Systems

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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What are the Barriers to Using Low Dose CT to Screen for Lung Cancer?

February 23, 2012
What are the Barriers to Using Low Dose CT to Screen for Lung Cancer?

By Benjamin Lok

Faculty Peer Reviewed

Lung cancer is the most common cause of cancer deaths globally and responsible for an estimated 221,120 new cases and 156,940 deaths in 2011 in the United States. Presently, the United States Preventive Services Task Force, the National Cancer Institute (NCI), the American College of Chest Physicians, and most other evidence-based organizations do not recommend screening for lung cancer with chest x-ray or low-dose helical computed tomography (CT) due to inadequate evidence to support mortality reduction. This…

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How Should You Choose the Best Anti-platelet Agents for Secondary Stroke Prevention?

February 16, 2012
How Should You Choose the Best Anti-platelet Agents for Secondary Stroke Prevention?

By Demetrios Tzimas, MD

Faculty Peer Reviewed

You are about to discharge a 75-year-old female with hyperlipidemia, hypertension, peripheral vascular disease, who was admitted to the hospital for an ischemic stroke. Being an astute physician, you would like to mitigate this patient’s risk of having a second stroke. But you ask yourself, “with all of the agents available today, what anti-platelet agents should I put this patient on to decrease her risk for a second stroke?”

The etiology of an ischemic stroke, as defined by…

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Obesity 2.0: More Than Just the Extra Weight

February 9, 2012
Obesity 2.0: More Than Just the Extra Weight

By Aviva Regev

Faculty Peer Reviewed

Introduction

Few people these days are unaware of the “obesity epidemic,” with its inception here in the United States and its steady, insidious spread around the globe. The numbers are truly staggering: in 2008, the World Health Organization estimated that 1.5 billion adults–over 20% of the earth’s population–were overweight, and 500 million of those were classified as obese, with a body mass index greater than 30. In the United States, over a third of the population is overweight, and…

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When Is Hemoglobin A1c Inaccurate In Assessing Glycemic Control?

February 1, 2012
When Is Hemoglobin A1c Inaccurate In Assessing Glycemic Control?

By Joseph Larese

Faculty Peer Reviewed

Hemoglobin A1C (HbA1c) is an invaluable tool for monitoring long-term glycemic control in diabetic patients. However, many clinicians managing diabetics have encountered the problem of HbA1c values that do not agree with fingerstick glucose logs. Before suspecting an improperly calibrated glucometer or poor patient record keeping, it is useful to consider the situations in which HbA1c may be spuriously elevated or depressed. These issues are best understood after reviewing how HbA1c is defined and measured–topics fraught with considerable confusion.…

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From The Archives: Myths and Realities: Colon Cleansing: Healthful or just a load of @$%!

January 26, 2012
From The Archives: Myths and Realities: Colon Cleansing: Healthful or just a load of @$%!

Please enjoy this post from the archives on July 16, 2009

By Chau Che MD

Faculty Peer Reviewed

You’ll have increased energy, radiant skin, reduced joint pain, improved asthma symptoms, and best of all…you will lose weight. These are some of the purported benefits of removing “toxins” (otherwise known as undigested material) from the colon through cleansing. As with fashion, music, and art, what’s old has a way of becoming trendy again…especially when celebrities such as Beyonce talk about it on the Oprah Winfrey show.…

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