Background: Previous studies have highlighted great variability in how primary care physicians arrive at the diagnosis of Attention Deficit/ Hyperactivity Disorder (ADHD) and their frequent use of unreliable methods. This study examines how physicians in family medicine residency programs evaluate for ADHD in light of the 2000 American Academy of…
Weakness of the neck extensors can lead to “dropped head syndrome,” a condition of progressive cervical kyphosis in which a patient is unable to hold their head up against the force of gravity. This condition can be associated with structural abnormalities of the spine as found in ankylosing spondylitis and…
Background: To determine the knowledge, attitudes and self-reported usage of emergency contraception (EC) in rural western North Carolina women. Methods: Using a cross-sectional survey, with a convenience sample, participants self-administered the survey in waiting rooms of eight medical clinics in three counties in western North Carolina. Participants included 401 English-speaking…
Heterotopic gastric mucosa patch (HGMP) has been reported to occur in various parts of the gastrointestinal system from mouth to anus. Extra-gastrointestinal locations have also been reported. Presence of ectopic gastric mucosa has been associated with complications such as ulceration, bleeding, perforations and malignant transformations. Most complications are probably related…
Background: Elevated plasma total homocysteine (tHcy) is a risk factor for coronary artery disease (CAD), but the mechanism is not known. This study evaluates the determinants and associations of tHcy in patients presenting with acute myocardial infarction (AMI). Methods: Plasma concentration of tHcy, protein C, protein S, and antithrombin were…
Strongyloides hyperinfection syndrome is one of several clinical manifestations of strongyloidiasis and has a mortality rate exceeding 85%. The syndrome is characterized by a high organism burden owing to autoinfection and is most common in immunocompromised hosts. The recovery of multiple pathogens is likely due to a piggyback phenomenon that…
Hot tub lung is a form of hypersensitivity pneumonitis (HP) reported to be associated with exposure to large aerosolized inocula of Mycobacterium avium complex (MAC). Although the pathogenesis of the disease is still poorly understood, the pathology of MAC-related HP can be similar to that of sarcoidosis, with well-formed granulomas….
In the city of Modena, Italy, daily temperatures registered during the year 2003 showed a higher mean increase of 3° C compared with the previous three years, with average temperature of 26.1° C, compared with 22.8° C. The reported ambient temperature was higher than 32.3° C in 84% of the…
Assessment of patients with unexplained hypotensive episodes in outpatient practice is often challenging, with an extensive differential diagnosis. The prevalence of systemic mast cell disease (MCD) is unknown, and the diagnosis is often elusive because serum and urine markers may become positive only after one of the self-limited, recurrent hypotensive…
Background: Influenza vaccination is recommended for all women who will be pregnant during the influenza season; however, little is known about the attitudes of physicians regarding vaccination of pregnant women. Methods: We conducted a survey of all the fellows of the American College of Obstetricians and Gynecologists (ACOG) who live…
The diagnosis of granular acute lymphoblastic leukemia (ALL) can be problematic as the cytoplasmic granules found in many blast cells may mimic those seen in acute myelogenous leukemia (AML). This rare variant of B-cell ALL is more commonly diagnosed in children, but may occur in adults. We report a case…
The early 20th century Southerner lived in a disease environment created by a confluence of poverty, climate and the legacy of slavery. A deadly trio of pellagra, hookworm and malaria enervated the poor Southerner-man, woman and child—creating a dull, weakened people ill equipped to prosper in the modern world. The…
This review assessed the overall effectiveness of repeated treatments with botulinum toxin type A (BoNTA) across different conditions, as documented in the published literature. Forty-four original research articles reporting on 16 different conditions were identified that included data on the duration or efficacy of multiple treatments with BoNTA. All of…
Injury to the renal vasculature is an uncommon occurrence in the setting of blunt abdominal trauma. The authors report the case of a 2-year-old girl who developed occlusion from an intimal flap in a renal artery (grade IV renal injury) after blunt abdominal trauma that was treated with a stent…
Idiopathic pulmonary arterial hypertension is a disease involving small muscular pulmonary arteries and arterioles. Treatment with prostacyclin analogs and endothelin receptor antagonists is the cornerstone of therapy in these patients. Recent evidence suggests that phosphodiesterase-5 inhibitors such as sildenafil may improve functional capacity and hemodynamics in patients with pulmonary arterial…
Background: Psychological casualties following public health emergencies are likely to significantly outnumber physical casualties. However, postevent psychological disorders may be under-recognized by primary care providers (PCPs). Methods: Rural PCPs in northern and central Florida were interviewed using a series of open-ended questions to assess knowledge of likely mental disorders, their…
Scleroderma renal crisis (SRC) has classically been defined as a new onset of accelerated arterial hypertension associated with a rapid increase in serum creatinine concentration and/or microangiopathic hemolytic anemia. SRC occurs in approximately 20% of patients with systemic sclerosis who have diffuse cutaneous manifestations. In addition, 10% of reported cases…
Spontaneous pneumomediastinum (SPM) is a rare and benign clinical entity characterized by free air around mediastinal structures. Precipitating factors include violent cough, asthma, inhalational drugs, labor and exercise. We report a case of SPM due to achalasia which to the best of our knowledge, has never been reported. In achalasia,…
Metastatic spread of prostate adenocarcinoma to the temporal bone is very rare. Involvement of the jugular foramen may result in Collet-Sicard syndrome. This syndrome is characterized by paralysis of the lower four cranial nerves. A case of metastatic prostate adenocarcinoma involving the temporal bone causing Collet-Sicard syndrome is presented. This…
The article by Jason Lanham1 describing the results of a survey which addresses the evaluation of attention deficit hyperactivity disorder (ADHD) by family medicine residents and staff from 17 different programs was heartening. Over 90% of respondents used information not only from parent and child but also from the teacher…
A few years back I was on call for the outpatient clinic and received a call from one of my partner’s patients stating she had just experienced a barrier contraception failure. The caller stated that this would be an ill-timed pregnancy and that she had heard from a friend that…
Esophageal inlet patch is considered a congenital anomaly, a remnant of gastric mucosa which is left behind during the descent of the stomach in embryologic development. It can be found in about 4.5% of infants and up to 12% of children. Its presence is estimated at around 1 to 10%…
Several studies have shown the association of acute myocardial infarction with high plasma homocysteine levels.1–4 These studies involved different populations and have involved different study designs. However, retrospective studies tend to show a higher degree of positive association with hyperhomocystinemia than prospective studies. In some studies, no association was found.5,6…
Scleroderma renal crisis (SRC) is a life-threatening visceral complication of systemic sclerosis (SSc) characterized by the abrupt onset of malignant hypertension and rapidly progressive, oliguric renal failure. Microangiopathic hemolytic anemia and thrombocytopenia are often found. Typical SRC patients have widespread (diffuse) skin thickening. Occasionally, however, the presentation is subtle, as…
The prevalence of pediatric obesity in the United States has increased dramatically in recent years. It will likely continue to be a major drain on healthcare resources as well as a significant source of morbidity and mortality. In some areas of the United States with a substantial minority population, up…
Expired CME Article Questions: Pediatric Obesity: Impact and Surgical Management
Expired CME Article – Pediatric Obesity: Impact and Surgical Management
Expired CME Credit Submission and Evaluation Form – Pediatric Obesity: Impact and Surgical Management
It is known that markedly elevated tumor markers are sensitive for malignancies and may indicate a poor prognosis requiring aggressive therapy.1 Although rare, it can also be due to nonmalignant conditions. This was highlighted in the case report by Sanchez et al2 published in the February issue of the Southern…
Certain gastric submucosal tumors (SMTs) that are considered to be gastrointestinal stromal tumors (usually larger than 3 cm) require operative intervention because pathologic confirmation of its malignant potential is very difficult to make by endoscopic biopsy alone. As hepatic cysts may mimic the symptoms of a submucosal tumor, endoscopic biopsy…
Eosinophilic gastroenteritis (EGE) is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract.1,2We report a patient with eosinophilic gastroenteritis, who was admitted to the hospital because of abdominal pain and distension, and was diagnosed as having Strongyloides stercoralis infestation after investigation.
When you visit Reactome http://www.reactome.org/cgi-bin/frontpage?DB=gk_current, select “Hemostasis” from the matrix of 23 pathways to view the amazing clotting cascade. The cascade opens as a hierarchy of events with each base item presenting details of a section of the pathway with associated biochemical input and output sequences, participating molecules, preceding and…
The rate of childhood obesity in the United States has tripled over the last 30 years, and currently, over 15% of children and adolescents are obese. Failure to treat obesity early can lead to complications such as high blood pressure, elevated cholesterol and triglyceride levels, diabetes mellitus, liver and kidney…
As a child in the 50s and later as a medical student in the 70s, my first exposures to the area of nonconventional, complementary and alternative healing were home remedies. The vitamins, salves, elixirs, nutritional supplements, and Polish peasant foods prescribed by my mother later intersected powerfully with natural remedies…
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