off a media frenzy and…

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Should Patients With Nephrotic Syndrome Receive Anticoagulation?

May 9, 2012
Should Patients With Nephrotic Syndrome Receive Anticoagulation?

By Jennifer Mulliken

Faculty Peer Reviewed

Case 1:

A 30-year-old African-American male with a history of bilateral pulmonary emboli presents with a 1-week history of bilateral lower extremity edema. Blood pressure is 138/83, cholesterol 385, LDL 250, albumin 2.9. Urinalysis shows 3+ protein. Twenty-four hour urinary protein is 7.2 grams.

Case 2:

A 47-year-old Hispanic male with a history of mild hypertension and venous insufficiency presents with a 3-month history of bilateral lower extremity edema. BP is 146/95, cholesterol 241, LDL 165, albumin 1.9.…

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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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