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Eric S. Daar, MD; Camlin Tierney, PhD; Margaret A. Fischl, MD; Paul E. Sax, MD; Katie Mollan, MS; Chakra Budhathoki, PhD; Catherine Godfrey, MD; Nasreen C. Jahed, MPH; Laurie Myers, MS; David Katzenstein, MD; Awny Farajallah, MD; James F. Rooney, MD; Keith A. Pappa, PharmD; William C. Woodward, DO; Kristine Patterson, MD; Hector Bolivar, MD; Constance A. Benson, MD; Ann C. Collier, MD, for the AIDS Clinical Trials Group Study A5202 Team

Few studies have compared once-daily treatment regimens for HIV-1. This randomized trial in antiretroviral-naive patients with HIV-1 showed that a once-daily ritonavir-boosted protease inhibitor regimen had similar effectiveness to a once-daily efavirenz-based regimen when combined with abacavir–lamivudine or tenofovir DF–emtricitabine. The ritonavir-boosted protease inhibitor regimen seemed to be better tolerated than the efavirenz-based regimen when combined with abacavir–lamivudine but not when combined with tenofovir DF–emtricitabine.

Topics: efavirenz, hiv-1, ritonavir, atazanavir, emtricitabine, tenofovir, lamivudine, abacavir
  
Mika Kivimäki, PhD; G. David Batty, PhD; Mark Hamer, PhD; Jane E. Ferrie, PhD; Jussi Vahtera, MD, PhD; Marianna Virtanen, PhD; Michael G. Marmot, MD, PhD; Archana Singh-Manoux, PhD; and Martin J. Shipley, MSc

Long working hours have been associated with increased risk for coronary heart disease, but it is unclear whether the addition of working hours improves risk assessment beyond other cardiovascular risk factors. This study of 7095 civil service workers in the United Kingdom found that the addition of self-reported working hours to the Framingham score resulted in better identification of individuals who later developed coronary heart disease.

Topics: coronary heart disease, framingham risk calculator
  
Marie Gousseff, MD; Laurent Arnaud, MD; Marc Lambert, MD, PhD; Arnaud Hot, MD; Mohamed Hamidou, MD; Pierre Duhaut, MD, PhD; Thomas Papo, MD; Martin Soubrier, MD, PhD; Marc Ruivard, MD, PhD; Giuseppe Malizia, MD; Nathalie Tieulié, MD; Sophie Rivière, MD; Jacques Ninet, MD, PhD; Pierre-Yves Hatron, MD; Zahir Amoura, MD, for the Capillary Leak Syndrome Registry

The systemic capillary leak syndrome (SCLS) is a rare condition characterized by unexplained episodic attacks of systemic capillary hyperpermeability that can lead to fatal pulmonary edema. Optimal management of SCLS is undefined. In this case series of 28 patients with SCLS in a European multicenter registry, survival 5 years after diagnosis was 85% in the 23 patients who had received prophylactic treatment with β2-agonists or intravenous immunoglobulin and 20% in 5 patients who had not. Clinical experience with these 28 patients with SCLS suggests that prophylactic treatment may improve survival.

Topics: capillary leak syndrome
  
Hanna E. Bloomfield, MD, MPH; Ange Krause, MD; Nancy Greer, PhD; Brent C. Taylor, PhD, MPH; Roderick MacDonald, MS; Indulis Rutks, BS; Preetham Reddy, MD; and Timothy J. Wilt, MD, MPH

This meta-analysis examined 22 trials including 8413 patients to determine whether patient self-management of anticoagulation (self-testing alone or in combination with self-adjustment of anticoagulant dose) reduces thromboembolic complications and all-cause mortality without increasing major bleeding events compared with clinic-based anticoagulation management. Patient self-management resulted in significantly fewer deaths and thromboembolic events without increased risk for serious bleeding in a selected group of motivated adults who required long-term anticoagulation with vitamin K antagonists. Further study should evaluate the cost-effectiveness and feasibility of these programs in U.S. settings.

Topics: treatment outcome, anticoagulation, chronic, self-management, hemorrhage, anticoagulation, anticoagulants, oral, thromboembolism, thromboembolic event ...
  
Richard L. Schilsky, MD; and Mark Crowther, MD

This Update summarizes studies published in 2010 that the authors consider highly relevant to the practice of hematology and oncology. Topics include oral rivaroxaban to treat symptomatic venous thromboembolism; anticoagulants, aspirin, and successful pregnancy outcome in patients with recurrent miscarriage; inexpensive interventions to reduce morbidity and increase survival in patients with sickle cell disease; fondaparinux in the treatment of selected patients with superficial thrombophlebitis; cancer prevention and management; and new drugs for cancer.

Topics: aspirin, cancer, medical oncology, hematology, breast cancer, metastatic melanoma, abortion, habitual, neoplasms, ...
  

This Update summarizes studies published in 2010 that the author considers highly relevant to the practice of rheumatology. Topics include osteoporosis, antineutrophil cytoplasmic antibody–associated vasculitis, rheumatoid arthritis, drug-free remission in rheumatoid arthritis, the spleen tyrosine kinase inhibitor r788, gout, reactive arthritis, and interleukin-17A inhibitors.

Topics: rheumatoid arthritis, rheumatology, gout, reactive arthritis, calcium, fructose, interleukins
  

This article is a reaffirmation of the 2004 U.S. Preventive Services Task Force (USPSTF) recommendation statement on screening for testicular cancer. The USPSTF performed a targeted literature search for benefits and harms of screening for testicular cancer in asymptomatic males and found no new studies. On this basis, the USPSTF does not recommend screening for testicular cancer in asymptomatic adolescent or adult males.

Topics: preventive medicine, advisory committees, testicular cancer, testicular malignant germ cell tumor
  

In this issue, Bloomfield and colleagues' study concludes that long-term anticoagulant management that involves some form of patient self-care is effective and safe compared with clinic-based management. The editorialists note the importance of further study to determine the general applicability and cost-effectiveness of patient self-management of anticoagulation.

Topics: personal digital assistant, international normalized ratio
  
Barbara M. Young, MD, CM

Having recently attended an excellent lecture on the evaluation of dementia, I was eager to test out my refreshed and updated skills on my next patient. Internet access is always very slow in Kuujjuaq, but I finally succeeded in downloading the cognitive assessment tool that had been suggested by the lecturer.

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Scott Winner, MD

I pushed the needle further into her breast, positioned it directly behind her nipple, and injected the local anesthetic lidocaine. “Ouch!” she said. Her cancerous left breast would be surgically removed in an hour.

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Pasquale Santangeli, MD; Luigi Di Biase, MD, PhD; and Andrea Natale, MD
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Nikola Sprigg, MD; Chamila M. Geeganage, PhD; and Philip M.W. Bath, MD
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Clive Kearon, MB, PhD; and Martin O'Donnell, MB, PhD
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Catherine Chakvetadze, MD; Vincent Mallet, MD, PhD; Laure Gaussec, MD; Laurent Hannoun, MD; and Stanislas Pol, MD, PhD
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Topics: chronic obstructive airway disease
  
Topics: preventive medicine, advisory committees, testicular cancer, testicular malignant germ cell tumor
  
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