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....

Physician Perspectives on Long-Term Relationships and Friendships with Patients: A National Assessment

Objectives: Shifts in the healthcare environment have introduced challenges to the long-term continuity of the doctor–patient relationship. This study examines whether certain demographic or religious characteristics of physicians are associated with maintaining long-term relationships (LTRs) and/or friendships with their patients and describes physicians’ opinions regarding the influence of such patient relationships on health...

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....

Development of a Flipped Medical School Dermatology Module: Erratum

In the May 2017 issue of Southern Medical Journal there are errors in the n values for Table...

Treatment-Naïve HIV-Infected Patients Have Fewer Gut-Homing β7 Memory CD4 T Cells than Healthy Controls

Objectives: The integrin α4β7 is the gut-homing receptor for lymphocytes. It also is an important co-receptor for human immunodeficiency virus (HIV) via glycoprotein (gp)120 binding. Depletion of gut cluster of differentiation (CD)4 T cells is linked to chronic inflammation in patients with HIV; however, measuring CD4 cells in the gut is invasive and not routine. As such, establishing a peripheral marker for CD4 depletion of the gut is needed....

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...

Nontraumatic Emergency Laparotomy: Surgical Principles Similar to Trauma Need to Be Adopted?

Objectives: In 2011, the Royal College of Surgeons published Emergency Surgery: Standards for Unscheduled Care in response to variable clinical outcomes for emergency surgery. The purpose of this study was to examine whether different treatment modalities would alter survival. Methods: All patients who underwent emergency laparotomy between April 2011 and December 2012 at Warwick Hospital (Warwick, UK) were included retrospectively....

Conjoint Treatment: A Novel Approach to Target the Syndemic Conditions of Trauma, Substance Abuse, and HIV in Women Living with HIV

The Centers for Disease Control and Prevention estimates that in the United States, 1.2 million adults and adolescents are living with human immunodeficiency virus (HIV).1 In a span of 15 years, from 1985 to 2000, the proportion of women living with HIV more than tripled.2 The Centers for Disease Control and Prevention estimated that by the end of 2013, 232,511 women were living with HIV in the United...

Still Invisible After All These Years

I still wonder what happened to him after he left the hospital against medical advice (AMA). About a week before, David had been admitted for a severe leg infection to the general medicine ward where I served as his attending physician. His hospitalization had an inauspicious beginning; he seemed very anxious from the moment he arrived on the...

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...

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...

Healthcare Utilization by Frail, Community-Dwelling Older Veterans: A 1-Year Follow-up Study

Objectives: Frailty is a prevalent clinical syndrome associated with a high risk of adverse health outcomes, including disability, morbidity, and mortality, that has become a major challenge for the healthcare system. The aim of this prospective study was to determine the level of healthcare utilization in prefrail and frail community-dwelling older military veterans. Methods: We studied a cohort of community-dwelling older veterans aged 65...

Commentary on “Still Invisible After All These Years”

In this issue of the Southern Medical Journal, Dr Manian contemplates how best to provide high-quality care, despite unusual patient behaviors, attitudes, or other problems.1...

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...

Trends in Abortion Incidence and Availability in North Carolina, 1980–2013

Objectives: Abortion incidence has declined nationally during the last decade. In recent years, many states, including North Carolina, have passed legislation related to the provision of abortion services. Despite the changing political environment, there is no comprehensive analysis on past and current trends related to unintended pregnancy and abortion in North Carolina. Methods: This study is a secondary analysis of vital registration data...

The “Hand-in” Project: Jump-starting Communication Between Inpatient and Outpatient Providers

Objectives: Communication between hospitalists and primary care providers (PCPs) upon discharge has been much discussed, but the transition from outpatient to inpatient has received less attention. We questioned whether a brief, standardized e-mail from the hospitalist to the PCP upon admission could facilitate information exchange, increase communication, elucidate PCP preferences, and improve outcomes. Methods: This prospective...

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...

Neoadjuvant and Adjuvant Therapies for Breast Cancer

Breast cancer remains the most common cancer in women in the United States, the second most common cause of cancer death, and the main cause of death in women ages 45 to 55 years. Molecular analyses have shown that breast cancer is divided into several subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 enriched, and basal-like), based on microarray techniques. Patients diagnosed as having breast cancer may undergo adjuvant...

Emerging Therapeutic Strategies in Breast Cancer

The field of medical oncology is experiencing a period of rapid evolution owing to advances in the fields of genomics, tumor biology, and immunology. These disciplines have provided valuable insights into the heterogeneity between breast tumors, key oncogenic drivers, and the role of the immune system in the natural history of breast cancer. This knowledge is translating into many novel therapeutic strategies using personalized medicines,...