Chiefs’ Inquiry Corner – 3/2/20

March 2, 2020

Being an outstanding physician and lifelong learner requires stoking the flames of clinical curiosity.  In Chiefs’ Inquiry Corner (CIC) we attempt to succinctly answer actual clinical questions that have been raised on the wards and in the clinics of NYU’s teaching hospitals.  Our answers are not meant to be all encompassing or practice changing but rather to serve as springboards for further exploration. For those of us with short attention spans, we hope CIC satisfies that craving for a morsel of knowledge in a digestible format.


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Beyond considerations for rate or rhythm control and anticoagulation, it is recommended that all patients newly diagnosed with atrial fibrillation undergo a basic workup to determine any underlying etiologic causes. This includes a thorough history and physical exam. Additionally, all patients regardless of signs and symptoms should have a transthoracic echocardiogram to evaluate for any structural heart disease, as well as blood work for electrolytes, thyroid function, renal function, hepatic function, and blood count.

References: AF Guidelines  
As of January, 2020, the CDC’s Advisory Committee on Immunization Practices (ACIP) no longer recommends that all adults aged 65 years or older receive PCV13 vaccination. This was based on a significant decline in invasive pneumococcal disease incidence in older adults that was attributed to vaccination of children against pneumococcus. Instead, it recommends shared decision-making for older adults with cerebrospinal fluid (CSF) leak, cochlear implant, or an immunocompromising condition (including chronic renal failure, nephrotic syndrome, iatrogenic immunosuppression, malignancy, asplenia, sickle cell disease or other hemoglobinopathies). They also recommend taking into account circumstances that put persons at higher risk for exposure to PCV13 serotypes including residence in a long-term care facility or living in areas with low pediatric PCV13 vaccination rates.

References: CDC ACIP  
Patients with HIV are at greatly increased risk of developing certain malignancies, termed “AIDS-defining malignancies” as they define the transition from HIV to AIDS. They include kaposi sarcoma, non-Hodgkin lymphoma and invasive cervical cancer. People with HIV are also at risk of developing other, non-AIDS defining malignancies, including oropharyngeal, lung, liver, and anal cancers, as well as Hodgkin lymphoma. 

References: Malignancy in AIDS