Clinical Questions

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 2012, …

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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 medical …

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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 5.9

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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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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 …

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