Class Act

To Inject, or Not to Inject: Using the Pneumococcal Vaccinations Effectively

September 19, 2014
To Inject, or Not to Inject: Using the Pneumococcal Vaccinations Effectively

By Luke O’Donnell, MD

Peer reviewed

Once formidable diseases, pneumonia, bacteremia, and meningitis are all now considered “bread-and-butter” internal medicine. Streptococcus pneumoniae is one of the major pathogens in these processes, causing 500,000 cases of pneumonia, 50,000 cases of bacteremia, and 3,000 cases of bacterial meningitis in the United States annually, with case fatality rates of 5-7%, 20%, and 30%, respectively .

Efforts to vaccinate against this gram-positive diplococcus started in mining sites near Johannesburg, South Africa around the turn of the last century…

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From the Bellevue Wards: Wellens’ Syndrome Revisited

September 18, 2014
From the Bellevue Wards: Wellens’ Syndrome Revisited

By Matthew Shou Lun Lee, MD

Peer Reviewed

Clinical Questions

-How common are elevated cardiac enzymes during Wellens’ syndrome?

-Can the EKG changes in Wellens’ syndrome be found with other causes?

Background

This post represents a follow-up to the 2009 article in Clinical Correlations by Dr. Erin Ducharme .

Wellens’ syndrome refers to a distinctive combination of clinical and EKG findings in unstable angina associated with high-grade lesions of the left anterior descending artery (LAD) . Initially described in 1982, the criteria has undergone…

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Neoplastic Fever: Pathophysiology, Clinical Features, And Diagnostic Assessment

August 13, 2014
Neoplastic Fever: Pathophysiology, Clinical Features, And Diagnostic Assessment

By David Kudlowitz, MD

Peer Reviewed

Neoplastic fever (aka tumor fever) is a challenging yet essential clinical diagnosis. In fevers of unknown origin, studies estimate that the incidence of neoplastic fever is anywhere from 7 to 31% . In the febrile patient with malignancy, tumor fever is the most common cause of non-infectious pyrexia (41%) . While leukemia, lymphoma, sarcoma, atrial myxoma, renal cell carcinoma, and liver metastases are the most common culprits, neoplastic fever has been reported in several other cancer types…

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Chimeras Could Bridge the Gap Between Treatment and Cure Or Are They Your Silent and Deadly Twin?

August 8, 2014
Chimeras Could Bridge the Gap Between Treatment and Cure Or Are They Your Silent and Deadly Twin?

By Pritha Subramanyam

Peer Reviewed

Mrs. CS is a 66-year-old Indian female who presents for a cardiology follow-up. The patient has a history of mitral regurgitation secondary to rheumatic fever she experienced as a child. As a teenager, her condition was diagnosed when she frequently became short of breath while playing sports in school. She was in good health until 24 years ago, when an acute episode of dyspnea while climbing stairs sent her to the emergency room. Her native mitral valve was found to…

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If You Could Give One Piece Of Advice To A Young Doctor…

July 25, 2014
If You Could Give One Piece Of Advice To A Young Doctor…

By Ali Marisa Mendelson, MD

Peer Reviewed

It was late when I left the call room on my last day as an intern in the step-down unit, and I hesitated before entering the stairwell. I considered turning instead towards the elevators, which would take me swiftly down seventeen floors, a world away from the sickness and disease we had spent the day battling. Instead, I took a detour to say good-bye to a patient I had met earlier in the month. I felt somewhat embarrassed…

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Medical Etymology: Scrofula

July 18, 2014
Medical Etymology: Scrofula

By Sagar S. Mungekar, MD

Peer Reviewed

It was around the 300s BCE when a sow must have had her snout near Mycobacterium intercellularae, an environmental saphrophyte that lives in soil and water. After some time, she—like many of her community—developed tubercles in her cervical lymph nodes. Aristotle noted that this happened to many domesticated animals such as pigs and oxen. Though this phenomenon was likely noted by many of the time, Aristotle’s is the first written record of it. Some time later, a physician…

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Vit-a-minute: Are Supplements Worth It?

July 11, 2014
Vit-a-minute: Are Supplements Worth It?

By Aditya K. Sreenivasan

Peer Reviewed

The Huffington Post recently publicized a large study on the health habits of doctors. The study, a survey done by Medscape with 31,399 participants, revealed that more than half of doctors take some form of dietary supplement. The most common form of supplement taken was a multivitamin . With the way doctors find themselves in constant discussions about “evidence based medicine” these days, we can assume that there are solid data showing that multivitamins are beneficial to long-term health.…

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Medical Eponyms: Recognizing the Medical Greats

June 11, 2014
Medical Eponyms: Recognizing the Medical Greats

By David Kudlowitz, MD

Peer Reviewed

Whether assessing for a Babinski sign, listening to Korotkoff sounds, or diagnosing Wolf-Parkinson-White Syndrome, we are surrounded by names of the medical greats in day-to-day medical practice. Medical eponyms for diseases, physical exam signs, procedures, and anatomic parts are considered by many practitioners to be tributes to their physician discoverers. However, over the past several years there has been an increasing resistance to the excessive use of eponyms, especially those associated with Nazi physicians . A compilation of medical…

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Caffeine and the Risk of Atrial Fibrillation

June 6, 2014
Caffeine and the Risk of Atrial Fibrillation

By Joshua Michael Lader, MD

Peer Reviewed

As physicians, we are frequently asked to weigh-in on dinnertime discussions about topics that, despite their relevance to everyday life, were never formally addressed in our medical training. For example, at a recent family gathering the conversation turned to a 78 year-old uncle who was recently diagnosed with atrial fibrillation. While this uncle had longstanding and likely poorly controlled hypertension, he would also typically drink 4 to 5 cups of coffee between breakfast and lunch. The debate then…

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The Rise in Tick-Borne Diseases: Is Climate Change Responsible?

June 4, 2014
The Rise in Tick-Borne Diseases: Is Climate Change Responsible?

By Nadia Jafar

Peer Reviewed

As a resident of Connecticut, I grew up acutely aware of tick-borne diseases. Nonetheless, I was surprised to see at least 3 cases of tick-borne infections during the month of my Medicine clerkship. This drove me to research the incidence of tick-borne diseases, specifically in the US, and the possible factors contributing to their increased prevalence.

In 1998, the list of reportable tick-borne pathogens in the US included Rocky Mountain spotted fever, tularemia, Lyme disease, human granulocytic ehrlichiosis/anaplasmosis, and human…

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Help Versus Hope: Acetylcholinesterase Inhibitors in Alzheimer’s Disease

May 21, 2014
Help Versus Hope: Acetylcholinesterase Inhibitors in Alzheimer’s Disease

By Jonathan Gursky

Peer Reviewed

Approximately 5.2 million Americans are currently living with Alzheimer’s disease (AD) , with this number expected to triple by the year 2050 . Alzheimer’s disease is now the sixth leading cause of death in the United States and accounts for $100 billion in healthcare expenditures each year . Nevertheless, the most devastating and far-reaching effects of Alzheimer’s disease hit close to home. While those with the disease progressively lose their memory, speech, and independence, it is the caretaker…

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Timekeeping

May 16, 2014
Timekeeping

By Nancy Hernandez

 

I did not know you until that time,

We scurried into your room

And found you pulseless, breathless, lifeless.

I was asked to keep

Time.

 

Fumbling for paper, I resorted to skin,

Marking the time we started to

Restore your blood flow.

Pumping in air,

Compressing your chest,

As you were infused with epinephrine,

I kept time.

 

Your story started pouring in,

You were post-op for an

Incision and drainage

Of your limb amputation site -

A diabetic’s fight.…

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