Class Act

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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Why Do We Do What We Do: Common Hospital Practices Revealed

February 27, 2015
Why Do We Do What We Do: Common Hospital Practices Revealed

By Dana Zalkin

Peer Reviewed

A code is called on the overhead speaker and the on-call teams rush to the scene to see what awaits them. EKG leads are being placed, medications are being ordered, and labs are being drawn. A medical student stands with a bag of ice, ready to grab the arterial blood gas (ABG) and run it down to the lab. “Why do we put the ABG on ice right away?” the student wonders. But in this moment, while a patient teeters …

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Acupuncture and Immune Modulation

January 9, 2015
Acupuncture and Immune Modulation

By Michael Lee, MD

Peer Reviewed

Clinical Case: Ms. A, an 84-year-old retired physician with a history of bronchiectasis of unclear etiology, is admitted with the chief complaint of chronic cough. Further inquiry into her medical history reveals that she contracted malaria as a child while living in Korea. She had been prescribed chloroquine by multiple doctors, but her symptoms of fevers and night sweats did not improve. It was a trial of acupuncture therapy, she says, that finally cured her of malaria.

Acupuncture refers …

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Falls in Older Adults—Risk Factors and Strategies for Prevention

October 15, 2014
Falls in Older Adults—Risk Factors and Strategies for Prevention

By Joseph Plaksin

Peer Reviewed

Falls are a major health problem for older adults. Various reviews and meta-analyses have estimated that 30% of people over age 65 and 50% of people over age 85 who live in the community will fall at least once. The prevalence of falls is even higher in long-term care facilities, occurring in more than 50% of people over age 65 . Fall-related injuries occur in 10-40% of falls and can range from minor bruises or lacerations to wrist …

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It Was Almost Called the Cylinder (& Other Who-Knew Facts about the Stethoscope)

October 10, 2014
It Was Almost Called the Cylinder (& Other Who-Knew Facts about the Stethoscope)

By Cindy Fang, MD

Peer Reviewed

“A wonderful instrument…is now in complete vogue in Paris…It is quite a fashion, if a person complains of cough, to have recourse to the miraculous tube which however cannot effect a cure but should you unfortunately perceive in the countenance of the doctor that he fancies certain symptoms exist it is very likely that a nervous person might become seriously indisposed and convert the supposition into reality.” —The London Times, September 19, 1824.

The novel medical instrument described …

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From The Archives: Ethical Considerations on the Use of Fear in Public Health Campaigns

October 9, 2014
From The Archives: Ethical Considerations on the Use of Fear in Public Health Campaigns

Please enjoy this post from the archives dated November 23, 2011

By Ishmeal Bradley, MD

Faculty Peer Reviewed

The goal of public health is to prevent or minimize disease and injury on a population level. How to achieve this end has changed over time, though. In previous decades, communicable diseases posed the greatest health risks. Consequently, public health officials used the tools of isolation, quarantine, and (forced) vaccination to combat these threats. Today, however, the major causes of morbidity and mortality are chronic conditions, many …

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