Bronchiectasis 101

Below are some key points regarding bronchiectasis:

  • Damage to the airways causing them to widen and become scarred. This causes impaired clearance of mucous resulting in buildup and recurrent lung infections.
  • Congenital etiologies (cystic fibrosis, primary ciliary dyskinesia, alpha-1 antitrypsin deficiency) versus acquired (post-infection, idiopathic, aspiration, immunodeficiency, auto-immune, ABPA).
  • Patients presents with chronic cough and sputum production. Affects women more than men.
  • Typically diagnosed by high resolution CT scan.
  • At risk for chronic colonization by Pseudomonas.
  • Typical infectious organisms include H. influenzae, Pseudomonas, Moraxella catarrhalis, Mycobacterium, Staph.
  • Treatment: Treat underlying condition, antimicrobrial therapy, surgical resection, lung transplant for end stage disease.

O’Donnell. CHEST. 2008.

Big News in the Field of Cancer!

At this year’s American Society of Clinical Oncology (ASCO) conference in Chicago recently, there were a lot of presentations on immunotherapy to treat cancer and tailoring therapies for individuals based on genetic mutations. Abstracts from the conference were recently published on ASCO’s website. The National Cancer Institute announced on Monday plans to launch a national research study sorting cancer patients to treatment groups based on genetic mutations rather than cancer type. This study could lead to drug trials that can be implemented more quickly and possibly match patients with a better suited drug for their cancer. These newer designed studies are referred to as “basket trials”. Click on the link below to a interesting graphic from the Washington Post that illustrates the difference between conventional clinical trials and basket trials.

A Novel Way to Target Cancer and its Treatments (Washington Post)

What Makes an Outstanding Upper Level Resident? 6 Tips May Help!

Dr. Juan Lessing and Dr. Nick Mark from the University of Washington presented some advice on how to be a great senior internal medicine resident at SGIM 2015, “6 Precepts to Becoming a Good Senior Resident”. Click on the link below to read it as it’s full of helpful advice and very applicable to the housestaff! Thanks to Dr. Anil Makam for the reference!

6 Precepts to Becoming a Good Senior Resident

Freakonomics Takes a Look at Healthcare! 

This past April, two podcasts were released by Freakonomics that took a closer look at randomized controlled trials and taking the approach of “less is more” in taking care of patients. The first podcast interviews Amy Finkelstein, an economist from M.I.T, who has been looking at the utility of conducting randomized controlled trials in studying health care delivery and uses the Oregon Medicaid Health Experiment as an example. In the second podcast, Dr. Anupam Jena (assistant professor at Harvard Medical School) is interviewed regarding a study he led that looked at outcomes in Medicare patients when specialists are away at a conference. Click on the links below to be directed to the podcast from the Freaknonomics website. Thanks to resident Sean Townsend for the reference!

How Do We Know What Really Works in Healthcare

How Many Doctors Does It Take to Start a Healthcare Revolution?

The Mentor-Trainee Relationship – A Lost Art of Medicine?

Recently, The New York Review of Books, published online an article written by Dr. Lara Goitein (pulmonologist/critical care board ceritified physician from New Mexico) who discusses the current state of residency training. She makes several references to the book, Let Me Heal: The Opportunity to Preserve Excellence in American Medicine, written by Dr. Kenneth M. Ludmerer from Washington University. Dr. Goiteini writes of when and where the current model of residency training began with Dr. William Osler and the importance of the mentoring relationship between faculty and the housestaff. Faculty who were held to the highest esteem by peers, residents, and the institution were the ones who were the best teachers. However, with healthcare undergoing major changes and how it’s delivered, Dr. Goitein is concerned about the erosion of this relationship and how residency training is changing. She comments on the recent ACGME guidelines regarding duty hours as well as how the institutions where residents train have changed and its effect on resident education. Check out the article below by clicking on the link! Thanks to several residents who referred to this article for the blog.

Training Young Doctors – The Current Crisis 

Milk-Alkali Syndrome 101

Below are some key points in diagnosing and managing milk-alkali-syndrome:

Triad of hypercalcemia, metabolic alkalosis, and acute kidney injury associated with the ingestion of large amounts of calcium and absorbable alkali.

  • Excessive amounts of calcium carbonate is considered 4-5 g daily
  • Originally described in association with the use of milk and sodium bicarbonate for the treatment of peptic ulcer disease
  • There may be a resurgence of this disorder due to increased calcium therapy for presenting/treating osteoporosis, more OTC calcium carbonate preparations, and use of calcium carbonate in patients with CKD to minimize secondary hyperparathyroidism
  • Among patients hospitalized with hypercalcemia, milk-alkali syndrome is the 3rd most common cause behind hyperparathyroidism and cancer
  • Pathogenesis remains uncertain as studies have shown that some patients given high amounts of alkali and calcium don’t develop milk-alkali syndrome
  • Although renal impairment is associated, it’s not a prerequisite to develop milk-alkali syndrome
  • Individual variations in the buffering capacity of bone may play role in the susceptibility to development of hypercalcemia
  • Patients at higher risk include
    • Older individuals
    • Those at risk for volume depletion (including patients on thiazide diuretics)
    • Medications that reduce GFR (ie ARB’s, ACE-I, NSAIDS)
  • Diagnosis is based upon the history of ingestion of calcium-rich medications and the exclusion of other causes of hypercalcemia
  • Treatment:
    • Stop offending agent
    • Treat with IV saline and furosemide
    • Hypocalcemia can occur transiently with rapid rise of PTH to supranormal levels which is unique to milk-alaki syndrome

(Medarov. Mayo Clin Proc. 2009 Mar; 84(3): 261–267.)

Dr. Jade Le talks about West Nile Virus on KERA!

Today on KERA – Dallas affiliate of NPR – Dr. Jade Le from the division of infectious diseases at UT Southwestern talked about West Nile virus and cases already being reported. She provides a quick overview of the infection including individuals who may be at higher risk. Listen to the interview by clicking on the link below!

West Nile Virus Came to Texas Early this Year