Showing papers in "Southern Medical Journal in 2002"

Limb amputation and limb deficiency: epidemiology and recent trends in the United States.

Abstract: Background.The purpose of this study was to provide a comprehensive perspective on the epidemiology and time trends in the incidence of limb amputations and limb deficiency in the United States.Methods.Data from the Healthcare Cost and Utilization Project from 1988 through 1996 were used to

Effects of once-daily and twice-daily dosing on adherence with prescribed glipizide oral therapy for type 2 diabetes.

Abstract: Background We evaluated differences in adherence and persistence with prescribed therapy of once-daily (OD) dosing compared with twice-daily (BID) dosing of glipizide in patients with type 2 diabetes. Methods The study cohort was derived from a pharmacy benefit manager claims database. Patients new to extended-release gastrointestinal therapeutic system (GITS) and immediate-release glipizide therapy were identified and followed for 1 year. Adherence indices (AIs) were calculated and persistence curves were constructed. Results Adherence indices rates were 60.5% in the GITS OD cohort and 52.0% in the BID cohort. Rates of persistence at 12 months were 44.4% in the GITS OD cohort vs 35.8% in the BID cohort. Conclusion Initiation of OD pharmacotherapy results in better adherence and persistence compared with a BID regimen, despite a greater daily pill burden in the OD cohort. These data suggest that dosing frequency exerts a greater impact on patient adherence and persistence than number of tablets per dose.

Emergency department overcrowding in Florida, New York, and Texas.

Abstract: Background This study was done to determine the incidence, causes, and effects of overcrowding in emergency departments (EDs) in Florida, New York, and Texas. Methods Surveys were mailed to a random sample of EDs in Florida, New York, and Texas. Questions included census, area population, frequency and causes of overcrowding, and impact. Causes of overcrowding were ranked on a 5-point scale. Results A total of 300 surveys were sent, and 210 (70%) were returned. Overcrowding was reported in 194 EDs (92%): New York (90%), Florida, (92%), and Texas (95%). Causes of ED overcrowding included hospital bed shortage, high medical acuity of patients, increasing patient volume, too few examination spaces, and shortage of RN staff. Overcrowding resulted in death, permanent disability, additional procedures, and increased length of hospitalization. Conclusion In this survey of EDs, overcrowding was pervasive. Many factors contribute to ED overcrowding. Poor medical outcomes may occur because of overcrowding.

Systematic review of clinical trials examining the effects of religion on health.

Abstract: Using MEDLINE, (limited to the English language and the reference lists of the randomized controlled trials (RCTs), we assessed the impact of religion on health outcomes via systematic, critical review of the medical literature. All RCTs published from 1966 to 1999 and all non-RCTs published from 1996 to 1999 that assessed a relationship between religion and measurable health outcome were examined. We excluded studies dealing with non-religious spirituality, ethical issues, coping, well-being, or life satisfaction. We used the Canadian Medical Association Journal's guidelines for systematic review of the medical literature to evaluate each manuscript. Nine RCTs and 25 non-RCTs met these inclusion/exclusion criteria. Randomized controlled trials showed that intercessory prayer may improvehealth outcomes in patients admitted to a coronary care unit but showed no effect on alcohol abuse. Islamic-based psychotherapy speeds recovery from anxiety and depression in Muslims. Non-RCTs indicate that religious activities appear to benefit blood pressure, immune function, depression, and mortality.

Simultaneous bilateral rupture of quadriceps tendons: analysis of risk factors and associations.

Abstract: Background Simultaneous bilateral quadriceps tendon rupture is an uncommon injury that is frequently misdiagnosed. It has been associated with multiple medical conditions including renal disease, rheumatologic disorders, and endocrine disorders. Methods All reported cases of simultaneous bilateral quadriceps tendon rupture were identified using MEDLINE. Each case was reviewed for information regarding the injury, and this information was analyzed. Results There were 66 cases of simultaneous bilateral quadriceps tendon rupture reported in the English-language literature. This review presents descriptive data on all the cases and analyzes the following factors surrounding rupture: age, sex, time before diagnosis, mechanism of injury, location of rupture, and associated chronic diseases. Most patients were treated surgically, followed by 4 to 6 weeks of immobilization, which resulted in a good outcome. Conclusion Numerous associations were found and are discussed in this review. Patients with quadriceps tendon rupture should be evaluated for an underlying chronic disease.

Deaths associated with pregnancy outcome: a record linkage study of low income women.

Abstract: Background. A national study in Finland showed significantly higher death rates associated with abortion than with childbirth. Our objective was to examine this association using an American population over a longer period. Methods. California Medicaid records for 173,279 women who had an induced abortion or a delivery in 1989 were linked to death certificates for 1989 to 1997. Results. Compared with women who delivered, those who aborted had a significantly higher age-adjusted risk of death from all causes (1.62), from suicide (2.54), and from accidents (1.82), as well as a higher relative risk of death from natural causes (1.44), including the acquired immunodeficiency syndrome (AIDS) (2.18), circulatory diseases (2.87), and cerebrovascular disease (5.46). Results are stratified by age and time. Conclusions. Higher death rates associated with abortion persist over time and across socioeconomic boundaries. This may be explained by self-destructive tendencies, depression, and other unhealthy behavior aggravated by the abortion experience.

Psychologic and physiologic effects of dieting in adolescents.

Abstract: Obesity in adolescents has increased by 75% in the past three decades. Cross-sectional and prospective surveys have shown that a large percentage of adolescents, particularly females and even those of normal weight, diet at some time. While moderate changes in diet and exercise have been shown to be safe, significant psychologic and physiologic consequences may occur with extreme or unhealthy dieting practices. Moderate dieting has been shown to be associated with negative self-esteem in some adolescents. The very act of starting any diet increases the risk of eating disorders in adolescent girls. Extreme methods of weight loss can have adverse physiologic effects if not closely monitored. Electrolyte disturbances, cardiac dysrhythmias, and even sudden cardiac death can result from unhealthy or extreme dieting practices. Such practices are associated with other problem behavior in adolescents. We review current information on dieting in teenagers and discuss psychologic and physiologic effects of these practices.

Bacterial Contamination of Paper Currency

Abstract: One-dollar bills were collected from the general community in western Ohio to survey for bacterial contamination. Pathogenic or potentially pathogenic organisms were isolated from 94% of the bills. These results suggest a high rate of bacterial contamination of one-dollar bills.

Obesity and health status in rural, urban, and suburban southern women.

Abstract: Background.Obesity has reached epidemic proportions over the past 20 years.Methods.This study investigated the differences in rates of obesity and perceptions of health status between rural, urban, and suburban Southern women based on selected socioeconomic factors. Using data from a nationa

Gastrointestinal Bleeding in Adult Patients With Meckel's Diverticulum: The Role of Technetium 99m Pertechnetate Scan

Abstract: Obscure gastrointestinal (GI) bleeding is often challenging for the primary care physician, but with improved diagnostic testing the cause of this blood loss is determined in most patients. However, approximately 5% of the time no underlying cause is found. One common etiology in patients younger than 40 years of age is a Meckel's diverticulum. The technetium 99m pertechnetate scan is the standard test for making this diagnosis. However, the sensitivity of the scan is only 62% in the adult population. In this case report, a patient with profound, hemodynamically significant GI blood loss had multiple negative studies. Subsequently, an abnormal vascular lesion was detected and during exploratory laparotomy, a Meckel's diverticulum was found and removed. Although the technetium pertechnetate scan is falsely negative in a number of cases, there are ways to increase its sensitivity and possibly avoid repeated testing.

Hyperinfective strongyloidiasis in the medical ward: review of 27 cases in 5 years

Abstract: Background Hyperinfective strongyloidiasis is rare, but the mortality rate is very high. It occurs most commonly in immunocompromised patients. We reviewed the clinical presentation and mortality rate of cases managed in our facility. Method Twenty-seven patients with hyperinfective strongyloidiasis admitted to our medical ward over a 5-year period were prospectively studied. Results In our study, there were 18 males and 9 females (mean age, 58 years). Weight loss, gastrointestinal symptoms, hypoproteinemia, and anemia were the main clinical presentations. Mortality rate was 26%; human T-lymphotropic virus (HTLV-1) infection, chronic alcoholism, eosinopenia, sepsis, and prerenal azotemia on admission were poor prognostic factors. HTLV-1 infection was the main underlying disease in 71% of patients, and 44% of patients had a history of chronic alcoholism. Conclusion Early diagnosis and treatment with thiabendazole may reduce mortality in hyperinfective strongyloidiasis. Hyperinfective strongyloidiasis may also be a clinical marker of HTLV-1 infection in areas where both entities are endemic or in immigrants from such areas.

Characteristics and outcomes of patients with Goodpasture's syndrome.

Abstract: Background.Goodpasture's syndrome is a rare disorder characterized by pulmonary hemorrhage, glomerulonephritis, and antiglomerular basement membrane antibodies.Methods.Case reports of Goodpasture's syndrome between 1993 and 2000 were identified using MEDLINE. Each case was reviewed for clini

Drug-associated heat stroke.

Abstract: During the June 1998 heat wave in New Orleans, 8 patients came to the emergency department of a large public hospital over a 14-day period. They were subsequently admitted to the intensive care unit with a diagnosis of heat stroke. On each of these days, the ambient temperature exceeded 33.3 degrees C (91.9 degrees F). Although the highest recorded temperature was only 35.6 degrees C (96 degrees F), the heat index reached a high of 44.5 degrees C (112 degrees F). Weather-related heat illnesses are well documented, but the reports rarely address contributing medications or drugs. In this series, 6 patients (75%) had been using medication or drugs known to induce or worsen hyperthermia. A seventh patient had been prescribed a phenothiazine, but actual use could not be established. An eighth patient had an unidentified agent detected on toxicologic screening. The most common drug identified was cocaine. Other drugs included diphenhydramine, tricyclic antidepressants, and phenothiazines. Six patients (75%) had rhabdomyolysis; 3 of them also had disseminated intravascular coagulation. There were 2 deaths, yielding a 25% mortality rate.

Rhabdomyolysis of infectious and noninfectious causes.

Abstract: Background.This study was done to determine variables associated with infectious rhabdomyolysis (IRM).Methods.In this retrospective case-control study, rhabdomyolysis (RM) was defined as a fivefold or greater elevation in creatine kinase (CK) levels with a muscle/brain (MB) fraction <5%. Pat

Awareness and use of over-the-counter pain medications: a survey of emergency department patients.

Abstract: Background A survey study was done to determine basic knowledge about and use of over-the-counter (OTC) pain medications among patients seen in our emergency department (ED). The hypothesis was that knowledge about OTC pain medications would be correlated with demographic characteristics. Methods The study was a prospective 21-question survey during randomized 4-hour shifts over a 6-week study period. Results Of the 213 subjects who participated, 143 (67%) reported having used some form of nonsteroidal anti-inflammatory drug (NSAID), and 127 (60%) had used acetaminophen products recently. Women were more aware of toxic interactions and gastrointestinal (GI) irritation related to these medications. Ibuprofen use correlated with age (younger individuals used more) and having no primary physician (those without a physician used less). Knowledge about GI effects correlated with age, sex, and education. Knowledge about renal and hepatic problems correlated with age and education. Conclusion Many patients use OTC pain medications. Many are ill informed about their use and side effects. More education is needed.

Improving glycemic control in adults with diabetes mellitus: shared responsibility in primary care practices.

Abstract: Background Primary care physicians provide care for most patients with diabetes mellitus, but few have the resources to achieve the level of glycemic control needed to avert complications Methods Primary care physicians referred patients with unsatisfactory glycemic control, frequent hypoglycemia, or inadequate self-management to an endocrinologist-directed team of nurse and dietitian educators for a 3-month program of intensive diabetes care Patients had at least weekly contact with a diabetes educator and received changes in insulin and/or other medication, coupled with extensive individualized instruction The main outcome measurement was change in glycosylated hemoglobin (HbA 1c ) level at 3 months Results The first 350 patients who completed the program had overall mean decrease in HbA 1 , level of 17% (95% CI 14%-19%) Conclusions Barriers to improving glycemic control may be overcome by establishment of a system of collaboration between primary care providers and endocrinologist-directed diabetes educators

Uterine rupture and dehiscence: ten-year review and case-control study.

Abstract: Background. Previous cesarean section, oxytocin administration, and fetal macrosomia increase the risk of uterine rupture or dehiscence (URD) Methods. All 25,718 deliveries at Riverside Regional Medical Center from January 1990 to June 2000 were reviewed to describe complications and identify risk factors for URD. Results. Eleven uterine ruptures and 10 dehiscences occurred during this period (0.08%). One maternal death (5%) and three neonatal deaths (14%) occurred. Other complications included intrapartum nonreassuring fetal status (67%), 5-minute Apgar score <7 (52%), maternal blood transfusion (24%), neonatal hypoxic injury (14%), hysterectomy (14%), and endometritis (10%). Uterine rupture/dehiscence was independently associated with feta weight ≥4,000 g, nonreassuring fetal status, use of oxytocin, and previous cesarean delivery; internal fetal monitoring reduced the risk of URD. Conclusions. To reduce the risk of URD, a delivery plan should include assessment of cesarean history and fetal macrosomia, judicious use of oxytocin, and intrapartum monitoring for nonreassuring fetal status.

Hepatitis A epidemic in the elderly.

Abstract: Background The purpose of this study was to characterize acute hepatitis A in patients more than 40 years old. Methods Retrospective chart reviews and physician questionnaires were used. Hospitalization, laboratory tests, comorbid conditions, complications, and mortality were assessed. Results A total of 180 cases of acute hepatitis A occurred in patients more than age 40. Hospitalization rates increased from 3% for the group aged 40 to 49 to 12% in the group aged 50 to 69 and 42% in those > or = 70 years old. The mean peak total bilirubin value was higher in hospitalized patients than in nonhospitalized patients (12.4 mg/dL vs 7.7 mg/dL). Comorbid conditions included significant alcohol consumption (8%), diabetes (16.6%), cardiovascular disease (54%), and chronic obstructive pulmonary disease (COPD) (21%). Complications included pancreatitis (4.1%), ascites (8.3%), prolonged cholestatic features (7.6%), and death (0.8%). Conclusion Hospitalization rates and rare complications associated with acute hepatitis A increase with age.

Treatment of latent tuberculosis infection in contacts of new tuberculosis cases in the United States.

Abstract: Background. Few data are available describing treatment completion rates among recently infected contacts of tuberculosis (TB) cases, a group at high risk for development of active TB Methods. Health department records were reviewed for all contacts of 360 culture-positive pulmonary TB cases reported from five health departments in the United States in 1996. Results. Of 2,267 contacts who completed screening, 630 (28%) had newly documented positive skin tests (121 with skin test conversion). Treatment of latent TB infection was documented to have been recommended for 447 (71%). Among these, treatment was documented to be initiated for 398 (89%). Of these, 203 (51%) were documented to have completed a 6-month course of treatment, and 78 (20%) received directly observed treatment. Treatment was recommended more often for contacts < 15 years of age, skin test converters, close contacts, and contacts of smear-positive cases. Treatment completion rates were higher for skin test converters. Conclusions. In this study, fewer than one third of all persons with newly documented positive skin tests detected during contact investigations were proven to have completed treatment. Achieving high rates of complction of therapy for latent TB infection in recently infected contacts of active cases of pulmonary TB is essential to maximize public health prevention efforts aimed at eliminating TB.

Sports medicine approach to low back pain.

Abstract: Low back pain is a common, recurrent affliction in the general population. Research has indicated that, contrary to traditional beliefs, bed rest is not an effective therapy. Existing evidence supports the use of early activity and exercise in treatment of acute and chronic low back pain. Since the sports medicine model of rehabilitation is based on early, progressive activity, its principles can be usefully applied to the management of low back pain in the general population.

Craniofacial hyperhidrosis successfully treated with topical glycopyrrolate.

Abstract: Treatment of craniofacial hyperhidrosis currently consists of thoracic sympathectomy, which is not widely available. Oral anticholinergic agents and beta-blockers may be effective but also carry significant side effects. We describe a healthy, active 27-year-old male resident physician who had excessive facial sweating with minimal exertion or stress. The sweating was especially pronounced on the forehead, nose, and upper lip. Daily topical application of a 0.5% glycopyrrolate solution to the face and forehead was offered. After the first treatment, facial sweating was significantly reduced and was well controlled under stressful situations, without any discomfort to the skin. No loss of efficacy was seen after multiple face washings. Facial hyperhidrosis recurred after withdrawal of the glycopyrrolate for 2 days, confirming its therapeutic effect. Two years later, he continues to use glycopyrrolate as needed. We conclude that topical glycopyrrolate is effective in treating craniofacial hyperhidrosis and is associated with few adverse effects.

Hemothorax and retroperitoneal hematoma after anticoagulation with enoxaparin.

Abstract: A 58-year-old woman with chronic obstructive pulmonary disease had spontaneous bilateral hemothorax and a retroperitoneal hematoma after 4 days of anticoagulation therapy with enoxaparin (1 mg/kg subcutaneously every 12 hours) for suspected pulmonary thromboembolism. The patient was successfully managed with red blood cell and plasma transfusions, multiple thoracenteses for evacuation of blood from the pleural space, short-term mechanical ventilation, and administration of bronchodilators, corticosteroids, and antibiotics. This is the first report of spontaneous hemothorax and the third report of spontaneous retroperitoneal hematoma associated with enoxaparin therapy.

Effect of parental education on decision-making about neonatal circumcision.

Abstract: Background We investigated the impact of unbiased, published, easily accessible brochures on the parental decision about circumcision. Methods A total of 190 women who were delivered of healthy male infants at Memorial-Hermann Hospital and Woman's Hospital of Texas from December 1, 1999, to April 30, 2000, were asked to complete a brief demographic self-description and questionnaire regarding their attitudes and beliefs about circumcision. The most recent American Academy of Pediatrics (AAP) brochure about circumcision was then distributed, and subjects completed the questionnaire a second time after reading the brochure. Results Eighty-five percent of participants opted for circumcision. No woman altered her decision on the basis of information in the AAP brochure. Regardless of parental desire for circumcision, responses to all questions before and after distribution of the AAP brochure were highly correlated. Circumcision status of the father and the parents' education and age were significantly associated with the decision to circumcise. There was no significant association between this decision and marital status, race, or religion. Conclusions Parental education about the medical indications and possible risks of circumcision has no impact on the decision-making process about neonatal circumcision.

Access to Care and Stage at Diagnosis for Patients With Lung Cancer and Esophageal Cancer: Analysis of the Savannah River Region Information System Cancer Registry Data

Abstract: Background.Disparities have been observed in both the incidences of lung and esophageal cancers and the survival of those patients. Our goals were to determine if race was associated with stage of cancer at diagnosis, and to identify predictors of advanced-stage lung and esophageal cancers.M

Ketorolac for pain management after abdominal surgical procedures in infants.

Abstract: Background.While the use of intravenous ketorolac in infants less than 6 months old has not been previously reported, ketorolac may reduce opioid use and prevent opioid-associated side effects that are frequent in this age group. We reviewed our experience with ketorolac in infants to develo

Maladies in musicians.

Abstract: Certain medical ailments occur with increased frequency among musicians and can affect musicians of all ages and ability. These maladies range in severity from incidental, asymptomatic findings among casual a nd occasional players to serious injuries that significantly disable professional musicians from practicing or performing. The most prevalent problems involve overuse of muscles resulting from repetitive movements of playing, often in combination with prolonged weight bearing in an awkward position. Other common problems include dermatologic irritation, peripheral neuropathies, focal dystonias, and otolaryngologic disorders. This review organizes the musical maladies according to section of the orchestra with further subclassification by pathologic process. By becoming familiar with the disorders associated with specific instruments, physicians will be better able to make the correct diagnosis in musicians with medical complaints.

Comparison of rectal and tympanic thermometry during exercise.

Abstract: Background.Heat-related deaths are among the most preventable injuries in athletics. We sought to examine two methods of monitoring body temperature during exercise as a means of preventing heat-related illnesses.Methods.Ten adult subjects exercised in hot, humid conditions while body temper

Rhabdomyolysis of infectious and noninfectious causes.

Abstract: Background. This study was done to determine variables associated with infectious rhabdomyolysis (IRM). Methods. In this retrospective case-control study, rhabdomyolysis (RM) was defined as a fivefold or greater elevation in creatine kinase (CK) levels with a muscle/brain (MB) fraction <5%. Patients with myocardial infarction or cerebrovascular accident or a recent history of surgery, trauma, or immobilization were excluded. Results. We analyzed 52 cases of RM seen at our institution between 1992 and 2000; IRM was the most frequent cause (31%), most commonly respiratory tract infections (38%). When a microorganism could be identified (50%), it was more often gram-negative (63%). Patients with IRM were elderly and had fever and lower CK levels. Infectious rhabdomyolysis was associated with a higher morbidity but not with a higher risk of death. Conclusions. Infectious rhabdomyolysis is the main cause of RM and must be suspected in elderly patients with fever and low levels of CK. From the Servicio de Medicina Interna y Documentación Clínica Complejo Hospitalario San Millán-San Pedro, Lardero, Spain. Reprint requests to José Ramón Blanco, MD, PhD, Avd Juan Carlos I, 90—Bloque C-6° A, ES-26140 Lardero (La Rioja), Spain. KEY POINTS • Infectious rhabdomyolysis (IRM) is the main cause of RM and respiratory infections its main etiology. The main microorganism implicated is gram-negative. • Among the clinical findings of fever, myalgias, and weakness, fever is the only one associated with IRM. • In IRM, levels of CK are lower than in other causes of