The pharmaceutical industry has produced many marvels, drugs that at their best can be lifesaving. There are, however, instances in which company profit motives can become so egregious that they are detrimental to public health. In my opinion, we are witnessing a potentially catastrophic example of this with Gilead Sciences’…
Obesity and associated diseases not only have an adverse effect on public health but also represent a tremendous global economic burden. The prevalence of obesity remains high in the past decade across all age groups.1 Diabetes mellitus affects 29.1 million people in the United States, and in 2012, 25.9% of…
Objectives: The South Texas Veterans Health Care System (STVHCS) implemented a Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)–based alcohol-withdrawal protocol in June 2013. The aim of this study was to determine the efficacy and safety of the new protocol. The primary objective was the evaluation of whether implementation…
Cardiac tamponade is a life-threatening condition requiring urgent detection to provide effective treatment. The diagnosis of cardiac tamponade is based upon clinical and echocardiographic findings, which often can be subtle. Classic physical examination findings include the Beck triad (hypotension, distended neck veins, and muffled heart sounds) and tachycardia and pulsus…
Objectives: We hypothesized that subspecialists perform more concomitant apical suspensions during transvaginal hysterectomy for uterovaginal prolapse as compared with general gynecologists. Methods: Retrospective analysis of the MedStar Health EXPLORYS database for women undergoing transvaginal hysterectomy for prolapse. Appropriate International Classification of Diseases-9 codes for uterine prolapse and incomplete and complete…
I thank Dr Brown for providing clinicians with a comprehensive approach to supporting caregivers in their own needs. Caring for a friend or family member with a terminal or protracted illness can be stressful and often can consume the caregiver, with little rest from the mental, emotional, and physical strain,…
During the last 50 years, it has become evident that atherosclerosis originates in childhood. Although cardiovascular disease (CVD) events are rare in children, autopsy data and imaging studies have documented subclinical disease in association with measurable risk factors during childhood. When present at a young age, risk factors track into…
Objectives: Gastroesophageal reflux disease (GERD) and dyspepsia cause significant healthcare resource utilization and greatly affect quality of life; therefore, a tendency exists to self-treat in lieu of formal diagnosis. Although their prevalence is established in the general population, their prevalence in physicians remains unknown. Our aim was to estimate the…
Patients with pericardial effusion are susceptible to cardiac tamponade. A compressing circumferential pericardial effusion typically results in an equalization of intracardiac and pericardial pressure during diastole and a progressive collapse of the right atrium and ventricle. Pulmonary hypertension that increases the afterload of the right ventricle may result in elevated…
In this issue of the Southern Medical Journal, Vidaeff and colleagues address the challenges the medical profession face in caring for patients from diverse cultures and backgrounds.1 They nicely identify issues of cultural differences—from the perspective of both the patient and the physician—that may, and likely do, affect patient–physician communication,…
Culturally sensitive health care represents a real ethical and practical need in a Western healthcare system increasingly serving a multiethnic society. This review focuses on cross-cultural barriers to health care and incongruent aspects from a cultural perspective in the provision of health care. To overcome difficulties in culturally dissimilar interactions…
To the Editor: Spouses, children, other relatives, and close friends journey with patients and often rely on healthcare team members for whole-person support. A number of studies have focused on meeting the spiritual needs of patients, but only more recently has attention been given to the spiritual needs of caregivers….
To the Editor: Recurrent Clostridium difficile infection (CDI) is a growing epidemic with high recurrence rates after antibiotic treatment. Because of the limited number of medications available, alternative therapies such as fecal microbiota transplantation (FMT) are being closely studied for their role in the treatment of CDI. A systematic review…
The perspective “No to Greed” by Terpening in this issue of the Southern Medical Journal provides an appraisal on the controversy surrounding the cost of sofosbuvir as a potentially curative treatment for hepatitis C virus (HCV).1 Sofosbuvir represents a substantial advance in the treatment of HCV. The drug is taken…
Atherosclerosis, the underlying mechanism of diseases of the arterial system, including the coronary, carotid, cerebral, renal, and peripheral arteries, is the leading cause of mortality in adults in the United States.1,2 Premature atherosclerosis becomes symptomatic before 55 years of age; however, pathologic features of atherosclerosis can occur in early childhood…
Objectives: Historically, surgical management of empyema was performed predominantly via open thoracotomy; however, during the past decade the use of video-assisted thoracoscopic surgery (VATS) as an alternative has increased. This study retrospectively compared the outcomes and management of patients with empyema at the University of Kentucky Medical Center who had…
Objectives: This study examined relations between elevated body mass index (BMI) and time to diagnosis with type 2 diabetes mellitus and its complications among older adults in the United States. Methods: Data came from the Medicare Current Beneficiary Survey, 1991–2010. A Cox proportional hazard model was used to assess relations…
Objectives: The development of pulmonary hypertension (PH) in non–World Health Organization group I PH adversely affects exercise capacity. It is unclear whether pulmonary artery hypertension (PAH)–specific drugs improve pulmonary hemodynamics and exercise capacity in such patients. Methods: We performed a retrospective chart review of consecutive patients with non–World Health Organization…
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