Clinical Questions

Gun Violence: A Public Health Concern?

June 9, 2016
Gun Violence: A Public Health Concern?

By Matthew B. McNeill, MD

Peer Reviewed

One can often feel numb or indifferent to the seemingly nightly reports of gun deaths on American news programs. Individual homicides, suicides, or accidental gun deaths are tragic and tragically commonplace. However, over the last two decades, a tide of unrest with the current role of guns in America has arisen in the wake of mass school shootings in places such as Jonesboro, AR (1998, 5 killed, 10 injured), Columbine, CO (1999, 13 killed, 24 injured), Red Lake …

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Wearable Health Trackers: Better behaviors, or Fashion fads?

May 25, 2016
Wearable Health Trackers: Better behaviors, or Fashion fads?

By David Valentine, MD

Peer Reviewed

Currently, well over one third of US adults use at least one health-related online service or app, with almost half of those focused on physical activity 1. With the growing popularity of wearable health tracking devices such as the Fitbit, Nike Fuel, Jawbone and more, the prevalence of these technologies is only set to grow. However, while more and more people know more and more about their health and habits by the day, little is known about perhaps the …

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Can N-Acetylcysteine be Used in Non-Acetaminophen Induced Acute Liver Failure?

May 20, 2016
Can N-Acetylcysteine be Used in Non-Acetaminophen Induced Acute Liver Failure?

By David Pineles, MD

Peer Reviewed

In the early 1970’s, scientists discovered in animal models that a minor metabolite of acetaminophen, N-acetyl-p-benzoquinone imine (NAPQI), accumulates in the body after ingestion. This metabolite is normally conjugated by glutathione, but when acetaminophen is taken in excess, the body’s glutathione reserves are inadequate to inactivate all of the toxic NAPQI. This metabolite is then free to cause direct damage to hepatocytes. If present in high enough concentrations, the liver damage can be so extensive that it results in …

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Bedside Rounds: How Useful are the Kernig and Brudzinski signs for Predicting Meningitis?

April 27, 2016
Bedside Rounds: How Useful are the Kernig and Brudzinski signs for Predicting Meningitis?

By Chio Yokose, MD

Peer Reviewed

Even in this era of modern medicine, bacterial meningitis remains a widely feared diagnosis in both resource-rich and -poor settings worldwide. Bacterial meningitis is among the ten most common infectious causes of death and kills approximately 135,000 people around the world each year .

It is a medical, neurologic, and sometimes neurosurgical emergency that affects 4 to 6 per 100,000 adults annually .  Many healthcare providers may consider the diagnosis when evaluating a patient, but it can nonetheless be …

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Don’t Tie Me Down! Do Neckties Spread Infection?

February 24, 2016
Don’t Tie Me Down! Do Neckties Spread Infection?

By Gabriel Campion

Peer Reviewed

For over a century, neckties have been a staple accessory in the wardrobe of the American professional man. Although white-collar dress codes have trended toward a more casual style, the quintessential physician still wears the white coat, a stethoscope draped around the neck, and, if male, a necktie. This is understandable. No one would accuse a profession using an oath that originally swore “by Apollo the Physician and by Aesculapius ” to be one that easily strays from tradition. However, …

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Could Metformin be the First Anti-Aging Drug?

February 11, 2016
Could Metformin be the First Anti-Aging Drug?

By Amy Shen Tang, MD

Peer Reviewed

“I would pay you if you took it away from me. I’d try to buy it back,” said Irving Kahn, the late Wall Street investment advisor when asked if he would ever retire from work . Mr. Kahn, who founded Kahn Brothers Group, Inc. with his sons more than 40 years ago, took an active role as chair of his company until his passing last winter at the ripe age of 109 years. Kahn and his siblings all …

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When and How Should We Examine the Spleen?

January 28, 2016
When and How Should We Examine the Spleen?

By Jenna Tarasoff

Peer Reviewed

A 65-year-old African woman presents with two months of fevers and 25-pound weight loss along with a month of nausea and retching, accompanied by left-sided abdominal pain. The exam is significant for axillary lymphadenopathy, abdominal distension, splenomegaly, and palpable purpura on her arms, legs, and back. Labs are significant for leukocytosis, lymphopenia, microcytic anemia, increased ferritin, and positive hepatitis C virus PCR. Abdominal CT shows multiple enlarged nodes and an enlarged spleen (splenomegaly). 

As I prepare to present my diagnosis …

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The Quest for the HIV Vaccine: Are We Closer Than We Think?

January 20, 2016
The Quest for the HIV Vaccine: Are We Closer Than We Think?

By Amar Parikh, MD 

Peer Reviewed

Amidst the global panic over the recent Ebola outbreak, another well-known pathogen that has been devastating the world for decades continues to smolder—the human immunodeficiency virus (HIV). According to the World Health Organization (WHO), in 2013 there were 35 million people worldwide living with HIV, 2.1 million of who were newly infected that year . HIV/AIDS has claimed the lives of nearly 40 million people to date, with 1.5 million people dying from AIDS in 2013 alone. Although highly …

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Is It Time to Reconsider Who Should Get Metformin?

December 11, 2015
Is It Time to Reconsider Who Should Get Metformin?

By Lauren Strazzulla

Current FDA guidelines for the use of metformin stipulate that it not be prescribed to those with an elevated creatinine (at or above 1.5 mg/dL for men and 1.4 mg/dL for women). It is also contraindicated in patients with heart failure requiring pharmacologic treatment, and people over age 80, unless their creatinine demonstrates that renal function is not reduced. These guidelines are in place to prevent lactic acidosis, an understandably feared complication of metformin. However, metformin is, by consensus, the initial drug …

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Are We Overusing Proton Pump Inhibitors?

November 13, 2015
Are We Overusing Proton Pump Inhibitors?

By Shimwoo Lee
Peer Reviewed
Case: A 31-year-old man with poorly controlled type 2 diabetes was hospitalized for community-acquired pneumonia. His home medications included esomeprazole. When asked why he was receiving this medication, the patient said it was first started during his prior hospitalization for “ulcer prevention” eight months ago and that he had continued to take it since. He denied any history of upper gastrointestinal symptoms. Esomeprazole was tapered off during this admission. When being discharged after successful treatment of his pneumonia, he was …

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Beta-blockers in Uncomplicated Hypertension: Is it Time for Retirement?

October 7, 2015
Beta-blockers in Uncomplicated Hypertension: Is it Time for Retirement?

By Robin Guo, MD

Peer Reviewed 

Beta-blockers were one of the first modern medications used for the treatment of blood pressure. Before 1950, treatment options for hypertension were limited. The alphabet soup of medications—reserpine, pentaquine, hydralazine, and guanethidine—were notorious for inducing orthostasis, sedation, constipation, impotence, or blurry vision . Then in the 1960s, propranolol and chlorothiazide were developed. Initially designed to treat angina pectoris, propranolol was serendipitously discovered to also lower blood pressure. Oddly, propranolol, like the other beta-blockers in its generation and thereafter, did …

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There’s an App for That: Fitness Apps and Behavior Change Theory

September 18, 2015
There’s an App for That: Fitness Apps and Behavior Change Theory

By Alyson Kaplan

Peer Reviewed

According to recent reports by the CDC, more than one-third (78.6 million) of American adults are obese. Approximately 17% (12.7 million) of children and adolescents ages 2-19 also meet criteria for obesity . Obesity-related health conditions, including diabetes, heart disease, certain types of cancer, and stroke are among the leading causes of preventable death. Yet, obesity is not the sole contributor to these diseases. Other health risk behaviors, including smoking, alcohol abuse, and lack of physical activity all interact to …

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