Clinical Questions

Why is Syphilis Still Sensitive to Penicillin?

July 30, 2009
Why is Syphilis Still Sensitive to Penicillin?

Sam Rougas MD

Faculty Peer Reviewed

It seems that every week a new article in a major newspaper is reporting what most infectious disease physicians have been preaching for several years. Antibiotic resistance is rapidly spreading. Infections such as Methicillin Resistant Staphylococcal Aureus, Extremely Drug Resistant Tuberculosis, and Vancomycin Resistant Enterococcus have journeyed from the intensive care units to the locker rooms of the National Football League. That being said, some bacteria have strangely and until recently inexplicably behaved. Syphilis, a disease caused by the …

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How Should You Approach a Patient Co-infected with HIV and Hepatitis C?

June 11, 2009
How Should You Approach a Patient Co-infected with HIV and Hepatitis C?

Uzma Sarwar MD

Faculty Peer Reviewed

With advancement in therapy, life expectancy has significantly increased among HIV-infected patients, and patients are now more likely to succumb to chronic disease processes. At present, approximately one third of deaths in HIV patients are related to liver disease, which has become the leading cause of death amongst HIV patients. The risk of death from liver disease in HIV patients is inversely related to their CD4 count. Infection with hepatitis C virus (HCV) accounts for the bulk of this …

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Does Acetazolamide Prevent Altitude Sickness?

May 7, 2009
Does Acetazolamide Prevent Altitude Sickness?

Seema Pursnani MD

Because your parents have designated you as the family doctor, your Uncle Joe calls to ask you if he should take this medication called Diamox before going trekking in the Himalayas. You work at Bellevue in New York City: who climbs mountains here? What do you say?

Why do illnesses develop from changes in altitude?

The essential culprit is the fall in atmospheric pressure with an increase in altitude. While at sea level, barometric pressure (Pb) is ~760mm Hg (1atm), whereas at …

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Should we treat asymptomatic autoimmune hepatitis?

April 30, 2009
Should we treat asymptomatic autoimmune hepatitis?

Bani Chander MD

Faculty Peer Reviewed

Autoimmune hepatitis (AIH) is a progressive, inflammatory disease of the liver of unknown etiology and may progress to cirrhosis. While it is does have a predilection for women, this disease entity crosses genders and ethnic groups, and may occur in both adults and children. AIH is characterized by a fluctuating course and is often associated with autoimmune features including hypergammaglobulinemia, circulating serum autoantibodies, and hepatitis with lymphoplasmacytic infiltration on liver biopsy . Autoimmune hepatitis is a heterogeneous disease with …

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The Skinny on Cachexia…Can it be Treated?

April 22, 2009
The Skinny on Cachexia…Can it be Treated?

Michael T. Tees, MD, MPH

On the wards and in the clinic, the physician is frequently presented with a patient with a decreased appetite and alarming weight loss. The patient is likely frustrated with their own fraility, the family is upset at the poor nutritional state of their loved one, but the healthcare provider should be the most concerned. This clinical presentation without a prior diagnosis is worrisome, and if the patient does have an underlying etiology, this likely represents progression.

Caring for the cachectic …

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Clinical Questions: How do you dose argatroban?

April 16, 2009
Clinical Questions: How do you dose argatroban?

Frederick Gandolfo, MD

Case: An 85 year-old woman admitted to the hospital with pneumonia and after a prolonged hospital course developed heparin-induced thrombocytopenia (HIT). She is currently being treated with argatroban and her platelet counts are recovering. You are the covering physician and are called by the lab for an INR of 12 on her routine labs. The patient shows no signs of bleeding and she is not on warfarin. The PTT at the time is 160 seconds. What is the appropriate course of action?…

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What is the Role of Colchicine in Recurrent Pericarditis?

March 14, 2009
What is the Role of Colchicine in Recurrent Pericarditis?

Commentary by Sabina Berezovskaya MD, PGY-3

Faculty Peer Reviewed

Up to 32% of patients with acute pericarditis will have a recurrent episode. Acute attacks are commonly precipitated by infections, malignancy, cardiac trauma, myocardial infection, or autoimmune disease. Recurrent pericarditis usually presents with symptoms akin to the acute attack, including chest pain, fever, pericardial rub, typical electrocardiographic findings (i.e. diffuse ST elevations and PR depressions), pericardial effusion and, infrequently, tamponade. The time to relapse after acute pericarditis usually occurs within 18 to 20 months; however some …

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Real Time Clinical Question: Rheumatology

February 13, 2009
Real Time Clinical Question: Rheumatology

Commentary by Jon-Emile Kenny MD, PGY- 2 

Faculty Peer Reviewed

At morning report, the case of a 55 F with known dermatomyositis (DM), and interstitial lung involvement who had presented to the hospital with increasing dyspnea was presented.  The discussion of the case opened with the cardinal manifestations of DM including proximal muscle weakness as diagnosed with EMG, cutaneous manifestations such as the heliotrope rash, the shawl sign, Gottron’s papules, Reynaud’s, and ‘Mechanics Hand’, and the systemic manifestations such as interstitial lung disease.

We then …

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Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

January 22, 2009
Should All Patients with Cellulitis Be Treated for Community-Acquired Methicillin-Resistant Staphylococcus Aureus?

Commentary by Melanie Maslow, MD, FACP, Associate Professor of Medicine, NYUSOM, Chief, Infectious Diseases, New York Harbor Healthcare System, NY

Faculty Peer Reviewed

Cellulitis is an acute spreading infection of the skin extending to the deep subcutaneous tissue characterized by pain, swelling, erythema and warmth. Cellulitis in the non-neutropenic patient, in the absence of bite wounds, salt or fresh water exposure, and coexisting ulcers is usually caused by Gram-positive pathogens, the most common being the beta-hemolytic streptococci and S .aureus, including methicillin-sensitive (MSSA) and methicillin-resistant …

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Analgesia for Cirrhotics: A Practical Approach

November 20, 2008
Analgesia for Cirrhotics:  A Practical Approach

Commentary by Albert B. Knapp MD, NYU Clinical Professor of Medicine (Gastroenterology)

THE CASE:
WS, a 49 yo year old Caucasian male with a known 35 year history of alcohol abuse, now presents with jaundice, tense ascites and a left shoulder fracture following a bar room brawl last night. He is admitted to the orthopedic service for elective pinning but is presently in great pain. You are consulted in regards to pain management….

THE QUESTION:
How should you approach the use of analgesia in patients …

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How Do You Approach a Patient with Arthritis and Hepatitis C?

August 7, 2008
How Do You Approach a Patient with Arthritis and Hepatitis C?

Commentary by Peter Izmirly MD, NYU Division of Rheumatology

A 54 year old male with a past medical history significant for hepatitis C genotype 1a s/p ifn/ribavarin 2003-2004 with HCV Qual negative in 2005 presents with 3 weeks of bilateral wrist pain. The pain is worst with extension. His exam is notable for diffuse tenderness when pressure is applied to his wrists. He has no obvious swelling, erythema, deformity or subcutaneous nodules. The remainder of his musculoskeletal exam in unremarkable. In addition, he has no …

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Admission screening cultures for MRSA: Is it time?

July 9, 2008
Admission screening cultures for MRSA: Is it time?

Commentary by Howard Leaf, M.D. Assistant Professor, Division of Infectious Diseases and Immunology 

Pressure continues to build for healthcare facilities to act to decrease hospital-acquired infections, particularly those associated with MRSA. This is partly data-driven, with one study reporting that 25% of patients acquiring MRSA colonization during a hospitalization subsequently become infected . The call to act is also partly a political response to concerns in the lay press about “superbugs” wreaking havoc both in hospitals and in the community. Seven states have either passed …

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