Mortality Prediction in Community-Acquired Pneumonia: The end of the road for SIRS?

By Martina McGrath, MD
December 19, 2017

In 2016, new consensus guidelines were issued for the clinical criteria for sepsis.1 The qSOFA score, incorporating tachypnea, low blood pressure and altered mental status, was proposed as a rapid, bedside assessment, and an alternative to SIRS criteria, to identify patients at high risk of adverse outcomes. Continue reading “Mortality Prediction in Community-Acquired Pneumonia: The end of the road for SIRS?”

Oxygen in Acute MI: Lack of Benefit and Possible Risk?

By Martina McGrath, MD
November 3, 2017

Acute myocardial infarction occurs where there is insufficient supply of oxygenated blood to an area of the heart, leading to myocardial injury and cell death. For decades, clinical guidelines have recommended the administration of supplemental oxygen as a first-line therapy for all patients experiencing myocardial ischemia, regardless of oxygen saturation.1 Continue reading “Oxygen in Acute MI: Lack of Benefit and Possible Risk?”

Sodium Restriction in Patients with Reduced GFR: Blood Pressure Benefits

By Martina McGrath, MD
October 18, 2017

The typical US diet is comprised of 3.4g of sodium per day on average, whereas current recommendations suggest that sodium intake should be limited to <2g/day for the general population1 and possibly lower for those with hypertension or cardiovascular disease.2 Continue reading “Sodium Restriction in Patients with Reduced GFR: Blood Pressure Benefits”

Increased Risk of Adverse Pregnancy Outcomes after Recovery from Acute Kidney Injury

By Martina McGrath, MD
September 26, 2017

Women with advanced chronic kidney disease (CKD) have long been known to be at increased risk of complications in pregnancy including preeclampsia, pre-term birth, small-for-dates offspring, and progression of underlying CKD following pregnancy.1 However, several recent studies have highlighted a less obvious connection between earlier stages of renal disease and adverse pregnancy outcomes.2,3 Continue reading “Increased Risk of Adverse Pregnancy Outcomes after Recovery from Acute Kidney Injury”

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”

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”

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”