Causes of asymptomatic microscopic hematuria

Excellent board-review lecture today by Dr. Sambandam! He is a little clinical pearl, the causes of asymptomatic microscopic hematuria:

  • Benign essential Hematuria (37%)
  • Benign Prostatic Hyperplasia (24%)
  • Urethral Infection (21%)
  • Urinary Tract Infection (7%)
  • Nephrolithiasis (4%)
  • Urethral calculus (2%)
  • Bladder tumor (2%)
  • Renal Cyst (1.5%)
  • Renal tumor (0.5%)

“The Flipped Patient”

This past December in JAMA, Dr. Jeffrey Chi and Dr. Abraham Varghese from Stanford University published an op-ed article in the Viewpoint section titled “The Flipped Patient”. They discuss how electronic health records (EHR) have provided many advantages in care of patients but point out some unintended consequences to training of physicians. Has EHR moved us away from the patient’s bedside? Do we bypass asking about the family history and past medical history because it already auto-populates on the note template? Has the question, “What brings you to the hospital?”, become obsolete with the abundance of information provided in the EHR before you even see the patient? Click on the link below to read the rest the article! Thanks to Dr. Croft and Dr. Kazi for the article reference.

“Ultimately, however, the nature of medicine is the interaction of a vulnerable human being in distress with a caring empathetic team represented by other humans.”

The Flipped Patient

HIV Treatment at Diagnosis According to U.S. Officials!

Yesterday the U.S. National Institutes of Health announced the early termination of a trial (START-Strategic Timing of AntiRetroviral Treatment) looking at early treatment of HIV at diagnosis due to clear benefits seen in the study. They recommended patients who learn they are HIV positive should immediately be put on antiretroviral therapy as their study shows a significant survival benefit. The START trial showed that the risk of death or serious illness in patients randomized to early treatment was reduced by 53%. The findings are expected to impact global guidlines regarding HIV treatment. Current W.H.O guidelines recommend treating at CD4 of 500, but acknowledged that treatment at CD4 count of 350 was more practical in many poor countries. They are expected to release updated guidelines very soon. Of note, the CDC recommends immediate treatment at diagnosis of HIV but estimated that 37% of Americans with HIV actually have prescriptions for antiretroviral therapy. Check out the link below from the NIH that summarizes their announcement!

NIH-Starting antiretroviral treatment early improves outcomes for HIV-infected individuals

(photo from Susan Sterner/Associated Press)