Taking Personalized Medicine to a New Level: CAR-T Cell Therapy

By Martina McGrath, MD
September 13, 2017

Each individual is estimated to have around 4 x 1011 T cells, comprising many millions of T cell clones,1 each randomly produced in the thymus with a unique T cell receptor (TCR) specific for a given antigen. This massive diversity in T cell repertoire gives our immune systems the capacity to protect against the incredible array of bacteria, viruses and fungi that assail us on a constant basis. Continue reading “Taking Personalized Medicine to a New Level: CAR-T Cell Therapy”

Quality of Life & Cost-Effectiveness of Intensive Blood Pressure Lowering

By Connor Emdin
September 6, 2017

In recent years, there has been considerable shift in treatment targets for blood pressure management. In 2014, the Eighth Joint National Commission (JNC 8) guidelines controversially up-revised blood pressure targets and recommended a target blood pressure of less than 140/80mm Hg in adults less than 60 years of age, increasing to less than 150/90mm Hg in those aged over 60 years. They argued that at the time, no randomized trial had demonstrated that lower blood pressure targets were associated with reduced risk of cardiovascular disease or death.1 These recommendations were a cause of heated debate and were inconsistent with recommendations from several other expert bodies, including American Heart Association and American College of Cardiology. Continue reading “Quality of Life & Cost-Effectiveness of Intensive Blood Pressure Lowering”

Vitamin D Supplementation and Reduced Risk of Upper Respiratory Tract Infections

By Martina M. McGrath, MD
August 30, 2017

As the cooler weather descends and the school year starts, we are again entering the season of viruses, colds, flu, and miscellaneous sniffles. Aside from vaccination and good hand hygiene, what else can we recommend to our patients to reduce their risk of upper respiratory tract infection?

A large meta-analysis of 25 randomized controlled trials of vitamin D supplementation and respiratory tract infections was published in the BMJ earlier this year.1 The researchers accessed patient-level data on 10,933 trial participants treated with supplemental vitamin D versus placebo. The trials included all age ranges, from birth to adults in their 70s , and had varied dosing regimens for vitamin D supplementation. Continue reading “Vitamin D Supplementation and Reduced Risk of Upper Respiratory Tract Infections”

Cardiac Risk Assessment in Young Adults: Predictive Value via the CARDIA Study

By Martina M. McGrath, MD
August 22, 2017

Metabolic changes leading to the development of atherosclerosis can start early in life, and are frequently unrecognized in their early stages. For example, obesity in childhood and young adulthood has repeatedly been shown to increase the risk of cardiovascular disease (CVD) later in life.1,2 Given the current epidemic of obesity, inactivity, and poor diet, this is an issue of great public health importance. Tools aimed at young people that encourage early recognition of modifiable risk factors could have major clinical impact in the long term. However, estimating a young person’s risk of CVD, in the absence of typical CV risk factors such as diabetes or hypertension has proven challenging. The Framingham risk score and similar cardiac risk estimating equations are useful tools in middle-aged and older adults but are poorly validated in younger people due to their low absolute risk and the frequent lack of traditional CV risk factors. Continue reading “Cardiac Risk Assessment in Young Adults: Predictive Value via the CARDIA Study”

Underutilization of Epinephrine for Anaphylaxis in Children

By Martina M. McGrath, MD
August 15, 2017

Food allergies are increasingly common and are reported to affect up to 7% of children.1 The most severe form of allergy is anaphylaxis, which is a rapid onset, potentially life-threatening, allergic reaction. Treatment is by urgent administration of intramuscular epinephrine, and early administration is associated with decreased severity of reaction and reductions in mortality.2 Despite the widespread availability of epinephrine, and extensive efforts in education of families and caregivers about recognition of anaphylaxis, delays in recognizing severe reactions and administering the appropriate treatment are still common.2,3 Continue reading “Underutilization of Epinephrine for Anaphylaxis in Children”

Results of Scalp Cooling to Prevent Chemotherapy-Induced Alopecia

By Charbel C. Khoury, MD
August 8, 2015

Being diagnosed with cancer can be devastating and life-changing. Furthermore, the side effects of chemotherapy are often very distressing, and hair loss is one of the more feared complications. When a patient, and particularly a woman, loses her hair to chemotherapy, she is faced with the stigma of the disease, and may feel that she is losing her identity, femininity, and sexuality.1 Patients with chemotherapy-associated alopecia are confronted with the lethal nature of cancer, and a minority of patients even choose to avoid chemotherapy for fear of losing their hair. Continue reading “Results of Scalp Cooling to Prevent Chemotherapy-Induced Alopecia”

Declining Risk of Sudden Death in Heart Failure with Reduced Ejection Fraction

By Connor Emdin
August 1, 2017

Heart failure is the cause of more than one million hospital admissions in the United States annually1 and is a leading cause of death worldwide.2 Heart failure with reduced ejection fraction (HFrEF), characterized by EF typically <40%, is observed in approximately 50% of individuals with heart failure1 and is associated with an elevated risk of sudden cardiac death due to ventricular arrhythmia.3 While implantable cardioverter-defibrillators (ICD) can reduce the risk of sudden death, substantial risk remains and implantation itself is expensive and associated with risks including infection, and device misfiring.1,4 Therefore identifying the patient population who will gain most benefit from ICD implantation is of considerable interest. Continue reading “Declining Risk of Sudden Death in Heart Failure with Reduced Ejection Fraction”

Daily Calorie Restriction vs Alternate Day Fasting for Weight Loss

By Martina M. McGrath, MD
July 7, 2017

Alternate day fasting (ADF) is a popular weight loss method, promoted via weight loss books and media. In the most widely promoted form, participants are advised to eat ~25% of their daily caloric needs on fasting days, alternating with unrestricted intake on nonfasting days. It has been suggested that it produces more significant weight loss and greater compliance than standard caloric restriction, as daily compliance is not necessary. Continue reading “Daily Calorie Restriction vs Alternate Day Fasting for Weight Loss”

Chocolate Intake and Risk of Atrial Fibrillation

By Martina M. McGrath, MD
June 7, 2017

Cocoa beans were highly prized by the Aztecs, used in religious ceremonies, traded for goods, and believed to have medicinal purposes.1 While cocoa beans are a rich source of anti-inflammatory flavonols and antioxidants, it is reported that modern manufacturing processes destroy most of these potentially beneficial substances.2 Furthermore, modern chocolate typically contains large quantities of sugar, meaning this popular indulgence is an unlikely health food supplement. Despite this, epidemiological studies have associated moderate chocolate consumption with reduced risk of myocardial infarction and several cardiovascular end points.3,4 Continue reading “Chocolate Intake and Risk of Atrial Fibrillation”