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Case Presentation: Acute Rheumatic Fever

August 29, 2008
Case Presentation: Acute Rheumatic Fever

Commentary by Bani Chander MD, PGY-3. and Ben Bergman MD, PGY-3

Please also see last week’s Class Act Post on the pathogenesis of Rheumatic Heart Disease 

A 34-year-old Hispanic male presents with the chief complaint of chest pain. The patient had been well until 10 days prior to admission, when he developed a severe sore throat accompanied by fever, rigors, and diffuse myalgias. There was no associated cough. Three days later, he visited his primary care physician at an outside facility and was prescribed…

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Class Act: Pathogenesis of Rheumatic Heart Disease

August 14, 2008
Class Act: Pathogenesis of Rheumatic Heart Disease

Class act is a feature of Clinical Correlations written by NYU 3rd and 4th year medical students. Prior to publication, each commentary is thoroughly reviewed for content by a faculty member.

Commentary by Matt Stein MS-4; Reviewed by Harold Horowitz MD, Professor, NYU Division of Infectious Diseases and Immunology

In general, acute rheumatic fever (ARF) is a delayed sequela of a group A streptococcus (GAS) pharyngeal infection. Following an initial throat infection, which is often either untreated or incompletely treated, there exists a latent period of two…

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Class Act: What is the risk of microbial keratitis in overnight wear of soft contact lenses?

July 11, 2008
Class Act: What is the risk of microbial keratitis in overnight wear of soft contact lenses?

Class act is a feature of Clinical Correlations written by NYU 3rd and 4th year medical students. These posts focus on evidenced based answers to clinical questions related to patients seen by our students in the clinics or on the wards. Prior to publication, each commentary is thoroughly reviewed for content by a faculty member.

Commentary by Frank Siringo, NYU Medical Student

Soft contact lens wear is the primary risk factor for microbial keratitis, a potentially vision-threatening infection of the cornea, with a…

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Breaking news: FDA issues new Boxed Warning for Fluoroquinolones

July 10, 2008
Breaking news: FDA issues new Boxed Warning for Fluoroquinolones

Commentary by Marilena S. Antonopoulos, PharmD, Pharmacology Editor

On July 8th, the FDA notified the manufacturers of fluoroquinolone antimicrobial drugs that a Boxed Warning in the product labeling and a Medication Guide for patients concerning the increased risk of tendinitis and tendon rupture is necessary. The FDA conducted a new analysis of the available literature and post-marketing adverse event reports which reconfirms that the use of fluoroquinolones is associated with an increased risk of tendon rupture.

The risk of developing fluoroquinolone-associated tendinitis and tendon rupture…

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Admission screening cultures for MRSA: Is it time?

July 9, 2008
Admission screening cultures for MRSA: Is it time?

Commentary by Howard Leaf, M.D. Assistant Professor, Division of Infectious Diseases and Immunology 

Pressure continues to build for healthcare facilities to act to decrease hospital-acquired infections, particularly those associated with MRSA. This is partly data-driven, with one study reporting that 25% of patients acquiring MRSA colonization during a hospitalization subsequently become infected . The call to act is also partly a political response to concerns in the lay press about “superbugs” wreaking havoc both in hospitals and in the community. Seven states have…

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Neutropenic Precautions Demystified

June 13, 2008
Neutropenic Precautions Demystified

Commentary by Rachana Jani MD, PGY-1 and Neal Steigbigel MD, Professor of Medicine (Infectious Diseases/Immunology)

Rachana Jani MD:  Walking onto an oncology floor, one cannot help but notice the precautionary signs that segregate these patients from the rest of the hospital. “No fresh fruits or flowers.” “Neutropenic isolation, please see nurse before entering.” The idea of neutropenic precautions first emerged in the 1960s when myelosuppressive therapy came to the forefront of cancer treatment. It only made sense that patients with an impaired immune…

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Should H. pylori Eradication Be Confirmed?

June 12, 2008
Should H. pylori Eradication Be Confirmed?

Commentary by Fritz Francois, MD, MS, NYU Division of Gastroenterology

Humans are essentially the only reservoir for Helicobacter pylori, which is estimated to colonize the stomach of about half the world’s population (1). Although the bacteria generally do not invade the mucosa, attachment to the epithelium leads to an inflammatory reaction with neutrophils, lymphocytes, plasma cells, and macrophages. Over time, the persistent inflammation leads to changes in the gastric mucosa that may predispose to the development of dysplasia(2).

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Some say tomato, some say nationwide outbreak of Samonellosis

June 10, 2008
Some say tomato, some say nationwide outbreak of Samonellosis

Commentary by Chirayu Gor, MD

The CDC has issued an alert regarding the outbreak of a rare type of Salmonella, termed Salmonella Saintpaul. Since mid-April, over 140 persons have been identified in 16 states with this uncommon serotype of Salmonella. Preliminary investigation has implicated tomatoes.

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The Rational Clinical Examination: Does This Patient with Diabetes Have Osteomyelitis of the Lower Extremity?

March 28, 2008
The Rational Clinical Examination: Does This Patient with Diabetes Have Osteomyelitis of the Lower Extremity?

Commentary by Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

The most recent installment in JAMA’s Rational Clinical Exam Series seeks to determine the accuracy of the history, physical exam, radiology and laboratory in making the diagnosis of osteomyelitis in diabetics. This is relevant given its frequency of occurrence and its cost and since the gold standard for diagnosis, namely a bone biopsy and culture, is less than optimal for a variety of reasons.

Less than 10% of the…

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HotSpots: Promed

March 7, 2008
HotSpots: Promed

Welcome to HotSpots, a new feature of Clinical Correlations. In this series, we intend to highlight unique websites of interest to the medical profession. Feel free to make suggestions for sites that should be featured in this series by clicking the comment field or sending us an email.

Commentary by Shrujal Baxi MD, NYU Chief Resident

http://www.healthmap.org/promed 

If you don’t know what the Chikungunya virus is or you want to know where the Plague is killing people in the world today, then this…

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Measles Alert!

February 20, 2008
Measles Alert!

Commentary by Rosemary Adamson MD, PGY-2

Be on the look-out for measles! New York City’s Department of Health and Mental Hygiene (DOHMH) issued a measles alert at the end of last November because there were 5 confirmed cases of measles being imported from abroad in 2007 to NYC. The DOHMH wished to raise healthcare provider awareness of measles, especially in travelers. Coming from the UK, this alert is close to my heart, as Britain has been battling with reduced uptake of the MMR vaccine and consequent…

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Meeting Perspectives: Annual Meeting of the Infectious Diseases Society of America (IDSA) October, 2007

December 13, 2007
Meeting Perspectives: Annual Meeting of the Infectious Diseases Society of America (IDSA)  October, 2007

Commentary by Neal Steigbigel MD, Professor of Medicine (Infectious Diseases/Immunology)

Methicillin resistant Staphylococcus aureus (MRSA) was a hot topic at this year’s IDSA meeting. The CA (community-acquired)-MRSA strains are spreading rapidly in the United States causing largely soft tissue infections, but also other infections such as serious necrotizing pneumonia. Clinicians can no longer rely on demographics in predicting which patient is at high risk for MRSA when an individual appears with a suspected staph infection. If the infection appears serious and is…

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