Issue - Southern Medical Association

Editorial

Tackling the Problem of Childhood Obesity

Obesity has become one of the most important public health problems in the United States (US).1 Body mass index (BMI) is the standard measure for classifications of overweight and obesity in children who are two years and older.2 An overweight condition for a child of 2–19 years old is defined…

Editorial

Vitamin D Deficiency in Primary Hyperparathyroidism

Vitamin D deficiency is common in the general population, and even more prevalent in primary hyperparathyroidism. Boudou et al1 reported that 93% of patients who underwent parathyroidectomy had vitamin D deficiency compared to 38% of the general population. Another study found low vitamin D in 81% of patients with primary…

Editorial

Overactive Bladder: An Urgent Problem

Urinary incontinence commonly affects women in the United States (US) with a prevalence of 15.7%. This prevalence increases with age, resulting in greater than 30% of women over 80 years of age experiencing significant incontinence.1 As the population in the US continues to grow older, this association between age and…

Editorial

What Is It?

What is the object on the radiograph pictured at right? The answer to this question is provided in the letter to the editor on page 71 of this issue.

Original Article

Primary Care Practice Addressing Child Overweight and Obesity: A Survey of Primary Care Physicians at Four Clinics in Southern Appalachia

Objective: The prevalence of childhood overweight and obesity in southern Appalachia is among the highest in the United States (US). Primary care providers are in a unique position to address the problem; however, little is known about attitudes and practices in these settings. Methods: A 61-item healthcare provider questionnaire assessing…

Original Article

Mortality from Chronic Obstructive Pulmonary Disease Among Adults Aged 25 Years or Older in North Carolina

Objectives: Recent reports highlight variation in the burden of chronic obstructive pulmonary disease (COPD) mortality across the United States. This report describes COPD mortality in North Carolina (NC). Methods: Data on COPD deaths were obtained from the National Vital Statistics System. COPD deaths were identified using International Classification of Diseases…

Original Article

Retrospective Analysis and Patient Satisfaction Assessment of Insulin Pump Therapy in Patients with Type 2 Diabetes

Objectives: To evaluate and assess glycemic control, total daily insulin requirements, weight, and patient satisfaction after changing from multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) therapy in patients with type 2 diabetes. Methods: This was a retrospective cross-sectional cohort analysis of an electronic medical records database from…

Review

Etiology and Treatment of Overactive Bladder in Women

Overactive bladder (OAB) is a condition that affects millions of women in the United States (US). Although the etiology is largely unknown, risk factors include Caucasian race, insulin-dependent diabetes mellitus, and history of depression. Patients present with urgency with or without urinary incontinence and often have urinary frequency and nocturia….

Review

Emergence of Klebsiella pneumoniae Carbapenemase-Producing Bacteria

Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria are a group of emerging highly drug-resistant Gram-negative bacilli causing infections associated with significant morbidity and mortality. Once confined to outbreaks in the northeastern United States (US), they have spread throughout the US and most of the world. KPCs are an important mechanism of resistance…

Case Report

Polyarteritis Nodosa in a Patient with Type 1 Autoimmune Hepatitis

Polyarteritis nodosa is a systemic necrotizing vasculitis that affects small- and medium-sized arteries. Liver involvement in patients with polyarteritis nodosa has been described, and ranges from asymptomatic elevation of aminotransferases to hepatic aneurysm rupture. We describe the case of a patient with type 1 autoimmune hepatitis and compensated liver cirrhosis…

Case Report

Disseminated Intravascular Large B Cell Lymphoma with Slowly Decreasing High-Density Lipoprotein Cholesterol

Intravascular large B cell lymphoma (IVLBCL) is a rare type of extranodal large B cell lymphoma in the lumina of small vessels. Low high-density lipoprotein cholesterol (HDL-C) is associated with sepsis, malignancy, and death. Recent evidence suggests an inverse relationship between HDL-C and non-Hodgkin lymphoma. We report the case of…

Case Report

Lead Poisoning from a Gunshot Wound

Lead poisoning from gunshot wounds is unusual. Awareness of this rare but serious complication can guide the physician in making a prompt diagnosis. We present a case of a 30-year-old male who had a remote history of a gunshot wound in the right knee and presented with right knee pain….

Letter to the Editor

An Unusual Cause of Chronic Lower Back Pain in an Elderly Woman: Lost Intrauterine Device

To the Editor: Intrauterine contraceptive devices (IUCD) are an effective means of contraception for many women worldwide. Migration of an IUCD into the urinary bladder, rectum, colon, peritoneum, omentum, appendix, wall of the iliac vein, or ovary has been reported.1 The most important potential complication of IUCD is uterine perforation….

Letter to the Editor

Prompt Diagnosis and Treatment of Strongyloidiasis in a Renal Transplant Patient

To the Editor: A 44-year-old woman on hemodialysis for the last nine years received a cadaveric renal transplant one month prior to presentation. She had immigrated to the United States from Guyana at age 29 years and subsequently had never traveled to an area where strongyloidiasis was known to be…

Letter to the Editor

Erythema Multiforme Secondary to H1N1 Vaccine

To the Editor: Since the development of the H1N1 pandemic vaccines, the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) have recommended vaccination to reduce the impact of the current H1N1 influenza pandemic.1,2 These vaccines have been developed and tested within a short period and are…

Letter to the Editor

Operational Tolerance After Immunosuppressive Withdrawal in a Case with Renal Transplantation

To the Editor: Renal transplantation is the first choice of replacement therapy in patients with end-stage renal disease. New immunosuppressive regimens have greatly reduced the risk of acute rejection and led to overall improvements in graft and patient survival. However, immunosuppressive drugs have numerous side effects and immunosuppression cannot prevent…

Errata

Effect of Sequential Treatment as a First-Line Therapy for Helicobacter pylori Eradication in Patients with Diabetes Mellitus: Erratum

In the article that appeared on page 988 of the October 2010 issue, incorrect dosing information regarding tetracycline was provided. The dose frequency should be tetracycline 500 mg four times per day (q.i.d.) for the remaining seven days, rather than tetracycline 500 mg once daily for the remaining seven days.

Errata

Cervical Myelopathy from Spinal Sarcoidosis as the Unexpected Initial Presentation for Systemic Sarcoidosis: Erratum

In the article that appeared on page 940 of the September 2010 issue, an author was inadvertently omitted from the article’s byline. The byline should appear as follows: Hien Nguyen, MD, Connie Le, MD, and Hanh Nguyen, MD. Dr. Hanh Nguyen’s affiliation is the Department of Family Medicine, University of…

Editorial

Addressing Childhood Obesity in Primary Care Practice: A Challenge and an Opportunity

With appropriate fanfare, First Lady Michelle Obama formally announced in February the far-reaching Let’s Move campaign, directed at eliminating in a generation America’s epidemic of childhood obesity.1 Encouraging involvement from a broad range of sectors–public, private, nonprofits, parents and youth–Let’s Move specifically tasks healthcare providers with a critical role in…

Editorial

Carbon Monoxide or Nitric Oxide: Which Came First?

Pulmonary hypertension has a poor prognosis with mortality, ranging as high as 50%. Echocardiograms, measures of pulmonary artery pressures, and ventilation-perfusion scans (V/Q scan) offer the most definitive diagnosis and assessment of disease progression and treatment progress. This pathology is characterized by dyspnea and tachypnea, as well as symptoms of…

In Memory

In Memory – Former SMA President G. Thomas Jansen, MD

Dr. G. Thomas Jansen, aged 84, of Little Rock, Arkansas passed away peacefully on September 14, 2010, surrounded by his family in prayer.

Review

Clinical Significance of Vitamin D Deficiency in Primary Hyperparathyroidism, and Safety of Vitamin D Therapy

Vitamin D deficiency occurs more frequently in patients with primary hyperparathyroidism (PHPT) compared with the general population, and is usually associated with an aggravated form of the disease. Current guidelines recommend measurement of serum levels of 25-hydroxy vitamin D (25-OHD) in all patients with PHPT, and their repletion if the…

Case Report

Carboxyhemoglobin Formation Secondary to Nitric Oxide Therapy in the Setting of Interstitial Lung Disease and Pulmonary Hypertension

Carbon monoxide (CO) has been widely recognized as an exogenous poison, although endogenous mechanisms for its formation involve heme-oxygenase (HO) isoforms, more specifically HO-1, in the setting of oxidative stress such as acute respiratory distress syndrome, sepsis, trauma, and nitric oxide use have been studied. In patients with refractory hypoxemia,…

Case Report

Intramural Gallstones Mimicking Typical Lithiasic Cholecystitis

Gallstone disease is common in the western population. Intramural gallstones are rare, with only a few cases reported in the literature. We present a 30-year-old female patient with typical symptoms of cholecystitis. The patient underwent laparoscopic cholecystectomy one month later. Dark greenish intramural gallstones were identified right after the resection…

Case Report

False-Positive Amplified Mycobacterium tuberculosis Direct Tests in Skin Specimens of Leprosy

The amplified Mycobacterium tuberculosis (M tuberculosis) direct test (MTD) is reported to be a highly sensitive (92.6%) and specific (100%) test for the detection of M tuberculosis. We report two cases of human leprosy in which false-positive amplified MTD testing on skin biopsies led to initial misdiagnoses of cutaneous M…

Case Report

Acute Epidural Abscess Complicating Pneumococcal Meningitis in Adult

Acute spinal epidural abscesses rarely complicate bacterial meningitis in adults. We report an uncommon case of advanced pneumococcal meningitis complicated by acute lumbar epidural abscess in an adult. A 35-year-old man was admitted to the medical intensive care unit with pneumococcal meningitis. On the eighth day of hospitalization, he presented…

Case Report

Adenoid Cystic Carcinoma of Trachea Treated with Tumor Curettage and Adjuvant Intensity Modulated Radiation Therapy

Primary tracheal tumors are rare, accounting for only 0.2% of all thoracic cancers. Adenoid cystic carcinoma (ACC) is the second most common tracheal malignancy. Most ACC patients present with dyspnea, and the symptoms often mimic those of asthma or chronic bronchitis. We report the case of a 79-year-old female patient…

Letter to the Editor

Radiation-Associated Prolactinoma

To the Editor: Prolactinoma is a secretory pituitary tumor. Clinical symptoms and manifestations are secondary to either prolactinoma-associated growth (resulting in cranial nerve palsies and visual field defects), adenoma-related hyperprolactinemia (resulting in sexual and gonadal dysfunction), or both. Men with prolactinoma typically develop tumor-induced impotence (characterized by decreased libido and…