Class Act

The Doctor Versus the Google Search: How to Enrich the Provider-Patient Relationship in the Age of Internet Health Information

October 15, 2010
The Doctor Versus the Google Search: How to Enrich the Provider-Patient Relationship in the Age of Internet Health Information

By Suzanne MacFarland, MS4

Faculty Peer Reviewed

 There is a stranger in the clinic room, and it is not your patient.  This stranger is a multifaceted, opinionated entity with likely conflict-of-interest.  This new acquaintance has already spoken to your patient and influenced the direction of this visit in the form of health statistics, symptom explanations, and feared complications.  Now your patient wants to know what you think.  In an age when patients will often have diagnosed their problem before they walk through a clinic door, …

Read more »

Does Vitamin D Supplementation Reduce the Risk of Cardiovascular Events?

October 6, 2010
Does Vitamin D Supplementation Reduce the Risk of Cardiovascular Events?

By Karina Vivar, MS4

Faculty Peer Reviewed

Vitamin D deficiency is highly prevalent in the U.S. and worldwide, and the problem appears to be worsening.  By definition, vitamin D deficiency is a serum 25-hydroxyvitamin D (25-OH D) level of less than 20 ng/mL.  Vitamin D insufficiency is defined as a serum 25-OH D level from 20 to 30 ng/mL.  Unless there is a high risk for fracture and a clinical suspicion of deficiency, it is not routine to screen for vitamin D deficiency, due to …

Read more »

Pass the Salt? A Look at Population-Based Sodium Reduction Interventions

September 24, 2010
Pass the Salt? A Look at Population-Based Sodium Reduction Interventions

By Ryan Macht, MS4

Faculty Peer Reviewed

On January 11th, the New York City Health Department announced its plans for the National Salt Reduction Initiative, a public health proposal designed to decrease sodium consumption throughout the country. High levels of dietary sodium have frequently been associated with increased rates of hypertension and adverse cardiovascular events. The mean salt intake in the United States is extremely high in all age groups and well above the current recommendations of 5.8 g (2300 mg sodium) for those under …

Read more »

The Heart in Acromegaly

September 1, 2010
The Heart in Acromegaly

By Ari Pollack, MD

Faculty Peer Reviewed

The onset of acromegaly is subtle, and its progression is usually very slow. In fact, the usual interval from the onset of symptoms until diagnosis is about twelve years. The manifestations of acromegaly result from excessive secretion of growth hormone (GH), which targets the liver, resulting in stimulation of hepatic secretion of insulin-like growth factor-1 (IGF-1), which causes many of the clinical manifestations of acromegaly.  The most common cause of acromegaly is a functional pituitary adenoma. The effects …

Read more »

Do I have a Concussion?

July 21, 2010
Do I have a Concussion?

By Radhika Sundararajan, M.D., Ph.D

Faculty Peer Reviewed

A healthy 18 year-old female presents to Urgent Care after slipping and falling this morning in the bathroom and hitting her head on the tile floor. She denies any loss of consciousness, vomiting, or current neurological deficits, but does have a mild occipital headache where she struck her head. She has heard a lot about recent research regarding concussions in young athletes and asks if you think she suffered a concussion and what this means for her.…

Read more »

Cannabinoid Hyperemesis: High on the Differential for Intractable Vomiting

July 15, 2010
Cannabinoid Hyperemesis: High on the Differential for Intractable Vomiting

By Sarah A. Buckley & Nicholas M. Mark

Faculty Peer Reviewed

An 18-year-old male presents complaining of crampy abdominal pain, nausea, and intractable vomiting for the past year. The symptoms are episodic, lasting several weeks and remitting for weeks to months. The patient states that his abdominal pain is 10 out of 10 in severity, and that he has been vomiting up to 20 times each day. He has been evaluated at multiple hospitals, and he has had numerous upper endoscopies, colonoscopies, swallowing studies, and …

Read more »

Marijuana and Multiple Sclerosis- Half-Baked? The Evidence Behind Cannabinoid Use for the Treatment of Pain and Spasticity in MS Patients

June 3, 2010
Marijuana and Multiple Sclerosis- Half-Baked? The Evidence Behind Cannabinoid Use for the Treatment of Pain and Spasticity in MS Patients

By Maura RZ Madou, MD

Faculty Peer Reviewed

When the New Jersey legislature approved a measure to legalize the use of marijuana for patients with chronic illnesses early this year, multiple sclerosis (MS) patient Charles Kwiatkowski, of Hazlet, N.J., rhetorically asked the New York Times; “The M.S. Society has shown that this drug will help slow the progression of my disease. Why would I want to use anything else?”1 New Jersey was the 14th state in the nation to approve such legislation. Does the drug …

Read more »

Oral Contraceptive Pills: Is It Really Safe to Eliminate Your Period?

May 21, 2010
Oral Contraceptive Pills: Is It Really Safe to Eliminate Your Period?

By Rachel Edlin, MD

Faculty peer reviewed

A 29-year-old female patient with a history of iron deficiency anemia and heavy menstrual periods comes into the clinic for a regular visit. She is tired of iron supplementation and its associated constipation. As she is currently on oral contraceptive pills, you recommend using these to reduce her menstrual period to four times a year. She asks, “Is that really safe?”

Is menstruation necessary?

Monthly menstruation is not the historical norm. Compared with modern women, women in prehistoric …

Read more »

Revisiting the USPSTF Breast Cancer Screening Guidelines: Ethics, and Patient Responsibilities

May 6, 2010
Revisiting the USPSTF Breast Cancer Screening Guidelines: Ethics, and Patient Responsibilities

David Shabtai

Faculty Peer Reviewed

 In a bold move, the U.S. Preventive Services Task Force recently changed their breast cancer screening guidelines – recommending beginning screening at age 50 and even then only every other year until age 75. Bold, because the Task Force members are certainly aware of the media circus that ensued when in 1997, an NIH group issued similar guidelines, prompting comparisons to Alice in Wonderland. The new guidelines, recommend “against routine screening mammography in women aged 40-49 years” as well as …

Read more »

Motivational Interviewing: Can You Really Change Behaviors?

April 27, 2010
Motivational Interviewing: Can You Really Change Behaviors?

Emily Stamell

Faculty peer reviewed

As a well-trained fourth year medical student, I inquire about smoking habits as part of almost all my patient encounters. Yet, I do not recall properly counseling a patient on smoking cessation aside from the one liner “You know you should quit, right?” During first and second year of medical school we are taught the stages of change model, which is just as obscure two years later as cell signaling pathways. I was recently introduced to what seemed like an …

Read more »

How Easily is Tuberculosis Spread?

March 31, 2010
How Easily is Tuberculosis Spread?

Molly Cason

Faculty peer reviewed

In a city of over 8 million people, New York City has an annual tuberculosis case rate of 11.4 per 100,000 people, which is more than twice the national average.  Seventy-one percent of these cases occur in people who were born outside the United States.1 As a student, I had a patient (Y) who was being evaluated for active tuberculosis because he is a household contact of a person (X) known to have active multi-drug resistant tuberculosis. I wondered what …

Read more »

The Evolution of Cardiac Biomarkers: What’s on the Horizon?

March 24, 2010
The Evolution of Cardiac Biomarkers:  What’s on the Horizon?

Rushi Parikh

Faculty peer reviewed

Cardiac biomarkers have historically been a mainstay of the diagnostic criteria of acute coronary syndrome (ACS). Previously utilized cardiac biomarkers include aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and myoglobin; now more often troponin and to a lesser extent creatine kinase-MB are the principal biomarkers used to diagnose ACS.1

Myocardial necrosis and the subsequent loss of cardiomyocyte membrane integrity lead to the release of cardiac biomarkers into the peripheral circulation. Biomarkers, however, do not indicate the cause of myocardial necrosis, and …

Read more »