Epinephrine in Out-Of-Hospital Cardiac Arrest: Increased Survival but at What Cost?

By Martina McGrath, MD
August 8, 2018

It is estimated that 1 in every 7.5 people in the US will die of sudden cardiac death.1 Survival following out-of-hospital cardiac arrest has increased in recent years, from 10.2% in 2006, to 12.4% in 2015.1 However, only 9% of those surviving to hospital discharge were classified as having good functional status. Therefore, significant long-term neurologic impairment is a common outcome of cardiac arrest. Continue reading “Epinephrine in Out-Of-Hospital Cardiac Arrest: Increased Survival but at What Cost?”

Cervical Cancer Screening Using HPV Testing Alone: Are We There Yet?

By Martina McGrath, MD
July 18, 2018

Although the overall incidence of cervical cancer is decreasing, it is estimated that over 200,000 women are living with cervical cancer in the US, and it is expected to lead to over 4,000 deaths in 2018.1 Cervical cancer is predominantly caused by infection of the cervical mucosa with human papilloma virus (HPV), particularly by several pro-oncogenic subtypes. Multiple HPV genotypes can infect the genital tract mucosa, but types 16 and 18 are responsible for the majority of cervical cancers. HPV infection is highly prevalent in sexually active young woman, and the majority will clear the infection within 8–24 months.2 Although cleared, HPV infection can lie dormant for prolonged periods. It can recur and be detected again decades later, mandating the need for cervical screening throughout a patient’s lifetime.3 In addition, observational data indicates that the relative risk of abnormal cervical cytology is markedly increased in those with persistent HPV infection, particularly where infection is with a high-risk type of HPV.2 Continue reading “Cervical Cancer Screening Using HPV Testing Alone: Are We There Yet?”

Dulaglutide in Type 2 Diabetes: Do GLP-1 agonists delay progression of diabetic nephropathy?

By Connor Emdin
June 27, 2018

Forty percent of patients with type 2 diabetes go on to develop chronic kidney disease (CKD).1 These patients are at markedly elevated risk of death from cardiovascular disease.2 They also suffer from reduced quality of life, particularly when CKD progresses to end-stage renal disease and dialysis.3 Despite the substantial morbidity and mortality associated with diabetic kidney disease, therapies are limited. In the National Kidney Foundation Clinical Practice Guidelines for Diabetes and CKD from 2012, only angiotensin converting-enzyme-inhibitors (ACE-inhibitors) and angiotensin-receptor blockers were recommended for protection of renal function in patients with CKD and diabetes with albuminuria.4 Continue reading “Dulaglutide in Type 2 Diabetes: Do GLP-1 agonists delay progression of diabetic nephropathy?”

Procalcitonin-Guided Antibiotic Therapy in Lower Respiratory Tract Infection: Is It Safe?

By Martina McGrath, MD
June 5, 2018

Pulmonary infection is one of the most common reasons for hospitalization in the US. Overprescription of antibiotics, due either to inappropriate initiation or excessive treatment duration, is an important contributor to antibiotic resistance and complications of therapy.1.2 Continue reading “Procalcitonin-Guided Antibiotic Therapy in Lower Respiratory Tract Infection: Is It Safe?”

Does Menu Labeling Lead to Healthier Food Choices?

By Lea Borgi, MD
May 16, 2018

Americans consume about a third of their calories outside the home,1 but estimating the calorie count of a restaurant’s meal can be extremely difficult. In a cross-sectional study of 1,877 adults and 330 school age children, two thirds of participants underestimated the calories of fast food meals.2 The larger the ingested meal, the larger the discrepancy between the estimated and the actual calorie content of that meal. In another study, participants consistently underestimated both the fat and calorie content of a range of menu items, where the actual content was up to 2 times greater than expected by consumers.3 Continue reading “Does Menu Labeling Lead to Healthier Food Choices?”

Nitrofurantoin versus Fosfomycin for Acute Uncomplicated Cystitis

By Martina McGrath, MD
May 9, 2018

Acute uncomplicated cystitis is defined as infection localized to the bladder without signs of further extension such as fever, flank pain/tenderness, or systemic symptoms. It is a highly prevalent problem and over half of all women experience at least one urinary tract infection (UTI) in their lifetime.1 In otherwise healthy women, with normal urinary tract anatomy, treatment can commonly be instituted without the need for urine culture. Both nitrofurantoin and fosfomycin are currently recommended as first-line agents for treatment of uncomplicated cystitis. However, some older studies have suggested that fosfomycin may have inferior efficacy.2 Continue reading “Nitrofurantoin versus Fosfomycin for Acute Uncomplicated Cystitis”

Unraveling the Science Behind Personalized Diets and Low-Fat vs Low-Carb Genotypes

By Lea Borgi, MD
May 1, 2018

The Centers for Disease Control reports that almost 71% of adults over the age of 20 are overweight or obese, making obesity one of the most pressing concerns in public health.1 While dietary guidelines set recommended intakes of the various food groups,2 some data suggests that patients may lose weight more effectively when recommendations are tailored to certain genetic traits.3,4 Continue reading “Unraveling the Science Behind Personalized Diets and Low-Fat vs Low-Carb Genotypes”

Food and Chemicals: An Unwanted Phthalate Partnership

By Lea Borgi, MD
April 24, 2018

Restaurant meals have more calories, salt, and fat than meals consumed at home.1 Additionally, eating out has been associated with an increased risk of obesity and hypertension.2

The Study

A recently published study found that there is even more reason for concern when it comes to food prepared away from home.3 Indeed, in an analysis of participants in the National Health and Nutrition Examination (NHANES), dining out was associated with a higher exposure to phthalate, an endocrine disrupting chemical (EDC).3 Phthalates, also called plasticizers, are found in several products, including food packaging and personal care products.4 By measuring urinary phthalate metabolites, authors were able to estimate individuals’ cumulative phthalate exposure. Continue reading “Food and Chemicals: An Unwanted Phthalate Partnership”

Cefepime-Induced Neurotoxicity

By Martina McGrath, MD
February 20, 2018

Cefepime is a fourth generation cephalosporin with extended spectrum of coverage, including gram-positive and gram-negative organisms, such as Klebsiella pneumoniae, Pseudomonas aeruginosa, Citrobacter and Serratia.1 It has activity against many multidrug-resistant gram negatives and is resistant to beta lactamases. Given its broad range of activity, it is a widely used and highly effective choice for hospitalized patients with a range of infections.

However, at elevated concentrations, cefepime can cross the blood-brain barrier Continue reading “Cefepime-Induced Neurotoxicity”

Assessing the Risks in Live Kidney Donation

By Martina McGrath, MD
February 13, 2018

Kidney transplantation is a life-saving procedure and is associated with at least a doubling in life expectancy of transplant recipients.1 Live-donor kidneys provide better kidney function and longer transplant survival than those from deceased donors. However, live donation is not entirely without risk, Continue reading “Assessing the Risks in Live Kidney Donation”