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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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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