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Idiopathic pulmonary fibrosis (IPF) is a life-threatening, progressive disease with no approved therapy. Endothelin-1 is believed to be involved in its pathogenesis. This trial aimed to determine the efficacy of ambrisentan, a selective endothelin receptor antagonist, in treating IPF but was terminated after an interim analysis indicated a low likelihood of efficacy. Patients who received ambrisentan were more likely to meet criteria for disease progression and respiratory hospitalizations than those who received placebo. Ambrisentan should not be used to treat patients with IPF.
In the United States, lungs are allocated on the basis of the lung allocation score (LAS), which incorporates clinical variables to balance expected survival with and without transplantation. Whether acute changes in the LAS are associated with altered survival after transplantation is unknown. In this study of U.S. lung transplant recipients, an acute change in the LAS during the 30 days before transplantation was associated with worse survival after transplantation. Further study of changes in LAS may help refine the selection of patients for lung transplantation.
It has been postulated that HIV infection accelerates hepatitis C virus (HCV)–related liver disease. This cohort study followed persons with HCV infection prospectively to compare the progression of liver disease in those with and without HIV infection. Using elastography to assess for the presence of fibrosis and cirrhosis semiannually, investigators found that patients with HIV and HCV coinfection had liver fibrosis measures equivalent to those of patients with only HCV who were nearly a decade older. Increasing age and HIV infection are independently associated with the stage of HCV-related liver fibrosis. The mechanism behind this observation warrants investigation.
Tobacco use increases the risk for tuberculosis. Targeting tobacco cessation efforts to smokers with suspected tuberculosis might be an effective use of limited resources in low- and middle-income countries. In this trial of smokers with suspected tuberculosis in Pakistan, behavioral support with or without bupropion therapy was more effective than usual care at achieving abstinence at 6 months. Investigators could not establish whether bupropion therapy provided additional benefit over behavioral support alone.
This review compared evidence on management strategies, including medical therapy alone, carotid endarterectomy (CEA) plus medical therapy, or carotid artery stenting (CAS) plus medical therapy, for adults with asymptomatic carotid artery stenosis. Evidence was neither sufficiently robust (for CAS) nor applicable to current clinical practice (for CEA) to determine the superiority of one strategy over another. Future trials should explore whether revascularization interventions provide benefit to patients treated by best-available medical therapy.
This Update summarizes studies published in 2012 that the authors consider highly relevant to the practice of infectious disease. Topics include sinusitis, azithromycin toxicity, infective endocarditis, asymptomatic bacteriuria and recurrent urinary tract infection, HIV prevention, a newly discovered pathogen, Lyme disease, and fungal meningitis.
In its recommendation on vitamin D and calcium supplementation to prevent fractures in adults, the U.S. Preventive Services Task Force concludes that the current evidence is insufficient to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation to prevent fractures in men or premenopausal women and of daily supplementation with >400 IU of vitamin D3 and >1000 mg of calcium to prevent fractures in noninstitutionalized postmenopausal women. It recommends against daily supplementation with ≤400 IU of vitamin D3 and ≤1000 mg of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women.
Evidence-based, well-implemented, and enforced gun policies can reduce gun violence, and this vision can be realized with the help of physicians. As the details of policy proposals unfold and the public and policymakers weigh the options, this commentary presents 5 strategies for physician engagement in these discussions.
In this issue, Tsuang and colleagues identify a new variable that independently predicts survival after lung transplantation: an increase in the lung allocation score 30 days before transplantation. The editorialist discusses the study and its findings, and concludes that the study should prompt a discussion about whether the current allocation system should be modified to limit access for candidates with unacceptably low predicted posttransplantation survival.
In this issue, the U.S. Preventive Services Task Force plunges headlong into ongoing debates about whether healthy adults—those who show no signs of vitamin D deficiency or osteoporosis—should be advised to take combined supplements of calcium and vitamin D to prevent bone fractures and, if so, at what level. The editorialists discuss the recommendations and their implications.
It is so difficult to bring up the topic of obesity with an obese patient. Yet, the inpatient, admitted with uncontrolled diabetes or hypertension presents a perfect teaching opportunity. But how do you tell someone you met 10 minutes ago that they need to lose weight?