Class Act

The Great Marijuana Debate – Effects on Psychosis and Cognition

August 13, 2015
The Great Marijuana Debate – Effects on Psychosis and Cognition

By Kristina Cieslak, MD

Peer Reviewed 

The heavily debated gradual decriminalization and legalization of marijuana will likely result in easier access for all ages. An informed debate has been stymied, however, by a lack of prospective data examining the various long-term effects of marijuana use on the brain, particularly among adolescents who use it heavily. This year, the National Institute on Drug Abuse (NIDA) initiated the “National Longitudinal Study of the Neurodevelopmental Consequences of Substance Use.” This study will follow a large cohort of children …

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Chronicles of a Second Year Medical Student

August 6, 2015
Chronicles of a Second Year Medical Student

By Matthew Siow

Peer Reviewed 

Day 1 of the medicine rotation: complete. I was on long call today, which meant three things. One, the hours during which I had to pretend I knew something were longer. Two, I saw a lot of things I had never seen before, from more common things like COPD exacerbations and acute pancreatitis to more obscure things like erythrodermic psoriasis and multiple brain abscesses. And third, it’s 8 PM and I am absolutely exhausted.

As I lie down and start …

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Morbidity & Mortality for James A. Garfield – A Book Review of “Destiny of the Republic: A Tale of Madness, Medicine, and the Murder of a President” by Candice Millard

July 31, 2015
Morbidity & Mortality for James A. Garfield – A Book Review of “Destiny of the Republic: A Tale of Madness, Medicine, and the Murder of a President” by Candice Millard

By David Kudlowitz, MD

Peer Reviewed 

Last December, an unremitting sore throat led President Barack Obama to see an ENT. When the fiberoptic exam revealed soft tissue swelling in his throat, his physicians ordered a CAT scan. After a 28-minute visit to Walter Reed Hospital and a normal imaging study, he was diagnosed with acid reflux.   It is likely that the president’s doctors were acting in an overabundance of caution. Unfortunately, President Obama is not the first American president to get superfluous medical care. For …

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The Role of Fish Oil in Arrhythmia Prevention

July 29, 2015
The Role of Fish Oil in Arrhythmia Prevention

By Steven Bolger

Peer Reviewed

Omega-3 fatty acids were first identified as a potential agent to prevent and treat cardiovascular disease through several epidemiologic studies of the Greenlandic Inuit in the 1970s suggesting that high consumption of fish oil was associated with a decreased risk of cardiovascular disease . Fish oil contains two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), that have been shown to be beneficial in treating hypertriglyceridemia and in the secondary prevention of cardiac events .

The GISSI-Prevenzione trial, …

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UV Nail Lamps and Cancer: A Correlation?

July 24, 2015
UV Nail Lamps and Cancer: A Correlation?

By Jennifer Ng, MD

Peer Reviewed 

Beauty and suffering are often thought to be intertwined.  It is hard to have your cake and eat it too.  In the quest for beauty, women (and men) have subjected themselves to toxic and potentially deadly practices, such as applying lead-based cosmetics to whiten their faces historically , or more recently, going to tanning beds and/or laying out in the sun for prolonged periods to get a “healthy glow.”  As we have become increasingly health-conscious and vigilant, more and …

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A Primer on CRP and Cardiovascular Risk

July 22, 2015
A Primer on CRP and Cardiovascular Risk

Cindy Fei, MD

Peer Reviewed

A 63-year-old woman with hypertension presents to your clinic for routine follow-up. She came across an online article regarding C-reactive protein and its purported link to heart disease, and she asks you whether she should be tested for it. She is an otherwise asymptomatic non-smoker without a family history of heart disease. Her only medication is hydrochlorothiazide. Her blood pressure measured in the office is 128/81 mmHg, her low-density lipoprotein is 110 mg/dL, and her high-density lipoprotein is 54 mg/dL. …

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Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate

July 10, 2015
Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate

By Shannon Chiu, MD

Peer Reviewed

The annual incidence of infective endocarditis (IE) is estimated to be 3 to 9 cases per 100,000 persons in developed countries . Neurologic complications are the most severe and frequent extracardiac complications of IE, affecting 15-20% of patients . They consist of 1) ischemic infarction secondary to septic emboli from the valvular vegetation, which can eventually undergo hemorrhagic transformation; 2) focal vasculitis/cerebritis from septic emboli obstructing the vascular lumen, which can then develop into brain abscess or meningoencephalitis; 3) …

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Spotlight Case Part 2: Hypergammaglobulinemia and defective humoral immunity in HIV-infected patients

June 12, 2015
Spotlight Case Part 2: Hypergammaglobulinemia and defective humoral immunity in HIV-infected patients

By Stephen Armenti, MD

Peer Reviewed

Please see Part 1 of this Spotlight Case which can be found here.

Case Report

A 45-year-old man with a history of mild intermittent asthma presented with two days of right knee pain and swelling accompanied by subjective fevers, shaking chills, and night sweats. He also reported one day of right calf and left groin pain. The patient denied a history of joint trauma, underlying joint disease, or surgery. There was no history of intravenous drug use, recent travel, …

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Defiance

June 5, 2015
Defiance

By Amar Parikh, MD

I recently visited The Metropolitan Museum of Art and stumbled across this sculpture called “Woman of Venice II” by Alberto Giacometti. It made me recall an experience I had with a patient on the hematology service this past autumn, and I could not help but marvel at how my patient and this work of art seemed to echo each other. Below is my effort at articulating some of the thoughts I had when I saw this sculpture.

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Spotlight Case Part 1: Oligoarticular Septic Arthritis-A Case of Disseminated Pneumococcal Disease

May 13, 2015
Spotlight Case Part 1: Oligoarticular Septic Arthritis-A Case of Disseminated Pneumococcal Disease

By Jennifer S. Mulliken, M.D.

Peer Reviewed

Case Report

A 45-year-old man with a history of mild intermittent asthma presented with two days of right knee pain and swelling accompanied by subjective fevers, shaking chills, and night sweats. He also reported one day of right calf and left groin pain. The patient denied a history of joint trauma, underlying joint disease, or surgery. There was no history of intravenous drug use, recent travel, or preceding illnesses. He was sexually active with women and reported inconsistent …

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Iron Deficiency Anemia: A Guide to Oral Iron Supplements

March 26, 2015
Iron Deficiency Anemia: A Guide to Oral Iron Supplements

By Cindy Fei, MD

Peer Reviewed

Iron deficiency is the most common cause of anemia in the United States. Despite this, there are a multitude of questions surrounding the best choice of supplementation. Which formulation of iron is best prescribed? Do newer preparations such as enteric-coated tablets help? How long do you treat for? The following is a review of the literature surrounding these questions.

In order to best understand the dosing regimens, let’s first review the metabolism of iron.

The body contains approximately 45mg/kg …

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Diabetic Foot Ulcers: Pathogenesis and Prevention

March 19, 2015
Diabetic Foot Ulcers: Pathogenesis and Prevention

By Shilpa Mukunda, MD

Peer Reviewed

On my first day on inpatient medicine at the VA Hospital, Mr. P came in with an oozing foot ulcer. Mr. P, a 60-year-old man with a 30 pack-year smoking history, poorly controlled diabetes, peripheral vascular disease, and chronic renal disease, had already had toes amputated. He knew all too well the routine of what would happen now with his newest ulcer. After two weeks of IV antibiotics and waiting for operating room time, Mr. P eventually had his …

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