Clinical articles

CHF exacerbations

May 2, 2008

  This interesting article describes a current Archives of Internal Medicine – Reasons Documented for Heart Failure Admissions At least one identifiable precipitating factor was found in 61.3% of patients, the researchers said. In order of frequency, they were: Pneumonia or respiratory processes at 15.3%. Ischemia or acute coronary syndromes at 14.7%. Arrhythmia at 13.5%. [...]

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A liver case

April 30, 2008

  Please create a differential diagnosis for the following liver tests in an 80 year old woman: Liver tests Total protein 4.8 Albumin 2.2 Total Bili 6.5 Direct Bili 4.3 Indirect Bili 2.2 Alk Phos 973 AST 170 ALT 100               viagra free viagra buy viagra online generic viagra [...]

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Yesterday’s acid base case

April 30, 2008

  Yesterday’s numbers: Electrolyte panel Na 141 Cl 112 BUN 18 K 4.3 HCO3 15 creat 0.7 Blood Sugar 105 ABG pH 7.33 pCO2 25 pO2 103 calc HCO3 13   Additional information: 1. She had increased ileal output. 2. Serum albumin was 5.7 3. Urine Na 10, urine K 47 and urine Cl 72 [...]

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Adjusting drug dosing in CKD

April 29, 2008

  A clinical pharmacology colleague has this wonderful interview published in Medscape this week – Drug Dosing in CKD — Comparing GFR Equations and the Role of the Pharmacist: An Expert Interview With Kurt A. Wargo, PharmD, BCPS I like this interview and link it for my own future use. viagra free viagra buy viagra [...]

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How should we predict the severity of CAP?

March 27, 2008

The new issue of the American Journal of Medicine has an addition to the world of CAP severity prediction – C-Reactive Protein Is an Independent Predictor of Severity in Community-acquired Pneumonia CRP does a better job of predicting complicated pneumonia than the two standard models – CURB65 and Pneumonia Severity Index .  Both indices are [...]

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When is tight control too tight

February 7, 2008

I have written before about my concerns over a HgbA1c goal of 7.0. Others have questioned this goal even more strenuously then me. This study may lead to a new evaluation of this ill-conceived performance indicator.Diabetes Study Partially Halted After Deaths For decades, researchers believed that if people with diabetes lowered their blood sugar to [...]

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Downstream benefits of a statin

October 11, 2007

Statin Therapy for Coronary Prevention Shows Extended Benefit Life The coronary prevention benefits of five years of statin therapy in a pioneering trial proved to have enduring power as long as a decade after the original study ended, researchers here found. The rate of coronary events was reduced by 27% over the entire 15 years [...]

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Dyspneic

October 5, 2007

Walking into the room, one could immediately noticed that Mr. Sutherland had severe dyspnea. He sat bolt upright (clearly a clue), but more remarkable was the look of apprehension on his face. One could imagine the fear that he had with every breath. I went over to the bedside, shook his hand and introduced myself. [...]

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Wernicke’s and bariatric surgery

March 13, 2007

This article caught my eye as an interesting fact to remember (internists like to collect facts which they may need one day). Then I noticed that the first author was a friend with whom I have previously written an article! Wernicke encephalopathy is a serious disorder caused by thiamine (vitamin B-1) deficiency. Dr Carl Wernicke, [...]

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Medscape case #9

November 28, 2006

Another acid-base and electrolyte case – not too difficult, but good teaching points – A 42 year old man with HIV

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