Clinical Questions

West Nile Virus: Just How Bad Is It?

March 5, 2014
West Nile Virus: Just How Bad Is It?

By Julian Horwitz

Peer Reviewed

As of mid-August 2012, the CDC had reported 1118 cases of West Nile virus (WNV) infections and 41 related deaths, which, pro rata, made 2012 the most prolific year for WNV in the United States . Although West Nile’s classification as a public health crisis remains debatable, the lack of treatment and vaccination options make associated severe infections a real threat.

West Nile virus, a single-stranded RNA virus of the Flavivirus family, was first isolated in Uganda in 1937 .…

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The Yolk Or The Egg

February 27, 2014
The Yolk Or The Egg

By Nicole A. Lamparello, MD and Molly Somberg, MD, MPA

Peer Reviewed

You hear it wherever you eat, whether at the deli ordering a breakfast sandwich or at the diner for Sunday brunch, “Egg whites only, please.” For the last decade, there has been a strong movement toward avoiding egg yolks; instead people are opting for only the ‘healthier’ egg white when ordering or cooking their breakfast.

However, are egg whites truly ‘healthier’ than eating whole eggs? What is the basis for this decision being…

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An antidote on the horizon? An update on the progress toward achieving reversibility for the new oral anticoagulants

February 21, 2014
An antidote on the horizon? An update on the progress toward achieving reversibility for the new oral anticoagulants

By Gabriel Schneider, MD

Peer Reviewed

The new oral anticoagulants (NOACs) are an appealing alternative to the burdensome vitamin K antagonists such as warfarin. These novel agents include direct thrombin inhibitors such as dabigatran (which inhibits thrombin) and factor Xa inhibitors such as rivaroxaban and apixaban (which prevent thrombin generation). Compared to warfarin, NOACs have fewer food and drug interactions, as well as a more predictable pharmacodynamic profile that serves to obviate the need for the frequent outpatient monitoring in most patients. In addition…

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Should Beta-Blockers Be Used In The Setting Of Cocaine-Related Chest Pain?

February 5, 2014
Should Beta-Blockers Be Used In The Setting Of Cocaine-Related Chest Pain?

By Matthew A. Haber

Peer Reviewed

The following is a hypothetical example of a classic exam question that one might come across as a medical student:

A 50-year-old male presents to the emergency department with severe chest pain. His past medical history is significant for congestive heart failure and stent placement. His vitals are significant for a blood pressure of 220/110 and a heart rate of 170. On physical exam he appears to be profusely sweating, and his pupils are markedly dilated. Troponin I is…

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How Much Do We Know About HDL Cholesterol?

January 29, 2014
How Much Do We Know About HDL Cholesterol?

By Gregory Katz, MD

Peer Reviewed

As levels of HDL cholesterol increase, rates of heart disease go down. It’s this fact that has given HDL its reputation as the “good cholesterol,” serving a crucial role in reverse cholesterol transport. According to our models, HDL ferries cholesterol away from our arteries – where its buildup leads to heart disease and stroke – and back towards our liver, safely out of harm’s way. The epidemiology backs this up: people with higher levels of HDL tend to…

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Can Young Patients Get Diverticular Disease?

January 23, 2014
Can Young Patients Get Diverticular Disease?

By Aaron Smith, MD

Peer Reviewed

Case: A 35 year-old, overweight female presents to the emergency room with five days of left lower quadrant abdominal pain. The pain is 10/10 in severity and accompanied by nausea, bloating, and loss of appetite.

Diverticulosis, the presence of small colonic outpouchings thought to occur secondary to high pressure within the colon, is an extremely common condition in elderly patients. Recent data suggests that up to 50% of people over the age of 60 have colonic diverticula. When…

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Is it Time to Skip the Gym?

January 15, 2014
Is it Time to Skip the Gym?

By Robert Mocharla, MD

Peer Reviewed

No. Sorry. Despite such reasonable excuses as – “I forgot my iPod”, “It’s pouring rain”, or “Game of Thrones is on” — an exhaustive literature search will not reveal a shred of evidence that you or most of your patients should skip daily exercise. However, a subset of your patients should indeed be skipping workouts regularly. The group referred to consists of endurance athletes (e.g. cyclists, swimmers, long-distance runners, competitive athletes). While this may not describe the majority of…

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Who Should We Screen for Hepatitis C: By Risk Or Birth Cohort?

January 8, 2014
Who Should We Screen for Hepatitis C: By Risk Or Birth Cohort?

By Jung-Eun Ha

Peer Reviewed

Over the last few years major changes have occurred in the diagnosis and treatment of hepatitis C. In 2011 the U.S. Food and Drug Administration (FDA) approved a rapid finger stick antibody test for hepatitis C virus (HCV) infection . The FDA also approved the protease inhibitors telapravir (Incivek; Vertex Pharmaceuticals, Cambridge, Massachusetts; Johnson & Johnson, New Brunswick, New Jersey) and boceprevir (Victrelis; Merck, Whitehouse Station, New Jersey), for the treatment of genotype 1 hepatitis C . In August…

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To Stent or not to Stent? A Review of the Evidence on the Utility of Stenting in Renal Artery Stenosis

November 22, 2013
To Stent or not to Stent? A Review of the Evidence on the Utility of Stenting in Renal Artery Stenosis

By Elizabeth Hammer, MD

Faculty Peer Reviewed

Renovascular hypertension, often caused by renal artery stenosis (RAS) due to atherosclerosis or fibromuscular dysplasia, is the most common potentially correctable cause of secondary hypertension. Although only approximately one percent of patients with hypertension have atherosclerotic renovascular disease (ARVD), the prevalence increases to 30-40% in patients with CAD, CHF, and PVD. Screening studies of asymptomatic populations in the United States demonstrate a disease prevalence of 7%, with an annual incidence of 0.5% per year in analyses of…

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FROM THE ARCHIVES – Kayexalate: What is it and does it work?

November 7, 2013
FROM THE ARCHIVES – Kayexalate: What is it and does it work?

Please enjoy this post from the archives dated December 1, 2010

By Todd Cutler, MD

Faculty Peer Reviewed

A 62-year-old male is hospitalized with an acute congestive heart failure exacerbation. On hospital day three, the patient’s symptoms have significantly improved with twice daily furosemide 80mg IV. He is continued on IV diuretics and aggressive electrolyte repletion. On day five of his admission, his basic metabolic panel is significant for a creatinine of 2.3 mg/dL (increased from 1.3 on admission) and a potassium concentration of

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To Stent or Not to Stent?

November 6, 2013
To Stent or Not to Stent?

By Anish Vani

Faculty Peer Reviewed

According to the 2010 Heart Disease and Stroke Statistics update of the American Heart Association, there are 17.6 million Americans living with coronary heart disease (CHD) . Fortunately, mortality from heart disease is on the decline in the United States and in countries with advanced health care, likely due to better management of acute coronary syndrome (ACS) and a reduction in lifestyle risk factors such as smoking. However, for the millions of Americans with stable ischemic heart disease (SIHD),…

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Can we teach the immune system to fight cancer?

November 1, 2013
Can we teach the immune system to fight cancer?

By Jenny Gartshteyn

Faculty Peer Reviewed

Since the start of vaccination – we’ve eradicated smallpox and polio, saved college kids from meningitis, averted flu epidemics, and decreased the incidence of HPV-related cervical cancer … but can we teach our immune systems to actively fight existing cancer?

Here’s the mechanism for an ideal anti-cancer vaccine:

With the growth and turnover of cancerous cells, cancer-specific tumor-associated antigens (TAAs) would be recognized and processed by professional antigen-presenting cells (APCs), such as dendritic cells and macrophages – which would…

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