The 10 most-cited articles in Southern Medical Journal, 2020

Arthropod-transmitted viruses (arboviruses) pose important public health challenges worldwide, and continue to do so even while the world is contending with the 2019 coronavirus disease (COVID-19) pandemic The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is spread by contact with respiratory droplets from infected individuals Arboviruses pose a different threat to humanity because of their efficient transmission by our formidable health adversary, the mosquito There is no evidence that mosquitoes are vectors for SARS-CoV-2 or the two structurally related viruses causing SARS or Middle East respiratory syndrome There are > 500 recognized arboviruses worldwide, 150 of which are known to cause human disease

The development of checkpoint inhibitors has changed the treatment paradigm for cancer. Checkpoint inhibitors nivolumab, pembrolizumab, and cemiplimab target programmed death-1 (PD-1), whereas durvalumab, avelumab, and atezolizumab target PD-ligand 1. Ipilimumab targets cytotoxic T lymphocyte-associated antigen 4. Used as monotherapy or in combination, these inhibitors have shown remarkable efficacy in melanoma, lung cancer, urothelial cancer, and many other solid tumors, and indications are continuing to evolve. Checkpoint inhibitors are well tolerated when compared with traditional chemotherapy. The major adverse effect profiles are idiosyncratic immune-mediated toxicities resulting from the abnormal activation of autoreactive T cells, which can lead to inflammation in any organ system. The most commonly affected organs are bowel, lung, skin, and endocrine. Pulmonary toxicity is important to recognize, and it can be more challenging to diagnose in lung cancer patients, given the nature of the disease course and treatment. This review article focuses on all of the pulmonary adverse…

OBJECTIVES: Although cancer is seen in every state in the United States, it does not affect every geographic area and population equally. Kentucky has the highest cancer incidence and mortality rates in the country, with an unusually high number of cases localized in its Appalachian region. Risk factors such as sun exposure, tobacco use, poor diet/exercise, poverty, and lack of access to healthcare centers contribute to this disparity. Because education levels in the area are low, cancer literacy (defined as how well a person can understand the advice of a healthcare professional and make appropriate lifestyle decisions) also is low. In this study, we examined the short-term and long-term effects of a brief cancer-related intervention on the cancer literacy of Kentucky middle and high school students. METHODS: test was used to test for significance. RESULTS: We observed an increase in the overall average test score from 50.2% (95% CI 47.8%-52.6%) on the pretest to 77.1% (95% CI 74.6%-79.7%) on the posttest immediately following the intervention. There also was an increase in the…

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has drastically changed resident training in the United States. Here, we explore the early perceived effects of COVID-19 on dermatology residents through an electronic sample survey and identify possible areas for targeted improvement in lieu of a possible second wave of COVID-19 cases. METHODS: On April 3, 2020, a survey of link with 25 questions was sent to dermatology program coordinators to be disseminated among dermatology residents in the United States. The survey was closed on April 13, 2020. All of the questions were optional and no personal identifiers were collected. RESULTS: A total of 140 dermatology residents from 50 different residency programs across 26 states responded to the survey. The majority of respondents (85%) reported negative effects of COVID-19 on their overall wellness. Despite the majority of residents (92%) speculating that COVID-19 will have negative long-term effects on the US economy, only 33% agreed or strongly agreed that it will affect their job prospects. Teledermatology was widely…

OBJECTIVE: White blood cells (WBCs) play a major role in inflammation, with effects on the vascular wall, the microvascular blood flow, and endothelial cells and endothelial function. Previous studies have shown that a high WBC count may increase the risk of cardiovascular complication rate and mortality after coronary artery bypass graft (CABG) surgery. The aim of the study was to evaluate the association between preoperative WBC count and the post-CABG clinical outcome. METHODS: A retrospective study that was based on 239 patients who underwent CABG surgery in our medical center. Statistical analysis estimated the effect of WBC count in postoperative clinical outcomes, including atrial fibrillation, length of stay, readmission rate, and death. RESULTS: = 0.02). CONCLUSIONS: Preoperative WBC count may have an effect on the postoperative clinical outcome in patients undergoing CABG. Surgeons should pay more attention to patients' WBC count and sex and plan surgery and postoperative management accordingly.

OBJECTIVE: Women of childbearing age are encouraged not to smoke because of well-documented adverse health outcomes. This study examines the association between e-cigarette use and respiratory conditions (asthma and chronic obstructive pulmonary disease [COPD]) among women of childbearing age. METHODS: The study used data from the Behavioral Risk Factor Surveillance System 2016-2017. The sample consisted of 131,965 women of childbearing age (18-44 years old). The main independent variable was smoking status and the primary outcomes were self-reported respiratory conditions such as asthma and COPD. Data were analyzed using descriptive statistics and multivariate logistic regression to assess the effects of e-cigarettes on asthma and COPD. RESULTS: In this sample of childbearing-age women, 2.79% were current e-cigarettes users with or without a history of combustible cigarette smoking and 3.02% were current dual users. Compared with nonsmokers, current e-cigarette users without a history of combustible cigarette smoking were associated with 74% higher odds of having asthma (adjusted…

OBJECTIVE: Research suggests a high prevalence of obesity in children with autism spectrum disorders (ASDs), but the prevalence of severe obesity and its association with risk factors unique to this population remain undetermined. This study sought to compare the prevalence of severe obesity in children with ASDs to that of the general population and investigated associated risk factors for obesity in this population. METHODS: A chart review was done on 592 patients with ASDs seen between 2013 and 2017 at a center in Houston, Texas. The prevalence of obesity in the study population was compared with 2013-2016 national data. Univariable, multivariable, and stratified analyses were performed to determine the association between risk factors and body mass index. RESULTS: The prevalence of obesity and severe obesity in our study population was similar to those reported in the general population. When stratified by age, children with ASDs ages 6 to 11 years had a significantly higher prevalence of severe obesity than the general population. CONCLUSIONS: The prevalence of severe obesity…

OBJECTIVES: Eosinophilic esophagitis (EoE) is characterized by upper gastrointestinal tract symptoms in association with esophageal mucosal biopsy specimens containing ≥15 intraepithelial eosinophils per high-power field. The etiology of EoE remains unclear, but an immunologic response to various foods and aeroallergens has been implicated. Seasonal variation has been reported in the diagnosis of EoE. The epidemiology and seasonal variation of EoE has never been studied in Oklahoma. The aim of this retrospective study was to determine epidemiology, clinical presentation, and seasonal variation of EoE in children seen from 2008 to 2015 at The Children's Hospital at Oklahoma University Medical Center (OUMC). METHODS: This was a single-center study involving the medical records of children aged 0 to 18 years with a diagnosis of EoE at OUMC in the Department of Pediatric Gastroenterology from January 2008 to December 2015. All charts with "eosinophilic esophagitis" in the diagnostic search history were reviewed. A diagnosis of EoE was defined as presence of ≥15 eosinophils per…

OBJECTIVES: Narrative medicine allows physicians and other health providers to share stories and reflect on the practice of medicine. Through the process of reflection and shared storytelling, narrative medicine may promote strategies for well-being and the prevention of physician burnout. Designed to foster skills to promote physician wellness, the required narrative medicine rounds activity during the family medicine clerkship at the Herbert Wertheim College of Medicine at Florida International University includes a written assignment and a small group session, during which students share their stories with their peers. METHODS: During the 2018-2019 academic year, a postsession survey asked students to identify strategies learned in the session that could be applied to future patient care and personal well-being; a thematic analysis of students' responses was conducted using inductive coding. Likert-style questions asked whether students learned something about themselves in this session, believed that they would write in the future, and understood the value of discussing…

OBJECTIVE: colitis reduces mortality. METHODS: < 0.05 was considered statistically significant. RESULTS: One hundred sixty-three patients met the inclusion criteria of the study. Approximately 85% of the patients underwent total abdominal colectomy. The average age of the patients was 65 years old, 51% of the patients were female, and 66% of the patients were white. The overall 30-day mortality was approximately 39%. The mortality rate of patients who underwent colectomy early compared to late was 13 (21%) vs 28 (45%), P = 0.009. The absolute risk difference was 0.24 with 95% CI: 0.07-0.42. CONCLUSIONS: There was a reduction of 24% in 30-day mortality when colectomies were performed before the development of septic shock.