JAMA

Distribuir contenido
Actualizado: hace 1 día 12 horas

Premedication for Neonates and Nonemergency Intubation—Reply

Mar, 18/09/2018 - 02:00
In Reply Drs Fideler and Grasshoff raise 2 concerns regarding our trial comparing 2 premedication regimens for neonates requiring nonemergency intubation in the neonatal intensive care unit (NICU). Concerning the potential neurotoxicity of anesthetics and analgesics on the developing human brain, epidemiological data on surgical anesthesia and experimental animal data have suggested an association between surgical anesthesia and neurodevelopmental impairment, resulting in an FDA warning in 2016. However, a single, brief exposure to a general anesthetic, as used in our study, was not within the scope of the FDA warning. Available data from premature infants exposed to anesthetics, sedatives, or analgesics in the NICU are limited but reassuring thus far. Epidemiological studies that found an association with neurodevelopmental impairment could not disentangle the respective roles of anesthetics, surgery, pain, or the underlying condition. Repeated early painful experiences in the NICU are associated with impaired neurodevelopment when premature infants are older, so it is necessary to evaluate the balance between eventual toxicity and pain. For this purpose, neurodevelopmental follow-up of the infants in the study is ongoing.

Safety of Topical Calcineurin Inhibitors for Hailey-Hailey Disease

Mar, 18/09/2018 - 02:00
To the Editor Dr Haley and colleagues described a patient with Hailey-Hailey disease (HHD) in a JAMA Clinical Challenge article. The authors stated that long-term topical calcineurin inhibitors (TCIs) such as tacrolimus or pimecrolimus could be applied to control HHD because they lacked the adverse effects of topical corticosteroids. However, the US Food and Drug Administration (FDA) issued a public health advisory in 2005 about a potential cancer risk associated with the use of tacrolimus, based on animal studies and case reports in a small number of patients. Although the finding is controversial, the number of patients in whom cancer developed after TCI therapy has been increasing. Development of squamous cell carcinoma has been reported with topical application of 0.1% tacrolimus for 10 months in a patient with HHD, and tacrolimus therapy may have promoted the development of squamous cell carcinoma from the HHD lesion. Because of limited and uncertain data on the long-term safety of topical TCIs in HHD treatment, especially as these agents are used off-label, TCIs should be applied as a second-line therapy for short-term or intermittent treatment of HHD, and patients treated with TCIs require careful follow-up.

Safety of Topical Calcineurin Inhibitors for Hailey-Hailey Disease—Reply

Mar, 18/09/2018 - 02:00
In Reply Mr Han raises an important point regarding the use of TCIs, which are labeled for use in atopic dermatitis, to treat HHD. The FDA issued a black box warning of a possible association between TCI use and the development of cancer (lymphoma and skin) based on case reports and animal studies, a warning not supported by the American Academy of Dermatology. Most of these animal studies demonstrated an increased risk of malignancy after administration of systemic or topical calcineurin inhibitors in doses far exceeding those used by humans.

Treatment of Chronic Hepatitis B Infection

Mar, 18/09/2018 - 02:00
To the Editor Dr Tang and colleagues summarized the current clinical evidence on the management of chronic hepatitis B virus (HBV) infection. I have some concerns about the review. First, it is not adequate to designate HBV e antigen (HBeAg) as HBV envelope antigen. HBeAg is not a structural component of HBV itself, but a derivative of HBV core antigen (HBcAg) that is secreted into the circulation during viral replication. The HBV envelope does not contain HBeAg.

Treatment of Chronic Hepatitis B Infection—Reply

Mar, 18/09/2018 - 02:00
In Reply The e in HBeAg has been referred to as an abbreviation for “envelope” in several recent studies. Magnius and Espmark first described a new antigenic specificity in individuals positive for Australia antigen (now known as HBsAg) and proposed the designation of e for this new specificity. Although they did not state what the e stood for, others have reported that Magnius and Espmark meant for it to be a stand-alone e. Because the earliest publications do not refer to the e antigen as standing for envelope, we conclude that it does not. The review article has been corrected online and a correction notice appears in this issue.

Incorrect Expansion of a Term and Other Clarifications

Mar, 18/09/2018 - 02:00
In the Review entitled “Chronic Hepatitis B Infection: A Review” published in the May 1, 2018, issue of JAMA, the term “hepatitis B envelope antigen” should have been “hepatitis B e antigen” in several places throughout the article. In Figure 1, the hepatitis e antigen was removed from the depiction of the hepatitis B virion. In Table 3, in the “isolated core” row, wording in the last column “interpretation details” was revised for the third bullet point. This article was corrected online.

Spring Downsizing

Mar, 18/09/2018 - 02:00
The lilac buds??are plumper now,unharmed??by April snows.A colony of ladybugs??feeds on honeyyou dabbed??on our antique window.Our last April here,??we inventorywhat we’ll keep,??what must go.

Proprietaries, Pianos and Probity

Mar, 18/09/2018 - 02:00
A correspondent, in calling attention to one of a series of resolutions we quoted last week, comments as follows: “Had this resolution been passed by the American Medical Association and been endorsed and published by The Journal, I am inclined to think that frenzied protests would have arisen in certain quarters about the attempt of the Association to throttle ‘independent medical journalism.’” The resolution referred to by our correspondent reads as follows:

Behavioral Interventions for Weight Loss

Mar, 18/09/2018 - 02:00
This JAMA Patient Page describes the US Preventive Services Task Force’s recent recommendations on behavioral interventions for weight loss to prevent obesity-related problems in adults.

JAMA

Mar, 18/09/2018 - 02:00