Mechanisms of Angiotensin Blockade in the Management of Diabetic Nephropathy

December 11, 2014
Mechanisms of Angiotensin Blockade in the Management of Diabetic Nephropathy

By Miguel A. Saldivar, MD

Peer Reviewed 

When a patient with diabetes comes into a clinic or hospital, it is not uncommon to hear the question, “Is he/she on an angiotensin-converting-enzyme (ACE) inhibitor (ACEI) or an angiotensin-receptor blocker (ARB)?” Most clinicians know the mantra: ACEIs are renoprotective in diabetes. Most are aware that clinical studies dating back to the 1990s have indeed shown the protective effects of ACEIs, such as captopril, against renal function deterioration in diabetes . Most are even aware that there are…

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Primecuts – This Week In The Journals

December 8, 2014
Primecuts – This Week In The Journals

By Amar Parikh, MD

Peer Reviewed

This week, the nation was rocked by the decision of a Staten Island grand jury to not indict Officer Daniel Pantaleo in the death of Eric Garner, who was killed after resisting arrest for suspicion of selling “loosies”, or single cigarettes from packs. This comes on the heels of the recent decision by the grand jury in Ferguson, Missouri to not indict Officer Darren Wilson in the shooting death of unarmed black teenager Michael Brown. In…

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From The Archives: Does Perioperative Smoking Cessation Improve outcomes?

December 4, 2014
From The Archives: Does Perioperative Smoking Cessation Improve outcomes?

Please enjoy this Post from the archives dated January 6, 2012

By Benjamin Wu, MD

Faculty Peer Reviewed

Mr. T is a 53-year-old man, with history significant for cholelithiasis. He decides to have an elective cholecystectomy after years of biliary colic. Mr. T is an active smoker and wanted to know if he should stop smoking prior to surgery?

Smoking is associated with adverse outcomes in surgery, however debate continues regarding the safety of perioperative smoking cessation. The current understanding of perioperative smoking cessation follows…

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Mystery Quiz

December 2, 2014
Mystery Quiz

Vivian Hayashi MD, Robert Smith MD

The patient is an 82 year old man with frequent breathlessness. The patient had been admitted several times in the past two years for congestive heart failure. Two years earlier, the patient suffered an NSTEMI. A diagnostic cardiac catheterization revealed triple vessel coronary disease. A decision to perform CABG vs coronary stenting was delayed pending an evaluation of iron-deficiency anemia associated with a positive test for fecal occult blood. A recent echocardiogram showed normal left ventricular function but diastolic…

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Myths and Realities: Airline Travel and Deep Venous Thrombosis-Does Economy Class Syndrome Really Exist?

November 26, 2014
Myths and Realities: Airline Travel and Deep Venous Thrombosis-Does Economy Class Syndrome Really Exist?

By Matthew Weiss, MD

Peer Reviewed

Background:

The number of worldwide air travelers is expected to surpass 3.3 billion by 2015 and possibly double by 2030 . These changes will likely be driven by international markets, where growth rates were twice that of domestic U.S. flights during the past two years . With more passengers taking to the skies and enduring longer international and transoceanic flights, the general practitioner is increasingly asked to advise on the risk of travel-associated venous thromboembolism (VTE). Accordingly, it is…

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Primecuts – This Week In The Journals

November 24, 2014
Primecuts – This Week In The Journals

By Chio Yokose, MD

Peer Reviewed

As temperatures took a noticeable dip earlier this week in New York City, prompting many of us to begrudgingly pull out our heavy down coats and boots from our closets, no place was hit harder than Buffalo, NY. Although no stranger to snow in this part of the country, even lifelong residents of Buffalo were shocked to wake up to a wall of white on Wednesday morning as a lake-effect storm, which rapidly developed over Lake Erie late Tuesday…

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Approach to the Hospitalized Patient with Community-Acquired Pneumonia: Should Procalcitonin Be Part of the Initial Evaluation?

November 21, 2014
Approach to the Hospitalized Patient with Community-Acquired Pneumonia: Should Procalcitonin Be Part of the Initial Evaluation?

By Matthew Light, MD

Peer Reviewed

A 79 year-old female, 20 pack-year ex-smoker with history of mild systolic congestive heart failure is referred to the emergency department (ED) after an outpatient visit with her primary care physician where she complained of fever, sinus congestion, myalgias, and productive cough. On arrival she is febrile, mildly tachypneic and tachycardic, but normotensive and with a normal oxygen saturation on room air. On exam she has bronchial breath sounds and rales in her left chest. The patient has a…

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Primecuts – This Week in the Journals

November 19, 2014
Primecuts – This Week in the Journals

By Max Padgett, MD, MPH

Peer Reviewed

The United States and China, the two largest producers of greenhouse gases, have reached a historic agreement on reducing carbon emissions. President Obama announced that the United States will aim to reduce emissions by 20-25% by the year 2025, while Chinese President Xi Jiping stated that carbon emissions would peak in China by 2030. Back in Washington, it was politics as usual. Senate and House Republicans declared the announcement as evidence of President Obama’s “war on coal.” According…

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