Class Act

Nothing QT (Cute) about it: rethinking the use of the QT interval to evaluate risk of drug induced arrhythmias

April 27, 2012
Nothing QT (Cute) about it: rethinking the use of the QT interval to evaluate risk of drug induced arrhythmias

By Aneesh Bapat, MD

Faculty Peer Reviewed

Perhaps it’s the French name, the curvaceous appearance on electrocardiogram (EKG), or its elusive and mysterious nature, but Torsades des pointes, a polymorphic ventricular arrhythmia, is certainly the sexiest of all ventricular arrhythmias. Very few physicians and scientists can explain its origin in an early afterdepolarization (EAD), and fewer still can explain its “twisting of the points” morphology on EKG. Despite its rare occurrence (only 761 cases reported to the WHO Drug Monitoring Center between 1983 and 1999)1,…

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A Study of Cultural Complications in the Management of Diabetes

April 18, 2012
A Study of Cultural Complications in the Management of Diabetes

By Kimberly Jean Atiyeh

Faculty Peer Reviewed

Ms. KS is a 49- year-old Bangladeshi woman with a history of diabetes mellitus and non-adherence to medical treatment or follow up, who was reluctantly brought to the Bellevue ER by her family for nausea, vomiting, and fevers for one day. Her most recent hospitalization was 9 months prior for epigastric discomfort in the setting of uncontrolled diabetes with a hemoglobin A1C of 12.4%. On arrival, her physical exam was significant for tachypnea, tachycardia, and dry mucus membranes.…

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Does the BCG Vaccine Really Work?

March 14, 2012
Does the BCG Vaccine Really Work?

By Mitchell Kim

Faculty Peer Reviewed

Mycobacterium tuberculosis, an acid-fast bacillus, is the causative agent of tuberculosis (TB), an infection that causes significant morbidity and mortality worldwide. A highly contagious infection, TB is spread by aerosolized pulmonary droplet nuclei containing the infective organism. Most infections manifest as pulmonary disease, but TB is also known to cause meningitis, vertebral osteomyelitis, and other systemic diseases through hematogenous dissemination. In 2009, there were an estimated 9.4 million incident and 14 million prevalent cases of TB worldwide, with a…

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Tales of Survival: An Open Letter to My Patient Mrs. B.

March 2, 2012
Tales of Survival: An Open Letter to My Patient Mrs. B.

By Vivek Murthy

Case report:

Mrs. B is a 68-year-old female with a PMH of small cell lung CA metastatic to the liver s/p last chemo six weeks ago presenting with RUQ pain migrating to her RLQ for the last 24 hours. Physical exam reveals a fatigued but pleasant African-American female appearing her stated age, in obvious pain that is making her eyes water. Exam is significant for R supraclavicular LAD, a distended abdomen, + Murphy’s sign, and exquisite tenderness to palpation and guarding in…

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What are the Barriers to Using Low Dose CT to Screen for Lung Cancer?

February 23, 2012
What are the Barriers to Using Low Dose CT to Screen for Lung Cancer?

By Benjamin Lok

Faculty Peer Reviewed

Lung cancer is the most common cause of cancer deaths globally and responsible for an estimated 221,120 new cases and 156,940 deaths in 2011 in the United States. Presently, the United States Preventive Services Task Force, the National Cancer Institute (NCI), the American College of Chest Physicians, and most other evidence-based organizations do not recommend screening for lung cancer with chest x-ray or low-dose helical computed tomography (CT) due to inadequate evidence to support mortality reduction. This…

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EKG Websites: A Review of the Most Viewed Websites

February 3, 2012
EKG Websites: A Review of the Most Viewed Websites

By Melissa Mroz and Rachel Bond

Faculty Peer Reviewed

The electrocardiogram (EKG) is a test not only interpreted by cardiologists.

In fact, it is usually early in the year that the new medical student is handed an EKG; top flipped down as not to “cheat” and asked to interpret the rhythmic black squiggles on red graph paper. I still remember the anxiety provoking questions asked on my Medicine Clerkship. As with many skills I thought would magically become part of my repertoire on July 1st…

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When Is Hemoglobin A1c Inaccurate In Assessing Glycemic Control?

February 1, 2012
When Is Hemoglobin A1c Inaccurate In Assessing Glycemic Control?

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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Death, Be Not Proud: The Case for Organ Donation

January 27, 2012
Death, Be Not Proud: The Case for Organ Donation

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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Male Hormonal Contraception

January 20, 2012
Male Hormonal Contraception

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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Why Are Asthma Patients Noncompliant With Their Inhalers?

January 11, 2012
Why Are Asthma Patients Noncompliant With Their Inhalers?

By Kristen Mattei

Faculty Peer Reviewed

I distinctly remember being 9 years old, sitting in my doctor’s office after a cold left me struggling for breath, doubled over and wheezing, when he told me that I had asthma. At first I didn’t believe the diagnosis, despite the fact that the albuterol inhaler he had given me was like a breath of life after running suicides on the soccer field. I wasn’t sick or weak! My father insisted I needed to “build my breath up,” and…

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Dance Therapy in Parkinson’s Disease: Can the Argentine Tango Improve Motor Function?

December 2, 2011
Dance Therapy in Parkinson’s Disease: Can the Argentine Tango Improve Motor Function?

By Neha Jindal

Faculty Peer Reviewed

Parkinson’s disease (PD) is a progressive neurodegenerative movement disorder that affects over 1 million people in the United States. People with PD often demonstrate postural instability, gait difficulties, and impaired functional mobility, which can lead to falls and decreased quality of life. Medical treatments for PD do not fully address gait and balance issues and, consequently, additional approaches are needed. One approach that has recently emerged in clinical studies is the use of dance, particularly the Argentine tango, as…

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Does Cranberry Juice Prevent Urinary Tract Infections?

November 9, 2011
Does Cranberry Juice Prevent Urinary Tract Infections?

By Jessie Yu

Faculty Peer Reviewed

A healthy 21-year-old female college student presents to clinic after one day of dysuria and increased frequency. You diagnose her with a recurrent urinary tract infection (UTI), and as you hand her a prescription for empiric antibiotic treatment, she asks you if drinking cranberry juice will prevent these in the future…

Drinking cranberry juice to prevent urinary tract infections (UTIs) has been a traditional folk remedy for hundreds of years. Stroll into any New York City pharmacy and…

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