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An Uncommon Cause of Low Back Pain

A 21-year-old active duty Air Force male without past medical history presented to our Emergency Department with low back pain. The patient had been performing general resistance strength training, including specific exercises focusing on the low back region, for about 2 months. A few hours after a workout session, he developed acute pain to the […]

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The Hyperlipidemia Effect: Pseudohyponatremia in Pancreatic Cancer

A patient’s newly discovered malignancy was evidently accompanied by a sodium deficit. The 48-year-old man presented to the Emergency Department for evaluation of abdominal pain and weight loss. He described gradual onset of severe, burning, epigastric pain with radiation to the back. In addition, he reported a 70-lb weight loss over 2 months, yellowing of […]

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Recognition and Prevention of Nosocomial Malnutrition: A Review and A Call to Action!

Nosocomial malnutrition in hospitalized adults is a morbid, costly, and potentially preventable and treatable problem. Although recognized as contributing to many serious complications of hospitalization, malnutrition is often missed when present on admission and rarely diagnosed if it occurs during hospital stay. Many routine clinical practices such as holding nutrition for testing or failing to […]

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Challenges in Ordering and Interpreting Pharmacogenomic Tests in Clinical Practice

More than 160 US Food and Drug Administration–approved medications have information in their labeling regarding genetic mutations known to be associated with efficacy or safety.1 Not surprisingly, pharmacogenomics is increasingly incorporated into clinical practice in an effort to optimize prescribing to improve treatment outcomes.2, 3, 4, 5 Clinical implementation of pharmacogenomics has been facilitated by efforts to standardize pharmacogenomic-related terminology and […]

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Dr. Joseph S. Alpert

Challenging Patients: An International Perspective

Recently, I related the sad stories of 2 challenging patients that I had helped to care for during one of my rotations as attending physician on our internal medicine service.1 The first patient was a frail elderly lady with a number of serious and potentially life-threatening illnesses who insisted on going home to her apartment where […]

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