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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.
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.
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.
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.
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.
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.
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.
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.
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.
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