Cover photograph by Richard Gambescia, MD
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Evidence suggests that salsalate can improve glycemia in type 2 diabetes, but its efficacy and safety have not been tested using currently accepted regulatory practices. This randomized trial of patients with poorly controlled type 2 diabetes found that salsalate improved hemoglobin A1c levels and decreased inflammatory markers over 1 year compared with placebo. However, weight and total and low-density lipoprotein cholesterol levels increased. Urinary albumin levels also increased but reversed after salsalate was discontinued. Salsalate may be beneficial in glucose control in type 2 diabetes, but further study of its effects on cardiac and renal outcomes is warranted.
Some U.S. studies have shown that black persons are more likely than white persons to be diagnosed with colorectal cancer and to die from it. This study of average-risk adults undergoing screening colonoscopy found that the prevalence of advanced colorectal neoplasia (ACN) was higher among white persons than black persons. Analyses that controlled for multiple risk factors showed that black men were 41% less likely than white men to have ACN. These findings suggest that disparities in access to screening explain the higher risk for ACN observed in black men than in white men.
In the northeastern United States, an acute febrile illness with marked elevation of aminotransferase levels and thrombocytopenia is often caused by human granulocytic anaplasmosis (HGA). This case report discusses 2 patients with presumed HGA whose diagnostic studies were negative for Anaplasma phagocytophilum and all tickborne infections common in the region. Molecular diagnostic assays detected Borrelia miyamotoi, an emerging pathogen. In patients with presumed HGA, especially those not rapidly responding to doxycycline, possible infection with B. miyamotoi should be considered.
Pressure ulcers are associated with substantial health burdens but may be preventable. This systematic review examined the utility of pressure ulcer risk assessment instruments and the benefits and harms of preventive interventions. It found that the effectiveness of formal risk assessment instruments and associated intervention protocols versus less standardized assessment methods and the effectiveness of other preventive interventions versus usual care have not been clearly established. Advanced static support surfaces seem to be more effective than standard mattresses for preventing ulcers in higher-risk populations.
Pressure ulcers are major sources of morbidity, mortality, and health care costs. This systematic review examined the comparative effectiveness and harms of strategies for treating pressure ulcers. It found moderate-strength evidence that air-fluidized beds, protein-containing nutritional supplements, radiant heat dressings, and electrical stimulation improved healing of pressure ulcers. Evidence to support the effectiveness and safety of alternating-pressure surfaces, platelet-derived growth factor, hydrocolloid, light therapy, and on dermatologic reactions with several local wound applications and adjunctive therapies is limited.
The recommendations from the U.S. Preventive Services Task Force recommend screening for HIV infection in all adolescents and adults aged 15 to 65 years, younger adolescents and older adults who have risk factors for HIV infection, and all pregnant women.
In this issue, Chowdri and colleagues' case reports provide further evidence of human Borrelia miyamotoi infection in the northeastern United States. The editorialists discuss the case reports and how they provide a better understanding of human B. miyamotoi infection but conclude that many questions about the infection remain unanswered.
The updated U.S. Preventive Services Task Force recommendations on screening for HIV infection converge with those from the Centers for Disease Control and Prevention. The editorialists comment on the Task Force recommendations and see them as informing the road map to the elusive end to AIDS.
Clinical trials, like all scientific experiments, are guided by protocols that outline the study design, conduct, and analysis. Deviations from the protocol that cannot be scientifically justified are worrisome because they could undermine the validity of the study or analysis. The editorialists discuss 2 recent Annals letters that address this problem.
Don't get sick in July. This adage stems from fear that patient care at a teaching hospital in July is delivered by brand-new physicians, sometimes with more confidence than competence. Once upon a July, 20 years ago now, I was that newly minted doctor.
Every day as I drive by the hospital where Dad was treated, I am disturbed by the thought that what our family experienced is being repeated daily in a medical culture that avoids guiding patients and their families through these difficult dialogues.