Class Act

50% of the Daily Salt Intake Recommended by the JNC-8 Is Consumed in a New York Minute

September 13, 2017
50% of the Daily Salt Intake Recommended by the JNC-8 Is Consumed in a New York Minute

By Andrew Sideris

Peer Reviewed

Reduction of dietary sodium is a well-known nonpharmacologic therapy to reduce blood pressure. The 8th Joint National Commission (JNC-8) recommends that the general population limit daily intake of sodium to less than 2.4 grams. On average, a mean reduction in systolic blood pressure of 2-8 mmHg is expected if dietary sodium intake is limited to no more than 2.4 grams per day.1 Further reduction of sodium to 1.5 grams is desirable for people with hypertension because it is associated with …

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Slow Respiration to Lower Blood Pressure

September 7, 2017
Slow Respiration to Lower Blood Pressure

By Omotayo Arowojolu

Peer Reviewed

Approximately 32% of American adults have high blood pressure (>140/90 mmHg),1 or hypertension, and only 54% of these individuals have well-controlled hypertension.2,3 Hypertension costs $48.6 billion each year in healthcare services, medications, and missed days of work. Additionally, one in three Americans have pre-hypertension (120-139/80-89 mmHg) and are considered at risk for developing hypertension.1 These individuals benefit from management of risk factors with changes in diet (reduced sodium), weight loss, increased physical activity, and smoking or alcohol cessation. On the …

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Should Beta Blockers be Used in Heart Failure with Preserved Ejection Fraction?

August 23, 2017
Should Beta Blockers be Used in Heart Failure with Preserved Ejection Fraction?

By Lauren Christene Strazzulla

Peer Reviewed

The lifetime risk for developing heart failure from age 55 on is 33% for men and 28.5% for women, and as the population ages, there is an increasing prevalence of this disease along with its associated health care costs . Heart failure is divisible into 2 distinct entities: those with left ventricular systolic dysfunction and those with cardiovascular compromise that does not decrease LV ejection fraction, which is termed heart failure with persevered ejection fraction (HFpEF) . While …

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When Doctors Get Personal

August 18, 2017
When Doctors Get Personal

By Leland Soiefer

Peer Reviewed

Mrs. S sat up straight and made excellent eye contact. Her tone was pleasant. She wore a colorful yellow shirt and dark green pants, and was accompanied by her husband; her gilded rings and earrings added flair to her outfit. Her neutral expression, however, stood out to me. She had seen a doctor several weeks ago regarding her first vaginal bleeding since menopause, and a uterine biopsy showing a precancerous lesion was subsequently performed. Surely by this point she had …

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Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?

April 12, 2017
Oxygen Saturation Target of 88-92% in COPD: Evidence-based Medicine?

By Christopher V. Cosgriff

Peer Reviewed

The American College of Physicians (ACP) recommends supplemental long-term oxygen therapy (LTOT) in all patients who have severe resting hypoxemia, defined as a PaO2 ≤55 mmHg or an SpO2 ≤88%. In patients with cor pulmonale or polycythemia they recommend initiation of oxygen therapy at a PaO2 ≤59 mmHg.1 Absent from the ACP recommendation is a target range to which saturation should be restored. The accepted standard of practice is restoration to a range of 88%-92%, and there are British …

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How Reliable Is Hemoglobin A1c?

April 6, 2017
How Reliable Is Hemoglobin A1c?

By Alexa Yuen

Peer Reviewed 

According to the CDC, there are 22 million people with an established diagnosis of diabetes mellitus in the United States, but more frightening is that the rate of diabetes continues to rise both nationally and globally, with predictions that 7.7% of the world’s adult population will be afflicted with the disease in 2030., Preventing, monitoring, and managing this disease is of utmost importance in responding to the growing epidemic. The hemoglobin A1c (HbA1c) blood test has become a powerful tool …

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Book Review: in-Training: Stories from Tomorrow’s Physicians

March 31, 2017
Book Review: in-Training: Stories from Tomorrow’s Physicians

By Amar Parikh, MD

Peer Reviewed

“Wounded healers. It’s a concept…inspired by the story of Chiron, a centaur in Greek mythology who was renowned for his skills as a healer. Chiron was wounded by a poisoned arrow but his immortal status sustained him…He was thus condemned to spend eternity roaming the earth in agonizing pain, healing everybody but himself….the phenomena of depression and suicide among medical students and doctors suggest that we…fit into this archetype. “

The above selection is an excerpt from a moving …

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A Trip Through the Granola Vortex

February 10, 2017
A Trip Through the Granola Vortex

By Michael J Hession

Peer Reviewed

Twenty blocks south of NYU Langone and steps east of First Avenue on 9th Street sits New York’s go-to supplier of fresh herbs, tinctures, and oils. Owned and operated since 1993 by Lata Chettri-Kennedy—The Green Witch of the East Village—Flower Power Herbs and Roots Inc. is lined floor-to-ceiling with shelves of cut and dried product in mason jars. A purple bumper sticker behind the counter proclaims “Health Care for People, Not for Profit,” and another infographic ranking peppers from …

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Gratitude: Benefits for the Soul, and the Body

February 3, 2017
Gratitude: Benefits for the Soul, and the Body

By Nicole Van Groningen, MD

Peer Reviewed

Although the “stress of the holidays” is a phrase used to refer to the multitude of to-do lists and travel obligations associated with the 6-week stretch between Thanksgiving and New Year’s Day, the pleasant emotional state associated with the season remains one of the most important positive influences on the American psyche. Chief among these warm emotions is an emphasis on gratitude for the people, relationships, opportunities, and circumstances we cherish. As the holiday season comes to a …

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What is the Evidence for Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema?

February 1, 2017
What is the Evidence for Noninvasive Ventilation in Acute Cardiogenic Pulmonary Edema?

By Jenna Conway, MD

Peer Reviewed

Introduction 

A 58-year-old man presents with worsening dyspnea and nonproductive cough for five days. Significant history includes a recent hospitalization for congestive heart failure. He is afebrile with a blood pressure of 95/55 mmHg, heart rate of 115 beats per minute, and oxygen saturation of 85% on room air. Physical exam is notable for rales bilaterally. Chest X-ray shows bilateral pulmonary infiltrates and an enlarged cardiac silhouette suggestive of cardiogenic pulmonary edema. Standard therapy is initiated with oxygen by …

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The Forbidden Fruit

January 27, 2017
The Forbidden Fruit

By Varun Narendra

Peer Reviewed

Griffith Hughes was the first to describe the grapefruit in 1750, naming it the “forbidden fruit” of Barbados for unknown reasons. Centuries later, it seems as if he may have been on to something, as grapefruit juice (GFJ) has been shown potentially to interact dangerously with a list of commonly prescribed medications. This list has steadily grown to include over 85 drugs.1 Meanwhile, the Internet is rife with anecdotes of near-death experiences attributed to drug interactions with the much-maligned fruit. …

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Optimism

January 25, 2017
Optimism

By Adam Blaisdell, MD

Peer Reviewed

Present Day – The patient is a 61 year-old male who presents with a one-week history of jaundice and intense pruritus. He has a medical history significant for hepatitis C virus (HCV) infection (genotype 1a) diagnosed 15 years ago, which was never treated. Three years prior, the patient was also diagnosed with hepatocellular carcinoma (HCC) and underwent transcatheter arterial chemoembolization (TACE) but was subsequently lost to follow-up. He has no documented evidence of cirrhosis. On this admission his total …

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