By Joseph Larese

Faculty Peer Reviewed

Hemoglobin A1C (HbA1c) is an invaluable tool for monitoring long-term glycemic control in diabetic patients. However, many clinicians managing diabetics have encountered the problem of HbA1c values that do not agree with fingerstick glucose logs. Before suspecting an improperly calibrated glucometer or poor patient record keeping, it is useful to consider the situations in which HbA1c may be spuriously elevated or depressed. These issues are best understood after reviewing how HbA1c is defined and measured–topics fraught with considerable confusion.…

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By Tracie Lin

Faculty Peer Reviewed

DEATH, be not proud, though some have callèd thee

Mighty and dreadfull, for, thou art not so;

For those whom thou think’st thou dost overthrow

Die not, poore death, nor yet canst thou kill me.

From rest and sleepe, which but thy pictures bee,

Much pleasure, then from thee, much more must flow,

And soonest our best men with thee doe goe,

Rest of their bones, and soul’s deliverie.

Thou art slave to Fate, Chance, kings, and desperate…

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By Kaley Myer, Class of 2012

Faculty Peer Reviewed

As a female, I like the idea of males taking hormonal contraceptives. In a semi-sadistic way, I relish the idea of a man taking a pill every day to prevent impregnation of my gender. Traditionally, contraception has been a female responsibility, from diaphragms to oral contraceptive pills to intrauterine devices. Male condoms, coitus interruptus, and the more permanent vasectomy require male participation, but these methods do not dominate the contraceptive market. Indeed, couples are encouraged to…

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By Santosh Vardhana, MD

A 36-year-old obese male with hypertension and hyperlipidemia presents to the ER with new knee pain, swelling, and erythema.  Joint aspiration reveals negatively birefringent crystals.  He is started on oral prednisone.

A 26-year-old woman with lupus presents to ER with edema, hematuria, and fevers.  On exam she hypertensive, febrile to 100.4C, and has periorbital and lower extremity edema.  Urine dipstick reveals 2+blood and protein.  She is started on IV methylprednisolone.

A 60-year-old man with HIV on HAART presents to the ER…

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By Sara-Megumi Naylor

Faculty Peer Reviewed

“Tell me…If you were ever unable to make your own decisions about your medical care, is there someone you would trust to make those decisions for you?”

There is silence.                

But then a response. We discuss. I record.

Then I proceed.

“I want to know…Have you given any thought to the goals of your hospital stay? I want to know what’s important to you.”

The only audible sounds in the quiet hospital room are the shallow…

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By Keri Herzog, MD
Faculty Peer Reviewed

The patient is a 62-year-old male who presented to an outpatient medical clinic complaining of a growing, slightly painful, periumbilical mass, and mild lower gastrointestinal discomfort over the last 4 months. On examination, the patient appeared cachectic with an erythematous soft nodule within the umbilicus. Laboratory evaluation revealed anemia (Hct: 28%) and colonoscopy detected a tumor in the sigmoid colon. Both biopsies of the sigmoid mass and the umbilical nodule revealed the presence of adenocarcinoma. Due to the…

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By Jonathan Leventhal

Faculty Peer Reviewed

Polypharmacy has become an integral part of daily life for millions of chronically ill patients worldwide, and rightfully so. Evidence-based studies have repeatedly demonstrated that multiple drugs are required for optimal therapeutic management in chronic diseases including diabetes, hypertension, and heart disease. A typical patient with cardiovascular disease will likely be on aspirin, a statin, an ACE inhibitor, a diuretic, a calcium channel- or beta-blocker, and possibly antidiabetic medications. Cardiovascular disease is only one area in which effective…

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By Andrea Mignatti , MD

Faculty Peer Reviewed

Among all the new medical therapies, this one will probably not be the most elegant or refined that you will read about. But it just may be one of the most unconventional ones you will come across.

From our experiences working on busy hospital wards, we know that Clostridium difficile colitis is an extremely serious infection that is becoming more prevalent due to the development of new hyper-virulent strains (toxinotype III BI/NAP1/027). It has been…

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