Breaking News: FDA issues new warning for Exenatide (Byetta®)

November 5, 2009
Breaking News: FDA issues new warning for Exenatide (Byetta®)

Kanika Ballani, Pharm.D.
Diana Hubulasvili, Pharm.D.

 Developed by Amylin Pharmaceuticals, Exenatide (Byetta®) is an incretin mimetic that is used as an adjunctive therapy with metformin, a sulfonylurea or a thiazolidinedione to improve glycemic control in type 2 diabetic patients. Mechanistically, Exenatide mimics the actions of endogenous incretin hormone, glucagon-like peptide (GLP-1), causing an increase in insulin secretion which slows gastric emptying and leads to a decrease in food intake. On November 3rd 2009, the FDA issued a safety warning on Exenatide associating it with the …

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How Does Alcohol Cause Cardiomyopathy?

November 4, 2009
How Does Alcohol Cause Cardiomyopathy?

Charles Levine

Faculty peer reviewed

Excessive consumption of ethanol (EtOH) has many deleterious effects on the human body. The heart is a target of damage from EtOH consumption, as chronic consumption of EtOH leads to decreased cardiac function and structural heart disease, including dilated cardiomyopathy.(1) The exact mechanism by which EtOH exerts its deleterious effects on the heart remains poorly understood and is an area of active research. This report will focus on some of the proposed mechanisms and some recent advances in the understanding …

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PrimeCuts: This Week in the Journals

November 2, 2009
PrimeCuts: This Week in the Journals

Tao Xu MD

Faculty peer reviewed

As we approach the end of fall, with large crowds in a variety of costumes gleefully marching in the pouring rain during the 36th Annual Village Halloween Parade, thoughts about flu season warnings seemed far away. But here is a story that will remind us of the global threat of the H1N1 virus. At the end of November, the annual Mecca will take place in Saudi Arabia, where an estimated 2.5 million pilgrims from 160 countries will find themselves …

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Tailoring Colon Cancer Screening

October 29, 2009
Tailoring Colon Cancer Screening

Guidelines for Colorectal Cancer Screening and the Recent Evidence Behind Them

 Nazia Hasan, MD MPH

Faculty peer reviewed

For most residents, screening for colorectal cancer (CRC) may seem as established as that for breast and cervical cancer. In reality, the use of CRC screening has only recently approached that of screening for those other malignancies. We have seen recently changes to the CRC screening guidelines last published by The American College of Gastroenterology in 2000. The updated screening guidelines for colorectal cancer became available in …

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Mystery Quiz- The Answer

October 27, 2009
Mystery Quiz- The Answer

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

The answer to the mystery quiz is thoracic splenosis. The key to the solution is the past medical history of a gunshot wound. Shrapnel is seen on the plain CXR (Image 1) as well as in the soft tissue of the back (Image 5). The CXR also shows a lateral diaphragmatic abnormality (Image 1, arrow) likely due to adhesions. The left upper quadrant is notable for colonic gas where one might expect a soft …

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PrimeCuts: This Week in the Journals

October 26, 2009
PrimeCuts: This Week in the Journals

Todd Cutler MD

Faculty peer reviewed

It’s a tired cliché, but this week the flies on the wall at the American Cancer Society were undoubtedly privy to some fascinating conversation. The dialogue began, in the popular press at least, with a special communication published in JAMA, in which the authors sounded a clarion call for a nationwide overhaul of the current breast and prostate cancer screening guidelines. In a strongly-worded argument, the authors synthesized the results of multiple studies at the levels of epidemiology, clinical …

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Mystery Quiz

October 23, 2009
Mystery Quiz

Vivian Hayashi MD and Robert Smith MD, Mystery Quiz Section Editors

A 61 year old man was referred to the pulmonary service for an abnormal pulmonary function test (PFT). The patient was a lifelong smoker and had symptoms suggestive of obstructive sleep apnea. The PFT showed a mixed obstructive and restrictive defect. The latter abnormality was considered to be out of proportion to the patient’s obesity, hence a chest CT scan was obtained to evaluate for possible parenchymal lung disease (shown below). Past history was …

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How to interpret troponins in renal disease?

October 21, 2009
How to interpret troponins in renal disease?

Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities. Troponin I levels drawn at 0, 6, and 12 hours after initial presentation are …

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