Issue - Southern Medical Association

Editorial

Could Religious Participation Be Recommended as a Therapeutic Intervention for Pregnant Cigarette Smokers?

Cigarette smoking during pregnancy is one of the most important preventable causes of adverse pregnancy outcomes.1 Adverse outcomes include spontaneous abortion, low birth weight, and preterm deliveries, as well as negative health and developmental problems such as sudden infant death syndrome, and attention deficit and other behavioral disorders.2,3 These effects…

Editorial

Discussing Social Activity with Older Adults: It’s More Than Small Talk

Consider this vignette: An 89-year-old retired teacher and widow lives alone in her own home. She is an ex-smoker with mildly symptomatic coronary artery disease. Her knees are problematic, painful to stand on, and unsteady, making her prone to falling. Fortunately she has escaped injury. She is nearly blind. Boredom…

Editorial

What about Social Engagement? Towards a More Holistic Approach to the Care of Older Patients

Think, for a moment, about the quality of your life as a physician, and the impact on your effectiveness in practice, if you had almost no opportunities for socializing outside of work. Would it even be possible to sustain this for very long? It is arguably vital for physicians and…

Editorial

Re-examining the Cardiovascular Therapeutic Benefits of Aspirin

Although originally touted to have no effect on the heart, aspirin indeed exerts cardiovascular therapeutic benefits. Aspirin has been shown to reduce the risk of a first myocardial infarction (MI) by one-third. Evidence suggests that a more widespread and appropriate use of aspirin in men and women would reduce the…

Editorial

Spontaneous Compartment Syndrome: Hughes and Buerger Smoking

In this issue, two cases are reported in which a vasculitic (Buerger disease) and a thrombotic (Hughes syndrome) condition interact with cigarette smoking with detrimental results. Despite the strong association with many diseases, the debate on the health impact of cigarettes rages on. First described by Felix von Winiwarter1 in…

Original Article

Cigarette Smoking During Pregnancy: Independent Associations with Religious Participation

Objective: Data from a national health survey were used to test the hypothesis of a negative association of smoking in pregnancy and three measures of religious participation and importance. Methods: The 2002 National Survey of Family Growth included 2395 women aged 15 to 44 years with a history of at…

Original Article

Patient Visits to a Midwestern Primary Care Practice-Based Research Network: A Comparison to Two National Primary Care Data Sets

Background: Regional primary care practice-based research networks (PBRNs) have made important contributions to the primary care literature, but have not been well-described. This study compares pediatric patient characteristics within a new regional PBRN to pediatric patient characteristics from two previously published national data sets. Methods: Descriptive patient data were collected…

Original Article

River Tree Rope Swing Injuries

Objective: To review injuries associated with falls from river tree rope swings (RTRS) and identify points of action for prevention. Methods and Methods: This study was a retrospective analysis of injury reports directly related to falls from RTRS. Case reports for 2002–06 were extracted from the National Electronic Injury Surveillance…

Expired CME Article

Physician Discussion About Social Activities in Primary Care Encounters With Older Adults

Objective: Involvement in social activities is linked to positive health outcomes. This study focused on the prevalence of social activity discussions during the primary care medical encounter, and examined how patient, physician, and contextual factors were associated with discussions between physicians and older patients. Methods: The research was a secondary…

Expired CME Article

Aspirin for Primary Prevention of Coronary Heart Disease: Using the Framingham Risk Score to Improve Utilization in a Primary Care Clinic

Objectives: Coronary heart disease (CHD) is the number one cause of death in adults in the industrialized world, and several large studies show that aspirin is helpful for the primary prevention of this disease. Unfortunately, few physicians are aware of its benefit, resulting in the underutilization of aspirin for the…

Expired CME Article

Odds Ratios and Risk Ratios: What’s the Difference and Why Does It Matter?

Odds ratios (OR) are commonly reported in the medical literature as the measure of association between exposure and outcome. However, it is relative risk that people more intuitively understand as a measure of association. Relative risk can be directly determined in a cohort study by calculating a risk ratio (RR)….

Case Report

The Spectrum of Thrombotic Thrombocytopenic Purpura: A Clinicopathologic Demonstration of Tacrolimus-Induced Thrombotic Thrombocytopenic Purpura in a Lung Transplant Patient

Immunosuppressive drugs used post-transplantation are among the most common causes of thrombotic thrombocytopenic purpura (TTP). Diagnosis is often confounded not only by its myriad presentations, but also because these manifestations may be explained by the comorbidities or complications of transplantation. A 61-year-old female who had a single lung transplant for…

Case Report

Strongyloides Hyperinfection Syndrome Complicating (Ectopic) Cushing Syndrome

Strongyloidiasis can present with a wide variety of symptoms and can lead to a potentially fatal hyperinfection. Although any factors that suppress the host defense mechanisms can potentially trigger hyperinfection, prolonged steroid use has been quite well described. A patient with disseminated small cell lung cancer suffered a Strongyloides stercoralis…

Case Report

Isolated Paget Disease of the Patella Complicated with Ipsilateral Femoral Head Bone Marrow Edema: A Case Report and Review of the Literature

The patella is rarely affected by Paget disease of bone. The authors report a 54-year-old lady with ipsilateral knee and hip pain, initially misdiagnosed as patella stress fracture and early degenerative hip arthritis, who was later found to have Paget disease of the patella with ipsilateral femoral head bone marrow…

Case Report

Atypical Autoimmune Polyglandular Syndrome Type 3 Overlapped by Chronic HCV Infection Resulting in Carcinogenesis and Fatal Infection

The case of a woman with insulin-dependent diabetes mellitus, autoimmune thyroiditis, atrophic gastritis, pernicious anemia, and immunologic thrombocytopenic purpura consisting of autoimmune polyglandular syndrome type 3 associated with a history of gonadal failure is reported. Hepatitis C viral infection added xerophthalmia, lymphocytic sialadenitis, and exacerbation of idiopathic thrombocytopenic purpura. This…

Case Report

Fluticasone-Associated Cutaneous Allergic Granulomatous Vasculitis: An Underrecognized but Important Cause of Drug-Induced Cutaneous Churg-Strauss Syndrome

Allergic granulomatous vasculitis, or Churg-Strauss syndrome, is a small vessel, multisystem vasculitis that can affect multiple organs. It is usually idiopathic, but recent case reports have implicated leukotriene receptor antagonists (LTRA) and inhaled corticosteroids in the development of this rare syndrome. We report a case that acutely developed skin-limited Churg…

Case Report

Brain Metastasis From Thymic Carcinoma in Association with SIADH and Pituitary Enlargement: A Case Report

A 49-year-old white female presented to the emergency room complaining of severe headaches. A brain computed tomography (CT) showed a large right temporal mass that measured 2.9 × 5 cm. Sodium was low at admission, which indicated syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Her pituitary gland was enlarged….

Letter to the Editor

Rapidly Developing Lower Abdominal Mass with Pronounced Azotemia: The Importance of Imaging

To the Editor: The association of a rapidly developing midline lower abdominal mass, the absence of urine output, and azotemia suggests lower urinary tract obstruction. The decision to manage a patient presenting with advanced obstructive azotemia with urinary bladder drainage and monitoring of the renal function, or instead to institute…

Case Report

Southern Tick-Associated Rash Illness: Erythema Migrans Is Not Always Lyme Disease

Southern tick-associated rash illness (STARI) is a rash occurring after a tick bite. It is a form of erythema migrans, an annular rash with central clearing that is almost identical with the erythema migrans seen in Lyme disease. The etiologic agent is not known but may be a Borrelia species….

Case Report

Compartment Syndrome in Patients with Buerger Disease and Anticardiolipin Antibodies

We report two cases of acute compartment syndrome in the anterior compartment of the lower limbs of patients with the diagnosis of Buerger disease associated with positive anticardiolipin antibodies. We comment on the rarity of the case and on the possibility of interference of two associated thrombogenic conditions. The need…

Expired CME Article

July 2008 CME Questions

July 2008 CME Questions

Expired CME Credit Submission and Evaluation Form

CME Submission Form

CME Submission Form

Editorial

What Does ‘Minimal Risk’ Mean for Pediatric Research?

Children have been subjects of medical research for many centuries. Nontherapeutic experiments on mentally retarded children using radioisotopes by researchers from the Massachusetts Institute of Technology between 1944 and 19741; and the hepatitis studies at Willowbrook in the 1950s and 1960s2 reinforced the need to recognize children as a highly…

Editorial

Thrombotic Microangiopathy After Lung Transplantation: A Difficult Diagnosis

In this issue of the Southern Medical Journal, the authors detail a comprehensive description of a case of thrombotic microangiopathy after lung transplantation. A 61-year-old woman who had previously received a single lung transplant for chronic obstructive pulmonary disease was admitted to the hospital with the acute onset of headache…

Original Article

Is Religiosity Associated with Corporal Punishment or Child Abuse?

There is limited empiric literature available regarding religion and corporal punishment and physical child abuse. The available empiric literature deals primarily with Christian denominations. Conservative Protestants, particularly those who believe in Biblical literalism or inerrancy, spank and/or physically abuse their children more than other Christian denominations. However, church attendance and…

Original Article

Religion and Medical Neglect

This is a literature review of religion-associated medical neglect of children. It attempts to document the most common denominations involved in religion-associated medical neglect. There is a discussion of the history of religious exemptions to medical care and health risks to children as a result of religious exemption. Suggestions are…

Original Article

Spirituality, Adolescent Suicide, and the Juvenile Justice System

Background: Spirituality is often overlooked as a coping method and resilience factor in the lives of adolescents. An improved understanding of the role of spirituality in the lives of adolescents will help in understanding the choices many teens face during times of personal crisis. Youth entering the juvenile justice system…

Patient's Page

Patient’s Page

Staying Social As You Age For older adults, social participation is linked to positive physical and mental health. Social activity also aids in recovery from illness. When you visit your doctor for a health problem, he may focus his attention on curing your physical illness without realizing the importance of…

Rapid Response

The Mediterranean Diet Paradigm

The hypothesis that the Mediterranean diet is highly protective was tested in a controlled trial. A 50 to 70% reduction in the risk of cardiovascular complications was recorded in patients having survived myocardial infarction. There was also significantly lower mortality, and fewer cancers were diagnosed during follow-up.

Rapid Response

Diabetic Neuropathy: Specialists and Primary Care Physicians in One Boat

Diabetic neuropathy is a common complication of diabetes that can lead to significant morbidity, mainly foot ulceration, limb amputations, and a tremendous impact on patients’ quality of life. Because most of these afflictions can be prevented by timely screening, early detection, and management, the education of physicians and patients is…

Rapid Response

Breaking Down Barriers to the Completion of Advance Directives

While today’s patient information systems have facilitated the investigation of the characteristics of patients completing advance directives, and the preferences that they have for their end-of-life care, several barriers to the completion of the documents have been identified, including the lack of communication between patients, their healthcare agents, and healthcare…

Rapid Response

Lowering LDL Cholesterol is Beneficial: How Much, How Long, and With Which Means Remains Unclear

The question whether cholesterol lowering with the combination of ezetimibe and simvastatin is beneficial cannot be answered with Effect of Combination Ezetimibe and High-Dose Simvastatin versus Simvastatin Alone on the Atherosclerotic Process in Patients with Heterozygous Familial Hypercholesterolemia (ENHANCE), a study examining a surrogate marker for atherosclerosis. Only the results…

Rapid Response

Novel Study on Minority Participation in Biomedical Research Provides New Insights and Reinforces Recent Findings

Using a novel and clever research design approach, Braunstein et al sheds valuable light on the line of inquiry into the recruitment of minorities into clinical studies. While the authors dutifully list what they perceive as possible limitations of their study, this Rapid Response focuses on the inevitable ‘trade-off’ between…

Rapid Response

The American Academy of Neurology Lyme Guidelines: Through the Looking Glass

Recently, the American Academy of Neurology released its guidelines for the diagnosis and treatment of neurologic Lyme disease. Although these guidelines were touted as “independent corroboration” of the controversial Infectious Diseases Society of America Lyme guidelines, the committees that formulated the two guidelines featured overlapping panel members (including the committee…

Rapid Response

Calcium and Fracture Risk

Bischoff-Ferrari et al conclude that “calcium intake was not significantly associated with hip fracture risk in men and women.” And while many issues need to be addressed and many have already been addressed by the authors of the manuscript and the accompanying editorial, some of the following issues need re-emphasis:…

Rapid Response

Chocolate: If It Sounds Too Good To Be True, Be Careful

This article sounds too good to be true; if you eat dark chocolate, your blood pressure goes down. The study recruited 119 individuals in Germany, and studied 44 of them. The study utilized a very small group of individuals, probably healthier than our average adult patients, who ate chocolate for…

Rapid Response

Is Routine Antimicrobial Prophylaxis Justifiable in Prepubescent Children with Recurrent Urinary Tract Infections?

Is Routine Antimicrobial Prophylaxis Justifiable in Prepubescent Children with Recurrent Urinary Tract Infections?The natural course of urinary tract infections (UTI) in children is unpredictable and management is controversial. Of the 3% of prepubescent girls and 1% of boys diagnosed with a UTI, up to 17% have infection-related renal scarring. In…

Review Article

Report of the International Society for Clinical Densitometry 2007 Adult Position Development Conference and Official Positions

The International Society for Clinical Densitometry (ISCD) periodically holds Position Development Conferences (PDCs) for the purpose of establishing standards and guidelines for the assessment of skeletal health—the nomenclature, indications, acquisition, analysis, quality control, interpretation, and reporting of bone density tests. Topics are selected for consideration according to criteria that include…

Review Article

Special Report on the 2007 Pediatric Position Development Conference of the International Society for Clinical Densitometry

The International Society for Clinical Densitometry periodically holds Position Development Conferences (PDCs) for the purpose of establishing standards and guidelines for the assessment of skeletal health, including nomenclature, indications, acquisition, analysis, quality control, interpretation, and reporting of bone density tests. Topics are selected for consideration according to criteria that include…

Letter to the Editor

Adenocarcinoma of the Lung Presenting as a Metastatic Tongue Mass

To the Editor: Metastasis to the tongue has been described rarely, and it occurs mostly in patients with generalized dissemination of a primary malignancy.1 In extremely rare situations, lingual metastasis has been the initial presentation of metastatic carcinoma.

Letter to the Editor

Serious Suicide Attempt with Duloxetine Treatment

To the Editor: Whether newer antidepressants may increase the risk of suicide is somewhat controversial. We describe a serious suicide attempt following initiation of duloxetine treatment.

Letter to the Editor

Reversible Acute Hepatitis Induced by Rosuvastatin

To the Editor: Hepatic adverse reactions are a class-effect of statins, rarely leading to serious liver damage. The current report describes reversible acute hepatitis in a patient treated with rosuvastatin.

Letter to the Editor

Diabetic Ketoacidosis Complicated by Pneumomediastinum and Mallory-Weiss Tear in a Young Boy with New Onset Type 2 Diabetes

To the Editor: We report a case of type 2 diabetes presenting as diabetic ketoacidosis (DKA) concomitant with pneumomediastinum and Mallory-Weiss tear. DKA is considered a cardinal feature of type 1 diabetes, but can occur spontaneously in type 2 diabetes. Pneumomediastinum and Mallory-Weiss tear are rarely associated with DKA; to…

Letter to the Editor

Wrestling with Drinking, Violence and the Active Media Consumer

To the Editor: In the February 2008 issue of the Southern Medical Journal, a study by Durant and colleagues demonstrates significant covariance between the frequency of 16 to 20-year-old adolescents watching professional wrestling and their engaging in a number of health risk behaviors, including unprotected sex, date fighting, and carrying…

Letter to the Editor

Association Between Acute Pancreatitis and Strongyloides stercoralis

To the Editor: Infection with Strongyloides stercoralis (strongyloidiasis) can present with various clinical manifestations. Pancreatitis is a common clinical diagnosis but its cause is unknown in 10 to 30% of cases.1 There is rare association between acute pancreatitis and strongyloidiasis in the medical literature. We present a case of pancreatitis…

Letter to the Editor

Adenocarcinoma of the Ileocecal Valve Occurring 35 Years After Jejunoileal Bypass

To the Editor: We are reporting a case of colon cancer that occurred 35 years after a jejunoileal bypass (JIB) and resulted in chronic intestinal obstruction. The JIB procedure was used to promote weight loss, but complications have limited its utilization.1 Colonic dysplasia and tubulovillous adenomas have been reported after…

Medical Webwatch

Medical Webwatch

The Public Health Image Library http://phil.cdc.gov/Phil/home.asp can be found at the US Centers for Disease Control and Prevention (CDC). Created by a working group at the CDC, the library provides an organized, universal electronic gateway to the CDC’s pictures. Because much of the critical information necessary for the communication of…