Cover photograph by Francisco González-Scarano, MD
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Low-carbohydrate diets are popular for weight loss, but their cardiovascular effects have not been well-studied, particularly in diverse populations. In this randomized trial, the authors examined the effects of a low-carbohydrate diet compared with a low-fat diet on weight and cardiovascular risk factors in a sample of obese black and white adults. The results suggest that restricting carbohydrates could be an option for persons who are seeking to lose weight and improve cardiovascular risk factors.
This analysis examined HIV-1 persistence in various tissues from 2 men with HIV who had undetectable HIV-1 after allogeneic hematopoietic stem cell transplantation. HIV had remained undetectable until 12 and 32 weeks after antiretroviral cessation. Rebound viremia and symptoms consistent with the acute retroviral syndrome developed in both patients. Reinitiation of active therapy led to viral decay and resolution of symptoms.
Diabetes prevalence in the United States has increased in the past several decades. The authors completed a series of cross-sectional studies based on data from nationally representative samples of men and women between 1976 and 2010 to better understand how trends in race/ethnicity, age, and obesity prevalence have contributed to this increase. After adjustment for these factors, diabetes prevalence still increased in men but not women, with body mass index being a substantial contributor.
Carotid artery stenosis (CAS) can cause ischemic stroke. This systematic review for the U.S. Preventive Services Task Force examined evidence about screening and treating asymptomatic adults for CAS. The authors found that screening with ultrasonography would result in many false-positive results because asymptomatic CAS has low prevalence. They also found that standard medical therapies used to prevent stroke, such as statins and antihypertensive agents, have reduced the rate of stroke in persons with asymptomatic CAS in recent decades.
This network meta-analysis of trial data examined the effect of different resuscitative fluids on mortality in patients with sepsis. It showed possible higher mortality with starches than with crystalloids and lower mortality with albumin and balanced crystalloids than with saline or starches. Trial designs, populations, and quality were heterogeneous, and estimates of effect, which were derived primarily from indirect comparisons, were sometimes imprecise.
This updated U.S. Preventive Services Task Force recommendation on screening for CAS applies to adults without a history of transient ischemic attack, stroke, or other neurologic signs or symptoms. The Task Force recommends against screening for asymptomatic CAS in the general adult population.
GlaxoSmithKline recently announced that it will no longer hire physicians to lecture prescribers about its products. This commentary discusses possible motivators behind this decision and why physicians should welcome it.
Several initiatives aim to shift our health care system toward a value-based purchasing system to improve the quality of health care. The Centers for Medicare & Medicaid Services (CMS) Physician Quality Reporting System (PQRS) uses a combination of incentive payments and payment adjustments to promote reporting of quality information. This article describes the PQRS and actions that clinicians need to take in 2014 to avoid penalties in CMS reimbursement in 2016.
In this issue, Henrich and colleagues report on 2 HIV-infected patients who had undetectable virus after hematopoietic stem cell transplantation that returned 12 and 32 weeks after stopping antiretroviral therapy. The editorialist discusses the study and what we have learned about long-term remission of HIV.
In this issue, the U.S. Preventive Services Task Force recommends against screening for asymptomatic CAS. However, such screenings are offered throughout the United States. The editorialist discusses the recommendation and warns potential consumers of these services to be aware that screening is unlikely to prevent them from having a stroke.
In this issue, Rochwerg and colleagues' network meta-analysis compares various strategies for fluid resuscitation in sepsis. The editorialist discusses the meta-analysis and raises unanswered questions about the role of crystalloid solutions in fluid resuscitation.
Harlan Casey's room was the farthest from the nurses' station at the end of the hallway, one usually saved for patients with contagious disease. Yet Harlan had clogged arteries and a failing heart.