Why Does Hypertriglyceridemia Lead to Pancreatitis?

October 4, 2007
Why Does Hypertriglyceridemia Lead to Pancreatitis?

Commentary by Daniel Frenkel, PGY-2

Case: A 46 year old male with diabetes on oral hypoglycemic medications is admitted to the hospital with one day of constant epigastric pain, nausea, vomiting, and an inability to tolerate oral intake. You are concerned about pancreatitis but laboratory analysis reveals amylase levels that are within the normal reference range. You notice that his glucose level is 410mg/dL and that the specimen is described as lactescent. Should you still be concerned about acute pancreatitis?

Lactescent or lipemic blood samples…

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Bedside Rounds: How Do You Diagnose and Treat Diabetic Neuropathy

October 3, 2007
Bedside Rounds: How Do You Diagnose and Treat Diabetic Neuropathy

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

Diabetic neuropathy is one of the most commonly encountered complications of diabetes mellitus. It is seen in up to 20% of diabetics. Patients typically present with neuropathic pain in a “glove and stocking” distribution with the earliest signs in the feet. Night time complaints of “my feet are on fire” are common. Relying on a patient’s complaint of “pain” or “numbness” is inadequate in the diagnosis of peripheral neuropathy since…

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ShortCuts-This Week in the Journals

October 2, 2007
ShortCuts-This Week in the Journals

Commentary by Danise Schiliro-Chuang MD, NYU Chief Resident

Let’s start on the theme of cardiovascular disease risk reduction, a topic making headlines this week. A September 28 New York Times article previews the release of new guidelines on perioperative care for patients undergoing noncardiac surgery. The guidelines, written by a panel of experts from the ACC and AHA, will recommend that patients undergo evaluation and treatment before noncardiac surgery only for active cardiac diseases such as severe angina, late-stage heart failure, significant arrhythmias and…

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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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Inpatient Diabetes Management: Case 3

September 27, 2007
Inpatient Diabetes Management: Case 3

Commentary by Mary Vouyiouklis MD, Fellow, and Ann Danoff MD, Director, Division of Endocrinology, Diabetes and Metabolism, NYU Medical Center 

Welcome to Case 3 of our special diabetes series intended to highlight the essentials of diabetes care in the inpatient setting. For the next several weeks, we plan to present individual cases followed by some management questions and answers.

Case 3: The case of Mr. Mejia

3A. Mr. Mejia is a 30 year old man with Type 1 diabetes who is admitted for…

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Pay-for-Performance: The Future of Medicine?

September 26, 2007
Pay-for-Performance: The Future of Medicine?

Commentary by Sandeep Mangalmurti MD, JD PGY-2 

“Pay-for performance” is the broadly encompassing term used to describe recent efforts to restructure physician compensation so that rewards are commensurate to performance. Initially limited to small pilot programs, pay-for-performance has rapidly expanded over the past decade; currently over half of all HMOs have implemented some form of it1, and plans are underway to introduce pay-for-performance measures into Medicare and Medicaid2.

There are various versions of pay-for-performance, and each presents its own advantages and disadvantages. The…

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ShortCuts-This Week in the Journals

September 23, 2007
ShortCuts-This Week in the Journals

Commentary by Cara Litvin MD, Executive Editor, Clinical Correlations

The sensation of déjà vu was likely very common this week. First, we experienced a flashback to 1994 when we saw OJ in handcuffs again…and then Hillary unveiled her new plan for universal health care. Her plan would require everyone to buy insurance, but emphasizes choices, including both the currently existing private options in addition to a public plan similar to Medicare. The plan also includes tax credits for families and small businesses to…

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Breaking News: FDA Issues New Warnings for Haldol

September 21, 2007
Breaking News: FDA Issues New Warnings for Haldol

Commentary by Helen Kourlas, PharmD

On September 17th 2007, the FDA issued an advisory warning healthcare professionals to avoid the use of higher than recommended doses of haloperidol, marketed as Haldol, Haldol Decanoate and Haldol Lactate. In addition to this warning, the FDA also emphasized that the injectable form of haloperidol is only approved to be administered as an intramuscular injection. Common off – label intravenous administration of haloperidol has led to numerous case reports of QT prolongation, Torsades de Piontes (TdP) and sudden death.…

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