Clinical Questions

How Safe Is That Tattoo?

April 27, 2011
How Safe Is That Tattoo?

By Farzon A. Nahvi

Faculty Peer Reviewed

 Once thought to be exclusively the domain of gang members, prisoners, and those in the military, tattoos are now increasingly popular with the general population. The increasing visibility of tattoos on high-profile individuals such as athletes, musicians, and actors, combined with the increasing acceptability of tattoos among professionals, have made tattoos a common part of modern culture. Nevertheless, tattoo artists are subject to little regulation, and tattoo art comes with some real…

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The Porcelain Terror: Can a Toilet Give You Gonorrhea?

April 13, 2011
The Porcelain Terror: Can a Toilet Give You Gonorrhea?

By Bradley Ching, Class of 2011

Faculty Peer Reviewed

 What do every road trip, football game halftime, and trans-continental plane flight have in common? Usually a disgusting toilet paired with the urgent need of people to use them. While no one takes pleasure from these encounters, could they in fact be a risk for acquiring a sexually transmitted disease?

Gonorrhea or “the clap,” as it is lovingly nicknamed, is caused by the bacteria Neisseria gonorrhoeae and…

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From The Archives: Does Acetazolamide Prevent Altitude Sickness?

March 31, 2011
From The Archives: Does Acetazolamide Prevent Altitude Sickness?

Please enjoy this post from the Clinical Correlations archives first posted May 7, 2009

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…

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Is Dark Chocolate Good For You?

March 30, 2011
Is Dark Chocolate Good For You?

By Lisa Parikh, MD

Faculty Peer Reviewed

I was recently counseling an overweight patient about nutrition and exercise when he asked, “Doc, is it true what they say about dark chocolate being good for you?” I told him that although I had heard about this, I was actually not too sure about the evidence behind this. As a strong supporter of the “I wish that the best tasting foods were good for you” club, I decided this was…

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From The Archives: The Skinny on Cachexia…Can it be Treated?

March 24, 2011
From The Archives: The Skinny on Cachexia…Can it be Treated?

Please enjoy this post from the Clinical Correlations archives first posted April 22, 2009

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…

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The Myth of the Helminth: Can Worms be the Next Therapeutic Breakthrough for IBD Patients?

March 16, 2011
The Myth of the Helminth: Can Worms be the Next Therapeutic Breakthrough for IBD Patients?

By Michael Guss, Class of  2012

Faculty Peer Reviewed

Helminths–parasitic worms that have co-evolved with humans and colonized our gastrointestinal (GI) tract for millennia–have developed the ability to modulate our inflammatory responses and evade our immune systems to survive . Until the 1930s, the helminth colonization of humans was almost universal, owing to poor sanitation conditions and an impure food supply . This changed as the economic development of the last century created improved sanitary conditions: clean running water,…

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From the Archives: Myths and Realities: Does the Weather Really Affect Arthritis?

March 3, 2011
From the Archives: Myths and Realities: Does the Weather Really Affect Arthritis?

Please enjoy this post from the Clinical Correlations archives first posted March 19, 2009

Aditya Mattoo MD

Faculty Peer Reviewed

For our first post, I wanted to address the age old belief that changes in the weather can affect arthritis pain. Since the time of Hippocrates, who wrote about the effects of hot and cold winds on people’s health, this topic has been debated. Even Osler suggested in 1892 that arthritis sufferers of wealth vacation…

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Is Vasopressin Indicated in the Management of Cardiac Arrest?

February 2, 2011
Is Vasopressin Indicated in the Management of Cardiac Arrest?

By Brandon Oberweis, MD

Faculty Peer Reviewed

Case Report:

A 65-year-old male with a past medical history significant for NYHA class IV heart failure was found by his wife to be unresponsive.  Emergency Medical Services was subsequently called and upon arrival, initiated chest compressions and defibrillation for cardiac arrest secondary to ventricular fibrillation.  Intravenous access was obtained and despite two episodes of defibrillation, the patient remained in ventricular fibrillation.  The patient was given one dose of…

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Should You Eradicate Helicobacter Pylori Prior to Chronic NSAID Treatment?

January 19, 2011
Should You Eradicate Helicobacter Pylori Prior to Chronic NSAID Treatment?

By Joshua Smith, MD

Faculty Peer Reviewed

CASE:  A 54-year-old Asian female with no significant past medical history presents to her primary care physician with the complaint of several weeks of pain in her fingers bilaterally along with pronounced, worsening morning stiffness.  She is subsequently diagnosed with rheumatoid arthritis (RA), and the decision is made to start her on long-term, high-dose non-steroidal anti-inflammatory drugs (NSAIDs).  Given the link between NSAIDs and peptic ulcer disease (PUD), should this patient first…

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Is a Low Vitamin D Level a Risk Factor for Colon Cancer?

December 16, 2010
Is a Low Vitamin D Level a Risk Factor for Colon Cancer?

By Nelson Sanchez, MD and Fritz Francois, MD, MS

Faculty Peer Reviewed

Case: A 45-year-old woman presents to your office for an annual check-up.  She states that her grandmother was recently diagnosed with colon cancer at the age of 90, and she wants to know what she can do to reduce her own risk for the disease.  She recently read an article about the benefits of vitamin D and wants to know if they extend to protecting against colon

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The Polymyxins: Why am I using them all the time, and what are they?

December 8, 2010
The Polymyxins: Why am I using them all the time, and what are they?

By Jon-Emile S Kenny

Faculty Peer Reviewed

A 65-year-old female with locally advanced rectal cancer is admitted to the ICU, hypotensive and febrile.  Her PICC line is removed and blood cultures drawn.  Fourty-eight hours later all cultures return ESBL Klebsiella with susceptibility only to polymyxin.

I sat on the venerable call-room couch staring mindlessly at the cluttered, nauseating walls repeating the word ‘polymyxin’ like an endless antimicrobial mantra.  What strange dosing it has, and an even more…

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Kayexalate: What is it and does it work?

December 1, 2010
Kayexalate: What is it and does it work?

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 5.9 mEq/L. His EKG is

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