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Susan N. Hocevar, MD; Christopher D. Paddock, MD; Cedric W. Spak, MD; Randall Rosenblatt, MD; Hector Diaz-Luna, MD; Isabel Castillo, RN, BSN; Sergio Luna, RN; Glen C. Friedman, MD; Suresh Antony, MD; Robyn A. Stoddard, DVM, PhD; Rebekah V. Tiller, MPH; Tammie Peterson, RN, MSN/MPH, CPTC; Dianna M. Blau, DVM, PhD; Rama R. Sriram, BS; Alexandre da Silva, PhD; Marcos de Almeida, PhD; Theresa Benedict, BS; Cynthia S. Goldsmith, MGS; Sherif R. Zaki, MD, PhD; Govinda S. Visvesvara, PhD; Matthew J. Kuehnert, MD, for the Microsporidia Transplant Transmission Investigation Team
Includes: Audio/Video

Encephalitozoon cuniculi, a microsporidial species most commonly recognized as a cause of renal, respiratory, and central nervous system infections in immunosuppressed patients, was identified as the cause of an illness cluster among 3 solid organ transplant recipients from a common donor. In this public health investigation, the authors tested specimens for microsporidia, reviewed donor medical records, and developed a questionnaire to assess for microsporidia infection. They concluded that microsporidiosis should be considered in febrile transplant recipients when tests for routinely encountered agents are unrevealing.

Topics: encephalitozoon cuniculi, microsporidiosis, organ transplantation, public health medicine, transplanted organ, infection in ...
  
Dhruv S. Kazi, MD, MSc, MS; Alan M. Garber, MD, PhD; Rashmee U. Shah, MD, MS; R. Adams Dudley, MD, MBA; Matthew W. Mell, MD; Ceron Rhee, MBA; Solomon Moshkevich, MBA; Derek B. Boothroyd, PhD; Douglas K. Owens, MD; and Mark A. Hlatky, MD

Choosing an antiplatelet therapy for acute coronary syndrome is complicated, particularly for percutaneous coronary intervention patients. Clopidogrel has been the standard of care, but 2 more expensive drugs, prasugrel and ticagrelor, are now approved for this disorder. This cost-effectiveness analysis compares 5 strategies involving these drugs, both with and without genotyping for polymorphisms of CYP2C19 before treatment.

Topics: acute coronary syndromes, antiplatelet agents, clopidogrel, percutaneous coronary intervention, cost effectiveness, pharmacogenetics, ...
  
Valérie Devauchelle-Pensec, MD, PhD; Xavier Mariette, MD, PhD; Sandrine Jousse-Joulin, MD; Jean-Marie Berthelot, MD; Aleth Perdriger, MD, PhD; Xavier Puéchal, MD, PhD; Véronique Le Guern, MD, PhD; Jean Sibilia, MD, PhD; Jacques-Eric Gottenberg, MD, PhD; Laurent Chiche, MD, PhD; Eric Hachulla, MD, PhD; Pierre Yves Hatron, MD; Vincent Goeb, MD, PhD; Gilles Hayem, MD; Jacques Morel, MD, PhD; Charles Zarnitsky, MD; Jean Jacques Dubost, MD; Jacques Olivier Pers, MD, PhD; Emmanuel Nowak, PhD; and Alain Saraux, MD, PhD

Primary Sjögren syndrome (pSS) is an autoimmune disorder that causes ocular and oral dryness and usually affects women aged 40 to 50 years. In this randomized trial conducted at 14 university hospitals in France, rituximab compared with placebo did not alleviate disease activity in patients with pSS. Although rituximab alleviated some symptoms during early treatment, it did not provide lasting benefit.

Topics: sjogren's syndrome, rituximab
  
Caroline A. Kim, MD, MS; Suraj P. Rasania, MD; Jonathan Afilalo, MD, MSc; Jeffrey J. Popma, MD; Lewis A. Lipsitz, MD; and Dae Hyun Kim, MD, MPH
Includes: CME | Audio/Video

For years, surgical aortic valve replacement has been used to treat aortic stenosis and has decreased mortality rates and improved quality of life. Transcatheter aortic valve replacement has recently surfaced as an alternative, but benefit has not been established. This review evaluates the changes in functional status and quality of life in patients after receiving transcatheter aortic valve replacement.

Topics: quality of life, functional status, transcatheter aortic-valve implantation, new york heart association ...
  
Heidi D. Nelson, MD, MPH; Miranda Pappas, MA; Bernadette Zakher, MBBS; Jennifer Priest Mitchell, BA; Leila Okinaka-Hu, MD; and Rongwei Fu, PhD

This systematic review, conducted to inform the U.S. Preventive Services Task Force, summarizes evidence about risk assessment and genetic counseling and testing for BRCA-related cancer in women. Findings include referral models that accurately estimate individual risk for BRCA mutations and several possible benefits of genetic counseling, including increased accuracy of risk perception, decreased intention for genetic testing among unlikely carriers, and decreased cancer-related worry. Potential benefits and harms of genetic counseling and testing varied according to the woman's underlying risk.

Topics: genetic counseling, breast cancer, genetic testing for cancer risk, genetic screening, hereditary ...
  
John E. Cornell, PhD; Cynthia D. Mulrow, MD, MSc; Russell Localio, PhD; Catharine B. Stack, PhD, MS; Anne R. Meibohm, PhD; Eliseo Guallar, MD, DrPH; and Steven N. Goodman, MD, PhD

A primary goal of meta-analysis is to improve the estimation of treatment effects by pooling results of similar studies. This article discusses the problems associated with using the DerSimonian–Laird estimator, a widely used method for pooling heterogeneous studies. The authors suggest using analyses based on a critical synthesis that recognizes the uncertainty in the evidence and describe several analyses that provide more accurate results than the DerSimonian–Laird method.

Topics: meta-analysis
  

The U.S. Preventive Services Task Force (USPSTF) recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer to identify a family history that may be associated with an increased risk for mutations in BRCA1 or BRCA2. The USPSTF recommends that women with positive screening results receive genetic counseling and, if indicated after counseling, BRCA testing. It recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for mutations in the BRCA1 or BRCA2 genes.

Topics: genetic testing for cancer risk, genetic screening, screening, hereditary breast and ovarian ...
  

In this issue, Hocevar and colleagues discuss their investigation into an illness cluster among 3 solid organ transplant recipients from a common donor, which they found to be due to infection with the microorganism E. cuniculi. The editorialist urges clinicians to be mindful of the potential for donor-derived infections and to notify the appropriate parties when such an infection is suspected.

Topics: organ transplantation, tissue donors, transplanted organ, infection in solid organ transplant recipients, ...
  

In this issue, Kazi and colleagues analyze the cost-effectiveness of 5 dual antiplatelet therapy strategies for acute coronary syndrome after percutaneous coronary intervention. The editorialist discusses the findings and commends the authors for conducting an analysis that included the potential benefits of new therapies and genetic testing.

Topics: acute coronary syndromes, antiplatelet agents, cost effectiveness, evidence-based medicine, decision making, pharmacogenetics ...
  
Cathy Liu, MD
Includes: Audio/Video

My life changed in an instant. I was in my second week of internal medicine residency at University of California, Davis, School of Medicine. I don't remember the car that hit me.

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Jonathan Kole, MD, MBE
Includes: Audio/Video

In the first 2 years of medical school, buried in biochemistry and living in lecture halls, we craved patient contact. Eager to serve and solve with science, we longed for opportunities to put our diagnostic skills to use.

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Andrew M. Fine, MD, MPH; Victor Nizet, MD; and Kenneth D. Mandl, MD, MPH
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Alanna Weisman, MD; and Gary F. Lewis, MD
Topics: hypertriglyceridemia, laser therapy, low-level, liposuction
  
Delphine Maret, DDS; Norbert Telmon, MD; Jacques Treil, MD; Philippe Caron, MD; and Cathy Nabet, DDS
Topics: dentistry, radiography, dental, pituitary adenoma, incidental findings
  
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Nicky Quinlan, MB, BCh, BAO
Includes: Audio/Video
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D. L. Longworth, MD
Includes: Audio/Video
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Topics: influenza virus vaccine, cardiovascular event
  
Topics: anticoagulants, oral, nonvalvular atrial fibrillation, ischemic stroke, vitamin k antagonist, dabigatran etexilate ...
  
Topics: acute coronary syndromes, anticoagulants, oral, venous thrombosis, gastrointestinal bleeding
  
Topics: cardiopulmonary resuscitation, resuscitators, cardiopulmonary, out-of-hospital cardiac arrest
  
Topics: diabetes mellitus, diabetes mellitus, type 1, diabetes mellitus, type 2, hemoglobin a, ...
  
Topics: physical therapy, urinary incontinence, stress, pelvic floor exercises, comparative effectiveness research, treatment ...
  
Topics: sumatriptan, naproxen, acute migraine
  
Topics: treatment outcome, metered dose inhaler device, asthma, acute, adrenergic beta2-agonists, spacer device ...
  
Topics: alcohol dependence, ethanol, gabapentin, drug/alcohol abstinence
  
Topics: rheumatoid arthritis, antirheumatic drugs, disease-modifying, fish oil
  
Topics: dementia, elderly, screening test, patient-focused outcomes, dementia screening
  
Topics: pregnancy, congenital abnormality, fetal death, metoclopramide
  

The Consult Guys bring a new perspective to the art and science of medicine with lively discussion and analysis of real-world cases and situations.

Topics: aortic valve stenosis, feces, heme
  
Topics: sjogren's syndrome, rituximab
  
Topics: breast cancer, ovarian cancer, genetic testing for cancer risk, screening, hereditary breast ...
  
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