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Lydia A. Bazzano, MD, PhD, MPH; Tian Hu, MD, MS; Kristi Reynolds, PhD; Lu Yao, MD, MS; Calynn Bunol, MS, RD, LDN; Yanxi Liu, MS; Chung-Shiuan Chen, MS; Michael J. Klag, MD, MPH; Paul K. Whelton, MD, MSc, MB; and Jiang He, MD, PhD

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.

Topics: carbohydrate, diet, blacks, dietary fats, carbohydrate restricted diet, changes in diet, obesity, ...
  
Timothy J. Henrich, MD; Emily Hanhauser, BS; Francisco M. Marty, MD; Michael N. Sirignano, BS; Sheila Keating, PhD; Tzong-Hae Lee, MD, PhD; Yvonne P. Robles, BA; Benjamin T. Davis, MD; Jonathan Z. Li, MD; Andrea Heisey, BS; Alison L. Hill, PhD; Michael P. Busch, MD, PhD; Philippe Armand, MD, PhD; Robert J. Soiffer, MD; Marcus Altfeld, MD, PhD; and Daniel R. Kuritzkes, MD

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.

Topics: hiv, hiv-1, hiv infection, anti-retroviral agents, allogeneic hematopoietic stem cell transplant, disease ...
  

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.

Topics: obesity, body mass index procedure, diabetes mellitus, age, diabetes mellitus, type 2, ...
  
Daniel E. Jonas, MD, MPH; Cynthia Feltner, MD, MPH; Halle R. Amick, MSPH; Stacey Sheridan, MD, MPH; Zhi-Jie Zheng, MD, MPH, PhD; Daniel J. Watford, MD, MPH; Jamie L. Carter, MD, MPH; Cassandra J. Rowe, MPH; and Russell Harris, MD, MPH

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.

Topics: carotid stenosis, ischemic stroke, screening
  
Bram Rochwerg, MD; Waleed Alhazzani, MD; Anees Sindi, MD; Diane Heels-Ansdell, MSc; Lehana Thabane, PhD; Alison Fox-Robichaud, MD; Lawrence Mbuagbaw, MSc; Wojciech Szczeklik, MD; Fayez Alshamsi, MD; Sultan Altayyar, MD; Wang-Chun Ip, MD; Guowei Li, MSc; Michael Wang, MD; Anna Włudarczyk, MD; Qi Zhou, PhD; Gordon H. Guyatt, MD; Deborah J. Cook, MD; Roman Jaeschke, MD; Djillali Annane, MD, PhD, for the Fluids in Sepsis and Septic Shock Group

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.

Topics: colloids, septicemia, starch, crystalloid, normal saline, fluid resuscitation, saline solution, albumin solution, ...
  

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.

Topics: carotid stenosis, ischemic stroke, screening
  

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.

Topics: physicians, drug industry, off-label use, prescribing behavior, pharmaceutical company, marketing, expert opinion, ...
  

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.

Topics: physician quality reporting system, health policy
  

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.

Topics: hiv, hematopoietic stem cell transplantation, hiv-1, allogeneic stem cell transplant, hiv infection, ...
  

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.

Topics: carotid stenosis, ischemic stroke, screening
  

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.

Topics: systemic infection, albumins, colloids, septicemia, starch, crystalloid, normal saline, fluid resuscitation, saline ...
  
Scott K. Heysell, MD, MPH
Includes: Audio/Video

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.

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Lynn Malinoff, EdD
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Russell Andrew Johnson, MD, MSc
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Denise L. Faustman, MD, PhD; Frederick B. Vivino, MD; and Steven E. Carsons, MD
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Alain Saraux, MD, PhD; Emmanuel Nowak, PhD; and Valérie Devauchelle-Pensec, MD, PhD
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Dhruv S. Kazi, MD, MSc, MS; Douglas K. Owens, MD, MS; and Mark A. Hlatky, MD
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NaNa Keum, MS; Chung-Cheng Hsieh, ScD; and Nancy Cook, ScD
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Alina Markova, MD; Sarah A. Kam, BA; Daniel D. Miller, MD; and Michael K. Lichtman, MD
Includes: CME
Topics: parasites, sarcoptes scabiei, scabies, skin diseases, parasitic, bedbugs, infestation by bed bug, ...
  
Topics: obesity, fat-restricted diet, carbohydrate, diet, blacks, dietary fats, carbohydrate restricted diet, changes ...
  
Topics: carotid stenosis, ischemic stroke, screening
  
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