Authors’ Response

To the Editor: The authors thank Dr Madias for his interest in our work. We discussed the possibility of takotsubo cardiomyopathy (TTC) and reverse TTC (rTTC) being a transient evolution of the same disease, given multiple reports in the literature of patients displaying temporal changes of akinetic areas during TTC with varying timelines....

Red Cell Width: An Emerging and Novel Biomarker of Systemic Inflammation

To the Editor: Systemic inflammation has been implicated in the etiology of many diseases and is often linked to poor health outcomes. Several indices have been used as markers for such inflammation....

Using Pill Identification Calls to Poison Centers as a Marker of Drug Abuse at Three Texas Military Bases

Objectives: Opioid abuse is a growing problem in civilian communities, and it has developed in the military as well. Telephone calls to poison centers requesting pill identification (ID) is a marker of drug abuse. This study identifies the number of pill ID calls made to the poison centers from areas containing and surrounding three Texas military bases during an 8-year period. Methods: We performed a retrospective observational study...

Utility of the Shock Index for Risk Stratification in Patients with Acute Upper Gastrointestinal Bleeding

Objectives: Patients with upper gastrointestinal bleeding (UGIB) frequently require hospitalization, and a small but significant percentage of these patients have adverse outcomes. Risk-scoring tools can help clinicians organize care and make predictions about outcomes. The shock index (heart rate divided by systolic blood pressure) has been used in multiple acute disorders and has the potential to identify patients with UGIB who are at risk for...

Acute Pancreatitis: Etiology, Pathology, Diagnosis, and Treatment

Acute pancreatitis is a fascinating disease. In the United States, the two most common etiologies of acute pancreatitis are gallstones and excessive alcohol consumption. The diagnosis of acute pancreatitis is made with a combination of history, physical examination, computed tomography scan, and laboratory evaluation. Differentiating patients who will have a benign course of their pancreatitis from patients who will have severe...

On “Why Is Reverse Takotsubo ‘Reverse’?”

To the Editor: I enjoyed reading the article by Rosu et al about the reverse (ie, inverse) variant (ie, hypocontractile base-ventricular segment and a hypercontractile apex) of takotsubo cardiomyopathy (rTTC) that appeared in the May 2017 issue of the Southern Medical Journal....

Subclinical Atherosclerosis Among Young and Middle-Aged Adults Using Carotid Intima-Media Thickness Measurements

Objectives: The presence of atherosclerotic plaque in the carotid arteries is a strong predictor of cardiovascular disease (CVD). Research and data on CVD risk have been derived primarily from individuals aged 55 years or older, and assessment of CVD risk among young and middle-aged adults seldom has been studied. The use of ultrasonography to measure carotid intima-media thickness (IMT) and carotid plaque appears to have utility to detect...

Commentary on “Using Pill Identification Calls to Poison Centers as a Marker of Drug Abuse at Three Texas Military Bases”

The opioid epidemic in the United States is fueled by both prescription medications and illicitly manufactured drugs. Individuals who purchase or obtain prescription opioids illegitimately may wish to confirm the authenticity of the pills. For those involved with regional poison center operations, it comes as no surprise that the public will call in to identify their...

Hospital Discharge Disposition of Stroke Patients in Tennessee

Objectives: Early determination of hospital discharge disposition status at an acute admission is extremely important for stroke management and the eventual outcomes of patients with stroke. We investigated the hospital discharge disposition of patients with stroke residing in Tennessee and developed a predictive tool for clinical adoption. Our investigational aims were to evaluate the association of selected patient characteristics with...

Management of Metastatic Spinal Cord Compression

Cancer metastasis is a key event in tumor progression associated not only with mortality but also significant morbidity. Metastatic disease can promote end-organ dysfunction and even failure through mass effect compression of various vital organs including the spinal cord. In such cases, prompt medical attention is needed to restore neurological function, relieve pain, and prevent permanent damage. The three therapeutic approaches to managing...

Commentary on “Hospital Discharge Disposition of Stroke Patients in the State of Tennessee”

In this issue of the Southern Medical Journal, Cho and colleagues assessed the hospital discharge location for patients with stroke and attempted to develop a tool to help determine the discharge location early in the clinical course.1 The treatment for acute ischemic stroke has come a long way since the approval of intravenous tissue plasminogen activator in 1995 to the advent and use of stent retrievers and large-bore aspiration catheters in...

Idiopathic Thrombocytopenic Purpura in Individuals Older than 75 Years: A Rare Series

To the Editor: Idiopathic thrombocytopenic purpura (ITP), currently referred to as primary immune thrombocytopenic purpura, is an autoimmune disease linked to the presence of autoantibodies responsible for the peripheral destruction and central inhibition of platelet growth.1 Bleeding results from unusually low levels of platelets, the cells that help blood coagulate.2 Treatment of ITP is based on the recommendations of experts2; however, in...

Predictors of 30-Day Mortality in Hospitalized Patients with Clostridium difficile Infection

Objectives: Clostridium difficile infection (CDI) is a significant cause of morbidity and mortality and is the most common nosocomial infection in the United States, with associated annual costs of approximately $3 billion. The epidemiology of CDI has changed with the identification of novel risk factors for incident and recurrent CDI. The aim of this study was to identify the predictors of 30-day mortality in hospitalized patients with...

Impact of Polypharmacy on Seniors’ Self-Perceived Health Status

Objectives: Polypharmacy is common among older patients and is linked to increased risk of adverse health outcomes. This study aimed to explore the association of polypharmacy and self-perceived health status (SPHS) among geriatric patients. Methods: This cross-sectional analysis of longitudinal observational research used national survey data from 2005–2008. Multivariate logistic regressions examined the likelihood of having a good/poor...

Association between Weight Change, Health Outcomes, and Mortality in Older Residents in Long-Term Care

Objectives: Despite the numerous health risks associated with being overweight, the effect of weight loss on health and longevity remains controversial, particularly in older adults. We explored the association among weight changes, health outcomes, and mortality in older residents of a skilled nursing facility. Methods: A 6-year retrospective chart review of residents of a long-term care facility was conducted, collecting monthly weights in...

Stroke Hospital Characteristics in the Florida–Puerto Rico Collaboration to Reduce Stroke Disparities Study

Objectives: Although disparities in stroke care and outcomes have been well documented nationally, state-based registries to monitor acute stroke care in Florida (FL) and Puerto Rico (PR) have not been established. The FL-PR Collaboration to Reduce Stroke Disparities (CReSD) was developed to evaluate race-ethnicity and regional disparities in stroke care performance. The objective of this study was to assess and compare hospital characteristics...

Colon Cancer Screening in Concierge Practice

Objectives: This study evaluated the effectiveness of the Center for Executive Medicine (CEM) concierge primary care practice on preventive colorectal cancer (CRC) screening rates relative to local and national comparator data. Methods: We performed an electronic medical record search encompassing our entire patient population who are between the ages of 50 and 75 years to determine the rate of CRC screening. We compared this rate with the...

Effect of Diet Liberalization on Bowel Preparation

Objectives: Precolonoscopy dietary regimens often are restricted to clear liquids; however, the superiority of a clear liquid diet (CLD) for bowel preparation quality is ambiguous. We performed a meta-analysis of randomized trials comparing bowel preparation outcomes between a low-residue diet (LRD) or regular diet (RD) compared with a CLD. Methods: MEDLINE, clinicaltrials.gov, Cochrane Central Register, Scopus, Embase, Cumulative Index to...

Pirfenidone and Nintedanib for Treatment of Idiopathic Pulmonary Fibrosis

Idiopathic pulmonary fibrosis is one of the most common entities of the family of disorders known as the interstitial lung diseases. It is a chronic, progressive, and often-fatal disease with a median survival time of 3 to 5 years. In 2014 the US Food and Drug Administration approved pirfenidone and nintedanib, two antifibrotic agents for the treatment of idiopathic pulmonary fibrosis. Because these are the only drugs approved that can alter the...

Why Is Reverse Takotsubo “Reverse”?

Objectives: Takotsubo cardiomyopathy (TTC) is an acute cardiac syndrome simulating myocardial infarction that is characterized by transient wall motion abnormalities in the absence of coronary artery obstruction. Reverse TTC (rTTC) is a recently described variant of TTC. This review defines and compares both forms of TTC, stating their resemblances and differences. Methods: We conducted a search of the MEDLINE database. Forty-one cases of...