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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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Grand Rounds: “Innate Immunity and Viral Pathogenesis”

December 4, 2007
Grand Rounds: “Innate Immunity and Viral Pathogenesis”

Commentary by Urania Rappo, PGY-2

This week’s Medicine Grand Rounds guest lecturer was Dr. Robert Finberg, currently Chair of the Department of Medicine at the University of Massachusetts Medical School. He earned his MD from Albert Einstein College of Medicine and trained in Medicine at Bellevue Hospital starting in 1974. He was a Fellow in Infectious Diseases at Harvard Medical School, and there established a rich research career over the ensuing twenty years. Dr. Finberg’s research focuses on host-microbial interactions, defining the cell surface proteins…

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FDA Approves Raltegravir- A First in New Class of HIV Medications

November 14, 2007
FDA Approves Raltegravir- A First in New Class of HIV Medications

Commentary by Helen Kourlas PharmD, Pharmacology Section Editor

On October 16th the FDA announced the approval of raltegravir (Isentress®) for the treatment of Human Immunodeficiency Virus (HIV)-1 infection in combination with other antiretroviral agents. The use of raltegravir is recommended for patients who have HIV-1 strains resistant to multiple antiretroviral medications. Raltegravir belongs to a new pharmacologic class of antiretrovirals called HIV integrase strand transfer inhibitors. Integrase is one of the three enzymes necessary for the HIV-1 virus to replicate, and integrase inhibitors can stop the…

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Grand Rounds: “Pseudomonas aeruginosa Pathogenesis-Studies of an Opportunist”

November 9, 2007
Grand Rounds: “Pseudomonas aeruginosa Pathogenesis-Studies of an Opportunist”

Welcome to our Grand Rounds Series. Each week, we plan to post a summary of the week’s Medicine Grand Rounds lecture. The summaries are reviewed and approved by the grand rounds speaker prior to posting.

Commentary by Ryan Farley MD, PGY-3

This week’s Medicine Grand Rounds guest lecturer was Dr. Barbara Kazmierczak , currently Associate Professor of Medicine and Microbial Pathogenesis at Yale University School of Medicine.  Dr. Kazmierczak is the principal investigator for several NIH grants studying Pseudomonas aeruginosa virulence…

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Rifaximin: A useful drug for travelers’ diarrhea

September 28, 2007
Rifaximin: A useful drug for travelers’ diarrhea

Commentary by Sumathi Sivapalasingam MD, NYU Division of Infectious Diseases

Rifaximin is an oral semi-synthetic analog of rifampin which is essentially not absorbed (bioavailability <0.4%) making it useful for the treatment of intra-luminal intestinal infections, while having little systemic side effects. There are several advantages to using rifaximin: it does not appear to lead to bacterial resistance, a problem frequently encountered with rifampin; colonic fecal flora is minimally altered; and it has a safety profile similar to placebo. Like other rifamycins, it exerts…

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Recent Legionella Outbreak in the Bronx

September 20, 2007
Recent Legionella Outbreak in the Bronx

Commentary by Elizabeth Hackett MD, PGY-3

On July 25th, 2007, the NYC Department of Health released an advisory requesting that all New York City physicians maintain a high index of suspicion for Legionnaires’ disease in patients presenting with community acquired pneumonia. This advisory was prompted by 27 cases of Legionella pneumonia reported in the Parkchester neighborhood of the Bronx during the fall of 2006 (zip code 10462 ). This cluster of cases represented an increase in incidence of the disease to 16.6 cases/100,000 in the…

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Reemergence of the Great Imitator: Overview of the Diagnosis and Treatment of Syphilis

August 17, 2007
Reemergence of the Great Imitator: Overview of the Diagnosis and Treatment of Syphilis

Commentary by Rosemary Adamson, PGY2,  Deena Altman PGY-1 and Harold Horowitz, Professor of Medicine, Section of Infectious Diseases 

Syphilis is back! You know the drill: an 80-something year old man presents with dementia and you send the TSH, B12 and RPR and get a head CT, all the while expecting some microvascular disease & age-related cortical volume loss. Imagine my surprise when my VA patient had a positive RPR and then the lumbar puncture returned a positive VDRL. To be fair, he wasn’t…

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The HPV vaccine: Recommended in the U.S., but required in Virginia

May 8, 2007
The HPV vaccine: Recommended in the U.S., but required in Virginia

Commentary By: Marshall Fordyce, PGY-3

Now that the dust has settled in Texas and Virginia, let’s clarify the role of the human papilloma virus (HPV) vaccine in our clinics. An excellent article in last week’s JAMA by its Editor-In-Chief, Dr. Catherine DeAngelis, and Lawrence Gostin, JD, highlights how the recent push for compulsory vaccination – a significant step beyond CDC recommendations – defied precedent and threatened public confidence in our national vaccine policy. Now, after the tussle of aggressive pharmaceutical lobbying and the public outcry…

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Is the PPD obsolete?

May 1, 2007
Is the PPD obsolete?

In February of this year the New York City Department of Health released a new policy paper indicating that they will no longer use the PPD as a screening tool for tuberculosis in their clinics.They have switched to the QuantiFERON-TB Gold, (QFT-G), a blood test. This test is an ELISA, which measures interferon-gamma secretion by t-lymphocytes in response to tuberculosis specific antigens. The test requires heparinized whole blood and must be processed within 12 hours of the blood draw.

The test exposes the patients t-lymphocytes…

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