ShortCuts-This week in the Journals

May 29, 2007
ShortCuts-This week in the Journals

The big bomb this past week was the Rosiglitazone Effect. Resulting in front page news in various newspapers (on multiple days), the meta-analysis in last week’s NEJM is causing quite the stir. For more information, see the post.

What’s old is what’s new. An interesting editorial on Medpage reviewed the reason that HCTZ is the most commonly prescribed thiazide, and it’s not efficacy. HCTZ is 4 letters and takes a second to write on a pad, chlorthalidone is 14 letters and, while possibly the…

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How should you approach a pregnant patient with chronic kidney disease?

May 25, 2007
How should you approach a pregnant patient with chronic kidney disease?

A 31 year old female with hypertension and proteinuria secondary to IgA nephropathy, currently treated with an ARB, presents to clinic stating that she would like to become pregnant.

What is the risk of fetal morbidity in the setting of ARBs/ACE-inhibitors? What antihypertensive medications are used during pregnancy? At what point would you switch a patient’s medications if she is trying to become pregnant? What is the natural course of IgA nephropathy during pregnancy?

-Minisha Sood MD, PGY-3

Pregnancy and Chronic Kidney

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FDA Black Box Warning on Gadolinium

May 24, 2007

Back in December we reported on the FDA cautioning practioners about the use of gadolinium (an mri contrast agent) in patients with chronic kidney disease.  The FDA is now requesting a black box warning  stating “that patients with severe kidney insufficiency who receive gadolinium-based agents are at risk for developing a debilitating, and a potentially fatal disease known as nephrogenic systemic fibrosis (NSF). In addition, it would state that patients just before or just after liver transplantation, or those with chronic liver disease, are also at risk…

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Not So Rosi…

May 24, 2007
Not So Rosi…

Commentary by Seagram Villagomez MD, Chief Resident

Since its approval in 1999, nearly 1 million Americans have used the thiazolidinedione (TZD) rosiglitazone (Avandia – GlaxoSmithKline) for the treatment of Type 2 Diabetes.  However, in a drug class which seems plagued by concerns, the safety profile associated with rosiglitazone has been brought to question. Previously, troglitazone (Rezulin) was pulled off the market secondary to hepatoxicity, while muraglitazar was not approved by the FDA given adverse cardiovascular events during early clinical trials.  In a…

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ShortCuts-This Week in the Journals

May 21, 2007
ShortCuts-This Week in the Journals

This week’s review is a potpourri of interesting if not groundbreaking articles.

The pharmaceutical industry certainly got off easier this week (see last week’s shortcuts) and the New York Times focused instead on the “industrialization” of the art of medicine. A hospital group in central Pennsylvania is offering insurers and patients bypass surgery for a flat fee with a 90 day guarantee. They’ve put 40 measures in place to make sure patients receive evidenced based care. If the any of the 40 measure…

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Clinical Pathology Conference 5/11/07-The Answer

May 18, 2007

Please review the posting of last week’s  CPC Case here.

When you’re ready you can download the CPC Answer here.

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Clinical Pharmacy Corner-The Thiazides

May 17, 2007
Clinical Pharmacy Corner-The Thiazides

 We’d like to introduce you to Clinical Correlations’ newest feature-Clinical Pharmacy Corner. This will be a bimonthly pharmacy themed post which will tackle both basic and complicated pharmacy issues. We will review the mechanisms of actions of various classes of medications, a worthwhile refresher for those of us who may have forgotten what we learned in pharmacology 101 in medical school. We will also answer our reader’s pharmacy questions based on actual cases. As always please send your clinical questions and feedback to…

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Mystery Quiz #3-The Answer

May 15, 2007
Mystery Quiz #3-The Answer

Before you read the answer you should read the orginal post form last week

The Final Poll Results (26 votes): metastatic disease (26%) , mycobacterial disease (22%) ,fungal disease (22%), bronchiolitis obliterans with organizing pneumonia (boop) (13%), septic emboli (9%) ,vasculitis, e.g. wegener’s (4%), thromboembolic disease (4%), sarcoid (0%)

The patient had granulomatous inflammation on pathology with acid-fast organisms seen. The culture grew mycobacterium avium (MAC). After treatment with azithromycin, ethambutol and rifabutin for eighteen months, the follow-up imaging showed significant clearing…

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