Commentary by Cara Litvin MD, Executive Editor Clinical Correlations 

Avandia again made headlines this week when an FDA advisory committee voted to allow the drug to remain on the market despite new data that suggests it may increase the risk of ischemic heart disease. The committee overwhelmingly agreed that Avandia increases the risk of myocardial infarction in diabetic patients. However, in a remarkable vote of 22 to 1,  the committee nevertheless agreed that the drug should be kept on the market with new labeling.…

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Commentary by Henry Tran, MD

This week we will be highlighting a few articles examining risk factors for the development of obesity & the metabolic syndrome, a treatment for hypertrophic cardiomyopathy, and hospital rankings.

Many people think that soft drink consumption has been a major contributing factor to the global epidemic of obesity.  So is there an association between drinking soda and metabolic risk factors for heart diseases?  A study by Dhingra et al. published online by Circulation examined a cohort of…

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Commentary by Michael Poles MD, Associate Editor Clinical Correlations

Let’s start with a plea to counsel our patients, family members and friends to undergo colorectal cancer screening as it was reported yesterday that President Bush had 5 polyps removed from his colon.

Out of the newspapers and into the journals, we see that the Lancet is reporting that long-term antiretroviral therapy restores CD4 counts in HIV patients to normal. These antiretroviral-naïve patients, if they maintained undetectable viral loads below 50 copies/ml and…

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Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

This week we focus on breast cancer and the outcome associated with hereditary factors and controversies surrounding the seemingly uncontroversial annual physical exam

This week’s New England Journal of Medicine reports on clinical outcomes in patients with breast cancer who carry the BRCA1 and BRCA2 mutations.  The investigators set out to answer the question of whether breast cancers associated with BRCA1 and BRCA2 mutations are associated with a poorer outcome,…

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This week finds us talking about markers for chronic kidney disease (remember we’re no longer allowed to use terms such as renal insufficiency),  a bit of positive news about a popular alternative medicine, a new inflammatory marker for coronary artery disease, a genetic basis for atrial fibrillation and most importantly the value of an adequate intake of chocolate.

The 7/3 issue of the Annals of Internal Medicine furthers our knowledge of cystatin c as an eventual replacement for creatinine and gfr.  Cystatin c is a serum…

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Commentary By: Josh Olstein, M.D. Chief Resident Internal Medicine

This week, the NEJM released the results of a survey about needlestick injuries among surgical residents. The frequency of needlestick injuries were quite high, residents averaged 3.8 injuries across all years of training. By their fifth year of training 99% of residents had experienced at least one needlestick injury. Perhaps the most shocking statistics however were the frequency of unreported needlestick injuries, including those related to high-risk patients. When surveyed about their latest exposure,…

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Commentary By: Sean Cavanaugh MD, Associate Editor Clinical Correlations

Not much in the way of surprise, a lot of the articles in the press this past week focused on cardiovascular health.

In the Lancet, the results of the VALIDD trial (the acronyms are getting a bit ridiculous eh?) were published. Although it seems that valsartan was not more effective than other agents at improving diastolic dysfunction, it seems that lowering the blood pressure aggressively (using any agents) DID effectively improve diastolic functioning.…

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A study reported in this week’s issue of JAMA attempts to correlate preoperative hematocrit levels with postoperative outcomes in elderly veterans undergoing noncardiac surgery. Both 30-day postoperative mortality and cardiac event rates increased in patients with hematocrits either higher or lower than the normal range (39 to 53.9%). A 1.6% increase in mortality was associated with every percentage point positively or negatively deviating from the normal range. Although compelling, this study does not establish a causal relationship between hematocrit and postoperative complications, and…

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It has been a little while, but stem cells are back in the news. Congress has passed legislation to provide more money for stem cell research, but did not reach a veto-proof majority. Meanwhile, scientists at MIT have successfully transformed mice skin cells into the equivalent of embryonic stem cells. The presumption is that these cells, which are indistinguishable from embryonic stems cells can then be forced to develop into any tissue under the proper stimulation. While this approach might obviate the need to…

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Much of the week in the media was spent discussing XDR TB. Andrew Speaker, a man on his way to his wedding in Santorini Greece (the picture of his wedding is to the right) managed to evade US security multiple times. The story is convoluted with many people telling different versions. It appears that he has smear negative, culture positive XDR-TB. His now father-in-law is a TB researcher, who insists that his new son-in-law did not catch it from his lab. Most importantly, when officials…

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The big bomb this past week was the Rosiglitazone Effect. Resulting in front page news in various newspapers (on multiple days), the meta-analysis in last week’s NEJM is causing quite the stir. For more information, see the post.

What’s old is what’s new. An interesting editorial on Medpage reviewed the reason that HCTZ is the most commonly prescribed thiazide, and it’s not efficacy. HCTZ is 4 letters and takes a second to write on a pad, chlorthalidone is 14 letters and, while possibly the…

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This week’s review is a potpourri of interesting if not groundbreaking articles.

The pharmaceutical industry certainly got off easier this week (see last week’s shortcuts) and the New York Times focused instead on the “industrialization” of the art of medicine. A hospital group in central Pennsylvania is offering insurers and patients bypass surgery for a flat fee with a 90 day guarantee. They’ve put 40 measures in place to make sure patients receive evidenced based care. If the any of the 40 measure…

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