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  A Man with Rheumatoid Arthritis and Lymphadenopathy A 46-year-old man with rheumatoid arthritis had anorexia and generalized lymphadenopathy. One month earlier, diffuse lymphadenopathy had developed in his neck, axillae, and groin. Serum protein electrophoresis disclosed a monoclonal spike in the gamma region. http://content.nejm.org/ |
Showing posts with label Journal of Medicine. Show all posts
Showing posts with label Journal of Medicine. Show all posts
Friday, April 25, 2008
Journal : A Man with Rheumatoid Arthritis and Lymphadenopathy
Journal : Artesunate for the Treatment of Severe Falciparum Malaria
A 35-year-old man presents with a febrile illness after travel in West Africa, and severe malaria is diagnosed. Treatment with artesunate is recommended. Artesunate is a member of a class of antimalarial agents called artemisinins, and it is at least as effective against severe malaria as quinine, with fewer side effects. Free Full Text CME Exam
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Journal : Use of Ezetimibe in the United States and Canada
Cynthia A. Jackevicius, Pharm.D., M.Sc., Jack V. Tu, M.D., Ph.D., Joseph S. Ross, M.D., M.H.S., Dennis T. Ko, M.D., and Harlan M. Krumholz, M.D., S.M.
ABSTRACT
Background Ezetimibe lowers low-density lipoprotein cholesterol, but current lipid-lowering guidelines in the United States and Canada do not recommend it as a first option for either primary or secondary prevention. We sought to describe the adoption of ezetimibe relative to that of other lipid-lowering agents and compare its use in the two countries.
Methods We conducted a population-level, cohort study using data from January 2002 to December 2006, provided by IMS Health, to describe prescribing practices and expenditures for lipid-lowering agents and ezetimibe in the United States and Canada.
Results From 2002 to 2006, the monthly number of prescriptions for lipid-lowering agents rose from 3719 to 7401 per 100,000 population in Canada and from 3927 to 6827 per 100,000 population in the United States. Of these prescriptions, the proportion for ezetimibe rose from 0.2% in 2003 to 3.4% in 2006 in Canada and from 0.1% in 2002 to 15.2% in 2006 in the United States. Statin use was relatively constant between 2002 and 2006 in Canada, whereas the proportion of statin prescriptions decreased from 86.5 to 80.8% in the United States. In 2006, the ratio of prescriptions for statins to those for ezetimibe was 26:1 in Canada and 5:1 in the United States. In 2006, expenditures for ezetimibe per 100,000 population were higher in the United States than in Canada by a factor of more than 4.
Conclusions Distinct patterns of use of ezetimibe emerged in the United States and Canada from 2002 to 2006, a difference that markedly altered the approach to the treatment of hyperlipidemia in the United States. The U.S. pattern increased overall costs, but the effect on clinical outcomes is uncertain.
Source Information
From the University Health Network (C.A.J.), the Department of Health Policy, Management and Evaluation, Faculty of Medicine (C.A.J., J.V.T.), and the Division of Cardiology, Schulich Heart Centre, Sunnybrook Health Sciences Centre (J.V.T., D.T.K.), University of Toronto; and the Institute for Clinical Evaluative Sciences (J.V.T., D.T.K.) — all in Toronto; the Department of Pharmacy Practice and Administration, College of Pharmacy, Western University of Health Sciences, Pomona, CA (C.A.J.); Mount Sinai School of Medicine and James J. Peters Veterans Affairs Medical Center, New York (J.S.R.); and the Department of Internal Medicine, Section of Cardiovascular Medicine, and the Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine (H.M.K.); the Center for Outcomes Research and Evaluation, Yale–New Haven Hospital (H.M.K.); and the School of Public Health, Section of Health Policy and Administration, Yale University (H.M.K.) — all in New Haven, CT.
This article (10.1056/NEJMsa0801461) was published at www.nejm.org on March 30, 2008.
Address reprint requests to Dr. Jackevicius at the Western University of Health Sciences, College of Pharmacy, 309 E. Second St., Pomona CA, 91766, or at cjackevicius@westernu.edu.
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Journal : Mutations in the Iodotyrosine Deiodinase Gene and Hypothyroidism
José C. Moreno, M.D., Ph.D., Willem Klootwijk, B.Sc., Hans van Toor, B.Sc., Graziella Pinto, M.D., Mariella D'Alessandro, Ph.D., Aubène Lèger, M.D., David Goudie, M.B., Ch.B., Michel Polak, M.D., Ph.D., Annette Grüters, M.D., Ph.D., and Theo J. Visser, Ph.D.
SUMMARY
DEHAL1 has been identified as the gene encoding iodotyrosine deiodinase in the thyroid, where it controls the reuse of iodide for thyroid hormone synthesis. We screened patients with hypothyroidism who had features suggestive of an iodotyrosine deiodinase defect for mutations in DEHAL1. Two missense mutations and a deletion of three base pairs were identified in four patients from three unrelated families; all the patients had a dramatic reduction of in vitro activity of iodotyrosine deiodinase. Patients had severe goitrous hypothyroidism, which was evident in infancy and childhood. Two patients had cognitive deficits due to late diagnosis and treatment. Thus, mutations in DEHAL1 led to a deficiency in iodotyrosine deiodinase in these patients. Because infants with DEHAL1 defects may have normal thyroid function at birth, they may be missed by neonatal screening programs for congenital hypothyroidism.
Source Information
From the Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands (J.C.M., W.K., H.T., T.J.V.); Paris Descartes–INSERM Unité 845, Necker Enfants Malades Hospital (G.P., M.P.), and Groupe Hospitalier Pitié–Salpêtrière (A.L.) — all in Paris; Cancer Research UK Cell Structure Research Group, Dundee University (M.D.), and Tayside University Hospitals National Health Service Trust, Ninewells Hospital and Medical School (D.G.) — all in Dundee, United Kingdom; and Charité Hospital, Humboldt University, Berlin (A.G.).
Address reprint requests to Dr. Moreno at the Department of Internal Medicine, Room Ee 593, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GE Rotterdam, the Netherlands, or at j.morenonavarro@erasmusmc.nl.
This article has been cited by other articles:
- Kopp, P. A. (2008). Reduce, Recycle, Reuse -- Iodotyrosine Deiodinase in Thyroid Iodide Metabolism. NEJM 358: 1856-1859
[Full Text] - http://content.nejm.org/
Journal : Pyruvate Kinase Deficiency and Malaria
Kodjo Ayi, Ph.D., Gundula Min-Oo, Ph.D., Lena Serghides, Ph.D., Maryanne Crockett, M.D., Melanie Kirby-Allen, M.D., Ian Quirt, M.D., Philippe Gros, Ph.D., and Kevin C. Kain, M.D.
SUMMARY
Malaria that is caused by Plasmodium falciparum is a significant global health problem. Genetic characteristics of the host influence the severity of disease and the ultimate outcome of infection, and there is evidence of coevolution of the plasmodium parasite with its host. In humans, pyruvate kinase deficiency is the second most common erythrocyte enzyme disorder. Here, we show that pyruvate kinase deficiency provides protection against infection and replication of P. falciparum in human erythrocytes, raising the possibility that mutant pyruvate kinase alleles may confer a protective advantage against malaria in human populations in areas where the disease is endemic.
Source Information
From the McLaughlin–Rotman Centre for Global Health (K.A., L.S., M.C., K.C.K.) and the Department of Medicine (I.Q., K.C.K.), University Health Network–Toronto General Hospital; Hematological Unit, Hospital for Sick Children (M.K.-A.); and the McLaughlin Centre for Molecular Medicine, University of Toronto (K.C.K.) — all in Toronto; and the Department of Biochemistry and Centre for the Study of Host Resistance, McGill University, Montreal (G.M.-O., P.G.).
This article (10.1056/NEJMoa072464) was published at www.nejm.org on April 16, 2008.
Address reprint requests to Dr. Gros at the Department of Biochemistry, McGill University, 3655 Promenade Sir William Osler, Rm. 907, Montreal, QC H3G 1Y6, Canada, or at philippe.gros@mcgill.ca.
This article has been cited by other articles:
- Daily, J. P., Sabeti, P. (2008). A Malaria Fingerprint in the Human Genome?. NEJM 358: 1855-1856
[Full Text]
Journal : Home Use of Automated External Defibrillators for Sudden Cardiac Arrest
ABSTRACT
Background The most common location of out-of-hospital sudden cardiac arrest is the home, a situation in which emergency medical services are challenged to provide timely care. Consequently, home use of an automated external defibrillator (AED) might offer an opportunity to improve survival for patients at risk.
Methods We randomly assigned 7001 patients with previous anterior-wall myocardial infarction who were not candidates for an implantable cardioverter–defibrillator to receive one of two responses to sudden cardiac arrest occurring at home: either the control response (calling emergency medical services and performing cardiopulmonary resuscitation [CPR]) or the use of an AED, followed by calling emergency medical services and performing CPR. The primary outcome was death from any cause.
Results The median age of the patients was 62 years; 17% were women. The median follow-up was 37.3 months. Overall, 450 patients died: 228 of 3506 patients (6.5%) in the control group and 222 of 3495 patients (6.4%) in the AED group (hazard ratio, 0.97; 95% confidence interval, 0.81 to 1.17; P=0.77). Mortality did not differ significantly in major prespecified subgroups. Only 160 deaths (35.6%) were considered to be from sudden cardiac arrest from tachyarrhythmia. Of these deaths, 117 occurred at home; 58 at-home events were witnessed. AEDs were used in 32 patients. Of these patients, 14 received an appropriate shock, and 4 survived to hospital discharge. There were no documented inappropriate shocks.
Conclusions For survivors of anterior-wall myocardial infarction who were not candidates for implantation of a cardioverter–defibrillator, access to a home AED did not significantly improve overall survival, as compared with reliance on conventional resuscitation methods. (ClinicalTrials.gov number, NCT00047411 [ClinicalTrials.gov] .)
Source Information
From the Seattle Institute for Cardiac Research (G.H.B., J.A., G.J., E.B.) and the University of Washington (J.E.P., W.T.L.) — both in Seattle; the Duke University Clinical Research Institute, Durham, NC (K.L.L., D.B.M., S.M., L.D.R., N.E.C.-C.); the University of Leicester, Leicester, United Kingdom (W.D.T.); the Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.M.T., J.J.Y.); Auckland City Hospital, Auckland, New Zealand (W.S., J.J.Y.); the University of Toronto, Toronto (P.D.); the Mayo Clinic, Rochester, MN (D.L.P., R.D.W.); and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (Y.R., E.B.S.).
This article (10.1056/NEJMoa0801651) was published at www.nejm.org on April 1, 2008.
Address reprint requests to Dr. Bardy at the Seattle Institute for Cardiac Research, 7900 E. Green Lake Dr. N., #302, Seattle, WA 98103-4819, or at gbardy@sicr.org.
This article has been cited by other articles:
- Callans, D. J. (2008). Can Home AEDs Improve Survival?. NEJM 358: 1853-1855
[Full Text] - http://content.nejm.org
Journal : Stents versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease
ABSTRACT
Background Several studies have compared the treatment effects of coronary stenting and coronary-artery bypass grafting (CABG). However, there are limited data regarding the long-term outcomes of these two interventions for patients with unprotected left main coronary artery disease.
Methods We evaluated 1102 patients with unprotected left main coronary artery disease who underwent stent implantation and 1138 patients who underwent CABG in Korea between January 2000 and June 2006. We compared adverse outcomes (death; a composite outcome of death, Q-wave myocardial infarction, or stroke; and target-vessel revascularization) with the use of propensity-score matching in the overall cohort and in separate subgroups according to type of stent.
Results In the overall matched cohort, there was no significant difference between the stenting and CABG groups in the risk of death (hazard ratio for the stenting group, 1.18; 95% confidence interval [CI], 0.77 to 1.80) or the risk of the composite outcome (hazard ratio for the stenting group, 1.10; 95% CI, 0.75 to 1.62). The rates of target-vessel revascularization were significantly higher in the group that received stents than in the group that underwent CABG (hazard ratio, 4.76; 95% CI, 2.80 to 8.11). Comparisons of the group that received bare-metal stents with the group that underwent CABG and of the group that received drug-eluting stents with the group that underwent CABG produced similar results, although there was a trend toward higher rates of death and the composite end point in the group that received drug-eluting stents.
Conclusions In a cohort of patients with unprotected left main coronary artery disease, we found no significant difference in rates of death or of the composite end point of death, Q-wave myocardial infarction, or stroke between patients receiving stents and those undergoing CABG. However, stenting, even with drug-eluting stents, was associated with higher rates of target-vessel revascularization than was CABG.
Source Information
From the Catholic University of Korea, St. Mary's Hospital, Gangnam (K.B.S., P.J.K.) and Yeoido (W.-S.C.), Seoul; the Department of Cardiology (D.-W.P., Y.-H.K., S.-W.L., C.W.L., M.-K.H., S.-W.P., S.-J.P.) and Division of Biostatistics (S.-C.Y.), Center for Medical Research and Information, University of Ulsan College of Medicine, Asan Medical Center, Seoul; Samsung Medical Center, Seoul (H.-C.G.); Chonnam National University Hospital, Gwangju (M.-H.J.); Yonsei University Severance Hospital, Seoul (Y.J.); Seoul National University Hospital, Seoul (H.-S.K.) and Bundang (I.-H.C.); Chungnam National University Hospital, Daejeon (I.-W.S.); Kyung Pook National University Hospital, Daegu (H.S.P.); Gachon University Gil Medical Center, Incheon (T.A.); and Ajou University Medical Center, Suwon (S.-J.T.) — all in Korea.
Drs. K.B. Seung and D.-W. Park contributed equally to this article.
This article (10.1056/NEJMoa0801441) was published at www.nejm.org on March 31, 2008.
Address reprint requests to Dr. Seung-Jung Park at the Department of Cardiology, University of Ulsan College of Medicine, Cardiac Center, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, Korea, or at sjpark@amc.seoul.kr.
This article has been cited by other articles:
- Jones, R. H. (2008). Percutaneous Intervention vs. Coronary-Artery Bypass Grafting in Left Main Coronary Disease. NEJM 358: 1851-1853
[Full Text] - http://content.nejm.org
Journal : Contaminated Heparin Associated with Adverse Clinical Events and Activation of the Contact System
Contaminated Heparin Associated with Adverse Clinical Events and Activation of the Contact System
There is an urgent need to determine whether oversulfated chondroitin sulfate (OSCS), which has contaminated heparin supplies worldwide, is the cause of severe anaphylactoid-like reactions. This study shows that the OSCS found in contaminated lots of unfractionated heparin directly activates the kinin–kallikrein pathway in human plasma, which can lead to the generation of bradykinin, a potent vasoactive mediator. 
April 23, 2008 (DOI: 10.1056/NEJMoa0803200), in Print June 5, 2008
April 23, 2008 (DOI: 10.1056/NEJMoa0803200), in Print June 5, 2008abstract and full article
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Saturday, March 29, 2008
Journal : Alcohol and Alcoholism
View Current Issue (Volume 43 Issue 2 March/April 2008)
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Alcohol and Alcoholism publishes papers on biomedical, psychological and sociological aspects of alcoholism and alcohol research, provided that they make a new and significant contribution to knowledge in the field. Papers include new results obtained experimentally, descriptions of new experimental (including clinical) methods of importance to the field of alcohol research and treatment, or new interpretations of existing results. Theoretical contributions are considered equally with papers dealing with experimental work provided that such theoretical contribution are not of a largely speculative or philosophical nature. Alcohol and Alcoholism is the official journal of the Medical Council on Alcohol.
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