Diagnostic Challenges in Latent Tuberculosis Infection: A Brief Review of Available Tests and their Appropriate Use

July 15, 2015
Diagnostic Challenges in Latent Tuberculosis Infection: A Brief Review of Available Tests and their Appropriate Use

By: Miguel A. Saldivar, MD

Peer Reviewed 

“Indeterminate.” Many clinicians have expressed frustration when reading this word on a Quantiferon-TB Gold test result. The obligate follow-up question is: what is the next best step? Repeat the Quantiferon? Ignore it altogether and perform a Tuberculin Skin Test (TST) instead? Even worse, what happens when both tests are performed with discordant results? In order to answer some of these questions, this article begins with a very brief overview of Mycobacterium tuberculosis (TB) infection epidemiology. This is followed …

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Primecuts – This Week In The Journals

July 13, 2015
Primecuts – This Week In The Journals

By David Valentine, MD

Peer Reviewed

In a busy week, here’s some world news highlights: After a month of dramatic drops in the Chinese markets, finances have begun to stabilize, but at the cost of many families’ savings; Greece offered the EU a new plan for a return to fiscal sustainability; the Syrian refugee crisis continued to worsen, with many fleeing into neighboring countries; and Scott Walker added his name to the list of GOP presidential candidates.

Liraglutide for a bit less weight

With obese …

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Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate

July 10, 2015
Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate

By Shannon Chiu, MD

Peer Reviewed

The annual incidence of infective endocarditis (IE) is estimated to be 3 to 9 cases per 100,000 persons in developed countries . Neurologic complications are the most severe and frequent extracardiac complications of IE, affecting 15-20% of patients . They consist of 1) ischemic infarction secondary to septic emboli from the valvular vegetation, which can eventually undergo hemorrhagic transformation; 2) focal vasculitis/cerebritis from septic emboli obstructing the vascular lumen, which can then develop into brain abscess or meningoencephalitis; 3) …

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Primecuts – This Week In The Journals

July 7, 2015
Primecuts – This Week In The Journals

By Rina Mauricio, MD

Peer Reviewed

This past week saw the coming and going of one of the most significant and dreaded days of the year, at least within the healthcare system. July 1 signals a transition point in medical training, whether that be from student to intern, intern to resident, or resident to fellow/attending. This time last year a new class of interns bonded over the excitement of starting residency while trying to savor their last few days of summer. They soon after learned …

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From the Archives: Myth vs. Reality: The July Effect

July 1, 2015
From the Archives: Myth vs. Reality: The July Effect

Please enjoy this post from the archives dated August 12, 2012

By Mark Adelman, MD

Faculty Peer Reviewed

Another July 1st has come and gone, marking the yearly transition in US graduate medical education of interns to junior residents, junior residents to senior residents, and senior residents to fellows. With this annual mid-summer mass influx of nearly 37,000 interns and other trainees taking on new clinical responsibilities, learning to use different electronic medical record systems and navigating the other idiosyncrasies of unfamiliar institutions, one …

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Primecuts – This Week In The Journals

June 29, 2015
Primecuts – This Week In The Journals

By Olivia Begasse De Dhaem, MD

Peer Reviewed

According to the latest data from UNHCR, the United Nations Refugee Agency, war and persecution displaced a total of 59.4 million people in 2014, primarily in developing countries. As the number of asylum-seekers fleeing from countries like Syria and Eritrea to Europe increases, the E.U. gave up on the plan for mandatory quotas to spread the refugees across the 28 E.U. countries, and suggested a voluntary program instead. Although there was no mass deportation after …

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Mystery Quiz-The Answer

June 19, 2015
Mystery Quiz-The Answer

Vivian Hayashi MD, Robert Smith MD

The answer to the mystery quiz is methicillin-resistant S. aureus (MRSA) pneumonia. The initial CXR (image 4) showed increased density in the area of the left hilum, hinting at a process in the superior segment of the left lower lobe. The next CXR (image 5) showed an airspace process in the left lower lobe that had rapidly evolved over 2 days. An interstitial process can be seen, as well, along with airspace disease (image 5, arrow). In addition, there …

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Mystery Quiz

June 18, 2015
Mystery Quiz

Vivian Hayashi MD, Robert Smith MD

The patient is a 46 year old female who presented to the emergency room with breathlessness, productive cough, subjective fever, and myalgia for one week. Her history was notable for mild persistent asthma treated with tiotropium, mometasone, formoterol, and albuterol as needed. The patient was homeless and lived in a shelter. She was poorly compliant with her medications. In the ER, the patient had a pulse rate of 102 bpm, was afebrile with normal blood pressure, and had diffuse …

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