Class Act

Medicine’s Favorite Default Diagnosis: Non-compliance

August 2, 2012
Medicine’s Favorite Default Diagnosis: Non-compliance

By Robert Keller

Faculty Peer Reviewed

In a small examination room on the Ambulatory Care floor of a large hospital in Brooklyn, I greet Ms. S, a 53-year-old Jamaican woman, as she walks through the door and plops herself down in the chair across from me. Having spent 20 minutes perusing her chart, I know that she suffers from morbid obesity, uncontrolled hypertension (blood pressure 165/95), and terrible diabetes (A1c 13.8%). I have already concluded that her worsening condition over the past 5 years, despite …

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Bystander CPR: How Much Does It Help?

July 18, 2012
Bystander CPR: How Much Does It Help?

By Andrew L. Weinstein

Faculty Peer Reviewed

You have just completed a certification course in basic life support and are competent at performing cardiopulmonary resuscitation (CPR) using chest compressions, a CPR mask, a bag-valve mask with impedance threshold device, and an automated external defibrillator (AED), all interventions recommended by the American Heart Association (AHA) to improve circulation following a sudden cardiac arrest. On your way home from the training center you see a man collapse and rush over to find him unresponsive, not breathing, and …

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How Bad is Binge Drinking, Really?

July 12, 2012
How Bad is Binge Drinking, Really?

By Patrick Olivieri

Faculty Peer Reviewed

Alcohol is a well-established part of our culture,as a social lubricant or a way to wind down at the end of the day. Recently, however, binge drinking (4 or more drinks for a woman, 5 or more drinks for a man) has been rapidly increasing, with as many as 32% of Americans reporting at least occasional bingeing. Additionally, men have been shown to binge drink 30% of the time when they go out socially.It is well known that alcoholism …

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Gout: A Disease of the Blessed or a Blessing in Disguise?

June 8, 2012
Gout: A Disease of the Blessed or a Blessing in Disguise?

By Krithiga Sekar

Faculty Peer Reviewed

“The patient goes to bed and sleeps quietly until about two in the morning when he is awakened by a pain which usually seizes the great toe, but sometimes the heel, the calf of the leg or the ankle… so exquisitely painful as not to endure the weight of the clothes nor the shaking of the room from a person walking briskly therein.”

—Thomas Sydenham  (1683)

Gout, an excruciatingly painful but relatively benign form of arthritis in the modern …

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BiDil: The Future of Medicine or a Return to a Dark Past?

May 31, 2012
BiDil: The Future of Medicine or a Return to a Dark Past?

By Christopher David Velez, MD

Faculty Peer Reviewed

Given the traumatic and often criminal role that medicine and the larger scientific community played in some of the most shameful acts of the 20th century, it is natural that the consequences of these collaborations have continued to reverberate to the present day. The chills sent down our spines can be sparked from reading treatises purporting to demonstrate the undeniable genetic evidence of racial superiority, or from the revulsion towards the degrees of complicity needed for the …

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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 recommendation, …

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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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