Issue - Southern Medical Association

Editorial

Duloxetine-Induced Tako-Tsubo Cardiomyopathy: Implications for Preventing a Broken Heart

Agatha Christie captured her readers with mystery. Robert Ripley fascinated us with a vast assortment of the bizarre and unusual. It is, therefore, not surprising that we are intrigued by the unsolved puzzle of tako-tsubo cardiomyopathy. In this issue of the Southern Medical Journal, Rotondi et al. help extend the…

Editorial

Metastatic Staphylococcus aureus Bloodstream Infections: Don't Dare Not to Show Respect

Staphylococcus aureus (S. aureus) is a major bacterial pathogen in all healthcare settings and the community. From 2003-2004, approximately 29% (78.9 million persons) and 1.5% (4.1 million persons) of the US population were colonized in the nose with S. aureus and methicillin-resistant S. aureus (MRSA) respectively.1 It is the most…

Editorial

Food Allergy: An Overdiagnosed but Underappreciated Problem

Food allergy, an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a given food, is a common clinical problem and has had much attention in the lay press recently. The National Institutes of Health just released a landmark publication on food allergy: “The…

Original Article

Comparing the Aspartate Aminotransferase (AST) to Platelet Ratio Index (APRI) Between African American and White Veterans with Chronic Hepatitis C

Objectives: The study of noninvasive markers of fibrosis, such as aspartate aminotransferase (AST) to platelet ratio index (APRI), have been limited in African American populations. Given the disparate outcomes of chronic hepatitis C in African American populations, comparative analyses of the APRI score should be undertaken. Compare the diagnostic accuracy…

Original Article

Association of Chlamydia pneumoniae Serology and Ischemic Stroke

Background: Stroke is one of the major causes of morbidity and mortality throughout the world. Reports about the role of Chlamydia pneumoniae infection in the development of atherosclerosis have been reported in many studies. The aim of the study was to evaluate the association between Chlamydia pneumoniae infection and ischemic…

Review

Vitamin D Deficiency in Patients with Congestive Heart Failure: Mechanisms, Manifestations, and Management

Recent research suggests that vitamin D may play a role in cardiovascular (CV) health. Although its exact role is still debated and is a matter of controversy, vitamin D deficiency has been linked to increased prevalence of CV risk factors and events. Factors that predispose persons with congestive heart failure…

Review

Protean Manifestations of Vitamin D Deficiency, Part 1: The Epidemic of Deficiency

Abstract: Just when vitamin deficiencies were thought to be a “thing of the past” a new vitamin deficiency-that of vitamin D has developed over the past 20 years. Vitamin D works like a hormone being produced primarily in one organ (the kidney) before circulating through the bloodstream to multiple organs…

Review

Protean Manifestations of Vitamin D Deficiency, Part 2: Deficiency and Its Association with Autoimmune Disease, Cancer, Infection, Asthma, Dermopathies, Insulin Resistance, and Type 2 Diabetes

Vitamin D deficiency is epidemic and its manifestations are protean. Vitamin D deficiency is associated with autoimmune diseases (particularly multiple sclerosis and type 1 diabetes) and has been associated with infection, allergy, asthma, and dermopathies (particularly psoriasis). Asthma may be worsened by vitamin D deficiency and correction of the deficiency…

Review

Protean Manifestations of Vitamin D Deficiency, Part 3: Association with Cardiovascular Disease and Disorders of the Central and Peripheral Nervous Systems

Vitamin D deficiency is associated with the risk factors of inflammation, insulin resistance and endothelial dysfunction, and left ventricular hypertrophy. As a result there is an increase in cardiovascular events (CVEs) associated with vitamin D deficiency. Vitamin D deficiency itself or secondary hyperparathyroidism or both may be responsible for the…

Case Report

"Tako-Tsubo" Cardiomyopathy and Duloxetine Use

We report the case of a 68-year-old woman in whom the use of duloxetine, a potent serotonin and norepinephrine reuptake inhibitor, was associated with “tako-tsubo” cardiomyopathy (TTC). Although several pathophysiological mechanisms for TTC have been proposed, available evidence suggests that an excess of catecholamines may play a major role. Our…

Case Report

Tumor-Induced Osteomalacia (TIO): Atypical Presentation

Tumor-induced osteomalacia is a rare acquired condition characterized by phosphaturia, hypophosphatemia and osteomalacia. We report an unusual presentation in a 15-year-old healthy male with a two-week history of cough and chest pain. The chest radiograph showed right middle lobe opacity and chest CT revealed a mass in the extra pleural…

Case Report

Large Blood Transfusion as a Rare Cause of Ventricular Fibrillation

Large blood transfusions are common in clinical practice. Though several complications have been described with this procedure, cardiac arrhythmias occur uncommonly in this setting. We describe a case of a previously healthy 17-year-old girl who developed wide-complex ventricular tachycardia rapidly culminating in a ventricular fibrillation cardiac arrest several hours following…

Case Report

Metastatic Methicillin-Sensitive Staphylococcus aureus Infection

Staphylococcus aureus bacteremia (SAB) is a common and increasingly recognized hospital- and community-acquired infection. To minimize morbidity and mortality, it is essential to determine which patients are at high risk for metastatic SAB. The risk-scoring system described by Fowler et al and the APACHE II scoring system can be helpful…

Case Report

Pelvic Tuberculosis and Shock in the Puerperium

Pelvic tuberculosis (TB) in pregnancy and puerperium is rare. Its atypical presentation as puerperal shock is more rare. We describe a case of pelvic TB that manifested as shock in a teenager who was two weeks postpartum. She failed to respond to antibiotics. Ziehl-Neelsen staining of aspirated pus from the…

Case Report

Acute Lithium Intoxication: Properly Directing an Index of Suspicion

Lithium is known for its efficacy and toxicity. Toxic effects have been characterized even with therapeutic levels. Most physicians will at some point be faced with a patient with altered mental status and no records of his or her history. The differential diagnosis of altered mental status is long, and…

Case Report

Early Surgical Intervention of Peritoneal Dialysis Catheter-Related Pseudomonas Peritonitis

We present two cases of peritoneal dialysis (PD) catheter-related Pseudomonas peritonitis that were poorly responsive to treatment guidelines of antibiotics and early catheter removal, and uncommonly complicated with ongoing intractable infections. An emergency exploratory laparotomy with extensive intraoperative peritoneal lavage and drainage was performed. The patients recovered dramatically and were…

Case Report

Isolated Septic Discitis Associated with Streptococcus bovis Bacteremia

Streptococcus bovis is a Gram-positive coccus that can be found in the intestinal flora of healthy people; it is also associated with colon cancer and infective endocarditis. We report on a 79-year-old male who initially presented with acute-onset lower back pain. Streptococcus bovis was detected in repeated blood cultures, and…

Case Report

Multiorgan Failure Following Mass Wasp Stings

Wasp bites usually bring temporary discomfort and pain, but on occasion, they can cause serious infections and fatal allergic reactions. We report on a patient who experienced massive wasp stings and developed multiple organ failure, including acute kidney, hepatic failure, and circulatory collapse 4 days later. He was treated with…

Letter to the Editor

Internal Medicine Resident Physicians May Be Uncomfortable with Managing Irritable Bowel Syndrome at the Completion of Residency

To the Editor: We read with great interest the article by Minocha et al, “Racial Differences in General Health, Suicidal Thoughts, Physical and Sexual Abuse in African-Americans and Caucasians with Irritable Bowel Syndrome.” The study revealed some differences, but still many similarities between African Americans and whites with irritable bowel…

Letter to the Editor

Pediatric Diabetes and Neuropsychiatry Disorder

To the Editor: I read the recent publication on pediatric diabetes and neuropsychiatry disorder (NPD) with great interest.1 Block et al. found that “It appears that pediatric diabetic males are affected with NPD to a greater extent than females.1” I would like to share some ideas on this article. Indeed,…

Editorial

Surgical Intervention for Peritoneal Dialysis Associated Refractory Pseudomonas Peritonitis: Using Water to Put Out a Forest Fire

Peritonitis due to Pseudomonas species is a serious complication of peritoneal dialysis (PD).1 It is a relatively uncommon cause of peritonitis, but can be more common in certain parts of the world like Hong Kong.2 Pseudomonas peritonitis is associated with higher likelihood of catheter loss and transfer to hemodialysis. In…

Original Article

Impact of Tracheal Mucosa Involvement on Clinical Characteristics of Sarcoidosis

Objectives: To investigate the impact of tracheal mucosa involvement on the clinical features of sarcoidosis. Methods: The clinical data of sarcoidosis patients with (Group A, n = 26) and without (Group B, n = 61) tracheal mucosa involvement were evaluated retrospectively. Results: The proportion of patients suffering from cough in…

Original Article

Hospitalizations of Children and Young Adults from Peanut-Induced Anaphylaxis in Texas

Objective: Population-based studies of peanut anaphylaxis in Texas children and young adults are lacking. The objective of this investigation was to report the clinical and demographic features of children discharged throughout Texas with a diagnosis of anaphylaxis triggered by peanut consumption and calculate the peanut anaphylaxis hospitalization rate by age…

Case Report

Giant Mediastinal Mass: Thymolipoma

A 26-year-old man presented with shortness of breath on exertion that was gradually getting worse. His history revealed a mass in the left hemithorax that had been growing on follow-ups. Physical examination only showed that the respiratory sounds were fainter on the left. Thoracic computerized tomography was performed to elucidate…

Case Report

Fever of Unknown Origin from a Left Atrial Myxoma: An Immunologic Basis and Cytokine Association

Myxoma is the most common primary tumor of the heart. The typical presentations include a triad of embolic phenomena, intracardiac flow obstruction, and constitutional symptoms. We report a case of cardiac myxoma presenting as prolonged fever. Leukocytosis with a left shift, anemia, and elevated C-reactive protein were noted. A large…

Case Report

Cryptococcal Endocarditis

Fungal infections of the heart are increasingly described especially in immunocompromised patients. Cardiac involvement can present with myocarditis, pericarditis or endocarditis. Cryptococcal endocarditis is extremely rare, with only four reported cases in the literature. The prognosis, natural history and the optimal management for cryptococcal endocarditis are not well described because…

Case Report

Chylous Ascites as a Rare Complication After Abdominal Aortic Aneurysm Surgery

Chylous ascites is a rare complication, and the treatment, which includes conservative and surgical strategies, is controversial. We describe two cases of chylous ascites that occurred after abdominal aortic aneurysm surgery. The first patient died of underlying diseases despite conservative treatment, while in the second patient, chylous ascites resolved with…

Case Report

Acquired Factor VIII Inhibitor (Acquired Hemophilia A) Presenting as Spontaneous Blood-filled Scrotum

Acquired hemophilia A, also known as acquired factor VIII deficiency, is an exceedingly rare bleeding diathesis that does not require any personal or family history of bleeding or clotting disorder. Because treatment is available, misdiagnosing or completely missing this diagnosis can be life threatening for patients. Clinicians should be aware…

Letter to the Editor

Resolution of Statin-Induced Myalgias by Correcting Vitamin D Deficiency

To the Editor: In the article by Bell DS,1 a case report resolution of statin-induced myalgias by correcting vitamin D deficiency was presented. Although vitamin D deficiency can cause myopathy and statins can induce a spectrum of skeletal muscle complaints,2 we believe that it is far-fetched to correlate statin myopathy…