Issue - Southern Medical Association

Original Article

The Effect of Sunless Tanning on Behavior in the Sun: A Pilot Study

Background: In the United States, indoor tanning is a booming industry and contributes to the ultraviolet light (UVL) burden that ultimately leads to skin cancer. “Sunless” tanning methods that avoid UVL exposure may represent a safe alternative. However, the effects of sunless tanning methods on ultraviolet light-related behaviors have never…

Expired CME Article

Malaria Primer for Clinicians in the United States

Though low, the incidence of malaria in the United States is not insignificant and can be the source of infection in febrile travelers returning from endemic areas. Clinicians practicing in the United States must have a basic understanding of the malaria life cycle and its treatments to properly diagnose and…

Expired CME Credit Submission and Evaluation Form

CME Credit—December 2005 CME Topic: Malaria Primer for Clinicians in the United States

Expired CME Credit Submission and Evaluation Form – Malaria Primer for Clinicians in the United States

Case Report

Pinch-an-inch Test for Appendicitis

Rebound tenderness is a widely used examination technique for patients with suspected appendicitis, but it can be quite uncomfortable. An alternative test for peritonitis is termed the “pinch-an-inch” test. This report describes two patients who presented with mild abdominal pain who subsequently were found to have appendicitis. In both patients,…

Case Report

Unusual Cause of Hypokalemic Paralysis in Aged Men: Sjögren Syndrome

Hypokalemic paralysis is a less recognized but reversible disorder in elderly patients. This report describes two elderly Chinese males (age 74 and 78 years) who had progressive muscle weakness and eventually paralysis. Physical examination showed symmetrical flaccid paralysis of extremities. Both had the major biochemical abnormality of profound hypokalemia (1.4…

Case Report

Brucella Glomerulonephritis: Case Report and Review of the Literature

The authors present the case of a 17-year-old shepherd who was diagnosed with diffuse proliferative glomerulonephritis and diffuse tubulointerstitial nephritis during the course of Brucella infection. The pathogenesis and the mechanism of renal involvement in brucellosis is discussed in light of the pertinent literature. Key Points * Brucella is a…

Case Report

Eosinophilic Pleural Effusion, Peripheral Eosinophilia, Pleural Thickening, and Hepatosplenomegaly in Sarcoidosis

In this atypical case of sarcoidosis with an unusual combination of clinical and laboratory findings, a 32-year-old male presented with a 3-month history of thoracic pain complicated with dyspnea. Laboratory tests, chest radiography, and CT scans of the chest and abdomen revealed eosinophilia of pleural effusion and blood, pleural thickening,…

Letter to the Editor

Pyomyositis of the Iliacus Muscle in an Adolescent

A ten-year-old female presented to the Emergency Room with the acute onset of left hip pain and was non-ambulatory when she was admitted to the hospital. On initial examination, she was in severe pain. She was afebrile with stable vital signs. The hip appeared normal, with no erythema or swelling,…

Letter to the Editor

Spontaneous Escherichia coli Meningitis with Subdural Empyema in an Adult

Spontaneous or nontraumatic Escherichia coli meningitis is rare in adults. We report a case of spontaneous E coli meningitis associated with a bilateral frontal subdural empyema in an adult.

Letter to the Editor

Rituximab is Effective in the Treatment of Refractory Immune Thrombocytopenic Purpura Associated with Chronic Lymphocytic Leukemia

Two percent of chronic lymphocytic leukemia (CLL) patients present with immune thrombocytopenic purpura (ITP). Corticosteroids, immune globulins (IVIG) and splenectomy remain the mainstay of treatment for ITP. Rituximab is a monoclonal antibody against CD20 antigen expressed on B-lymphocytes. Because of its B-cell depleting capability, it has been employed in the…

Editorial

The Art and Science of Diagnosing Acute Appendicitis

In this month’s article by Adams et al, the early diagnosis of acute appendicitis comes full circle. Appendectomy for acute appendicitis remains one of the most common intra-abdominal surgeries performed in the United States. For Americans, the lifetime risk of developing appendicitis is 8.6% for males and 6.7% for females,…

Spirituality/Medicine Interface Project

An Introduction to the Spirituality/Medicine Interface Project

Faith and healing have long been intertwined and are often difficult to separate. Even in the present days of rigorous scientific experimentation and evidence-based medicine, there is no doubt that, at least in some instances, faith instrumentally affects the prognosis of illness.

Spirituality/Medicine Interface Project

The Southern Medical Association’s Perspective

Through the ages, belief systems have had remarkable effects upon the course of human events. Individual belief systems have often been the catalyst for performance beyond personal abilities or resources. In light of this, the following questions require consideration. Does a synergism exist between spirituality and medicine? If so, how…

Spirituality/Medicine Interface Project

Religion, Spirituality and Medicine: The Beginning of a New Era

This issue of The Southern Medical Journal inaugurates the Journal’s Spirituality/Medicine Interface Project. The project is crucial because it represents the first time that a mainstream professional medical journal has attempted to systematically examine both the positive and negative effects of religiosity/spirituality on health and health care delivery. The topic…

Spirituality/Medicine Interface Project

Clergy as Health Care Providers

Religious community is important to the lives of a substantial portion of the population in the United States. Across the country, there are nearly 500,000 churches, temples, and mosques.1 Approximately 4 in 10 Americans attend one of these places of worship at least once a week, 6 in 10 attend…

Spirituality/Medicine Interface Project

Definition of Terms: Spirituality versus Religiousness

Nowhere is the need to define and clarify terms more fundamental than when discussing spirituality and religion. Though often set in the stone of tradition, this topic is so nebulous, subjective, emotional, and, at times, even prejudicial, that clear definitions are needed to avoid further ambiguity and confusion. Such a…

Spirituality/Medicine Interface Project

Physician’s Perspective Combining Spirituality and Medicine: One Physician’s Approach

An increasing number of publications in recent years have examined the importance of physicians taking into consideration a patient’s religious or spiritual background in the practice of medicine in an effort to provide more holistic care. Koenig has succinctly described reasons why it is not only reasonable but important for…

Spirituality/Medicine Interface Project

Partnering Together? Relationships Between Faith-based Community Health Centers and Neighborhood Congregations

Objective: The US Bureau of Primary Health Care has promoted collaboration between federally funded community health centers and neighborhood religious congregations, yet little is known about how such organizations currently interact in underserved neighborhoods. Methods: Semistructured interviews were conducted with leaders from five faith-based, urban community health centers and 23…

Editorial

Atypical Presentations of Sjögren Disease

It has been more than 70 years since Swedish ophthalmologist, Henrik Sjögren, described the triad of xerophthalmia, parotid enlargement, and arthritis. Fifty years before that, Mikulicz noted a correlation between cellular destruction in the lacrimal and salivary glands with cellular infiltrates. Over the ensuing years, literally thousands of papers have…

Original Article

An Outcome Study of the Use of Computed Tomography for the Diagnosis of Appendicitis in a Community-based Emergency Department

Objectives: Previous studies evaluating the use of CT in the diagnosis of appendicitis have taken place at university-based institutions where surgical bedside consultation seems prudent before radiological study. In the private hospital setting, the emergency department (ED) physician is responsible for diagnosis. We attempt to assess if this process is…

Original Article

Effectiveness of a School-based Intervention to Increase Health Knowledge of Cardiovascular Disease Risk Factors Among Rural Mississippi Middle School Children

Background: Few school-based interventions have been evaluated to assess health awareness among children in rural southern areas. The purpose of this controlled investigation was to increase health awareness among middle school-aged children residing in a racially diverse rural community in Mississippi. Methods: This investigation assessed health knowledge before and after…

Original Article

Factors that Affect Parental Disciplinary Practices of Children Aged 12 to 19 Months

Background: Physicians are encouraged to provide counseling regarding parental discipline. Quality counseling requires knowledge of disciplinary practices and factors that affect these practices. Methods: One hundred and eighty two parents of 12- to 19-month-old children from general pediatric clinics in North Carolina and Alabama were interviewed regarding discipline using the…

Article

In Appreciation

In Appreciation

Case Report

Unusual Presentation of Sjögren Syndrome

This case report describes a patient with Sjögren syndrome (SS) whose sole presenting feature was bilateral and painful submandibular gland enlargement. Extensive workup for alternate etiologies was negative and while serologies specific for SS were unremarkable, the diagnosis was eventually suggested by excisional biopsy. This case highlights the difficulty in…

Expired CME Article

CME Questions: A Malaria Primer for Clinicians in the United States

Expired CME Article Questions- A Malaria Primer for Clinicians in the United States

Editorial

The Threat of Malaria for US Travelers

Although malaria has been eradicated from most industrialized and Western countries, a number of travelers to tropical countries where the disease remains a major cause of morbidity and death present with the disease upon their return. Imported cases of malaria number about 25,000 annually, although only about 10,000 are reported,…

Editorial

Brucella Glomerulonephritis

Reports of renal involvement with brucellosis are rare and anecdotal even though patients can excrete brucellae in the urine. Mild proteinuria may be commonly seen with brucellosis. However, cases of interstitial nephritis, pyelonephritis, immunoglobulin (Ig)A and membranous nephropathy, massive proteinuria, and caseating granulomas have all been reported in the literature.1–5…

Editorial

Do All Patients with Suspected Appendicitis Benefit from CT Imaging in Community-based Emergency Departments?

The classic presentation of acute appendicitis involves the orchestrated complaint of vague periumbilical pain that localizes to the right lower quadrant and is accompanied by anorexia, nausea and emesis. However, this classic presentation is not usually the rule and approximately 15 to 21% of all appendectomies performed are unnecessary. The…

Editorial

Environmental Influences on Diet and Physical Activity in Childhood: Opportunities for Intervention

The high prevalence of childhood overweight has become a national health issue, and the prevalence of overweight in rural areas is rising at a particularly accelerated rate. There is a great need for school-based intervention efforts specifically targeting the prevention and reduction of excess weight gain and other cardiovascular disease…

Article

Medical Webwatch

The Medical Schools page of the Association of American Medical Colleges at http://www.aamc.org/medicalschools.htm offers a wealth of information for applicants to medical degree courses. The first item on the menu is Medical College Admission Tests (MCAT). Almost all US medical schools require applicants to submit MCAT scores, and medical college…

Article

The Patient’s Page

Do you allow your kids to ride without a seatbelt? Do you let them run around the house with scissors? Of course not. You want to keep them safe, don’t you? Well, if their safety is your priority, you may want to take a quick look at your pantry. Childhood…

Letter to the Editor

Response to Determining Functional Significance of Subclavian Artery Stenosis Using Exercise Thallium-201 Stress Imaging

The functional significance of subclavian artery stenosis is easily gauged by history and physical examination, and I was therefore surprised to see the recommendations in this article for using exercise thallium-201 stress imaging.1 This is carrying the situation a bit too far. The case report of the lady in this…

Letter to the Editor

Quinupristin–dalfopristin-induced Reticulocytopenic Anemia

Quinupristin-dalfopristin was approved by the FDA in 1999 for bacteremia and life-threatening infections with vancomycin-resistant Enterococcus faecium. 1 Other indications include complicated skin and soft-tissue infections with methicillin-susceptible Staphylococcus aureus and Streptococcus pyogenes. 2 Quinupristin-dalfopristin has also been used for methicillin-resistant S aureus, coagulase-negative staphylococcus, and Streptococcus pneumoniae. 3 Adverse…

Letter to the Editor

Malignant Fibrous Histiocytoma, Malignant Melanoma and Squamous Cell Carcinoma Arising from Different Areas in an Adult

Malignant fibrous histiocytoma (MFH) is a well-defined and common malignant mesenchymal tumor of soft tissue occurring in late adult life.1 It usually involves the deep soft tissue and skeletal muscles of the proximal part of the extremities, especially the thigh.1 Skin cancers, such as basal cell carcinomas, squamous cell carcinomas…

Letter to the Editor

Colistin-associated Acute Renal Failure: Revisited

Daram et al1 recently presented a case report outlining the occurrence of acute renal failure, purported to be caused by “colistin,” in a 57-year-old male. In their letter to the editor,1 the authors cited four papers from the literature spanning the period 1962 to 1971, related to the potential for…

Letter to the Editor

Response to Dr. Powell’s Comments Regarding Our Manuscript Entitled: “Determining Functional Significance of Subclavian Artery Stenosis Using Exercise Thallium-201 Stress Imaging.”

We appreciate the careful reading and comments from Dr. Powell. We would like to clarify a few points which are essential to the understanding of the significance of this paper.

Spirituality/Medicine Interface Project

What Do We Know about the Effectiveness of Faith-based Health Programs?

“Some needs and hurts are so deep they will only respond to a mentor’s touch or a pastor’s prayer,” said President George W. Bush in his first inaugural address in January 2001.1 “Church and charity, synagogue and mosque lend our communities their humanity, and they will have an honored place…

Spirituality/Medicine Interface Project

Religious Awareness Training for Medical Students: Effect on Clinical Interpersonal Behavior

We conducted a pilot study to examine the effect of religious-awareness training on medical students’ “bedside manners.” Research has documented physician avoidance of religious inquiry due to discomfort and lack of training.1–3 Other research suggests that medical students exposed to religion in medicine display more empathy and positive attitudes toward…

Spirituality/Medicine Interface Project

Debate Question: Should Physicians Incorporate Spirituality into the Care of Patients? Patients’ Perspective

Eleven years ago my husband, Phillip, was admitted to the hospital with complications of undiagnosed diabetes. Within hours his physician, a fellow church member, informed me that he was critically ill and suggested that I get his affairs in order. He then asked if he could contact our church and…

Spirituality/Medicine Interface Project

Selected Annotated Bibliography

A substantial number of patients desire spiritual interaction with their physician, but the desire is for a limited intensity in that interaction.The Religion and Spirituality in the Medical Encounter Study (RESPECT) was conducted at 6 academic medical centers in 3 states (NC, FL, VT) and involved 456 patients. Results may…