Clinical Questions

Should Beta Blockers be Used in Heart Failure with Preserved Ejection Fraction?

August 23, 2017
Should Beta Blockers be Used in Heart Failure with Preserved Ejection Fraction?

By Lauren Christene Strazzulla

Peer Reviewed

The lifetime risk for developing heart failure from age 55 on is 33% for men and 28.5% for women, and as the population ages, there is an increasing prevalence of this disease along with its associated health care costs . Heart failure is divisible into 2 distinct entities: those with left ventricular systolic dysfunction and those with cardiovascular compromise that does not decrease LV ejection fraction, which is termed heart failure with persevered ejection fraction (HFpEF) . While …

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Are Electronic Cigarettes Safer Than Traditional Cigarettes?

August 9, 2017
Are Electronic Cigarettes Safer Than Traditional Cigarettes?

By Gabriel Lutz

Peer Reviewed

Due to the pervasiveness of television and print marketing of electronic cigarettes (e-cigs) in a multitude of flavors and device designs, e-cig use is on the rise in the general population. As physicians, how should we advise our patients looking to quit smoking or those looking for a “healthier” alternative? What does the evidence say about the health risks of e-cigs in first-time smokers?

Generally, e-cigs are composed of a battery and a vaporization chamber that heats a liquid solution …

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How Reliable Is Hemoglobin A1c?

April 6, 2017
How Reliable Is Hemoglobin A1c?

By Alexa Yuen

Peer Reviewed 

According to the CDC, there are 22 million people with an established diagnosis of diabetes mellitus in the United States, but more frightening is that the rate of diabetes continues to rise both nationally and globally, with predictions that 7.7% of the world’s adult population will be afflicted with the disease in 2030., Preventing, monitoring, and managing this disease is of utmost importance in responding to the growing epidemic. The hemoglobin A1c (HbA1c) blood test has become a powerful tool …

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Why Does Our Hair Turn Gray?

March 30, 2017
Why Does Our Hair Turn Gray?

By Chio Yokose, MD and Aaron Smith, MD

Peer Reviewed 

All but a lucky few of us will one day see our locks lose their color. But what is the physiologic basis for this unsightly transformation, known scientifically as canities? Why does our hair turn gray?

Hair pigment is derived from the compound melanin, which is formed during melanogenesis in lysosome-like organelles called melanosomes, found in the cytoplasm of melanocytes . Melanocytes are ectodermal cells that migrate from the neural crest to the skin during …

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Gamechanger? Should Steroids be Added to Treat Community Acquired Pneumonia?

March 23, 2017
Gamechanger?  Should Steroids be Added to Treat Community Acquired Pneumonia?

By Martin Fried, MD

Peer Reviewed

Welcome to Gamechangers, a series that takes a critical look at the latest in medical literature to answer one important question: would the results of this article change my practice? Featuring thorough evidence-based review as well as expert commentary, our aim is for this series to help you decide if the results of a given study are, in fact, a gamechanger. 

Why does this matter?

Community-acquired pneumonia (CAP) is a common and potentially serious infection that can lead to …

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Is there such a thing as too much information?

December 1, 2016
Is there such a thing as too much information?

By Mariya Rozenblit, MD  

Peer Reviewed

On my first day of internship I was faced with the seemingly simple task of consenting a patient for a blood transfusion. I went over the informed consent form with the patient, explaining the benefits and possible risks, and asked the patient if he had any questions. He did not and happily signed the form. However, I was left wondering if he truly comprehended the information. How much did he know about hepatitis C and HIV and how these …

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Gamechanger? Is Spironolactone the Magic Bullet for Resistant Hypertension?

November 9, 2016
Gamechanger?  Is Spironolactone the Magic Bullet for Resistant Hypertension?

By Amar Parikh, MD

Peer Reviewed

Welcome to Gamechangers, a series that takes a critical look at the latest in medical literature to answer one important question: would the results of this article change my practice? Featuring thorough evidence-based review as well as expert commentary, our aim is for this series to help you decide if the results of a given study are, in fact, a gamechanger.

A 65 year-old Hispanic male with type 2 diabetes, hypertension, hyperlipidemia, and erectile dysfunction presents to clinic for

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Why It Isn’t So Cool To Go Gluten-Free

October 12, 2016
Why It Isn’t So Cool To Go Gluten-Free

Chloe Cipora Goldman, MD

Peer Reviewed

During a recent encounter with a 32 year-old female presenting for surgical clearance for knee surgery, the patient touted that she was in superb health, exercised daily, and even followed a “healthy” gluten-free diet, despite not having celiac disease. This patient is one of the millions of Americans that have jumped on the gluten-free bandwagon, which has been made popular with the help of athlete and celebrity endorsements. The idea that gluten is something that should be avoided has …

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PCSK9 Inhibitors: Who Could Need More than a Statin?

October 5, 2016
PCSK9 Inhibitors: Who Could Need More than a Statin?

By Rhodes Hambrick

Peer Reviewed

The atherosclerotic cardiovascular disease (ASCVD) risk associated with hyperlipidemia (HLD), readily apparent from the Framingham Heart Study1 of the mid-20th century, has been the target of innumerable attempted pharmacologic interventions ever since. One class of agents, the HMG-CoA reductase inhibitors, or statins, became – and have remained2 – the gold standard for managing HLD-associated ASCVD risk in the setting of the remarkably favorable findings of multiple studies in the 1990s.3-5 While other agents, including niacin, fish oil, and fibrates, have …

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Oxygen-Induced Hypercapnia in COPD: What is the Mechanism?

September 28, 2016
Oxygen-Induced Hypercapnia in COPD: What is the Mechanism?

By Jonathan Glatt

Peer Reviewed 

It was my first week on the wards as a third-year medical student, and I found myself huddled with the team in a busy corner of the Bellevue ED, listening to a man cough and wheeze his way through an interview. He was an elderly patient with an extensive smoking history–a lifetime of a destructive habit that had dilated and distorted his lungs beyond repair. He told us, between bouts of breathlessness, of worsening dyspnea and copious sputum production over …

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Little Knowledge, Large Problem: Lack of Nutrition and Obesity Education in Medical Curricula

September 23, 2016
Little Knowledge, Large Problem: Lack of Nutrition and Obesity Education in Medical Curricula

By Elissa Driggin

Peer Reviewed

At almost every single one of my medical school interviews, each interviewer, noting my college major in nutritional science, asked some variation of the question, “What should I be eating to stay healthy?” Each time, I was left unsure of whether or not this question was aimed to gauge my ability to hold a conversation in a stressful environment, articulate my thoughts in a logical manner, or fulfill some other mysterious goal of the infamous medical school interview process. Or, …

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Are We Too Clean or Too Dirty? The Hygiene Hypothesis in Asthma

September 21, 2016
Are We Too Clean or Too Dirty? The Hygiene Hypothesis in Asthma

By James Barger

Peer Reviewed

Asthma, an obstructive pulmonary disease characterized by bronchospasm and chronic airway inflammation, has afflicted mankind for millennia. In the 1st century AD, the Greek physician Aretaeus of Cappadocia described an attack thus:

“the cheeks are ruddy, eyes protuberant, as if from strangulation…voice liquid and without resonance…they breathe standing, as if desiring to draw in all the air which they possibly can inhale, and, in their want of air they also open the mouth as if thus to enjoy the more …

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