Clinical Questions

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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Corticosteroids and Prophylaxis. What complications should you try to prevent in patients on chronic corticosteroids?

October 30, 2013
Corticosteroids and Prophylaxis.  What complications should you try to prevent in patients on chronic corticosteroids?

By Robert Joseph Fakheri, MD

Faculty Peer Reviewed

A 55 year-old male is recently diagnosed with systemic sarcoidosis. The patient is started on prednisone 40mg with the plan to decrease the dose after remission of symptoms, which may take a number of months. What kind of prophylaxis should the patient receive?

Corticosteroids are an effective treatment option for a number of diseases spanning many specialties. However, long-term corticosteroid treatment is marred with a number of side effects including hypertension, hyperglycemia, weight gain, adrenal suppression, osteoporosis,…

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From The Archives: Creatine Kinase: How Much is Too Much?

October 24, 2013
From The Archives: Creatine Kinase: How Much is Too Much?

Please enjoy this post from the archives dated November 3, 2010

By Jon-Emile Kenny, MD

Faculty Peer Reviewed

A 37-year-old man, with no past medical history and taking finasteride for male pattern baldness, is admitted to Medicine with profound lower extremity weakness after a weekend of performing multiple quadriceps exercises. His measured creatine phosphokinase (CPK) is over 35,000 IU/liter. I wonder to myself, what is the risk to his kidneys and can I mitigate the damage?

Rhabdomyolysis means destruction of striated muscle. Physical manifestations range from…

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Why Aren’t Patients Using Advance Directives?

October 23, 2013
Why Aren’t Patients Using Advance Directives?

By Abigail Maller, MD

Faculty Peer Reviewed

Advance directives are a means for patients to communicate their wishes regarding medical decisions to their families and health care professionals once they are unable to make these decisions themselves. These documents, together with the assignment of health care proxies, help avoid a discrepancy between what a patient wanted in terms of end-of-life care and the level of care that they end up receiving . These resources also prevent confusion and promote mutual understanding between providers and family…

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Is there a Non-Invasive Method to Diagnose Cirrhosis/Hepatic Fibrosis?

October 11, 2013
Is there a Non-Invasive Method to Diagnose Cirrhosis/Hepatic Fibrosis?

By Becky Naoulou, MD

Faculty Peer Reviewed

Clinical Question:

You are asked to see a 45 year-old male with a medical history significant for untreated hepatitis C (HCV RNA 5,000,000 copies/mL, genotype 1a). He presents complaining of worsening fatigue and weakness for several months. Labs are remarkable for mildly elevated transaminases, low albumin, and an elevated INR. The patient is very worried because he has heard that hepatitis C can cause liver cancer and asks you if there is a non-invasive screening test for liver…

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Does Running Cause Knee Osteoarthritis?

September 14, 2013
Does Running Cause Knee Osteoarthritis?

By Karin Katz, MD

Faculty Peer Reviewed

Post-summer is here. Despite the heat and what feels like 100% humidity, the East River Path is packed with runners. No amount of car fumes pouring onto the path could stop those in training. Others are circling the 6-mile-loop around Central Park. Or, if you are bored of running the typical routes, for a few Saturdays, Park Avenue will be shut down for automobile traffic. New Yorkers love to run (well, some do). And while unforeseen circumstances…

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Electronic Cigarettes: What We Know So Far

August 28, 2013
Electronic Cigarettes: What We Know So Far

By Daniel Taupin

Faculty Peer Reviewed

 

Image. Typical e-cigarette consisting of (A) LED light, (B) battery/circuitry, (C) atomizer, (D) replaceable mouthpiece cartridge containing glycerin or propylene glycol, water, flavorings, and often dissolved nicotine. Courtesy of Horsten at en.wikipedia.

A man sits in a crowded Manhattan coffee shop, enjoying his oversized latte while reading his favorite blog on an ultrathin laptop. There are several devices plugged into the computer’s USB ports: an external hard drive, a smart phone, and… a cigarette? He unplugs the cigarette,…

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From The Archives: Does Heyde Syndrome Exist?

August 8, 2013
From The Archives: Does Heyde Syndrome Exist?

Please enjoy this post from the Archives dated September 29, 2010

By Lara Dunn, MD

Faculty Peer Reviewed

In 1958, EC Heyde published 10 cases of aortic stenosis (AS) and arteriovenous malformations (AVMs) of the gastrointestinal tract in the New England Journal of Medicine . Thus, the association between aortic stenosis and intestinal angiodysplasia became known as Heyde Syndrome. Yet the existence of this syndrome has been controversial.

Contrasting conclusions have been obtained by studies conducted to evaluate this association. In a prospective study, Bhutani…

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From The Archives: Why Does Multiple Myeloma Treat The Kidneys So Poorly?

July 11, 2013
From The Archives: Why Does Multiple Myeloma Treat The Kidneys So Poorly?

Please enjoy this post from the Archives dated September 22, 2010

By Jon Emile Kenny, MD

Faculty Peer Reviewed

“You mean I’ve got cancer and my kidneys are failing, doc?” said my frail patient on the Bellevue oncology service shortly after a medical student had told him that his kidneys were damaged. Indeed, his new diagnosis of multiple myeloma was accompanied by an admission creatinine of 2.5 mg/dL.

About a quarter of patients with multiple myeloma have renal insufficiency at diagnosis . There are…

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Are We Too Hesitant to Anticoagulate Elderly Patients with Atrial Fibrillation? A Risk-Benefit Analysis

June 28, 2013
Are We Too Hesitant to Anticoagulate Elderly Patients with Atrial Fibrillation? A Risk-Benefit Analysis

By Sunny N. Shah, MD

Faculty Peer Reviewed

Background:

Atrial fibrillation (AF) is the most common cardiac arrhythmia and its prevalence increases with age. In fact, the lifetime incidence of AF is approximately 25% in individuals by age 80, with the incidence nearly doubling with each decade of life after age 50. (1) Multiple randomized controlled trials have shown that oral antithrombotic therapy with warfarin or aspirin decreases the risk of ischemic stroke in patients with AF. (2-6) Meta-analyses reveal a relative risk reduction of…

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Should I Add Sugar or Splenda to My Coffee?

June 6, 2013
Should I Add Sugar or Splenda to My Coffee?

By Reda Issa

Faculty Peer Reviewed

As a medical student, I adjusted to waking up at 6 AM every day – with the help of coffee, of course. Living in New York City and its fast-paced routine requires that extra kick those beans provide. So, should I add sugar or Splenda to my coffee? Half a century ago this question did not exist, but obesity was not a word in the Merriam-Webster then. Today, we have to think more carefully.

Non-sucrose based sweeteners can be…

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