Class Act

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…

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…

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?

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…

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…

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…

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…

Read more »

When Clopidogrel Fails…

March 10, 2010
When Clopidogrel Fails…

Marisa Mizus

Faculty peer reviewed

Clopidogrel (Plavix) has been the standard of care for patients with coronary artery disease following percutaneous coronary intervention (PCI) for the past decade.  Although it is a successful antiplatelet treatment in many patients, like any hero, it has a weakness: formation of its active metabolite depends on two hepatic cytochrome P450 (CYP450)-dependent steps.  Clopidogrel resistance, or non-response, is correlated with an increased risk of major adverse cardiovascular events, including reinfarction and stent thrombosis.(1)  It…

Read more »

Zolpidem and Uncontrollable Nocturnal Eating Binges

February 24, 2010
Zolpidem and Uncontrollable Nocturnal Eating Binges

John Cruz

Faculty peer reviewed

A number of studies have shown that zolpidem (Ambien), the most commonly prescribed sleep-inducing medication on the market, can produce uncontrollable nocturnal eating behavior among users.  Sleep related eating disorder (SRED) is characterized by partial arousals from sleep to ingest food, usually within the first three hours after sleep onset, occurring one to six times per night.1  Patients describe an “automatic” inclination to eat and an inability to return to sleep…

Read more »

What Should We Know About Bedbugs?

February 18, 2010
What Should We Know About Bedbugs?

Jia Huang

Faculty peer reviewed

A 46 year-old Asian female presented with recurrent pruritic erythematous papules in a partially linear pattern over her forearms, face, and trunk. Each papule measured about 3/4 inch in diameter. The eruption first appeared two to three weeks ago and simultaneously appeared over these areas. She denies using any new skin products or taking any new medication. Travel history is positive for a recent trip to Los Angeles. Bedbugs were suspected and the patient…

Read more »

How Do You Advise the Balding Patient?

January 13, 2010
How Do You Advise the Balding Patient?

Sagar Mungekar

Faculty Peer Reviewed

The incidence of male pattern hair loss can reach almost 100% in some ethnic groups.1, 2 While treatment of the condition is usually deferred to dermatologists, it is often the primary care physician (PCP) who is first approached for advice. Several medical and surgical treatments exist for male pattern hair loss. Herbal supplements and products on infomercials make cursory non-FDA-approved claims of hair growth. Minoxidil, once developed for hypertension, is available over the counter…

Read more »

What is the Role of Drug Therapy in Treating Obesity?

November 19, 2009
What is the Role of Drug Therapy in Treating Obesity?

Arlene Chung

Faculty Peer Reviewed

Despite the high prevalence of obesity1 and its associated morbidity2 and mortality 3,4, it represents one of the most difficult chronic conditions to treat. Barriers include a metabolically toxic environment, a history of ill-fated weight-loss regimens, and a general view of obesity as primarily a social, not a medical problem. 5 Deep down, the belief that obesity really is the result of gluttony and sloth probably persists. However, as we learn more about the…

Read more »