Clinical Questions

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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Is Personalized Medicine Really the Cure? Looking Through the Lens of Breast Cancer

May 3, 2013
Is Personalized Medicine Really the Cure?  Looking Through the Lens of Breast Cancer

By Jessica Billig

Faculty Peer Reviewed 

Although millions of dollars are spent towards cancer research every year, progress toward a cure is less than ideal. Last year the New York Times posted a piece about the burgeoning improvements on the genomic front that could lead to a new approach to cancer treatment. “The promise is that low-cost gene sequencing will lead to a new era of personalized medicine, yielding new approaches for treating cancers and other serious diseases” . Through genomic technology, physicians will be able…

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Health Care: Do Celebrities Know Best?

April 25, 2013
Health Care: Do Celebrities Know Best?

By Emma Gorynski

Faculty Peer Reviewed

The power that celebrities have over Americans is undeniable. We look to them for guidance on what to listen to, what to wear, and even what to name our children. Celebrities even affect the decisions we make about our own health care. With the increasing popularity of direct-to-consumer advertising, celebrities are promoting pharmaceuticals and other health-related products.

Is there a role for celebrities in health advocacy? On one hand, celebrities can increase public awareness of medical conditions and encourage…

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Did Abraham Lincoln Have Marfan Syndrome?

April 19, 2013
Did Abraham Lincoln Have Marfan Syndrome?

By Anna Krigel

Faculty Peer Reviewed

The iconic image of Abraham Lincoln is ubiquitous in our lives, from his small face on the penny to his large figure looming over the National Mall in Washington, D.C. Lincoln fascinates historians because of his significant role in American history when our nation was bitterly divided, but he intrigues physicians because of his remarkable stature. A reporter once described the 16th president as a “tall, lank, lean man considerably over six feet in height with stooping shoulders, long…

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Have a Cow? How Recent Studies on Red Meat Consumption Apply to Clinical Practice

April 12, 2013
Have a Cow? How Recent Studies on Red Meat Consumption Apply to Clinical Practice

By Tyler R. McClintock

Faculty Peer Reviewed

“Red Meat Kills.” “Red Meat a Ticket to Early Grave.” “A Hot Dog a Day Raises Risk of Dying.” Such were the headlines circulating in popular press last year when the Annals of Internal Medicine released details of an upcoming article out of Frank Hu’s research group at the Harvard School of Public Health . Analyzing long-term prospective data from two large cohort studies, researchers found that individuals who ate a serving of unprocessed red meat each day…

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White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

March 20, 2013
White Coat Hypertension: Are Doctors Bad for Your Blood Pressure?

By Lauren Foster

Faculty Peer Reviewed

Hypertension is a pervasive chronic disease affecting approximately 65 million adults in the United States, and a significant cause of morbidity and mortality . Antihypertensives are widely prescribed due to their effectiveness in lowering blood pressure, thereby reducing the risk of cardiovascular events. However, the phenomenon of the “white coat effect” may be a complicating factor in the diagnosis and management of hypertensive patients. It is well established that a considerable number of people experience an elevation of their…

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Morgellons: Real Disease or Delusion Turned Internet Meme?

October 3, 2012
Morgellons: Real Disease or Delusion Turned Internet Meme?

By Robert Mazgaj

Faculty Peer Reviewed

Morgellons disease is an “unexplained dermopathy” characterized by fibers emerging from skin lesions, and associated with various cutaneous sensations. Inspired by a curious medical condition reported by a 17th century English physician, Morgellons was actually named in 2002 by Mary Leitao, a layperson, to describe the mysterious set of symptoms reportedly suffered by her then 2-year-old son. Leitao then launched the not-for-profit Morgellons Research Foundation (MRF) along with a (no longer active) website, www.morgellons.org. MRF successfully petitioned members of…

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Fractional Excretion of Sodium (FENa): Diagnostic Godsend or Gimmick?

September 5, 2012
Fractional Excretion of Sodium (FENa): Diagnostic Godsend or Gimmick?

By Jon-Emile S Kenny, MD

Faculty Peer Reviwed

A 62- year-old man with a history of hypertension, diastolic dysfunction and chronic kidney disease is admitted 4 days after beginning outpatient treatment of community acquired pneumonia with cefpodoxime and azithromycin; he had been intermittently vomiting for two days, but proudly states that he has been keeping all of his home medications down, including hydrochlorothiazide. The morning after his admission, he was noted to have a serum creatinine of 3.4 mg/dL (from a baseline of 1.7 mg/dL).…

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Are Dentists Really Causing Infective Endocarditis?

August 29, 2012
Are Dentists Really Causing Infective Endocarditis?

By Jeffrey Krutoy, DDS

Faculty Peer Reviewed

Bacterial infective endocarditis is a potentially devastating disease, and while it may be an easy tradition to blame the dentist, recent research and new guidelines from the American Heart Association (AHA) indicate that it may not be so simple.

Infective endocarditis (IE), while relatively uncommon (with yearly incidence rates ranging from 2 to 6 cases per 100,000 people), results in high rates of morbidity and mortality even when treated. For this reason, physicians have emphasized the importance…

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Should We Measure Apolipoproteins to Evaluate Coronary Heart Disease Risk?

August 24, 2012
Should We Measure Apolipoproteins to Evaluate Coronary Heart Disease Risk?

By Navya Nair, MD

Faculty Peer Reviewed

Coronary heart disease (CHD) is the major cause of mortality worldwide. Lipoproteins play a major role in the development of this disease. Current guidelines advocate that low-density lipoprotein (LDL) cholesterol should be the primary target for lipid lowering therapy. However, there is a growing literature on the atherogenic potential of apolipoprotein B (apo B)-containing lipoproteins and the protective effect of apolipoprotein A-one (apo AI)-containing lipoproteins. Many studies suggest that these apolipoproteins be used as markers to evaluate risk…

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