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A Mediastinal Mass in a Young Man

Mar, 19/06/2018 - 02:00
A healthy young adult presented to the emergency department reporting 6 months of fatigue, dry cough, dyspnea, and weight loss. A chest x-ray showed opacification of the right lung field and a CT revealed a centrally necrotic mass in the right anterior mediastinum, right pleural effusion, and compression of the superior vena cava. What would you do next?

Ertugliflozin for Type 2 Diabetes

Mar, 19/06/2018 - 02:00
This Medical Letter review summarizes clinical study data, adverse effects, drug interactions, and dosage and administration of the sodium-glucose co-transporter 2 inhibitor ertugliflozin alone and in fixed-dose combinations with metformin for the treatment of adults with type 2 diabetes.

Representation of Patients With Chronic Kidney Disease in Trials of Cancer Therapy

Mar, 19/06/2018 - 02:00
This study characterizes the exclusion of patients with chronic kidney disease (CKD) in randomized clinical trials of drug treatment for bladder, breast, colorectal, lung, and prostate cancer.

Motivation to Participate in PTSD Research

Mar, 19/06/2018 - 02:00
To the Editor The randomized clinical trial by Dr Foa and colleagues compared massed prolonged exposure therapy, spaced prolonged exposure therapy, present-centered therapy, and a minimal-contact control on severity of posttraumatic stress disorder (PTSD) among active duty military personnel. The results were different from what was expected from previous studies. Individuals receiving spaced therapy did no better than those randomized to present-centered therapy, a comparison condition to control for common factors in psychotherapy. Foa and colleagues and the Editorial by Hoge and Chard were unable to explain these results.

Motivation to Participate in PTSD Research—Reply

Mar, 19/06/2018 - 02:00
In Reply Drs Roth and Hofmann comment on how motivational factors may have influenced the outcomes of our recent randomized clinical trial comparing prolonged exposure therapy with present-centered therapy in active duty military with PTSD. We agree that motivational factors are important and may help explain the more modest outcomes observed for prolonged exposure and other evidence-based PTSD treatments in military personnel compared with civilians. Other reasons may include the repeated and yet varied nature of military combat trauma, the type of trauma, the use of multiple medications, and comorbid conditions such as head injuries, physical injuries, and chronic pain. However, motivational factors in civilians, such as Medicaid and service-related compensation for veterans, can also influence treatment outcome. The purpose of our study was to report the main findings from our clinical trial; the analysis of predictors of treatment response is currently ongoing. Other research studies are being conducted by our group and others testing intervention modifications to improve treatment outcomes for combat-related PTSD.

Bariatric Surgery and Hypertension

Mar, 19/06/2018 - 02:00
To the Editor In an Editorial in the obesity theme issue, Dr Livingston discussed the different results of 2 cohort studies regarding use of medications for hypertension and hyperlipidemia after bariatric surgery and suggested that it is unlikely that hypertensive patients undergoing bariatric surgery would be able to discontinue their medication. We partly disagree and would like to comment and discuss recent evidence indicating that gastric bypass may be associated with both remission of hypertension and discontinuation of antihypertensive drugs.

Bariatric Surgery and Hypertension—Reply

Mar, 19/06/2018 - 02:00
In Reply Bariatric surgery has a credibility problem. Aggressive claims were made in the past about the benefits of the jejunoileal bypass, banded gastroplasty, and the laparoscopic banding procedure—all of which proved wrong once long-term outcomes were known. In contrast, there is high-quality evidence that the Roux-en-Y and gastric sleeve resection effectively result in long-term weight loss and diabetes control. Despite these successes, clinicians remain skeptical about bariatric surgery in part because of a long history of the bariatric community overstating the benefits of weight loss operations.

Strategies to Prevent Obesity-Related Cancer

Mar, 19/06/2018 - 02:00
To the Editor The Viewpoint by Dr Massetti and colleagues emphasized the link between obesity and cancer and called for more robust clinical intervention to prevent and treat obesity. The authors proposed that sustainable weight loss be achieved by comprehensive strategies that support patients’ efforts to make significant lifestyle changes. However, most published studies have shown that the long-term success rate of lifestyle changes is low. Although lifestyle changes may be sufficient to reduce body weight prior to sustained obesity, once obesity is established, body weight seems to become biologically fixed and lifestyle programs become less effective.

Strategies to Prevent Obesity-Related Cancer—Reply

Mar, 19/06/2018 - 02:00
In Reply Trends in the negative health consequences of overweight and obesity are on the rise, coinciding with trends in rates of obesity. It is therefore not surprising that obesity accounts for a significant portion of health care costs in the United States. As Dr Chen and his colleagues point out, our Viewpoint emphasized the opportunities for comprehensive approaches to preventing obesity-related cancers within health care settings. To achieve significant effect on obesity and obesity-related cancers, all tools of the medical and public health community must be brought to bear on the problem. Chen and colleagues propose bariatric surgery as a treatment for severe obesity and a strategy for cancer prevention for eligible patients. As they note, achieving sustainable weight loss among patients with overweight and obesity presents significant challenges. For these reasons, efforts to prevent further weight gain among those who are not yet obese—and would not be eligible for surgery or other invasive medical approaches to treating overweight—are critical. For patients with obesity who have not been successful in losing weight, health care professionals can consider a variety of strategies that meet patients’ needs, including surgical approaches. Data such as those cited by the authors provide empirical links between interventions for overweight or obesity and associations with cancer outcomes. Such findings can inform understanding of the links among weight, weight gain and loss, and cancer.

Incorrect Data in Abstract and Text

Mar, 19/06/2018 - 02:00
In the US Preventive Services Task Force Recommendation Statement “Screening for Prostate Cancer: US Preventive Services Recommendation Statement” published in the May 8, 2018, issue of JAMA, data were incorrect in the abstract and text. In the “Importance” section of the abstract, the “Importance” subsection of the Rationale section, and the “Burden of Disease” subsection of the Discussion, the lifetime risk of being diagnosed with prostate cancer should have been reported as 11%. This article was corrected online.

Incorrect Data in Table Footnote and Text

Mar, 19/06/2018 - 02:00
In the Clinical Review entitled “Does This Patient Have Acute Mountain Sickness? The Rational Clinical Examination Systematic Review” published in the November 14, 2017, issue of JAMA, a numeric value in the equation in footnote a of Table 2 was incorrect. The footnote should have read: “Based on the random-effects meta-regression model of the 6 scores in 91 studies, the predicted prevalence (%)???13.4?×?[altitude (m)/1000]???14.2. For example, travelers at 2500 m would have an estimated prevalence of 19%???13.4?×?[2500/1000]?–?14.2.” In the Scenario Resolution section, the second sentence should have read: “Based on our model, predicted prevalence of moderate to severe AMS at 4000 m (13?100 ft) is approximately 39% (Figure).” The fourth sentence in the Scenario Resolution section should have read: “Thus, the probability that the patient has AMS is approximately 67%.” This article was corrected online.

A Day in the Life: Physician Cares for HIV-Positive Patients in Jail

Mar, 19/06/2018 - 02:00
This Medical News story describes a day in the life of an infectious disease specialist caring for incarcerated individuals living with HIV.

For Patients With Type 2 Diabetes, What’s the Best Target Hemoglobin A 1C ?

Mar, 19/06/2018 - 02:00
This Medical News article discusses new clinical guidance for blood glucose targets.

The Need to Simplify Measuring Quality in Health Care

Mar, 19/06/2018 - 02:00
The leadership of US health care institutions as well as practicing clinicians have raised concerns about the burdens being placed on them by the many quality and performance metrics required by various payers and regulators. Although the total number of health care measures in use in unknown, some 1700 reportedly are used by the Centers for Medicare & Medicaid (CMS) alone. The multiplicity of metrics is not a new problem, but resolving this issue is proving difficult.

Ethical Guidelines for Genomic Research in Africa

Mar, 19/06/2018 - 02:00
A consortium of African investigators published guidelines for the ethical handling of genomic research and biobanking in Africa. This Framework aims to help African scientists retain control of the trove of genetic information originating in Africa so that it can be used to benefit the health and welfare of people on the continent.

New Platform Showcases Scientific Research From Africa

Mar, 19/06/2018 - 02:00
The African Academy of Sciences (AAS) launched AAS Open Research, a platform for rapid publication and open peer review to showcase cutting edge scientific research by investigators on the African continent who are affiliated with the AAS and programs supported through its funding platform, the Alliance for Accelerating Excellence in Science in Africa (AESA).

Preemptive Antibiotic Use Reduces Childhood Deaths

Mar, 19/06/2018 - 02:00
Twice-yearly mass distributions of the oral broad-spectrum antibiotic azithromycin to preschool children in 3 sub-Saharan African countries reduced child mortality, according to research from the MORDOR Study Group, an international collaboration of investigators.

Biosimilar Approved for Anemia

Mar, 19/06/2018 - 02:00
The first biosimilar to epoetin alfa for patients with anemia from chronic kidney disease, chemotherapy, or zidovudine treatment for HIV infection has received FDA approval.

Neurovascular Stent Caution

Mar, 19/06/2018 - 02:00
The FDA has offered safety recommendations regarding neurovascular stents used in stent-assisted coiling (SAC) of wide-neck intracranial aneurysms. Agency officials said the FDA has received reports of strokes and deaths in the treatment of unruptured brain aneurysm that may be related to how the device was used or to patient characteristics.

New Relief for Opioid Withdrawal

Mar, 19/06/2018 - 02:00
Lofexidine hydrochloride has received FDA approval to help alleviate opioid withdrawal symptoms. It’s the first nonopioid medication approved to relieve the misery of symptoms such as nausea, vomiting, profuse sweating, and tachycardia. In March an FDA advisory committee recommended the approval.

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