Class Act

By Any Other Name

May 4, 2016
By Any Other Name

By Kathy May Tran

Peer Reviewed

Six weeks ago, Mr. S had fever, chills, cough, and rhinorrhea, which ultimately self-resolved. Two weeks later, he noticed right-sided neck pain that radiated towards his ear. When the pain progressively worsened, he presented to the emergency department. On physical exam, Mr. S was febrile to 100.5°F, tachycardic, diaphoretic, and in obvious pain. His right neck was swollen, erythematous, and tender to palpation. Laboratory results were significant for a white blood cell (WBC) count of 19.5 x 103/uL with …

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Physicians and Medical Innovation

April 15, 2016
Physicians and Medical Innovation

By Vivek Kumar

Peer Reviewed

As healthcare workers, we learn about the most intimate factors governing patients’ lives. We learn about their fears, goals, and motivations on a daily basis. We are on the front lines and see the cracks in the system that prevent optimal health. With all of this privileged knowledge, healthcare workers should be at the forefront of medical innovation. Surprisingly, however, very few physicians engage in entrepreneurship, despite the significant need and variety of roles available .

In the current medical …

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Outpatient Rhythm Monitoring: Available Options and Diagnostic Yield

March 29, 2016
Outpatient Rhythm Monitoring: Available Options and Diagnostic Yield

By Iulia Giuroiu, MD

Peer Reviewed

A 70-year-old woman with hypertension, early dementia, and non-specific chest pain of unclear etiology presents with recurrent left-sided chest pain. Unfortunately, she is a poor historian; it appears that her chest pain is similar to past episodes. Prior workups, which included an echocardiogram, had been unremarkable. To confound matters further, the patient’s current pain appears to be reproducible when pressure is applied to her chest. She is admitted overnight for close observation. No electrocardiogram (ECG) changes are found and …

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Presidential Politics-How Do the Candidates Healthcare Policies Measure Up?

March 25, 2016
Presidential Politics-How Do the Candidates Healthcare Policies Measure Up?

By Ajay Prakash, MD

Peer Reviewed

Discussions about healthcare policy have played a central role throughout the presidential primaries. It is incredibly important for healthcare providers to have an understanding of healthcare’s current state and the manner in which each of the presidential candidates intends to reform it. This work will describe the public positions espoused by the presidential candidates in both the Republican and Democratic primaries. Where specifics are available, we will provide them. Where they are not, we will attempt to highlight those …

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Exercise-Induced Rhabdomyolysis: How Fitness May Actually Be Hurting You

March 17, 2016
Exercise-Induced Rhabdomyolysis: How Fitness May Actually Be Hurting You

By Jessica Morgan

Peer Reviewed

CrossFit and SoulCycle. To many people these words mean nothing. However, ask any twenty-something or college student and they will probably tell you they have participated in a class or two, or have a friend who participates. Depending on whom you approach, you might even get the sense that these are not just exercise classes, but more like a spiritual experience or a tight-knit community of like-minded individuals, all striving for physical excellence. Some have accused these programs of being …

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PTH versus PTHrP — Small Differences, Big Implications

March 3, 2016
PTH versus PTHrP — Small Differences, Big Implications

Samantha Kass Newman, MD

Peer Reviewed 

A 48-year-old depressed male smoker with a bit of an alcohol problem presents to the emergency department with worsening fatigue, severe lower back pain, constipation, abdominal pain, and 4 days of coffee ground emesis.

This could be anything. Viral gastroenteritis? Perhaps. Food poisoning? Probably not. Upper GI bleed? Likely, given his alcohol use. You send off routine labs, and then are called for a critical value: his calcium is 13.8 mg/dL. The albumin is normal. Next, you check the …

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Hirudotherapy: An Ugly Means of Avoiding Uglier Outcomes

January 22, 2016
Hirudotherapy: An Ugly Means of Avoiding Uglier Outcomes

By Jonathan Bekisz

Peer Reviewed

“Do you want to see something gross? Go into the soiled utility room and check out what’s in the jar.” Never one to pass on the opportunity to “see something gross,” I poked my head in and examined the tiny glass jar that sat on the counter. Living up to its billing, within the container sat about a half dozen leeches. Contrary to my assumption that any role these segmented worms had in the field of medicine went away with …

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The Quest for the HIV Vaccine: Are We Closer Than We Think?

January 20, 2016
The Quest for the HIV Vaccine: Are We Closer Than We Think?

By Amar Parikh, MD 

Peer Reviewed

Amidst the global panic over the recent Ebola outbreak, another well-known pathogen that has been devastating the world for decades continues to smolder—the human immunodeficiency virus (HIV). According to the World Health Organization (WHO), in 2013 there were 35 million people worldwide living with HIV, 2.1 million of who were newly infected that year . HIV/AIDS has claimed the lives of nearly 40 million people to date, with 1.5 million people dying from AIDS in 2013 alone. Although highly …

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Lies My Patients Told Me: “I Take My Medications Every Day.”

January 15, 2016
Lies My Patients Told Me: “I Take My Medications Every Day.”

By Rebecca Sussman

Peer Reviewed

Reviewing medical evidence has become such a habit that sometimes it feels almost impossible to think independently. I’ve always been a top-down thinker; I go with my gut instinct, and then look for the evidence to support my assessment.

The problem is that very often it feels like what patients need most is not the precision of a particular etiology or the selection of a medication that is perfectly and precisely tailored to their condition and comorbidities; what they need …

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Is It Time to Reconsider Who Should Get Metformin?

December 11, 2015
Is It Time to Reconsider Who Should Get Metformin?

By Lauren Strazzulla

Current FDA guidelines for the use of metformin stipulate that it not be prescribed to those with an elevated creatinine (at or above 1.5 mg/dL for men and 1.4 mg/dL for women). It is also contraindicated in patients with heart failure requiring pharmacologic treatment, and people over age 80, unless their creatinine demonstrates that renal function is not reduced. These guidelines are in place to prevent lactic acidosis, an understandably feared complication of metformin. However, metformin is, by consensus, the initial drug …

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Supporting Evidence

October 30, 2015
Supporting Evidence

By: Amy Ou

During a weekend off at my parents’ home, the subject of this chronic cough that I had developed for the entirety of the winter season came up. My mother, noticeably more concerned about it than I, asked: “Did you get a flu shot? Did you get your cough after you got your flu shot? You know this happened when you were little, right? I just don’t know about those flu shots, I think they have some bad side effects. Your dad and …

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HDL Quantity, Necessary But Not Sufficient For Cardioprotection

September 30, 2015
HDL Quantity, Necessary But Not Sufficient For Cardioprotection

By Kerrilynn Carney, MD

Peer Reviewed

Coronary heart disease remains the leading cause of death globally despite the use of statin therapy. Although major statin studies suggest an average 31% reduction in relative risk of coronary events, a residual risk of 69% remains to be addressed. (1) The search for a medical therapy to ameliorate residual risk has become the holy grail of cardiologists and pharmaceutical companies alike. While high-density lipoprotein cholesterol levels (HDL) independently predict cardiovascular disease risk, interventions to raise circulating HDL levels …

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