Showing papers in "Southern Medical Journal in 2005"
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TL;DR: Providing music to caregivers may be a cost-effective and enjoyable strategy to improve empathy, compassion, and relationship-centered care while not increasing errors or interfering with technical aspects of care.
Abstract: Music is widely used to enhance well-being, reduce stress, and distract patients from unpleasant symptoms. Although there are wide variations in individual preferences, music appears to exert direct physiologic effects through the autonomic nervous system. It also has indirect effects by modifying caregiver behavior. Music effectively reduces anxiety and improves mood for medical and surgical patients, for patients in intensive care units and patients undergoing procedures, and for children as well as adults. Music is a low-cost intervention that often reduces surgical, procedural, acute, and chronic pain. Music also improves the quality of life for patients receiving palliative care, enhancing a sense of comfort and relaxation. Providing music to caregivers may be a cost-effective and enjoyable strategy to improve empathy, compassion, and relationship-centered care while not increasing errors or interfering with technical aspects of care.
283 citations
TL;DR: Measurement of 25-hydroxyvitamin D in the blood and not 1,25-dihydroxyv vitamin D is used to determine vitamin D status, and a blood level of at least 20 ng/mL is considered to be vitamin D sufficient.
Abstract: Vitamin D is very important for overall health and wellbeing. A major source of vitamin D comes from exposure to sunlight. Measurement of 25-hydroxyvitamin D in the blood and not 1,25-dihydroxyvitamin D is used to determine vitamin D status. A blood level of 25-hydroxyvitamin D of at least 20 ng/mL is considered to be vitamin D sufficient. Vitamin D deficiency increases the risk of many common cancers, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and type I diabetes.
209 citations
TL;DR: Identification of risk factors for PPH after a vaginal delivery may afford prophylactic treatment of such women with reduction of morbidity, according to a single tertiary obstetric hospital.
Abstract: Objective To determine, in a single tertiary obstetric hospital, the incidence of and risk factors for postpartum hemorrhage (PPH) after a vaginal birth. Methods PPH was defined as measured blood loss greater than 1,000 mL and/or need for a transfusion. Results Over a 4-year period, 13,868 of 19,476 women delivered vaginally, with a PPH rate of 5.15%. Identified risk factors for PPH were Asian race, maternal blood disorders, prior PPH, history of retained placenta, multiple pregnancy, antepartum hemorrhage, genital tract lacerations, macrosomia (>4 kg), and induction of labor, as well as chorioamnionitis, intrapartum hemorrhage, still birth, compound fetal presentation, epidural anesthesia, prolonged first/second stage of labor, and forceps delivery after a failed vacuum. Conclusions Identification of risk factors for PPH after a vaginal delivery may afford prophylactic treatment of such women with reduction of morbidity.
190 citations
TL;DR: Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients.
Abstract: Ischemic colitis is the most common form of intestinal ischemia. It manifests as a spectrum of injury from transient self-limited ischemia involving the mucosa and submucosa to acute fulminant ischemia with transmural infarction that may progress to necrosis and death. Although there are a variety of causes, the most common mechanism is an acute, self-limited compromise in intestinal blood flow. Patients typically have mild abdominal pain and tenderness over the involved segment of bowel. There is usually passage of blood mixed with stool, but hemodynamically significant bleeding is unusual. Although computed tomography may have suggestive findings, colonoscopy is the procedure of choice for diagnosis. Supportive care with intravenous fluids, optimization of hemodynamic status, avoidance of vasoconstrictive drugs, bowel rest, and empiric antibiotics will produce clinical improvement within 1 to 2 days in most patients. Twenty percent of patients will have development of peritonitis or may deteriorate despite conservative management and will require surgery.
159 citations
TL;DR: Cure of infection was achieved in 83% (24/29) of evaluable patients, but 50% of those achieving cure still had infection-related sequelae, and intravenous antibiotic therapy for at least 8 weeks was the only clinical factor associated with cure.
Abstract: Objective Staphylococcus aureus is the most common cause of hematogenous vertebral osteomyelitis in adults. To better define clinical features and therapeutic outcomes, the charts of 40 adult patients with S aureus hematogenous vertebral osteomyelitis were retrospectively reviewed. Methods Retrospective chart review using standardized data collection form. Results S aureus hematogenous vertebral osteomyelitis commonly occurred in the settings of recent invasive procedures (55% of patients), insulin use (28%), and hemodialysis (20%). Ten percent of patients had S aureus bacteremia or vascular catheter infection within the preceding 6 months. Median time from first symptom to diagnosis was 51.3 days. A portal of entry for S aureus was identified in 13 patients (32.5%); intravenous catheters were the likely origin in 9 of those 13 patients. Concurrent endocarditis was present in 4 patients. Forty-eight percent of patients had neurologic abnormalities and 60% of patients had an epidural, paraspinous, or psoas abscess demonstrated by neuroimaging. S aureus was isolated through fine-needle aspiration in 17 of 23 patients (74%) and from blood cultures in 23 of 34 patients (68%). Infection was due to methicillin-susceptible S aureus in 67.5% of patients. All patients received intravenous antibiotics for a mean duration of 58.6 days; 36 of 40 (90%) also received concomitant rifampin. Twenty-seven percent and 12.5% of patients underwent surgical debridement and CT-guided drainage of abscesses, respectively. After intravenous therapy, 19 of 30 eligible patients received oral continuation treatment. The mean duration of total antibiotic therapy was 142.2 days. Conclusions Cure of infection was achieved in 83% (24/29) of evaluable patients, but 50% of those achieving cure still had infection-related sequelae. Intravenous antibiotic therapy for at least 8 weeks was the only clinical factor associated with cure (P = 0.05, two-tailed Fisher exact test).
144 citations
TL;DR: Nonelective cesarean deliveries have a higher risk of PPH than women delivered electively, and risk factor identification and prevention should be a priority.
Abstract: Objective To determine the incidence and risk factors for postpartum hemorrhage (PPH) associated with cesarean delivery Methods Blood loss at cesarean delivery was measured and defined as 1,000 to 1,499 mL or greater than 1,500 mL and/or the need for a blood transfusion Variables were identified and evaluated to determine the factors associated with PPH Results There were 1,844 elective and 2,993 nonelective cesarean deliveries over 4 years The PPH rate in nonelective cesarean (675%) was greater than after elective cesarean (484%, P = 0007) Risk factors for PPH after an elective operation included leiomyomata, blood disorders, placenta previa, antepartum bleeding, preterm birth, and general anesthesia Nonelective cesarean PPH risk factors included blood disorders, retained placenta, antepartum transfusion, antepartum/intrapartum hemorrhage, placenta previa, general anesthesia, and macrosomia (odds ratio > 15, confidence interval > 15) Conclusions Nonelective cesarean deliveries have a higher risk of PPH than women delivered electively Risk factor identification and prevention should be a priority
137 citations
TL;DR: The article concludes by looking at the major detrimental side effects, such as liver damage and cardiovascular changes, which physicians may encounter when treating AAS abusers.
Abstract: The following article is a literature review of supraphysiologic doses of anabolic-androgenic steroids (AAS) This article contains a brief review of the history of AAS, the chemistry of the varying forms of AAS, and proposed mechanisms of action The article then focuses on how AAS are used in an illicit manner by the general population Terms such as "stacking" and "pyramiding" are discussed The article concludes by looking at the major detrimental side effects, such as liver damage and cardiovascular changes, which physicians may encounter when treating AAS abusers
114 citations
TL;DR: The injury rate in professional boxing matches is high, particularly among male boxers, and superficial facial lacerations is the most common injury reported.
Abstract: Objective: Although a popular endeavor, boxing has fallen under increased scrutiny because of its association with traumatic brain injury. However, few studies have investigated the overall epidemiology of boxing injuries from representative samples, and no study has ever documented the incidence of injuries in female boxers. This study is a review of professional boxing data from the state of Nevada from September 2001 through March 2003. Materials and Methods: Medical and outcome data for all professional boxing matches occurring in Nevada between September 2001 and March 2003 (n = 524 matches) were analyzed on the basis of a pair-matched, case-control design. Cases were boxers who received an injury during the boxing matches. Boxers who were not injured served as control subjects. Both conditional and unconditional logistic regression models were used to assess risk factors for injury. Results: The overall incidence rate of injury was 17.1 per 100 boxer-matches, or 3.4 per 100 boxer-rounds. Facial laceration accounted for 51% of all injuries, followed by hand injury (17%), eye injury (14%), and nose injury (5%). Male boxers were significantly more likely than female boxers to receive injuries (3.6 versus 1.2 per 100 boxer-rounds, P = 0.01). Male boxing matches also ended in knockouts and technical knockouts more often than did female matches (P < 0.001). The risk of injury for those who lost the matches was nearly twice the risk for the winners. Those who lost by knockout had double the risk of injury compared with those who lost by other means. Neither age nor weight was significantly associated with the risk of injury. Conclusions: The injury rate in professional boxing matches is high, particularly among male boxers. Superficial facial lacerations are the most common injury reported. Male boxers have a higher rate of knockout and technical knockouts than female boxers. Further research is necessary to determine the outcomes of injury, particularly the long-term neurologic outcome differences between sexes.
100 citations
TL;DR: Recently it has become clear that genetic causes, such as fully or partially expressed congenital long QT syndrome, may also play a role, and the relative importance of each of these factors is reviewed.
Abstract: Cocaine abuse kills thousands every year. Preexisting coronary artery disease appears to account for many of the deaths, but often the mechanism is much more complex. There exists a widely held but utterly mistaken notion that cocaine-related deaths are due to drug overdose. Except in the case of drug couriers ("body packers") with massive drug exposure, death is not dose related, and cocaine blood levels cannot be used to predict toxicity. Most deaths occur after prolonged drug use, which initiates a series of changes at the molecular, cellular, and tissue levels. All of these changes favor sudden death. Potentially lethal myocardial alterations include hypertrophy, fibrosis, and microangiopathy. Recently it has become clear that genetic causes, such as fully or partially expressed congenital long QT syndrome, may also play a role. The relative importance of each of these factors is reviewed.
94 citations
TL;DR: Cutaneous CAMRSA infection typically presents as an abscess, with or without surrounding cellulitis, in otherwise healthy participants of athletic activities who have or do not have MRSA-associated risk factors.
Abstract: Objectives Cutaneous community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) has been identified in otherwise healthy individuals either with or without methicillin-resistant S. aureus (MRSA)-associated risk factors who participate in athletic activities. The purpose of this study was to describe the clinical features of CAMRSA skin infection that occurred in university student athletes, evaluate the potential mechanisms for the transmission of MRSA infection of the skin in participants of athletic activities, and review the measures for preventing the spread of cutaneous CAMRSA infection in athletes. Methods A retrospective chart review of the student athletes from the University of Houston whose skin lesions were evaluated at the Health Center and grew MRSA was performed. The clinical characteristics and the postulated mechanisms of cutaneous MRSA infection in the athletes were compared with those previously published in reports of CAMRSA skin infection outbreaks in other sports participants. Results Cutaneous CAMRSA infection occurred in seven student athletes (four women and three men) who were either weight lifters (three students) or members of a varsity sports team: volleyball (two women), basketball (one woman), and football (one man). The MRSA skin infection presented as solitary or multiple, tender, erythematous, fluctuant abscesses with surrounding cellulitis. The lesions were most frequently located in the axillary region (three weight lifters), on the buttocks (two women), or on the thighs (two women). The drainage from all of the skin lesions grew MRSA, which was susceptible to clindamycin, gentamicin, rifampin, trimethoprim/sulfamethoxazole, and vancomycin; five of the isolates were also susceptible to ciprofloxacin and levofloxacin. All of the bacterial strains were resistant to erythromycin, oxacillin, and penicillin. The cutaneous MRSA infections persisted or worsened in the six athletes who were empirically treated for methicillin-sensitive S. aureus at their initial visit. Complete resolution of the skin infection occurred after the abscesses had been drained and the athlete had been treated with systemic antimicrobial therapy for which the bacterial strain was susceptible. Conclusions Cutaneous CAMRSA infection typically presents as an abscess, with or without surrounding cellulitis, in otherwise healthy participants of athletic activities who have or do not have MRSA-associated risk factors. Athletes who have MRSA skin infections include weight lifters and team members from competitive sports such as basketball, fencing, football, rugby, volleyball, and wrestling. Bacterial culture of suspected infectious skin lesions should be performed to establish the diagnosis of cutaneous MRSA infection and to determine the antibiotic susceptibility of the bacterial isolate. Treatment of cutaneous MRSA infection involves drainage of the abscess (either spontaneously or after incision) and appropriate systemic antimicrobial therapy. Direct skin-to-skin physical contact with infectious lesions or drainage, skin damage that facilitates the entry of bacteria, and sharing of infected equipment, clothing, or personal items may result in the acquisition and transmission of MRSA infection in participants of athletic activities. Earlier detection and topical treatment of the athlete's skin wounds by their coaches, avoidance of contact with other participants' cutaneous lesions and their drainage, and good personal hygiene are measures that can potentially prevent the spread of cutaneous MRSA infection in participants of athletic activities.
93 citations
TL;DR: This article summarizes the research base, probable mechanism of actions, and clinical applications of acupuncture, and outlines how to integrate acupuncture into a clinical practice, and describes referral and training issues.
Abstract: This article summarizes the research base, probable mechanism of actions, and clinical applications of acupuncture. It offers the clinician a deeper understanding of appropriate conditions for which acupuncture may be useful, outlines how to integrate acupuncture into a clinical practice, and describes referral and training issues.
TL;DR: The basic mechanism of action of imiquimod, current FDA-approved and non–FDA-approved uses, and key points of medication application frequency, possible adverse effects, and use in combination therapy are discussed.
Abstract: Imiquimod, an imidazoquinoline amine, is an immune response modifier first FDA-approved for the treatment of external genital and perianal warts in 1997. Since its appearance on the market, its antiviral and antitumor properties have been used in the treatment of a variety of dermatologic conditions. In this review article, the basic mechanism of action of imiquimod, current FDA-approved and non-FDA-approved uses of imiquimod, and key points of medication application frequency, possible adverse effects, and use in combination therapy are discussed. Common skin conditions that may be eradicated with imiquimod are emphasized.
TL;DR: An evaluation of laboratory testing for rheumatic illnesses is discussed, including the well-known acute phase proteins, the use of ANA in screening, and the newer antibodies which may potentially allow for an earlier diagnosis.
Abstract: Laboratory testing for the rheumatic diseases can allow for rapid diagnosis and appropriate management, while false-positive tests can lead to inappropriate management and unnecessary concern for the patient An evaluation of laboratory testing for rheumatic illnesses is discussed, including the well-known acute phase proteins, the use of ANA in screening, and the newer antibodies which may potentially allow for an earlier diagnosis A thorough history and examination are arguably the best screening tests Clinicians should be judicious in their use of laboratory testing, and should only do so in an attempt to further refine the diagnosis
TL;DR: This article reviews the recent literature on extrapulmonary small cell carcinomas and discusses the differential diagnosis of pleural masses and the relation to asbestos exposure.
Abstract: This article reviews the recent literature on extrapulmonary small cell carcinomas. Until now, only four cases have been published in the English literature, two of those in the Southern Medical Journal. Sharing the information on diagnosis and treatment of these cases is important for better understanding and treatment of these patients. The differential diagnosis of pleural masses and the relation to asbestos exposure is briefly discussed. In addition, the available literature on other extrapulmonary localizations of small cell carcinoma is reviewed. The focus is on the available larger series of patients. Small cell carcinoma of the skin is included. This form of small cell carcinoma is often excluded from the larger review series, but can be an important alternative in the diagnostic process of patient evaluation.
TL;DR: Limited data suggest that the majority of morbidity and mortality from APAP overdose can be averted by initiation of NAC within the first 16 hours of ingestion and possibly even later.
Abstract: Acetaminophen (APAP) is the most common drug overdose in pregnancy. Available data regarding APAP overdose in pregnancy is limited to case reports and a small prospective case series. APAP has been demonstrated to cross the placenta and in toxic doses may harm the fetal and maternal hepatocytes. Fetal hepatocytes metabolize APAP into both active and toxic metabolites. These toxic metabolites may cause fetal hepatic necrosis. N-acetylcysteine (NAC) has also been demonstrated to cross the placenta and may bind toxic metabolites in both the mother and the fetus. Limited data suggest that the majority of morbidity and mortality from APAP overdose can be averted by initiation of NAC within the first 16 hours of ingestion and possibly even later. NAC may be safely administered during pregnancy and should be initiated early after APAP overdosage. The literature was reviewed through the use of OvidMEDLINE® database, encompassing 1966 to the present. Searches were conducted using the key words acetaminophen, paracetamol, N-acetylcysteine, overdose, and hepatotoxicity. The search was further refined by selecting articles that contained these search words together with the key word pregnancy. Only English language papers were reviewed. Articles were selected on the basis of relevance to the topic. Pertinent citations found in the selected articles were also reviewed.
TL;DR: The issue of switching antipsychotic medication in the context of a developing metabolic disorder is discussed with regard to appropriately balancing risk and benefits and collaborative treatment between a psychiatrist and an endocrinologist is encouraged.
Abstract: This article reviews the epidemiology of weight gain and diabetes mellitus in general and in patients with severe mental illness in particular. Body mass index is defined, and possible predictors for weight gain in patients receiving antipsychotic medications are also enumerated. Information on risk of association with type 2 diabetes mellitus is described, as well as information on dyslipidemias within the rubric of the metabolic syndrome. Recent consensus panel reports and their recommendations for ongoing patient monitoring are reviewed. The issue of switching antipsychotic medication in the context of a developing metabolic disorder is discussed with regard to appropriately balancing risk and benefits. Collaborative treatment between a psychiatrist and an endocrinologist is encouraged. The primary care physician may be required to fulfill both roles.
TL;DR: In unstable elderly patients with hyperthyroidism, antithyroid medication can quickly produce a euthyroid state and surgical thyroid ablation may be necessary in patients who fail to respond to radioactive iodine therapy and in patients with multinodular goiter.
Abstract: Thyroid disorders are common in the elderly and are associated with significant morbidity if left untreated. Typical symptoms may be absent and may be erroneously attributed to normal aging or coexisting disease. Physical examination of the thyroid gland may not be helpful, as the gland is often shrunken and difficult to palpate. Usually only myxedema coma requires levothyroxine parenterally; all other forms of hypothyroidism can be treated with oral levothyroxine. Low-dose levothyroxine should be initiated and increased gradually over several months. In unstable elderly patients with hyperthyroidism, antithyroid medication can quickly produce a euthyroid state. Radioactive iodine therapy is more definitive and is well tolerated, effective, and preferred. Surgical thyroid ablation may be necessary in patients who fail to respond to radioactive iodine therapy and in patients with multinodular goiter. If there is a suspicion of malignant disease, early biopsy or fine needle aspiration for cytology should be considered.
TL;DR: A patient-centered approach to the use of nutritional supplements in cancer care is described, which covers prevention, acute active care, and post-acute care (follow-up visits and prevention of recurrence).
Abstract: In recent years, complementary and alternative medicine has become popular among the general population in the Western world. Cancer patients have joined this global trend, often seeking supplements to conventional oncologic care, usually without their physicians' knowledge. Among the most common forms of complementary and alternative medicine used by cancer patients are natural products such as herbs and megavitamins. The extensive use of nutritional supplements by cancer patients raises multiple questions and challenges for the physician. Since there are limited scientific data on the efficacy and safety of many nutritional supplements, advising patients about when to use them during the course of illness is difficult. This is true for each stage of cancer care: prevention, acute active care (radiation, chemotherapy, surgery), and post-acute care (follow-up visits and prevention of recurrence). The authors describe a patient-centered approach to the use of nutritional supplements in cancer care.
TL;DR: Few preresidency variables correlate to success during an orthopaedic residency, with the only statistically significant correlations to OITE scores were USMLE step I performance and marital status.
Abstract: Objectives: Orthopaedic surgery remains one of the most competitive specialties, with more than a 99% match fill rate in the past several years. An oversupply of qualified applicants leads to intense competition for these residency spots, allowing program directors to be more selective in choosing their future residents. Although many previous studies have documented factors important to program directors in the admission process, less is known about how preselection factors correlate with subsequent performance in a residency program. Methods: The relation of both demographic and academic factors with subsequent performance on the Orthopaedic In-Training Examination (OITE) were studied. These factors include United States Medical Licensing Examination (USMLE) step I scores, Alpha Omega Alpha (AOA) status, research publications, age entering residency, marital status, and medical school affiliation. Results: In this study, the only statistically significant correlations to OITE scores were USMLE step I performance and marital status. Those residents who had previously scored above 220 on the USMLE step I had higher average OITE scores than those scoring below 220. Residents who were married also had higher average OITE scores. A trend with regard to AOA status also was found, with residents scoring slightly higher on the OITE if they were members of AOA. Conclusions: Few preresidency variables correlate to success during an orthopaedic residency.
TL;DR: A retrospective analysis of patients with methicillin-sensitive Staphylococcus aureus infections who were treated with outpatient parenteral antimicrobial monotherapy found vancomycin was associated with a significantly greater number of side effects than was ceftriaxone, cefazolin, or oxacillin.
Abstract: Objectives: As increasing numbers of patients are being treated with outpatient parenteral antimicrobial therapy (OPAT), it becomes ever more important to ascertain the risks and benefits of such treatment for patients.
TL;DR: Apart from specific antibiotic selection, medical treatment and outcomes for anaerobic spondylodiscitis are similar to those for aerobic vertebral disk infection.
Abstract: Background Bacterial spondylodiscitis is rarely caused by anaerobic organisms. We describe two patients with lumbar vertebral osteomyelitis and discitis caused by anaerobic bacteria, including an unusual occurrence after an endodontic procedure, and review the salient clinical features and outcomes of 31 previously reported cases. Methods Case reports and review of the literature. Results Median age at presentation was 65 years, with a male-to-female ratio of 2:1. The most common presenting symptoms were back pain, fever, and neurologic deficits. The lumbar spine was most frequently involved (43%); an equal number of cases involved contiguous extension or hematogenous spread. Causative anaerobes were recovered from disk space or vertebrae (13), blood (4), and/or soft tissue abscess and included Bacteroides species (12), Propionibacterium acnes (7), Peptococcus species (4), Peptostreptococcus species and Clostridium species (3 each), Corynebacterium diphtheroides and Fusobacterium species (2 each), and unspecified anaerobes (3). Conclusions Apart from specific antibiotic selection, medical treatment and outcomes for anaerobic spondylodiscitis are similar to those for aerobic vertebral disk infection.
TL;DR: Empirical evidence for a “faith-health connection” may have little influence on physicians’ conceptions of and approaches to religion in the patient encounter.
Abstract: Background Despite expansive medical literature regarding spirituality and medicine, little is known about physician beliefs regarding the influence of religion on health. Methods Semistructured interviews with 21 physicians regarding the intersection of religion, spirituality, and medicine. Interviews were transcribed, coded, and analyzed for emergent themes through an iterative process of qualitative textual analysis. Results All participants believed religion influences health, but they did not emphasize the influence of religion on outcomes. Instead, they focused on ways that religion provides a paradigm for understanding and making decisions related to illness and a community in which illness is experienced. Religion was described as beneficial when it enables patients to cope with illness but harmful when it leads to psychological conflict or conflict with medical recommendations. Conclusions Empirical evidence for a "faith-health connection" may have little influence on physicians' conceptions of and approaches to religion in the patient encounter.
TL;DR: The authors reviewed MEDLINE and references of major articles in the published literature over the last 30 years regarding the complications of alcohol Abuse to discuss the critical care aspects of alcohol abuse.
Abstract: The authors reviewed MEDLINE and references of major articles in the published literature over the last 30 years regarding the complications of alcohol abuse and discuss the critical care aspects of alcohol abuse This article discusses the severe medical conditions associated with alcohol abuse that lead to admission to the medical intensive care unit The clinical manifestations, pathophysiology, diagnostic studies, and management of these conditions are discussed in detail
TL;DR: Appropriate maternal BMI at conception followed by adequate weight gain during pregnancy may have a substantial influence on reducing the number of low birth weight deliveries.
Abstract: Objectives: The primary purpose of this study was to describe the proportion of low birth weight that could be potentially prevented by programs focusing on maternal prepregnant body mass index (BMI) and/or weight gain during pregnancy. Methods: In this historic cohort design, study data consisted of birth certificates linked to the Pregnancy Risk Assessment Monitoring System for South Carolina resident women delivering in South Carolina during 1998 and 1999. Statistical analysis was conducted with the use of X 2 , population-attributable risk, and logistic regression. The analysis was performed using SUDAAN to accommodate the analysis weight and extrapolate the sample data to the South Carolina state population. Results: Eight percent of the very low birth weight (VLBW) rate in South Carolina can be attributed to inadequate weight gain in pregnancy. Approximately 19% of the state's VLBW rate can be attributed to either underweight or overweight BMI at conception. Women with less than adequate weight gain were 1.4 times more likely to deliver a VLBW baby and 1.9 times more likely to deliver a moderately low birth weight baby as compared with women with adequate weight gain. Conclusions: Appropriate maternal BMI at conception followed by adequate weight gain during pregnancy may have a substantial influence on reducing the number of low birth weight deliveries.
TL;DR: Intraventricular administration of rt-PA appears to be beneficial in cases of IVH even though it is occasionally associated with serious complications.
Abstract: Hydatid cysts of the head and neck are rare, even in countries where echinococcal infestation is endemic. This report presents two patients with hydatid cyst, diagnosed using ultrasonography and computed tomography, in whom the cysts were located between the right cervical paravertebral muscles and below the superficial muscles of the right temporal region.
TL;DR: In the Southeast, mental health and substance Abuse services are sparse and stigma is high; thus, innovative treatment strategies are needed to address the high levels of co-occurring mental illness and substance abuse.
Abstract: Objectives: Mental illness and substance abuse have been consistently associated with poor HIV-medication adherence and other negative health outcomes. Methods: A brief mental health and substance use screening instrument was administered to 1,362 HIV-infected individuals receiving care at two academic medical center Infectious Diseases Clinics in North Carolina. Results: Study results indicated high frequencies of symptoms of mental illness (60%), substance abuse (32%), and co-occurring symptoms of mental illness and substance abuse (23%). Younger age (P = 0.03), male sex (P < 0.001), and higher viral load (P < 0.001) were associated with substance use problems. White race (P = 0.001), younger age (P = 0.023), and higher viral load (P = 0.042) were associated with symptoms of mental illness. Conclusions: In the Southeast, mental health and substance abuse services are sparse and stigma is high; thus, innovative treatment strategies are needed to address the high levels of co-occurring mental illness and substance abuse. Antiretroviral therapies will not reach their potential for slowing the HIV/AIDS epidemic and prolonging survival if comorbidities that influence patient behavior are not addressed.
TL;DR: Past CMV infection may be a common factor that links atherosclerosis and diabetes, and up to 12 times greater odds of having type 2 diabetes for persons previously exposed to CMV.
Abstract: BACKGROUND Infection is known to play a role in type 1 diabetes, but there is a paucity of information on its role in diabetes mellitus type 2. We examined the seroprevalence of selected viruses in a group of predominantly Hispanic patients with type 2 diabetes and control subjects without diabetes. METHODS One hundred thirteen patients, 83 with type 2 diabetes and 30 control subjects, all undergoing hemodialysis at the same facility in San Antonio, Texas, were tested for antibodies against coxsackie B viruses, cytomegalovirus (CMV), and parvovirus. Sixty-six of these patients and 25 control subjects were tested bimonthly for 6 months. RESULTS We observed a greater seroprevalence of anti-CMV IgG antibodies among patients with diabetes (97.6%), compared with control subjects (86.7%), and the difference was statistically significant [OR = 6.2, 95% CI: 1.1 to 36.0, P < 0.05]. Three draws on a subset of 91 patients produced still greater odds [OR = 12.4, 95% CI: 1.3 to 117, P < 0.05]. There were significantly more (P < or = 0.001) vascular complications among patients with diabetes. There was a colinearity of trends between diabetes, seropositivity to CMV, and age. CONCLUSIONS Our findings indicated an up to 12 times greater odds of having type 2 diabetes for persons previously exposed to CMV. Since accelerated atherosclerosis is also associated with diabetes and CMV, past CMV infection may be a common factor that links atherosclerosis and diabetes. No other viruses tested in this study, either coxsackie B viruses or parvovirus, showed a significant association with type 2 diabetes.
TL;DR: Patients with low literacy were significantly less likely to understand the adverse health consequences of obesity and the need to lose weight and to report being ready to lost weight.
Abstract: OBJECTIVES: The purpose of this study was to determine the association between the literacy level of overweight/obese patients and their weight-loss knowledge, attitudes, and readiness METHODS: Structured patient interviews and a literacy screening instrument were administered in two primary care clinics at a university-based public hospital RESULTS: A convenience sample of 210 overweight or obese adult outpatients (body mass index > or =25 kg/m2 or > or =30 kg/m2, respectively) were enrolled Mean respondent age was 52 years; 74% were female, and 76% were black Two thirds of patients read below a 9th grade level Half of patients across all literacy levels reported currently attempting weight loss There was a significant relation between literacy level and weight-loss knowledge, attitudes, and readiness (P < 005) CONCLUSIONS: Patients with low literacy were significantly less likely to understand the adverse health consequences of obesity and the need to lose weight and to report being ready to lose weight Patient education and counseling for weight loss should be tailored for patients with low literacy skills
TL;DR: Health knowledge of rural adolescents can be increased through partnerships with schools and multidisciplinary teams of health care professionals, and information obtained may be used in planning school-based interventions in other diverse, rural communities.
Abstract: Background Few school-based interventions have been evaluated to assess health awareness among children in rural southern areas The purpose of this controlled investigation was to increase health awareness among middle school-aged children residing in a racially diverse rural community in Mississippi Methods This investigation assessed health knowledge before and after a 16-week school-based intervention in 205 fifth-grade students Height, weight, BMI, body composition, waist circumference, dietary intake, blood lipids and lipoprotein concentrations, blood glucose concentrations, and resting blood pressure were measured to enhance student awareness of cardiovascular disease risk factors Values in the intervention school were compared with those obtained simultaneously in a control school within the same community Results The school-based intervention was effective in increasing health knowledge in the intervention as compared with the control school Secondarily, it was effective in improving certain dietary behaviors Utilizing health care professionals in the classroom to teach students appropriate lifestyles and actually measuring cardiovascular risk factors to increase awareness among students was effective in increasing overall health knowledge Conclusions Health knowledge of rural adolescents can be increased through partnerships with schools and multidisciplinary teams of health care professionals Ongoing efforts to reduce childhood obesity and cardiovascular disease risk factors are urgently needed, and information obtained during this investigation may be used in planning school-based interventions in other diverse, rural communities
TL;DR: A new era in the treatment of immune-mediated inflammatory disorders has begun with the clinical availability of anticytokine therapy, and biological agents that are currently available include 3 agents that decrease the activity of tumor necrosis factor-α (infliximab, adalimumab, etanercept) and an interleukin-1 receptor antagonist (anakinra).
Abstract: A new era in the treatment of immune-mediated inflammatory disorders has begun with the clinical availability of anticytokine therapy. Biological agents that are currently available include 3 agents that decrease the activity of tumor necrosis factor-alpha (infliximab, adalimumab, etanercept) and an interleukin-1 receptor antagonist (anakinra), with many more in development. Those extraordinarily effective medications are an important addition to our therapeutic armamentarium, and, although originally developed for rheumatoid arthritis and Crohn disease, have been found to be efficacious in the treatment of seronegative spondyloarthropathies (psoriatic arthritis, ankylosing spondylitis) and juvenile rheumatoid arthritis. Their role is currently being defined in other autoimmune disorders such as uveitis, sarcoidosis, interstitial lung disease, vasculitis, inflammatory myopathies, graft-versus-host disease, and Sjogren syndrome.