Recent geopolitical events, including the terrorist attacks on the United States on September 11, 2001, and ongoing military operations in Iraq, have raised awareness of the often severe psychological after-effects of these and other types of traumatic events. Post traumatic stress disorder (PTSD) represents the most severe of these sequelae….
Primary care physicians are responsible for providing healthcare to most patients with type 2 diabetes. In this role, it is critical that physicians utilize a whole-patient treatment approach that includes lifestyle modifications and pharmacotherapy aimed to achieve glycemic control, in addition to the management of any comorbid conditions or risk…
Hispanics experience a higher rate of diabetes than non-Hispanic whites and tend to have worse glycemic control and a greater risk of diabetes-related complications. Once oral antidiabetic agents become insufficient, insulin plays an important role in achieving glycemic goals. However, many Hispanic patients are resistant to initiating insulin therapy or…
Abstract:Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. Although HSP is typically a disease of children, adult cases have been described. HSP can affect multiple organs with a characteristic rash present in all patients. Most cases resolve with symptomatic treatment, but serious complications can occur such as renal…
Human monocytic ehrlichiosis (HME) is a tick-borne disease transmitted during the summer months in the mid-Atlantic, southeastern and south-central United States. A large proportion of patients presenting with ehrlichiosis must be hospitalized because of the severity of their presenting signs, symptoms and lab abnormalities. We report a case of HME…
Hyponatremia secondary to the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is an uncommon complication of treatment with centrally acting drugs including selective serotonin reuptake inhibitors (SSRIs) and antipsychotic medications. Antipsychotics are commonly used for the treatment of behavioral and psychiatric symptoms in elderly patients with dementia, and the…
Severe psychiatric derangements are a rare manifestation of Graves disease or toxic goiter. An 18-year-old male college student was hospitalized with depression and psychotic behavior. He was found to have thyrotoxicosis due to subacute thyroiditis, as evidenced by a reduced radioactive iodine uptake, elevated thyroglobulin level, and spontaneous remission into…
A 53-year-old man with no past medical history was admitted with complaints of hematuria, flank and abdominal pain of one week duration. He also complained of an enlarging new neck mass one month before presentation. The laboratory assessment showed a calcium level of 17.3 mg/dL (normal 8.5–10.5 mg/dL), serum albumin…
Cystic hygroma is a congenital anomaly of lymphatic origin, which mainly develops during childhood. Its development in adulthood, however, has been proposed to be related to several predisposing factors such as trauma, infection, tumor growth or iatrogenic stimuli. The development of cystic hygroma in the extremities of adults is extremely…
To the Editor: Spontaneous pneumomediastinum (SPM) is a well-known entity that presents with acute chest pain, dyspnea and subcutaneous emphysema. It typically occurs after maneuvers that increase intrathoracic pressure, such as vomiting, retching, sneezing, childbirth, and straining at stool. The other known causes of SPM include asthma, interstitial lung disease…
To the Editor: Lung cancer usually metastasizes to the bone, liver, brain, and adrenal glands.1,2 Breast metastasis of nonsmall cell lung cancer (NSCLC), is a very rare entity, being found in fewer than 0.5% of patients, and carries a poor prognosis.2 Breast metastases are more commonly associated with malignant melanoma,…
To the Editor: Ganglioneuroblastoma (GNB) is a type of neuroblastic tumor derived from the neural crest and arises in the sympathetic chain and adrenal gland.1 This tumor is extremely rare in adults. To our knowledge, only one adult case has been reported as having primary renal GNB in the English…
To the Editor: Rifampicin (RFP) is one of the most effective antibiotics available for the treatment of tuberculosis. Its best known side effect is liver toxicity. Fewer than 4% of patients have immunoallergic reactions such as rash, fever, nausea, and vomiting.1 More severe hypersensitivity reactions are uncommon and occur in…
Cases of tick-borne zoonotic diseases such as Rocky Mountain Spotted Fever, Lyme disease, and the human ehrlichioses are on the rise in the United States.1,2 These emerging diseases are complex in their ecology, often perplexing in their clinical presentation, and challenging to diagnose. Lisa Prince et al3 in this month’s…
The atypical antipsychotic drugs are mainstays in the treatment of various psychiatric disorders. These newer, second generation agents include clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), and aripiprazole (Abilify). The newer atypical agents are thought to be as effective as the older, phenothiazine-type antipsychotics and generally better…
Background: Women and minorities continue to account for a higher proportion of AIDS incidence and mortality than their male and white counterparts. This study examined whether race and gender were associated with antiretroviral use among HIV-infected individuals in the southeastern US. Methods: Multivariate regression analyses were used to identify whether…
Background: Clostridium difficile-associated diarrhea (CDAD) is a leading cause of nosocomial diarrhea in the United States, and may be associated with significant morbidity and occasional mortality. Diarrhea is also very common among hospitalized patients and is often related to a variety of factors not related to C difficile infection. Methods:…
Background: The aims of this study are to compare the diabetes-related lower extremity amputation (LEA) rate trend in South Carolina (SC) to that of the United States (US) and to determine changes in LEA rates in SC according to age, race, gender, and amputation site. Methods: National Hospital Discharge Survey…
Objective: To study the association between physicians’ complaint records and their risk management experiences in a regional healthcare center. Data Sources: Patient complaints about physicians in a large border state medical center’s hospital and outpatient clinics were recorded and coded. The study period was from January 2001 through December 2003….
A 45-year-old man with paranoid schizophrenia with delusions was transferred from a group home for treatment of diabetic ketoacidosis (DKA). Six months before this episode, he had been hospitalized in an inpatient psychiatric institution and treated with valproic acid and quetiapine 400 mg with normal blood sugars recorded. The patient…
Quetiapine is an atypical antipsychotic agent approved by the FDA for the treatment of schizophrenia, acute mania, and bipolar depression. Recently, reports of medication abuse, particularly intranasal and IV abuse, have been described. Three cases of oral misuse of quetiapine are presented and clinical implications are discussed. Clinicians should exercise…
CME Questionnaire and Credit Form
Type 2 diabetes has reached epidemic proportions in the United States and spawned a public health crisis which has placed enormous medical and socioeconomic burdens on the healthcare system.
Type 2 diabetes mellitus is an inexorably progressive disease. Over time, as insulin resistance increases and beta cell function declines, treatment with injected insulin becomes necessary for most patients to maintain euglycemia. In the landmark United Kingdom Prospective Diabetes Study (UKPDS), 53% of the patients who were started on a…
The connection between the thyroid gland and mental disorders has been recognized since at least the 19th century when Parry and Graves described behavioral changes linked to hyperthyroidism. While links between hypothyroidism and mental illness were described earlier, it was Richard Asher’s astute observations on myxedema madness and its treatment1…
Kumar K. An adolescent with chest pain. South Med J 2006;100:1402–1403.An author was omitted from this letter. The author list should have read: Krishan Kumar, MD and M. Waseem, MD. The journal regrets this omission.
Neuroradiology http://spinwarp.ucsd.edu/NeuroWeb is prepared by John R. Hesselink, MD, with pathology provided by Nancy Karpinski, MD, University of California, San Diego Medical Center, Radiology Department. At the top of the page is the “J Hess Collection” which is a list of 24 teaching files. When opening the cases, the image…
Managing Post Traumatic Stress Disorder Can you answer “yes” to any of the following questions? * Have you ever been attacked or suffered an injury in combat? * Have you ever been physically or sexually abused, as a child or an adult? * Have you ever witnessed or been victim…
To the Editor: Many pet medications are pharmacologically similar to those prescribed for human use. We describe a case in which a pet’s antiepileptic drug (phenobarbitone) was deliberately used for self-poisoning. To our knowledge, this is the first known instance of a deliberate self-poisoning utilizing pet medication.
To the Editor: A 49-year-old woman was hospitalized for a nonresolving left leg ulcer. The patient had a history of uncontrolled type 2 diabetes mellitus, and was evaluated by vascular surgery, who believed that the ulcer was a complication of uncontrolled diabetes. Physical examination was positive for an extremely tender,…
To the Editor: A 30-year-old male, diagnosed as having paranoid schizophrenia for the previous 9 years, without any past or family history of major neurologic or psychiatric disorder, was initiated on intramuscular haloperidol 10 mg q.12 hours because of agitated behavior. On the fourth day, he developed sudden onset of…
To the Editor: Osteoarthritis (OA) is one of the leading causes of chronic disability in the elderly, predominantly because of involvement of the knee and hip joints. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely used to reduce pain and inflammation and improve function in OA patients. We have been aware…
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