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?”

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”

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”

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”

Syncope—Are We Missing an Important Cause?

By Adam Schaffer, MD
April 19, 2017

As a hospitalist, syncope is an admitting diagnosis that I consider a challenge. Syncope is a presentation that we see frequently, and so can start to seem routine. Though published estimates of the causes of syncope vary, most have shown that the etiologies of syncope that we are most concerned about—such as bradyarrhythmias or ventricular tachyarrhythmias—make up a minority of cases. In one retrospective cohort study of the causes of syncope in 987 patients who were referred for cardiac electrophysiology evaluation, bradyarrhythmias accounted for 13.6% of cases and ventricular tachyarrhythmias accounted for 12.1% of cases.1  Vasovagal syncope, among the more benign etiologies of syncope, accounted for 47.0% of cases. These numbers come from a population of patients who were referred for electrophysiology evaluation, and so it is very possible that cardiac arrhythmias were overrepresented in this population compared to an unselected group of patients. Thus clinicians who evaluate syncope patients need to remain vigilant in order to correctly identify the minority of syncope patients who have a potentially serious cause of their syncopal episode. Continue reading “Syncope—Are We Missing an Important Cause?”

Intensive Intervention in Type 2 Diabetes Leads to Long-Term Gains

Steno Type 2 Trial: Striking long-term benefits of multiple risk factor intervention in type 2 DM.

By Martina M. McGrath, MD
April 14, 2017

Risk factor management in patients with diabetes is challenging, and despite best medical efforts, few achieve the targets set out by society guidelines1. Two recently published papers reporting long-term follow up of Steno-2 are a timely reminder as to what can be achieved with a structured, well-resourced approach to caring for these patients. Continue reading “Intensive Intervention in Type 2 Diabetes Leads to Long-Term Gains”

Treating Addiction as a Syndrome: Bridging Research and Clinical Practice


Submitted by:

Howard J. Shaffer, PhD1; Matthew Tom, PhD; Margaret F. Y. Wong, DSW; Elda M. L. Chan, PhD; Gordon L. F. Cheng, PhD; Camilla K. M. Lo, MSW; Eric K. Y. Ma, MPhil; Ryan H. Y. Wong, MSW
April 6, 2017

Addictive behaviors often coexist with each other and with other common mental health problems (Regier et al., 1990; Kessler et al., 2008), but traditional treatment models view different expressions of addiction as unique disorders (e.g., substance use disorder, alcohol use disorder, gambling disorder, etc.). When patients seek treatment for a particular expression of addiction, clinicians usually refer them to services that “specialize” in the presenting problem. Consequently, because of the extent of co-occurring disorders among people with addiction, treatment-seekers might experience confusion and treatment fragmentation, leading to a decrease in clinical compliance. Continue reading “Treating Addiction as a Syndrome: Bridging Research and Clinical Practice”

Interpreting Hemoglobin A1c in African Americans with Sickle Cell Trait

By Charbel C. Khoury, MD
March 16, 2017

Hemoglobin A1c (HbA1c) testing is mainstay in screening, diagnosis, and management of diabetes mellitus.1 Since it measures the glycation of hemoglobin occurring over the entire lifespan of a red blood cell, the HbA1c is a very practical measure for clinicians and can be used to surmise the mean blood glucose over the previous 8 to 12 weeks.2 Nonetheless, several patient-specific factors such as iron/vitamin B12/folate deficiency anemias, chronic kidney disease, cirrhosis, and erythropoietin treatment have been known to affect the reliability of this assay, due to variations in red cell turnover.2  Moreover, HbA1c levels may vary with race. In fact, numerous studies have suggested that African Americans may have higher HbA1c levels than non-Hispanic whites with the same fasting and post-glucose load glucose levels.3 Continue reading “Interpreting Hemoglobin A1c in African Americans with Sickle Cell Trait”

A Thiazide a Day to Keep Fractures Away?

By Martina M. McGrath, MD
March 7, 2017

Observational data have indicated a reduction in fracture risk in patients treated for hypertension with thiazide diuretics.1 Thiazides reduce urinary calcium losses (hence their use in patients with calcium-based renal calculi) and have been postulated to have a stimulatory effect on osteoblasts, leading to improvements in bone density. However, there have been no randomized trials to demonstrate benefit of one antihypertensive class over another in protection against fractures. Patients with hypertension are at increased risk of falls and fractures, making this an important consideration, particularly in the elderly. Continue reading “A Thiazide a Day to Keep Fractures Away?”