April 22nd, 2018

Some ID Stuff We’re Talking About on Medical Rounds — with Bonus Andy Borowitz Podcast

Sam approaching a “scent detection box.”

As an infectious diseases specialist attending on the general medical service each year, I am the beneficiary of a wonderful knowledge exchange.

The smart house staff and my generalist co-attending teach me the latest about hyperkalemia, anticoagulation, anemia, alcohol withdrawal, acute renal injury, COPD, atrial fibrillation, pancreatitis, asthma, diabetes, and congestive heart failure — to name a few of the non-infectious issues that come up routinely during inpatient care.

For example, I am now quite comfortable saying HFpEF — which, if you haven’t done inpatient medicine in a while, is pronounced “HEF-PEF,” and most certainly did not get mentioned a single time during my residency training.

And what do they get in return? A bunch of infectious diseases snippets, factoids, random comments, and (I hope) clinical pearls, such as the following:

Meanwhile, in other news, there’s this podcast — highly recommended and entertaining!

Friends: ten years ago, I had a near-death experience (seriously). Dr. Paul Sax, an esteemed expert in infectious…

Posted by Andy Borowitz on Thursday, April 19, 2018

And note, not a single mention of an antibiotic.

8 Responses to “Some ID Stuff We’re Talking About on Medical Rounds — with Bonus Andy Borowitz Podcast”

  1. M Weinstein says:

    “ig-rah” or “Eye- grah” ?
    I vote the latter

  2. Rebeca Plank says:

    Paul, doxycycline was signed fair and square! It may be generic but it’s no longer a “free agent”.

    Plus, your first draft pick, ceftriaxone, seems to have its own anti-inflammatory properties:

    https://journals.lww.com/jtrauma/Abstract/2012/09000/The_beta_lactam_antibiotic,_ceftriaxone,_provides.18.aspx?trendmd-shared=0

  3. Mohammed alabdullah says:

    Nice site i like the notes
    Could you sign me up

    Regards
    Mohammed Alabdullah
    Transplan ID staff

    • Paul Sax says:

      Dear Mohammed,
      I’ve had several people ask about “signing up” recently.
      Just put your email address in the right side of the page where it says, “Subscribe to HIV and ID Observations via Email”. It will very faint text, but it works!
      Paul

  4. Loretta S says:

    Thanks, as always, Paul. Always so much great material packed into these types of posts from you.

    Ah, fluoroquinolones. Sigh. They worked so well for so many infections we commonly see in primary care. They were such reliable friends to have in Antibiotic World. Now I treat them as if they were radioactive. Not quite, but you get the picture. My personal scary fluoroquinolone story concerns a patient of one of my colleagues. The patient had been prescribed ciprofloxacin for a UTI (this was prior to the FDA warning) and developed crystal-induced acute kidney injury (confirmed via renal biopsy). The patient returned to the office about a week after starting the drug, complaining of fatigue. Bloodwork showed a GFR of 4!!! She did recover, thank goodness, although her long-term GFR took a hit. That story plus the FDA warning made me “unfriend” fluoroquinolones for most primary care infections, unless there is no other alternative.

    Regarding HFpEF and it’s flip side, HFrEF (which I guess is pronounced hef-ref?) — l noticed a few years ago that my friends in cardiology made frowny faces when I said “diastolic heart failure” or “systolic heart failure”. Now I, too,say HFpEF and HFrEF. I wish there was an alert system to let us know when commonly-used medical terms become passe. Hey, there’s an idea for an app!

  5. Blinky Ray says:

    “The most important risk factors for cefepime neurotoxicity are older age and decreased renal function.” .. has anyone looked at ertapenem as well? Think decreased renal function is a major risk factor for neurotoxicity but not widely published. Rgds

  6. John Cascone says:

    Look forward to your blog every week. Thank you!

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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