Issue - Southern Medical Association

Original Article

Dark Chocolate Effect on Platelet Activity, C-Reactive Protein and Lipid Profile: A Pilot Study

Background: Dark chocolate (DC) is one of the richest sources of flavonoids. Since DC has been demonstrated to have beneficial effects on the cardiovascular system, our study examined its effect on platelet reactivity, inflammation, and lipid levels in healthy subjects. Methods: In 28 healthy volunteers, we analyzed the effect of…

Original Article

Improving Inpatient Venous Thromboembolism Prophylaxis

Objectives: The number and types of inpatients given inadequate prophylaxis for venous thromboembolism (VTE) are not known; patients receive less than appropriate prophylaxis with some frequency. Methods: Initially we evaluated VTE prophylaxis at a community hospital by comparing prophylaxis patterns in adult inpatients for whom some prophylaxis was indicated. Patients…

Original Article

Pediatricians are More Supportive of the Human Papillomavirus Vaccine than the General Public

Objective: The purpose of this study was to determine pediatricians’ attitudes about the human papillomavirus (HPV) vaccine and to compare their attitudes with those expressed by the general public. Methods: Eight-hundred and fifty pediatricians from the American Academy of Pediatrics were surveyed, including general pediatricians (n = 450), and members…

Original Article

Predictive Factors for Septic Shock in Patients with Ventilator-Associated Pneumonia

Background: Ventilator-associated pneumonia (VAP) is one of the most frequent infections in intensive care units (ICUs), and nearly 50% of patients with VAP develop septic shock. Septic shock is an independent predictor for mortality in these patients. Objective: To investigate the predictors for septic shock in VAP patients receiving appropriate…

Original Article

Smoking Status and Levels of Knowledge Regarding Cigarettes Among Primary School Teachers

Objectives: Teachers are believed to be important role models for their students. This study’s objective was to determine primary school teachers’ smoking status, their level of knowledge regarding cigarettes and their attitude towards prohibition; and to obtain preliminary data that may contribute to the development of antismoking campaigns in schools….

Original Article

Complementary and Alternative Medicine Use Among Primary Care Patients in West Texas

Background: This study explored factors related to practitioner-based complementary and alternative medicine (CAM) usage among primary care clinic patients in rural West Texas areas, including physicians’ awareness of their patients’ CAM use. Methods: A convenience sample was drawn from nine clinics that served low-income populations. Surveys were distributed to patients…

Expired CME Article

Understanding and Identifying Bias and Confounding in the Medical Literature

Bias and confounding are types of error that may be encountered in the collection, analysis, or interpretation of research data. Bias and confounding may result in erroneous research conclusions with adverse consequences for patients and health care providers. In this article, we provide clinician-friendly descriptions and examples of bias (including…

Expired CME Article

The Dementia Caregiver—A Primary Care Approach

Caring for loved ones with dementia is challenging and stressful for family members who have to provide the home care. The responsibility takes a huge physical, emotional, and financial toll on the caregivers, which is known as caregiver burden. The survival and quality of life of the dementia patient have…

Editorial

Highlights from the 20th Annual Southern Region Burn Conference: November 2007

Figure. No caption available. November 24, 2007, marked the 20th anniversary of the first Southern Region Burn Conference. Ever since it was first established to provide an educational forum for burn care providers on a regional level, the annual conference has been an energetic and productive meeting for all members…

Case Report

The Role of Multiple Drug-Eluting Stents in the Treatment of Cardiac Transplant Vasculopathy

A 60-year-old male with cardiac transplantation six years prior was seen for easy fatigability and dyspnea on exertion. Electrocardiogram revealed new T-wave inversions in the anterolateral leads. Cardiac catheterization showed diffuse multivessel disease with significant stenosis consistent with cardiac transplant vasculopathy (CTV). Percutaneous intervention was performed with DES with improvement…

Case Report

Cryptococcal Meningitis Presenting as Pseudosubarachnoid Hemorrhage

Abstract:A 50-year-old man presented with progressive visual loss, headache, and two days of confusion. A computed tomography of his head suggested subarachnoid hemorrhage with accompanying right parietal ischemic infarction. The magnetic resonance image was consistent with right parietal perisulcal pial and superficial cortical inflammation; a subjacent vasogenic edema with a…

Case Report

Adalimumab-Induced Acute Myelogenic Leukemia

Newer biological treatment strategies have been developed in the last decade with some promising outcomes. Their safety, however, has been questioned lately with multiple reports of increased risk for malignancies and infectious complications. These reports render their use suboptimal. We report a 44-year-old woman receiving adalimumab (Humira®) for advanced juvenile…

Case Report

Spontaneous Renal Artery Thrombosis and Common Iliac Artery Dissection in a Previously Healthy Young Adult

A previously healthy 20-year-old male with a history of easy bruising presented to the emergency department complaining of intermittent left lower quadrant abdominal pain for one week. He was diagnosed with vascular (type IV) Ehlers-Danlos syndrome (EDS) and attendant defects in type III collagen leading to spontaneous left renal artery…

Case Report

Concurrent Primary Hyperparathyroidism and Humoral Hypercalcemia of Malignancy in a Patient with Clear Cell Endometrial Cancer

A 65-year-old Caucasian woman with a known history of clear cell endometrial cancer presented with hypercalcemia. Further evaluation demonstrated that the patient had primary hyperparathyroidism due to a parathyroid adenoma, as well as an increased parathyroid hormone-related peptide secondary to her malignancy. To the best of our knowledge, this is…

Case Report

Severe Reaction from Envenomation by the Brown Widow Spider, Latrodectus geometricus (Araneae: Theridiidae)

The brown widow, Latrodectus geometricus, is one of five species of Latrodectus in the United States, and is reported to be one of the least dangerous. However, we report a previously healthy patient bitten by a brown widow, resulting in a serious reaction requiring hospitalization. Symptoms included severe pain, cramps,…

Editorial

Reflections from Paula Oliver Pell, SMA President 2007–2008

I had the honor of being the 102nd President of the Southern Medical Association. When I moved to Georgia more than 20 years ago, I was invited to join the SMA by the Councilor of Georgia, Dr. Terrell Tanner. I went to the Annual Scientific Assembly and found a wonderful…

Article

Chairman’s Choice: “Slip Sliding Away”—The Importance of Quality Performance in Wound Care Products

Abstract:We outline how a change in the manufacturing of an impregnated gauze dressing product impacts upon wound healing and describe the steps taken by the manufacturer and by the University of Alabama at Birmingham (UAB) in the identification and resolution of the problem. After a change in name and manufacturing…

Article

Critical Issues in Burn Care

Burn care, especially for serious burn injuries, represents a considerable challenge for the healthcare system. The American Burn Association has established a number of strategies for the management of burn patients and dedicates its efforts and resources to promoting and supporting burn-related research, education, care, rehabilitation, and prevention, often in…

Editorial

The Role of Drug-Eluting Stents in Treating Cardiac Transplant Vasculopathy

The paper by Garg et al1 in the present issue of this journal discusses the role of drug-eluting stents (DES) in cardiac transplant vasculopathy (CTV), also known as cardiac allograft vasculopathy. The authors report an interesting case of a postcardiac transplant patient with an atypical presentation who on coronary angiography…

Editorial

Genital Tuberculosis: A New Challenge in an Old Disease

In this issue of the Southern Medical Journal, a case of genital tuberculosis (GTB) was reported in a young African refugee woman presenting with primary infertility, intermittent pelvic pain and menstrual irregularities.1

Editorial

Hereditary Hemorrhagic Telangiectasias and Brain Abscesses

Hereditary hemorrhagic telangiectasias (HHT), or Osler-Weber-Rendu syndrome, is an uncommon autosomal dominant disease characterized by visceral and mucosal telengiectasias and arteriovenous malformations of the lungs, brain, and other solid organs.1–3 The development of a brain abscess is an uncommon but potential complication of HHT, which results from the right-to-left pulmonary…

Abstract

Selected Abstracts from the 20th Annual Southern Region Burn Conference

Case Report

Turcot Syndrome (Glioma Polyposis): A Case Report

Turcot’s syndrome (glioma-polyposis) is a rare hereditary disorder characterized by association of colonic polyposis with primary tumors of the central nervous system. We report a case of a 27-year-old male diagnosed with Turcot’s syndrome after an autopsy. The patient survived for more than two decades after his initial presentation with…

Case Report

Infertility in a US Resettled African Refugee: A Case Report of Genital Tuberculosis

A 27-year-old, previously healthy Somali refugee presented with infertility. Cultures of endometrial tissue were positive for fully susceptible tuberculosis and she was diagnosed with genital tuberculosis. After 12 months of antituberculosis therapy, she attempted to become pregnant; however, use of in vitro fertilization and surrogate carrier probably will be needed…

Case Report

Viral Rhabdomyolysis

Virus-induced myopathy can be an important cause of life-threatening rhabdomyolysis. We report the case of a 30-year-old patient who developed rhabdomyolysis and acute renal failure in association with herpes simplex virus infection.

Expired CME Article

December 2008 CME Questions

Understanding and Identifying Bias and Confounding in the Medical Literature1. Which of the following factors does not contribute to the development of information bias (i.e., bias resulting from error in how information is measured or classified)?A. Length of time between exposure and outcome.B. Length of time population is studied.C. Method…

Expired CME Article

CME Submission Form

Editorial

Show Me the Evidence: Now What Do I Do with It?

The process of evidence-based medicine (EBM) “involves tracking down the best external evidence with which to answer our clinical questions.”1 The next question that comes up is how to appraise this evidence. The busy clinician is inundated with information provided in journal articles, CME offered by professional organizations, industry-sponsored lectures,…

Editorial

Pseudosubarachnoid Hemorrhage: A Zebra Worth Looking for

Nearly 30,000 individuals suffer spontaneous subarachnoid hemorrhage (SAH) annually in the United States, the vast majority due to a ruptured cerebral aneurysm. A smaller percentage of patients will suffer SAH of other etiologies, such as arteriovenous malformations, dural arteriovenous fistulae, spinal arteriovenous malformations, cerebral vasculitis, and hemorrhagic neoplasms.Computed tomography (CT)…

Editorial

How Do You Teach an Old Dog New Tricks? Lessons from Venous Thromboembolism Prophylaxis Guidelines

Prevention is paramount to current medical management, particularly when the evidence supporting preventative therapies is robust. One such “preventative therapy” focuses on strategies for inpatient prevention of venous thromboembolic disease in medically and surgically ill patients. Venous thromboembolism (VTE) is a significant sequela of inpatient hospitalization with estimated prevalence rates…

Editorial

Recent Insights on Dark Chocolate Consumption and Cardiovascular Risk

Chocolate contains a variety of different compounds with cocoa as the main ingredient.1 Cocoa is rich in polyphenols, a subgroup of dietary flavonoids, that seems to be able to reduce cardiovascular risk.2,3 Dark chocolate is popular in Europe and the United States and is a potent source of polyphenols; therefore,…

Acknowledgment

Patient’s Page

Toy Safety: Thinking Inside the BoxWhen viewing play as a child’s work and toys as a child’s tools, toy selection becomes serious business.1 Government regulations on toys have been in place since 1972, when the United States Consumer Product and Safety Commission (USCPSC) was formed.2 However, as 2007 saw the…

Article

In Appreciation

The editor and staff of the Southern Medical Journal would like to extend their appreciation to those who served as reviewers during 2008.The editorial staff apologizes for any omissions or errors.John Abide, MDCraig Aboltins, MB BS (Hons), FRACPWilliam Ackerman III, MDRichard Adair, MDBamidele Adesunloye, MDSushil Ahlawat, MDJatinder Ahluwalia, MDAmir Ahmadi,…

Medical Webwatch

Medical Webwatch

Breast Pathology on the Web http://www.breastpathology.info/ is authored by Dr. Jeremy Thomas, Lead Consultant Pathologist, Edinburgh Breast Unit, United Kingdom, and is described as being “An easily accessible entry point to the understanding of the pathology of breast diseases” and is targeted at “trainees in breast pathology” and features “cross-specialty…

Letter to the Editor

Do Not Overlook Polymyalgia Rheumatica as a Cause for Immobility in Poorly Communicating Dementia Patients

To the Editor:A patient that I recently saw illustrates how polymyalgia rheumatica (PMR) may not be immediately obvious in patients with dementia. In May 2008, an elderly woman with Alzheimer disease was hospitalized under my care after falling and being unable to get up. She initially denied any pain or…

Letter to the Editor

Right Ventricular Extension of Inferior Wall Myocardial Infarction: Importance of Right-Sided Electrocardiogram

To the Editor:Right ventricular myocardial infarction (RVMI) is associated with substantial in-hospital mortality and morbidity. These cases can be frequently missed. It is important to identify these patients early to facilitate timely revascularization. This case highlights the utility of right-sided electrocardiogram (EKG) in the identification of such patients.An 80-year-old male…

Letter to the Editor

Ortner Syndrome in an Elderly Vasculopath

To the Editor:Isolated left recurrent laryngeal nerve palsy (LRNP) occurs most often due to extrinsic compression from mediastinal masses. The resultant dysphonia when secondary to cardiac or vascular pathology is termed the cardiovocal syndrome or Ortner syndrome. Here, we report a rare cause of the cardiovocal syndrome and its management.A…

Letter to the Editor

Mental Illness, Disability and Weight Regulation in Children

To the Editor:We appreciate the opportunity to discuss a relevant question raised by Hasnain et al1 on the risk for overweight and the prevalence of overweight in children with mental illness. They found a high-risk group (HRG) of 54.5% for the 6- to 11-year age group, and 51.1% in the…

Letter to the Editor

Impending Compartment Syndrome and Hemothorax After Brodifacoum Ingestion

To the Editor:A 26-year-old female presented to the emergency room with acute onset of painful swelling of her right leg for one day and menorrhagia for one week. There was no personal or family history of any bleeding diathesis.Examination revealed minimal bloody ooze from the patient’s lips. Her right calf…

Letter to the Editor

An Unusual Cause of Acute Unexplained Blood Loss in a Patient on Chronic Hemodialysis

To the Editor:Patients on chronic hemodialysis with acute and unexplained blood loss are at a high risk for bleeding because of uremia-induced platelet dysfunction, as well as the intermittent use of heparin with dialysis treatments.A 46-year-old male presented to the emergency department, because his dialysis center had instructed him to…

Letter to the Editor

Pleural Effusion Heralds Acute Leukemic Transformation of Chronic Myelomonocytic Leukemia

To the Editor:Chronic myelomonocytic leukemia (CMMoL) is a myelodysplastic/myeloproliferative disease characterized by peripheral monocytosis exceeding 1 × 109/L, peripheral and bone marrow blast percentages less than 20%, and absence of a Philadelphia chromosome. Pleural effusion (PE) secondary to CMMoL is uncommon. We report a patient with CMMoL who developed PE…

Letter to the Editor

Paraneoplastic Salt Dysgeusia

To the Editor:Alterations in taste include absence of taste (ageusia), abnormal or unpleasant taste (dysgeusia), or craving of non-nutritive substances or various foodstuffs (pica); these alterations may result from a variety of disorders.1 Cancer patients may develop taste alteration due to chemotherapy or irradiation involving the head and neck. The…

Letter to the Editor

A Rare Cause of a Large Mesenteric Mass

To the Editor:Mesenteric lipodystrophy is a rare but benign condition that is part of a disease spectrum of idiopathic inflammatory and fibrotic changes that affect the mesentery. A 54-year-old Caucasian male presented to his family physician for a routine examination. A large midline abdominal mass was palpated in the periumbilical…

Letter to the Editor

A Case of Nonoliguric Acute Kidney Injury Associated with Acetaminophen Overdose

To the Editor:Acetaminophen (N-Acetyl-p-aminophenol) poisoning is known to cause necrotic liver failure and occasionally result in extrahepatic toxicities, including nephrotoxicity. We report a case of a 32-year-old African-American man, in which nonoliguric acute kidney injury was associated with fulminant liver damage, following an intentional overdose of 48 grams (599 mg/kg)…