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We contend that the presence of concomitant allergic fungal sinusitis (AFS) and allergic bronchopulmonary mycosis in the same patient represents an expression of the same process of fungal hypersensitivity in the upper and lower airways. We have termed this process the SAM syndrome, an acronym for sinobronchial allergic mycosis. Diagnostic criteria have been established for the SAM syndrome, and the clinical characteristics of one previously unreported and four previously reported patients have been tabulated. Patients with the SAM syndrome have chronic sinusitis involving multiple sinuses, asthma, immediate cutaneous reactivity to fungal allergens, peripheral eosinophilia, and radiographic evidence of bronchiectasis. Total serum IgE levels are usually elevated as well. A variety of chest radiographic abnormalities may occur, ranging from mass lesions to diffuse pulmonary infiltrates and even normal findings on chest radiographs. Patients present for an evaluation of either sinus or lung disease and, at that time, demonstrate no clinical features that distinguish them from patients with isolated sinus or lung disease. All patients reported to date have had clinical responses to therapy with corticosteroids. We postulate that SAM is underdiagnosed in patients with AFS, a disease recently reported from medical centers in the southeastern and western United States. Moreover, since our patient had a mutation in the cystic fibrosis transmembrane conductor regulator (CFTR) gene, we further hypothesize that CFTR gene mutations may play an important role in the pathogenesis of the SAM syndrome. [ABSTRACT FROM AUTHOR]

Bias based on skin color, religion, immigrant status, gender, and ethnicity are deeply rooted in American culture and have existed within the infrastructure of American medicine from the beginning. Now, medical educators are struggling to find curriculum and experiences that effectively address explicit and implicit bias among our increasingly diverse group of students, house staff, and practitioners. The leadership, experience, and lessons learned needed to scrub present medical school curricula of racial bias, to develop an antiracist curriculum, and to test its effectiveness already lies with the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), and the National Medical Association (NMA). We call on these organizations to jointly convene a consortium of medical educators, social scientists, curricular specialists, and others to chart a way forward to assist medical schools and professional organizations in developing evaluable curricular materials and experiences to eliminate bias in health care., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The recent US Food and Drug Administration approval of the marijuana constituent cannabidiol as safe and effective for treatment of 2 rare forms of epilepsy has raised hopes that others of the 500 chemicals in marijuana will be found to be therapeutic. However, the long-term consequences of street marijuana use are unclear, and recent studies raise red flags about its effects. Changes in brain maturation and intellectual function, including decreases in intelligence quotient, have been noted in chronic users and appear permanent in early users in most but not all studies. These studies suggest that at a minimum, regular marijuana use should be discouraged in individuals under the age of 21., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Epidemics of opioid use are old news in the United States, but an epidemic that kills over 200,000 Americans is not. A multiplicity of intertwined factors have brought us to this place. From 30,000 feet, it is the story of good intentions gone bad, a drug industry gone rogue, and government watch dog agencies gone to sleep. At ground level, it is the story of physicians unfamiliar with addictive drugs and drug addiction, new long-acting opioids deceptively marketed, cheap black tar heroin, encouragement to use opioids for chronic noncancer pain by professional organizations with conflicts of interest and without science, a culture intolerant to pain and tolerant to drug use, and the greedy response of the pharmaceutical industry and drug cartels to an expanding market opportunity. These factors are among those that have joined to form a tsunami of addiction and deaths that keeps on coming. A better understanding of them could speed the end of the present cycle of opioid abuse, perhaps prevent others, and inform future decisions about pain management., (Copyright © 2018 Elsevier Inc. All rights reserved.)

We report the successful treatment of an HIV-infected patient with progressive strongyloidiasis as a component of immune reconstitution disease and a review of the literature on this topic. In our experience, pre- and post-antiretroviral therapy intestinal biopsies support a novel mechanism of immune reconstitution disease to Strongyloides stercoralis. We conclude that extended, dual antihelminthic therapy and temporary discontinuation of antiretroviral therapy may be effective in similar patients., (Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Food allergy is an adverse immune reaction that occurs reproducibly on exposure to a given food. Prevalence rates of food allergy continue to increase worldwide, sparking continual research efforts in finding a suitable and safe cure. Food avoidance, the current standard of care, can be difficult to achieve. This review aims to provide a broad overview of immunoglobulin E-mediated food allergy, highlighting its epidemiology, masqueraders, immunopathophysiology, clinical presentation, diagnostic work-up and available preventative and treatment strategies. This review also discusses novel, investigative therapies that offer promising therapeutic options, yet require continued research efforts to determine safety effects. Inducing tolerance, whether by immunotherapy or by the administration of monoclonal antibodies, allows us to move toward a cure for food allergy, which could vastly change this field of allergic diseases in the coming decades., (Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

Many people see telemedicine as a solution to the nation's health disparities and in Mississippi as a solution to our last place in health. More than 13 years ago, the University of Mississippi Medical Center developed a successful TelEmergency program that saved rural Critical Access Hospitals and now provides telehealth services throughout the state. This occurred without acrimony because of partnerships that the University of Mississippi Medical Center developed with telecommunications companies, state government, health professions' licensure boards, and private donors. Today, the telemedicine market is exploding across the country with the entry of for-profit corporations into the medical market. These corporations often are more inclined to work with legislators rather than physicians, and some physician groups have attempted to limit their expansion. With the future of telemedicine now determined in part by the courts, rather than the providers, new pitfalls have arisen. The Mississippi experience may be helpful in navigating this new territory., (Copyright © 2016 Elsevier Inc. All rights reserved.)

By 1965, the policies and programs of Lyndon B. Johnson's Great Society brought optimism to black physicians and a new wave of resistance against black civil rights advocates in the American South. The largest of the first Head Start programs, Child Development Group of Mississippi (CDGM), had its roots in Freedom Summer 1964 and the Medical Committee for Human Rights. Like other proposed programs with strong medical components, CDGM was caught in a legislative Bermuda triangle created by the powerful Mississippi congressional delegation to maintain white supremacy and plantation economics. Physician-led investigations exposed the extraordinary level of poor health among Mississippi's black children, supported Head Start as a remedy, and awakened the white medical establishment to health disparities of the Jim Crow period. It was also the beginning of positive change in the previously silent white medical community in the South and their support of civil justice in health., (Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

The civil rights and social legislation of the Great Society following the Civil Rights Act of 1964 was slow to provide relief for black in the South. Mississippi Senator James Eastland led an effort to defund Head Start, including his state's program, Child Development Group of Mississippi (CDGM), a program with a strong medical component. A senatorial committee, including Robert Kennedy, came to investigate CDGM in 1967. The unimaginable poverty, hunger, malnutrition and chronic disease found in black families was vehemently denied by Eastland. Visits of physician groups then corroborated the findings. The Mississippi delegation made sure that food relief never came and funding for CDGM ceased. Health services were lost to 6000 impoverished children. The epic television documentary, Hunger in America, soon premiered on network television. It triggered ongoing efforts to address health disparities, including implementation of the National Nutrition and Health Survey (NHANES). Similar physician leadership is needed to address the lasting health disparities in our country., (Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.)

There is adequate evidence to demonstrate that bias toward obese individuals by health professionals is common. Bias predisposes to errors in medical judgment and care. There is also evidence to show that the pathophysiology of obesity is more complex than eating too much and moving too little. Widespread obesity is a new phenomenon in the United States and reflects changes in culture, including food, at many levels. The modern abundance of low-cost, available, palatable, energy-dense processed foods and the ability of these foods to activate central nervous system centers that drive food preference and overeating appear to play an important role in the obesity epidemic. The usual hormonal systems that promote body weight homeostasis appear to have been counterbalanced by pleasurable (hedonic) influences these foods generate in higher neurologic networks, including the limbic system. The use of medical technology, such as functional magnetic resonance imaging, to quantitate hedonic responses to food, enhance taste, and effectively develop and market commercial food products has produced new areas of ethical concern and opportunities to better understand eating and satiety. These developments further demonstrate the urgency to address the bias that exists toward obese patients., (Copyright © 2015 Elsevier Inc. All rights reserved.)

A group of black physicians whose request to attend educational programs at the University of Mississippi Medical Center had been rebuffed by the school's second dean played a central role in helping UMMC survive a federal investigation for non-compliance with the Civil Rights Act of 1964. Unknown to Dean Robert Marston, these physicians had been active in civil rights activities at both state and national levels and were in dialogue with federal civil rights agencies and with the NAACP who filed the complaint against UMMC. Marston called on them as part of a marathon of preparation for the inspection, and they assisted him in achieving an improbable outcome, a finding of compliance. In the process, Marston developed a positive relationship and ongoing dialogue with these black physicians and realized their value to Mississippi. In turn, they elected him to membership in the Mississippi Medical and Surgical Society.

Little information is available on the lives and experiences of black physicians who practiced in the South during the Jim Crow era of legalized segregation. In Mississippi and elsewhere, it is a story of disenfranchised professionals who risked life, limb, and personal success to improve the lot of those they served. In this second article on this topic, we present the stories of some of the physicians who were leaders in the civil rights movement in Mississippi as examples. Because the health disparities they sought to address have, not of their own making, been passed on to the next generation of physicians, the lessons learned from their experience are worthy of consideration., (Copyright © 2014 Elsevier Inc. All rights reserved.)

The roles of black physicians in the South in the period leading up to the Civil Rights Act of 1964 and the Voting Rights Act of 1965 have not been fully disclosed. In Mississippi and elsewhere in the South, it is a story of disenfranchised professionals who risked life, limb, and personal success to improve the lot of those they served. This first of 2 articles on the subject provides an overview of the forces for and against the struggle for civil rights and social justice in medicine in the South. We use newly available data from Mississippi as a prime example. An understanding of these forces is essential to an understanding of medical education and medical practice in this period and helps explain why the South remains in last place in most indicators of health today., (Copyright © 2014 Elsevier Inc. All rights reserved.)

In clinical practice, nonallergic rhinosinusitis (rhinopathy) is a common diagnosis of exclusion. The mucous recirculation syndrome is one incompletely defined condition that masquerades as nonallergic rhinopathy. Mucous recirculation syndrome, a curable condition, should be differentiated from nonallergic rhinopathy. The underdiagnosis of this condition is due in part to a lack of diagnostic criteria. In this article, we review the medical literature to better characterize mucous recirculation syndrome and to establish diagnostic criteria for it., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Robert Q. Marston, MD, a gregarious Rhodes and Markel Scholar, native Virginian, and well-connected National Institutes of Health-trained medical scientist found himself the new dean and hospital director of a promising academic medical center at age 38. It was 1961 and the University of Mississippi Medical Center (UMMC) in Jackson was, unknown to him, about to be at the geographic center of the struggle for African American civil rights. That struggle would entangle UMMC in a national search for social justice and change the course of American history and American medicine. Shortly after his arrival, the new dean received and refused a written request from the Secretary of the Mississippi Chapter of the National Medical Association (NMA) to make educational venues at the segregated medical center available to black physicians. The same year, UMMC became the primary medical provider for sick and injured Freedom Riders, sit-in and demonstration participants, and others who breached the racial divide defined by the state's feared Sovereignty Commission. That divide was violently enforced by collaboration among law enforcement, Citizens' Councils, and the Ku Klux Klan. The crescendo of the civil rights struggle that attended Marston's arrival included a deadly riot following James Meredith's integration of the Ole Miss campus in Oxford in 1962, the death of National Association for the Advancement of Colored People (NAACP) Field Secretary Medgar Evers at UMMC in 1963, a national controversy over UMMC's role in the autopsies of 3 civil rights workers murdered in Neshoba County, an attempt at limited compliance to Title VI of the Civil Rights Act of 1964, and a federal civil rights complaint against UMMC by the NAACP Legal and Educational Fund in 1965. That complaint noted that UMMC was out of compliance with the Civil Rights Act of 1964 and seriously threatened its federal funding and academic operations. Marston developed a compliance strategy that included the hiring of the first black faculty member, a request for an immediate federal civil rights inspection, and secretive overnight integration of the hospitals and clinics. A key to his strategy was engagement of support from the black community, with whom he had previously developed no relationship. Marston asked NAACP Field Director Charles Evers for support, and met with 5 black Mississippi physicians. Among the 5 was Robert Smith, MD, a founding member of the Medical Committee for Human Rights, the NMA officer whose request for NMA membership-access to the medical center was ignored. He was unaware of their local and national civil rights roles and active dialogue with the federal government on implementation of Title VI. The desire of the black physicians to see UMMC become an equal opportunity health resource resulted in their quiet assistance that aided UMMC compliance initiatives and played a major role in the successful outcome of the 1965 investigation of the charges of Title VI violations. This success established Marston as a national figure in academic medicine and contributed to his selection for positions as Director of The National Institutes of Health and President of the University of Florida. As commemorations of the 50(th) anniversary of Freedom Summer of 1964 proceed, UMMC has become arguably the most racially integrated academic health center in the United States., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Among primary immunodeficiencies, antibody deficiencies are the most common. Patients often are examined first by multiple medical providers by whom the diagnosis may be missed or delayed, because signs and symptoms are usually sinopulmonary in origin, simulate common respiratory infections or respiratory allergies, and are usually responsive to symptomatic antimicrobial treatment. Because these diseases can be treated effectively, it is important to recognize them before complications occur. We have provided updated information on the more common antibody deficiency syndromes, their diagnostic assessment, and advances in treatment.

Purpose: To determine the contents of chicken nuggets from 2 national food chains., Background: Chicken nuggets have become a major component of the American diet. We sought to determine the current composition of this highly processed food., Methods: Randomly selected nuggets from 2 different national fast food chains were fixed in formalin, sectioned and stained for microscopic analysis., Results: Striated muscle (chicken meat) was not the predominate component in either nugget. Fat was present in equal or greater quantities along with epithelium, bone, nerve, and connective tissue., Conclusion: Chicken nuggets are mostly fat, and their name is a misnomer., (Copyright © 2013 Elsevier Inc. All rights reserved.)

In 1945, a wave of GI-Bill-supported African American students, qualified for admission to medical schools, returned from their service in World War II. The possibility that their acceptance would integrate all-white medical schools was a problem for the southern governors. The governors responded with a carefully considered plan to shunt these African American applicants to historically black medical colleges by joining in a Compact and attempting to purchase Meharry Medical College in Nashville, Tennessee. This untold story of American medicine and its connection to our present shortage of African American physicians in the South needs to be remembered and passed on to future generations., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Purpose of Review: Allergic fungal sinusitis (AFS) results from an immunoglobulin E (IgE)-mediated, eosinophil-predominant hypersensitivity reaction to extramucosal fungi within the paranasal sinuses. Although the pathogenesis of this noninvasive process is still not fully understood, there is new information. Recently, the use of allergen immunotherapy with fungal antigens as an adjunct in treatment of AFS has been evaluated. In this review, we summarize the experience in the published literature on the topic., Recent Findings: There is evidence to suggest that allergen immunotherapy to fungal allergens may be effective in the treatment of symptoms of AFS and may decrease the rate of postoperative exacerbations and further operations. There is no evidence that this therapy induces immune complex disease. These studies pave the way for controlled trials of immunotherapy in patients with AFS., Summary: Allergen immunotherapy to fungi shows promise as a treatment to decrease the recurrence of AFS and should be considered a part of the treatment regimen. However, because the number of patients treated has been small and one study suggested that fungal immunotherapy administered before removal of fungal contents from the sinuses could worsen sinusitis, controlled studies are essential to moving forward.

Background: Abdominal migraine is a diagnostically challenging childhood disorder, characterized by recurrent episodes of abdominal pain, which has not been clearly demonstrated to occur in adults., Methods: We used 2 sets of consensus criteria for the diagnosis of abdominal migraine in children to evaluate adults suspected of having this condition in both our own patient population and in the medical literature. Two patients in our clinic and 11 patients from the medical literature composed our initial study cohort and were analyzed using the International Classification of Headache Disorders, 2(nd) Edition and American College of Gastroenterology Rome III Diagnostic Criteria for abdominal migraine in children., Results: Ten of these patients met inclusion criteria for definite or probable abdominal migraine and comprised our final study cohort. The 10 patients from this adult cohort shared common demographic and clinical characteristics with children suffering from abdominal migraine, including a familial history of migraine in 90%., Conclusions: Our findings demonstrate that abdominal migraine occurs and should be considered in the differential diagnosis of recurrent abdominal pain in adults, especially if there is a family history of migraine headaches., (Copyright © 2012 Elsevier Inc. All rights reserved.)

There are few useful tools to provide dietary health education including calorie and portion control to patients, particularly in a busy ambulatory health care setting. In this report, we provide results of the evaluation of an adaptation of the recent US Department of Agriculture dietary recommendations modified for the southern diet and individuals with limited knowledge of healthy eating. Using standardized methods, we found that the "Southern Remedy Healthy Eating Plate" was well accepted by patients and can be used quickly and effectively in the outpatient setting. Moreover, the review of this placemat with easy to understand instructions for meals and snacks was associated with acceptable levels of data retention after a single visit averaging 5 minutes. Although the need for some modification of instruction techniques was identified, the Southern Remedy Healthy Eating Plate appears to be a practical and useful format for providing structured dietary counseling and education in this setting and others.