Southern Medical Journal最新文献

{"title":"Hyperphosphatemic Familial Tumoral Calcinosis.","authors":"Margaret Kaszycki, Beija Villalpando, LaTonya Hickson, Sarika Rao, Klaas Wierenga, Hillary Garner, Olayemi Sokumbi, Leila Tolaymat","doi":"10.14423/SMJ.0000000000001759","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001759","url":null,"abstract":"<p><p>Hyperphosphatemic familial tumoral calcinosis (HFTC) is a rare, autosomal recessive condition characterized by fibroblast growth factor 23 signaling pathway dysregulation, hyperphosphatemia and ectopic calcifications (which manifest as joint motion limitations), inflammatory bony pain, and disability. Given the rarity and multiorgan involvement of HFTC, a multidisciplinary approach including Dermatology, Ophthalmology, Dentistry, Nephrology, Endocrinology, Rheumatology, and Genetics is necessary for diagnosis and treatment. We present a multidisciplinary diagnostic and treatment approach for a patient with HFTC due to a <i>GALNT3</i> gene mutation with unique imaging highlighting the extent of calcinosis seen in HFTC. In this case study, a 34-year-old female patient found to have HFTC was first evaluated at an outpatient academic dermatology center in October 2020 and studied for 1 year. Genetic testing revealing a homozygous c.1319C > A variant in <i>GALNT3</i> predicted to result in a missense mutation p.Ala440Glu. HFTC should be considered for patients presenting with diffuse calcinosis cutis-like features, and a multidisciplinary evaluation should be pursued.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 12","pages":"705-708"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772477","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding Trends in Pediatric Drowning Injuries in North Carolina.","authors":"Maura Olcese, Anna E Waller","doi":"10.14423/SMJ.0000000000001763","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001763","url":null,"abstract":"<p><strong>Objective: </strong>Drowning is a leading cause of injury-related death in the pediatric and adolescent population. This epidemiologic study describes the trends in emergency department (ED) visits for pediatric drowning injury in North Carolina and the impact of the coronavirus disease 2019 (COVID-19) pandemic on incidence rate.</p><p><strong>Methods: </strong>Data were obtained using the North Carolina Disease Event Tracking and Epidemiologic Collection Tool, a public health surveillance system, to identify ED visits for drowning injury from 2016 to 2022. We performed a chart review on a subset of patients to further characterize injury.</p><p><strong>Results: </strong>A total of 1285 ED encounters were identified. In North Carolina, the incidence rate of pediatric drowning has been decreasing, abruptly in 2019 and again in 2020. The postpandemic rate continued in the same downward trend, suggesting that the COVID-19 pandemic did not affect the overall statewide incidence rate of pediatric drowning (<i>P</i> = 0.14). The age distribution of children treated in the ED for drowning injury in North Carolina changed following the pandemic.</p><p><strong>Conclusions: </strong>This study is limited by the fortunate rarity of pediatric drowning events. Injuries may be underreported because these are only ED presentations. This study relied on provider documentation in electronic health records. The definition of postpandemic is not well defined, and sequelae of the COVID-19 pandemic may not yet be fully appreciated. The incidence of North Carolina ED encounters for drowning injury in the pediatric population has decreased, and the COVID-19 pandemic had a noticeable, although not statistically significant, effect.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 12","pages":"690-695"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Standard and Extended Dexamethasone Duration on Mortality in Patients with Severe COVID-19.","authors":"Andrew Sephien, Marc Lozano, Sean-Patrick Prince, Denisse Camille Dayto, Caroline Minton, Ambuj Kumar, Nishant Nerella, Guarav Shah","doi":"10.14423/SMJ.0000000000001760","DOIUrl":"10.14423/SMJ.0000000000001760","url":null,"abstract":"<p><strong>Objectives: </strong>Current guidelines recommend dexamethasone 6 mg/day for up to 10 days in patients with severe coronavirus disease 2019 (COVID-19) requiring supplemental oxygenation or mechanical ventilation. The practice has significant variation, however, and dexamethasone has been used for >10 days for many patients with severe COVID-19. The aim of this study was to assess the benefits and risks associated with standard versus extended use of dexamethasone in patients with severe COVID-19.</p><p><strong>Methods: </strong>A multicenter retrospective cohort study was conducted from January 2021 to December 2021. All of the consecutive patients with severe COVID-19 receiving 6 mg/day dexamethasone were eligible for inclusion. The primary outcome was the incidence of in-hospital mortality for patients treated with dexamethasone 6 mg/day for the standard duration of 10 days versus an extended duration of >10 days.</p><p><strong>Results: </strong>A total of 1294 patients met the inclusion criteria: 803 received the standard duration of dexamethasone and 491 received the extended duration. The incidence of in-hospital mortality was significantly higher (<i>P =</i> 0.003) in the extended duration group (36.5%) compared with the standard duration group (28.5%), with no significant difference in in-hospital major adverse cardiac events (16.1% for extended vs 13.2% for the standard duration; <i>P</i> = 0.15).</p><p><strong>Conclusions: </strong>The results show that extended duration of dexamethasone compared with standard duration is associated with a significant increase in in-hospital mortality in patients with severe COVID-19. These findings need to be confirmed in well-designed and performed randomized controlled trials.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 12","pages":"701-704"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142772463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative Exploration of Contraceptive Knowledge in Men and Women.","authors":"Olivia Moumne, Lori M Gawron, Kathryn E Storck, Jessica N Sanders, David K Turok, Misha Pangasa","doi":"10.14423/SMJ.0000000000001762","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001762","url":null,"abstract":"<p><strong>Objectives: </strong>The level of knowledge about contraceptives overall is low in the United States. This qualitative study adds to the literature that explores gendered differences in contraceptive knowledge. Specifically, we examined knowledge regarding different contraceptive methods, directions on use, mechanism of action, efficacy, and adverse effects. We also looked at men's perspectives on their partner's knowledge.</p><p><strong>Methods: </strong>Participants were interviewed at a Planned Parenthood Association of Utah clinic. They were asked about contraception knowledge, attitudes, and male involvement in contraceptive decision making. In this secondary analysis, we reanalyzed codes that were previously identified under primary analysis for specific content about contraceptive knowledge and differences by sex.</p><p><strong>Results: </strong>We found an overall low level of knowledge about contraceptives, particularly in men as compared with women. Men often overestimate their female partners' knowledge. Men were more likely to understand how to use methods that require their direct participation. Although women's contraceptive knowledge was better than that of the male participants, it was still poor overall.</p><p><strong>Conclusions: </strong>A low level of knowledge about contraceptives is associated with increased rates of unintended pregnancy. This study demonstrates a need for improved education about contraception. Given the impact of male opinion in contraceptive use, efforts to increase their knowledge could be important interventions to increase contraceptive uptake.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 12","pages":"681-685"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Shift Distribution in Academic Hospital Medicine Fellowship across 10 Years.","authors":"Anup Das, Ethan Molitch-Hou, Shannon K Martin","doi":"10.14423/SMJ.0000000000001755","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001755","url":null,"abstract":"<p><strong>Objectives: </strong>As hospital medicine (HM) has grown as a specialty, it has been paralleled by an increase in HM fellowship training programs. Limited data are available surrounding clinical exposure for HM fellows. Using data from a large academic medical center with a long-standing HM fellowship program, we reviewed the types of clinical shifts and distribution of shift data completed by HM fellows from 2013 to 2023.</p><p><strong>Methods: </strong>We performed a retrospective analysis of clinical shifts available from an internal Web-based scheduling program. Shifts performed by HM fellows were downloaded from May 2013 through February 2023. We characterized clinical service shifts as day coverage, off-hour coverage, teaching services, or jeopardy. We calculated summary statistics of the number of shifts worked by HM fellows per year.</p><p><strong>Results: </strong>During a period of 10 years, 22 HM fellows completed 4430 shifts, with a mean total of 197.3 shifts during fellowship (standard deviation 56.7 shifts). Most of the shifts completed by HM fellows were off-hours shifts (51.0%, n = 2214), with less exposure to daytime shifts (n = 1285, 29.6%) and the least exposure to teaching shifts (n = 390, 9.0%).</p><p><strong>Conclusions: </strong>HM fellows spend the majority of their clinical time on off-hours shifts, which does not reflect the clinical practice of an academic hospitalist. The least amount of time was spent attending on traditional teaching services. Because HM fellowships are designed to prepare HM fellows for careers as academic hospitalists, more work is necessary to determine how best to optimize and standardize clinical exposure while maintaining adequate time for opportunities to engage in academic development.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 11","pages":"674-677"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565114","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Frailty on COVID-19 Hospitalizations: Results from the California State Inpatient Database.","authors":"Muni Rubens, Anshul Saxena, Venkataraghavan Ramamoorthy, Sandeep Appunni, Md Ashfaq Ahmed, Zhenwei Zhang, Yanjia Zhang, Rehan Sha, Samer Fahmy","doi":"10.14423/SMJ.0000000000001754","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001754","url":null,"abstract":"<p><strong>Objectives: </strong>Frail patients are at greater risk of experiencing adverse clinical outcomes in any critical illness due to decreased physiologic reserves, greater susceptibility to the adverse effects of treatment, and greater needs for intensive care. In this study, we sought to assess the prevalence of frailty and associated adverse in-hospital outcomes among coronavirus disease 2019 (COVID-19) hospitalizations using the 2020 California State Inpatient Database (SID).</p><p><strong>Methods: </strong>For this study, we conducted a retrospective analysis of data from all COVID-19 hospital patients aged 18 years and older. We identified hospitalizations that were at high risk of frailty using the Hospital Frailty Risk Score. The primary outcome of our study was in-hospital mortality, and the secondary outcomes were prolonged length of stay, vasopressor use, mechanical ventilation, and intensive care unit admission.</p><p><strong>Results: </strong>The prevalence of frailty was 44.3% among COVID-19 hospitalizations. Using propensity score matching analysis, we found that the odds of mortality (odds ratio [OR] 4.54, 95% confidence interval [CI] 4.28-4.82), prolonged length of stay (OR 2.81, 95% CI 2.70-2.90), vasopressor use (OR 8.65, 95% CI 7.45-10.03), mechanical ventilation (OR 6.90, 95% CI 6.47-7.35), and intensive care unit admission (OR 7.17, 95% CI 6.71-7.66) were significantly higher among the group of frail patients.</p><p><strong>Conclusion: </strong>Our findings show that frailty could be used for assessing and risk stratifying patients for improved hospital outcomes.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 11","pages":"646-650"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of HIV Status and Charlson Comorbidity Index on COVID-19 Clinical Outcomes in a Case-Control Study.","authors":"Rebecca C Gerrity, Melissa Parkinson, Rachel Strength, Chinelo N Animalu, Nathan Davidson, Christian J Fuchs, Christopher D Jackson, Nathan A Summers","doi":"10.14423/SMJ.0000000000001753","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001753","url":null,"abstract":"<p><strong>Objectives: </strong>During the course of the coronavirus disease 2019 (COVID-19) pandemic, numerous comorbidities were identified as risk factors for increased morbidity and mortality. Few studies have examined human immunodeficiency virus (HIV) and COVID-19 co-infection and the impact of HIV on COVID-19 outcomes. In this study, we compared outcomes of people living with HIV with COVID-19 with a control group to examine outcomes.</p><p><strong>Methods: </strong>We identified 45 people living with HIV admitted with COVID-19 to one of three large healthcare systems in Memphis, Tennessee, between March 1 and October 31, 2020. We matched the people living with HIV in a 1:1 fashion to a control group of COVID-19-positive patients without a recorded history of HIV and compared clinical outcomes. Nine pairs were not able to be optimally matched, so a sensitivity analysis was completed by repeating the same analyses in the primary analysis while excluding the nine mismatched pairs.</p><p><strong>Results: </strong>Patients did not differ significantly in demographic variables due to the matching algorithm, and there was no significant difference in measured outcomes between people living with HIV and controls. A CD4 count of <200 cells per microliter was not significantly associated with increased morbidity or mortality. Controlling for HIV status, an elevated Charlson Comorbidity Index score of >3 was associated with increased intubation (<i>P</i> = 0.02), vasopressor use (odds ratio [OR] 4.81, <i>P</i> = 0.04), intensive care unit level of care (OR 4.37, <i>P</i> = 0.007), mortality (OR 7.14, <i>P</i> = 0.02), and length of overall hospital stay in days (<i>P</i> = 0.004).</p><p><strong>Conclusions: </strong>We found no difference in outcomes of people living with HIV in comparison to matched controls based on HIV status but found that an increased Charlson Comorbidity Index score led to increased morbidity and mortality regardless of HIV status.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 11","pages":"651-656"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"User-Friendly Medication Packaging: The Birth Control Pill Story.","authors":"Sujeeth Shanmugam, Steven R Feldman","doi":"10.14423/SMJ.0000000000001747","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001747","url":null,"abstract":"","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 11","pages":"669"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancement of a Vertically Integrated Training Program (VITP): Introspective Assessment and Expansion.","authors":"Greyson Fox Tran, Matthew Magee, Rafik Sadik Gendi, Buckley McCall, Jaron Pettis, Donald J DiPette","doi":"10.14423/SMJ.0000000000001749","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001749","url":null,"abstract":"<p><p>With the number of medical school applicants more than doubling during the past 30 years, there has been an increased need to mentor premedical undergraduate students. The Vertically Integrated Training Program at the University of South Carolina School of Medicine, Columbia, was created to provide direct mentoring for college students interested in a career as a physician. Online surveys were distributed at the beginning and end of the Fall 2023 semester to gain insight into the success of the program's events from the undergraduate perspective. Data suggest a trend toward positive change in terms of increased confidence of undergraduate students regarding the process of applying to and finding success in medical school. This article reviews the development of the Vertically Integrated Training Program, evaluates the success of the program, and suggests next steps for the organization.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 11","pages":"670-673"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"LGBTQ+ Health Inequities in a Rural, Conservative Context: Alabama Compared with Other Southern States.","authors":"Sarah MacCarthy, Austin H Johnson, J Mac DeLay, Mallie Froehlich, Chase Harless, Marc N Elliott","doi":"10.14423/SMJ.0000000000001751","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000001751","url":null,"abstract":"<p><strong>Objectives: </strong>There are no statewide statistics regarding the health of lesbian, gay, bisexual, transgender, and queer (LGBTQ+) Alabamians. To fill this gap, we used data collected by the Southern Equality Research and Policy Center to compare Alabama with other southern US states regarding the health and well-being of LGBTQ+ people.</p><p><strong>Methods: </strong>We tested for unadjusted differences between Alabama and other southern states using χ² tests for dichotomous outcomes and the Wilcoxon rank-sum test for ordinal outcomes. Multivariate logistic models predicted dichotomous outcomes from an Alabama indicator, a continuous rurality variable, and a racial and ethnic minority indicator to control for differences in rurality and racial and ethnic composition; multivariate linear regression was used to approximate the point estimate of adjusted differences.</p><p><strong>Results: </strong>Alabama and other southern states had statistically similar and high levels of abuse, harassment, and poor mental and physical health. Alabamians lived in ZIP codes with somewhat higher rural-urban commuting area code rurality scores (AL 1.76; South 1.70; <i>P</i> = 0.036, where 1 is the most urban category). More than one-fourth of Alabama respondents reported experiencing self-harming behaviors; one-third reported suicidal ideation (33.1%); more than half reported anxiety disorders (57.6%); more than two-thirds reported being depressed (69.2%); and 25% to 75% experienced or feared emotional and physical abuse because of their identity. Multivariate adjusted results were generally similar to unadjusted results.</p><p><strong>Conclusions: </strong>Alabama LGBTQ+ populations, who live in more rural settings than in most prior studies, experience markedly poor outcomes.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"117 11","pages":"634-639"},"PeriodicalIF":1.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142565141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}