Posts Tagged ‘NEJM’

Primary Prevention of Cardiovascular Events — A Pragmatic Approach

Posted by James Yeh, M.D. M.P.H. • May 25th, 2016

Ms. Barnstable is a 66 year-old woman who is seeing you for an annual physical check-up today.  She does not take any medications and is a smoker.  She asks if there are drugs that she should be taking to lower her risks for heart attacks and strokes. Besides smoking cessation counseling, what do you tell… Read More…

A Man with Olfactory Hallucinations

Posted by Carla Rothaus • May 20th, 2016

Involvement of the nervous system is reported in 5 to 15% of patients with sarcoidosis, although autopsy series indicate that the frequency of lesions in the nervous system may be higher. A 32-year-old man presented with a 1-year history of olfactory hallucinations and a 6-week history of intermittent numbness and paresthesias on the left side. MRI revealed… Read More…

Coronary-Artery Bypass Grafting

Posted by Carla Rothaus • May 20th, 2016

Appropriate selection of patients for coronary-artery bypass grafting (CABG) is critical to ensure good outcomes. The evaluation of patients for CABG relies on a systematic assessment of the characteristics and coronary anatomy known to be associated with a survival benefit from CABG as compared with medical therapy or percutaneous coronary intervention (PCI). There is increasing… Read More…

Rate Control versus Rhythm Control for Atrial Fibrillation after Cardiac Surgery

Posted by Ravi Parikh, M.D., M.P.P. • May 18th, 2016

Whether you are a resident on the cardiology, surgery, or general medicine service, encountering patients with atrial fibrillation is common. Many patients, particularly after cardiac surgery, go in and out of atrial fibrillation so often that residents caring for them often ignore the blinking lights and loud alarms from telemetry machines after a while. However,… Read More…

A Woman with Psychosis

Posted by Carla Rothaus • May 13th, 2016

The combination of malabsorption and autoimmunity strongly suggests the possibility of celiac disease, which is not always associated with gastrointestinal symptoms. Although neurologic and psychiatric symptoms of celiac disease are not widely recognized, they have been reported. Examination of a 37-year-old woman with adult-onset psychosis revealed weight loss, a thyroid nodule, anemia, and micronutrient deficiencies. Diagnostic tests… Read More…

Caregivers of Critically Ill Patients

Posted by Carla Rothaus • May 13th, 2016

Unpaid caregivers (typically family or close friends) are essential to the sustainability of North American health care systems, because their unpaid labor annually accounts for $27 billion in Canada and $642 billion in the United States. Although caregiver assistance can be beneficial for patients, such care may have negative consequences for caregivers, including poor health-related… Read More…

COPD Is Not the Whole Story

Posted by Rachel Wolfson • May 11th, 2016

Many diagnostic guidelines use black or white parameters – either patients meet the criteria and have the disease, or they don’t. While guidelines like this can be useful for developing clear definitions, in practice many patients fall within a gray area. The current diagnosis of Chronic Obstructive Pulmonary Disease (COPD), for example, relies on spirometry… Read More…

Eye of the Beholder

Posted by Carla Rothaus • May 6th, 2016

Dermatomyositis, polymyositis, and necrotizing autoimmune myopathy all cause proximal muscle weakness. Proximal weakness is often progressive, with patients reporting difficulty in raising their arms above their head, climbing stairs, or standing from a seated position. Clinically, dermatomyositis is distinguished from polymyositis and necrotizing autoimmune myopathy by its distinctive dermal findings. A 47-year-old man presented to an… Read More…

Herniated Lumbar Intervertebral Disk

Posted by Carla Rothaus • May 6th, 2016

“Sciatica” refers to pain in a sciatic-nerve distribution, but this term is sometimes used indiscriminately to describe back and leg pain. Lumbar “radiculopathy” more specifically refers to pain with possible motor and sensory disturbance in a nerve-root distribution. After lumbar stenosis, spondylolisthesis, and fracture have been ruled out, approximately 85% of patients with sciatica are… Read More…

Scaling the ALPS — Antiarrhythmic Drugs in Out-of-Hospital Cardiac Arrest

Posted by Bhavna Seth, M.D. • May 4th, 2016

Imagine you are out for an evening jog when a young man, who is running ahead of you, collapses. You rush over and a rapid assessment suggests that he is unresponsive, has no pulse, and is not breathing. You start chest compressions and a bystander calls 911. EMS arrives soon, however, after 5 cycles of… Read More…