Author Archives: John

VA Resident Report: What is the management strategy of Kaposi Sarcoma and pneumocystis pneumonia in a HIV positive patient?

The Bottom Line: The management of pulmonary KS is challenging. There is a risk of precipitating IRIS upon initiating cART. Chemotherapy can also cause further immunosuppression and increase the risk of further infections. In many of these patients, initiation of … Continue reading

Posted in VA | Tagged ,

EUHM Resident Report: What is the correlation of HSV encephalitis and intracerebral hemorrhage?

The mechanism of hemorrhagic complication in HSV encephalitis is unclear. The possible mechanisms  include small vessel rupture due to vasculitis and transient hypertension caused by increased intracranial pressure. Gyral pattern of the hemorrhage may suggest that the hemorrhagic complication in … Continue reading

Posted in EUHMidtown | Tagged ,

EUHM Resident Report: How to handle difficult patient situations?

Difficult encounters are estimated to represent 15 to 30 percent of family physician visits. Factors contributing to these difficult clinical encounters may be related to the physician, patient, situation, or a combination. Physicians can recognize these visits as challenging by … Continue reading

Posted in EUHMidtown | Tagged

VA Resident Report: What is the effectiveness of POEM for achalasia?

Available data suggests POEM is very effective in the relief of symptoms in patients with achalasia. However, POEM is associated with a very high incidence of pathologic reflux. The clinical sequalae of the increase in pathologic reflux are currently incompletely … Continue reading

Posted in VA | Tagged

VA Resident Report: Review of Fournier’s gangrene

The Bottom Line: Fournier’s gangrene is a progressive necrotizing soft-tissue infection (NSTI) of the external genitalia and/or perineum. It is a urological emergency requiring prompt diagnosis and treatment — even with administration of parenteral broad-spectrum antibiotics and expedited aggressive surgical debridement, the disease … Continue reading

Posted in VA | Tagged , ,

VA Resident Report: What is the mechanism of metabolic alkalosis with villous adenoma?

The Bottom Line: When diarrhea is the cause of metabolic alkalosis, rather than acidosis, the mechanism is determined by measuring the electrolyte content in stool. Large losses of chloride may occur in patients who have villous adenomas or other secretory … Continue reading

Posted in VA

VA Resident Report: What are the adverse effects of PPI use on B12 levels?

The Bottom Line: Studies of PPI use and vitamin B12 deficiency have yielded mixed results. Absorption decreased from 3.2 to 0.9% (P ¼ 0.031) in patients on omeprazole 20 mg daily, and from 3.4 to 0.4% in patients on higher … Continue reading

Posted in VA | Tagged