On-pump versus off-pump CABG.

N Engl J Med. 2010 Mar 4;362(9):852; author reply 853-4

Authors: Taggart DP

PMID: 20213877 [PubMed - indexed for MEDLINE]

On-pump versus off-pump CABG.

N Engl J Med. 2010 Mar 4;362(9):852-3; author reply 853-4

Authors: Caplan LR

PMID: 20213880 [PubMed - indexed for MEDLINE]

On-pump versus off-pump CABG.

N Engl J Med. 2010 Mar 4;362(9):852; author reply 853-4

Authors: Augoustides JG

PMID: 20213879 [PubMed - indexed for MEDLINE]

On-pump versus off-pump CABG.

N Engl J Med. 2010 Mar 4;362(9):852; author reply 853-4

Authors: Kieser TM

PMID: 20213878 [PubMed - indexed for MEDLINE]

A controlled trial of initial antiviral regimens for HIV-1 infection.

N Engl J Med. 2010 Mar 4;362(9):854-5; author reply 855

Authors: Leiner S

PMID: 20213882 [PubMed - indexed for MEDLINE]

Revascularization for renal-artery stenosis.

N Engl J Med. 2010 Feb 25;362(8):762-3; author reply 763-4

Authors: Esposito P, Piotti G, Dal Canton A

PMID: 20191667 [PubMed - in process]

A novel antibody associated with autoimmune pancreatitis.

N Engl J Med. 2010 Feb 25;362(8):759-60; author reply 760-1

Authors: Park do H, Hwang JY, Kim MH

PMID: 20191666 [PubMed - in process]

A novel antibody associated with autoimmune pancreatitis.

N Engl J Med. 2010 Feb 25;362(8):759; author reply 760-1

Authors: Wang CC, Kao JH

PMID: 20191665 [PubMed - in process]

Management of lung nodules detected by volume CT scanning.

N Engl J Med. 2010 Feb 25;362(8):757-8; author reply 758-9

Authors: Bölükbas S, Eberlein M, Schirren J

PMID: 20191664 [PubMed - in process]

Revascularization for renal-artery stenosis.

N Engl J Med. 2010 Feb 25;362(8):763; author reply 763-4

Authors: Mills NL, Dhaun N, Uren NG

PMID: 20191669 [PubMed - in process]

Revascularization for renal-artery stenosis.

N Engl J Med. 2010 Feb 25;362(8):762; author reply 763-4

Authors: Wilentz JR

PMID: 20191668 [PubMed - in process]

The Democrats' Last Ditch -- Reconciliation or Bust.

N Engl J Med. 2010 Mar 3;

Authors: Iglehart JK

PMID: 20200360 [PubMed - as supplied by publisher]

Haitian Amputees -- Lessons Learned from Sierra Leone.

N Engl J Med. 2010 Mar 3;

Authors: Kelly JD

PMID: 20200359 [PubMed - as supplied by publisher]

Choosing Asthma Step-up Care.

N Engl J Med. 2010 Mar 3;

Authors: von Mutius E, Drazen JM

PMID: 20197426 [PubMed - as supplied by publisher]

Step-up Therapy for Children with Uncontrolled Asthma Receiving Inhaled Corticosteroids.

N Engl J Med. 2010 Mar 3;

Authors: Lemanske RF, Mauger DT, Sorkness CA, Jackson DJ, Boehmer SJ, Martinez FD, Strunk RC, Szefler SJ, Zeiger RS, Bacharier LB, Covar RA, Guilbert TW, Larsen G, Morgan WJ, Moss MH, Spahn JD, Taussig LM,

BACKGROUND: For children who have uncontrolled asthma despite the use of low-dose inhaled corticosteroids (ICS), evidence to guide step-up therapy is lacking. METHODS: We randomly assigned 182 children (6 to 17 years of age), who had uncontrolled asthma while receiving 100 mug of fluticasone twice daily, to receive each of three blinded step-up therapies in random order for 16 weeks: 250 mug of fluticasone twice daily (ICS step-up), 100 mug of fluticasone plus 50 mug of a long-acting beta-agonist twice daily (LABA step-up), or 100 mug of fluticasone twice daily plus 5 or 10 mg of a leukotriene-receptor antagonist daily (LTRA step-up). We used a triple-crossover design and a composite of three outcomes (exacerbations, asthma-control days, and the forced expiratory volume in 1 second) to determine whether the frequency of a differential response to the step-up regimens was more than 25%. RESULTS: A differential response occurred in 161 of 165 patients who were evaluated (P<0.001). The response to LABA step-up therapy was most likely to be the best response, as compared with responses to LTRA step-up (relative probability, 1.6; 95% confidence interval [CI], 1.1 to 2.3; P=0.004) and ICS step-up (relative probability, 1.7; 95% CI, 1.2 to 2.4; P=0.002). Higher scores on the Asthma Control Test before randomization (indicating better control at baseline) predicted a better response to LABA step-up (P=0.009). White race predicted a better response to LABA step-up, whereas black patients were least likely to have a best response to LTRA step-up (P=0.005). CONCLUSIONS: Nearly all the children had a differential response to each step-up therapy. LABA step-up was significantly more likely to provide the best response than either ICS or LTRA step-up. However, many children had a best response to ICS or LTRA step-up therapy, highlighting the need to regularly monitor and appropriately adjust each child's asthma therapy. (ClinicalTrials.gov number, NCT00395304.) Copyright 2010 Massachusetts Medical Society.

PMID: 20197425 [PubMed - as supplied by publisher]

Haiti -- A View from the Ship.

N Engl J Med. 2010 Mar 3;

Authors: Curran M

PMID: 20200363 [PubMed - as supplied by publisher]

The Israeli Field Hospital in Haiti -- Ethical Dilemmas in Early Disaster Response.

N Engl J Med. 2010 Mar 3;

Authors: Merin O, Ash N, Levy G, Schwaber MJ, Kreiss Y

PMID: 20200362 [PubMed - as supplied by publisher]

Ministry of Touch -- Reflections on Disaster Work after the Haitian Earthquake.

N Engl J Med. 2010 Mar 3;

Authors: Goodman A

PMID: 20200361 [PubMed - as supplied by publisher]

Medicare's opportunity to encourage innovation in health care delivery.

N Engl J Med. 2010 Mar 4;362(9):772-4

Authors: Mechanic R, Altman S

PMID: 20200381 [PubMed - in process]

Images in clinical medicine. Neuropathic ulceration.

N Engl J Med. 2010 Mar 4;362(9):e26

Authors: Teelucksingh S, Naraynsingh V

PMID: 20200380 [PubMed - in process]

Health Care Reform -- Where Do We Go from Here?

N Engl J Med. 2010 Mar 3;

Authors: Wilensky GR

PMID: 20200364 [PubMed - as supplied by publisher]

Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy.

N Engl J Med. 2010 Mar 4;362(9):790-9

Authors: Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Capparelli EV, Adamson PC,

BACKGROUND: Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine. The most efficacious and tolerable initial empirical treatment has not been defined. METHODS: In a double-blind, randomized, controlled clinical trial, we compared the efficacy, tolerability, and neuropsychological effects of ethosuximide, valproic acid, and lamotrigine in children with newly diagnosed childhood absence epilepsy. Drug doses were incrementally increased until the child was free of seizures, the maximal allowable or highest tolerable dose was reached, or a criterion indicating treatment failure was met. The primary outcome was freedom from treatment failure after 16 weeks of therapy; the secondary outcome was attentional dysfunction. Differential drug effects were determined by means of pairwise comparisons. RESULTS: The 453 children who were randomly assigned to treatment with ethosuximide (156), lamotrigine (149), or valproic acid (148) were similar with respect to their demographic characteristics. After 16 weeks of therapy, the freedom-from-failure rates for ethosuximide and valproic acid were similar (53% and 58%, respectively; odds ratio with valproic acid vs. ethosuximide, 1.26; 95% confidence interval [CI], 0.80 to 1.98; P=0.35) and were higher than the rate for lamotrigine (29%; odds ratio with ethosuximide vs. lamotrigine, 2.66; 95% CI, 1.65 to 4.28; odds ratio with valproic acid vs. lamotrigine, 3.34; 95% CI, 2.06 to 5.42; P<0.001 for both comparisons). There were no significant differences among the three drugs with regard to discontinuation because of adverse events. Attentional dysfunction was more common with valproic acid than with ethosuximide (in 49% of the children vs. 33%; odds ratio, 1.95; 95% CI, 1.12 to 3.41; P=0.03). CONCLUSIONS: Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects. (ClinicalTrials.gov number, NCT00088452.)

PMID: 20200383 [PubMed - in process]

Comparison of dopamine and norepinephrine in the treatment of shock.

N Engl J Med. 2010 Mar 4;362(9):779-89

Authors: De Backer D, Biston P, Devriendt J, Madl C, Chochrad D, Aldecoa C, Brasseur A, Defrance P, Gottignies P, Vincent JL,

BACKGROUND: Both dopamine and norepinephrine are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other. METHODS: In this multicenter, randomized trial, we assigned patients with shock to receive either dopamine or norepinephrine as first-line vasopressor therapy to restore and maintain blood pressure. When blood pressure could not be maintained with a dose of 20 microg per kilogram of body weight per minute for dopamine or a dose of 0.19 microg per kilogram per minute for norepinephrine, open-label norepinephrine, epinephrine, or vasopressin could be added. The primary outcome was the rate of death at 28 days after randomization; secondary end points included the number of days without need for organ support and the occurrence of adverse events. RESULTS: The trial included 1679 patients, of whom 858 were assigned to dopamine and 821 to norepinephrine. The baseline characteristics of the groups were similar. There was no significant between-group difference in the rate of death at 28 days (52.5% in the dopamine group and 48.5% in the norepinephrine group; odds ratio with dopamine, 1.17; 95% confidence interval, 0.97 to 1.42; P=0.10). However, there were more arrhythmic events among the patients treated with dopamine than among those treated with norepinephrine (207 events [24.1%] vs. 102 events [12.4%], P<0.001). A subgroup analysis showed that dopamine, as compared with norepinephrine, was associated with an increased rate of death at 28 days among the 280 patients with cardiogenic shock but not among the 1044 patients with septic shock or the 263 with hypovolemic shock (P=0.03 for cardiogenic shock, P=0.19 for septic shock, and P=0.84 for hypovolemic shock, in Kaplan-Meier analyses). CONCLUSIONS: Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events. (ClinicalTrials.gov number, NCT00314704.)

PMID: 20200382 [PubMed - in process]

Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults.

N Engl J Med. 2010 Mar 4;362(9):800-11

Authors: Selvin E, Steffes MW, Zhu H, Matsushita K, Wagenknecht L, Pankow J, Coresh J, Brancati FL

BACKGROUND: Fasting glucose is the standard measure used to diagnose diabetes in the United States. Recently, glycated hemoglobin was also recommended for this purpose. METHODS: We compared the prognostic value of glycated hemoglobin and fasting glucose for identifying adults at risk for diabetes or cardiovascular disease. We measured glycated hemoglobin in whole-blood samples from 11,092 black or white adults who did not have a history of diabetes or cardiovascular disease and who attended the second visit (occurring in the 1990-1992 period) of the Atherosclerosis Risk in Communities (ARIC) study. RESULTS: The glycated hemoglobin value at baseline was associated with newly diagnosed diabetes and cardiovascular outcomes. For glycated hemoglobin values of less than 5.0%, 5.0 to less than 5.5%, 5.5 to less than 6.0%, 6.0 to less than 6.5%, and 6.5% or greater, the multivariable-adjusted hazard ratios (with 95% confidence intervals) for diagnosed diabetes were 0.52 (0.40 to 0.69), 1.00 (reference), 1.86 (1.67 to 2.08), 4.48 (3.92 to 5.13), and 16.47 (14.22 to 19.08), respectively. For coronary heart disease, the hazard ratios were 0.96 (0.74 to 1.24), 1.00 (reference), 1.23 (1.07 to 1.41), 1.78 (1.48 to 2.15), and 1.95 (1.53 to 2.48), respectively. The hazard ratios for stroke were similar. In contrast, glycated hemoglobin and death from any cause were found to have a J-shaped association curve. All these associations remained significant after adjustment for the baseline fasting glucose level. The association between the fasting glucose levels and the risk of cardiovascular disease or death from any cause was not significant in models with adjustment for all covariates as well as glycated hemoglobin. For coronary heart disease, measures of risk discrimination showed significant improvement when glycated hemoglobin was added to models including fasting glucose. CONCLUSIONS: In this community-based population of nondiabetic adults, glycated hemoglobin was similarly associated with a risk of diabetes and more strongly associated with risks of cardiovascular disease and death from any cause as compared with fasting glucose. These data add to the evidence supporting the use of glycated hemoglobin as a diagnostic test for diabetes.

PMID: 20200384 [PubMed - in process]

Management of varices and variceal hemorrhage in cirrhosis.

N Engl J Med. 2010 Mar 4;362(9):823-32

Authors: Garcia-Tsao G, Bosch J

PMID: 20200386 [PubMed - in process]

A trial of a 7-valent pneumococcal conjugate vaccine in HIV-infected adults.

N Engl J Med. 2010 Mar 4;362(9):812-22

Authors: French N, Gordon SB, Mwalukomo T, White SA, Mwafulirwa G, Longwe H, Mwaiponya M, Zijlstra EE, Molyneux ME, Gilks CF

BACKGROUND: Streptococcus pneumoniae is a leading and serious coinfection in adults with human immunodeficiency virus (HIV) infection, particularly in Africa. Prevention of this disease by vaccination with the current 23-valent polysaccharide vaccine is suboptimal. Protein conjugate vaccines offer a further option for protection, but data on their clinical efficacy in adults are needed. METHODS: In this double-blind, randomized, placebo-controlled clinical efficacy trial, we studied the efficacy of a 7-valent conjugate pneumococcal vaccine in predominantly HIV-infected Malawian adolescents and adults who had recovered from documented invasive pneumococcal disease. Two doses of vaccine were given 4 weeks apart. The primary end point was a further episode of pneumococcal infection caused by vaccine serotypes or serotype 6A. RESULTS: From February 2003 through October 2007, we followed 496 patients (of whom 44% were male and 88% were HIV-seropositive) for 798 person-years of observation. There were 67 episodes of pneumococcal disease in 52 patients, all in the HIV-infected subgroup. In 24 patients, there were 19 episodes that were caused by vaccine serotypes and 5 episodes that were caused by the 6A serotype. Of these episodes, 5 occurred in the vaccine group and 19 in the placebo group, for a vaccine efficacy of 74% (95% confidence interval [CI], 30 to 90). There were 73 deaths from any cause in the vaccine group and 63 in the placebo group (hazard ratio in the vaccine group, 1.18; 95% CI, 0.84 to 1.66). The number of serious adverse events within 14 days after vaccination was significantly lower in the vaccine group than in the placebo group (3 vs. 17, P=0.002), and the number of minor adverse events was significantly higher in the vaccine group (41 vs. 13, P=0.003). CONCLUSIONS: The 7-valent pneumococcal conjugate vaccine protected HIV-infected adults from recurrent pneumococcal infection caused by vaccine serotypes or serotype 6A. (Current Controlled Trials number, ISRCTN54494731.)

PMID: 20200385 [PubMed - in process]

Clinical problem-solving. Stalking the diagnosis.

N Engl J Med. 2010 Mar 4;362(9):834-9

Authors: Chamarthi B, Morris CA, Kaiser UB, Katz JT, Loscalzo J

PMID: 20200388 [PubMed - in process]

Images in clinical medicine. Congenital cytomegalovirus infection.

N Engl J Med. 2010 Mar 4;362(9):833

Authors: Abdel-Latif Mel-A, Sugo E

PMID: 20200387 [PubMed - in process]

Collection of data on patients' race and ethnic group by physician practices.

N Engl J Med. 2010 Mar 4;362(9):846-50

Authors: Wynia MK, Ivey SL, Hasnain-Wynia R

PMID: 20200391 [PubMed - in process]

Ethosuximide in childhood absence epilepsy--older and better.

N Engl J Med. 2010 Mar 4;362(9):843-5

Authors: Vining EP

PMID: 20200390 [PubMed - in process]

Treating shock--old drugs, new ideas.

N Engl J Med. 2010 Mar 4;362(9):841-3

Authors: Levy JH

PMID: 20200389 [PubMed - in process]

A controlled trial of initial antiviral regimens for HIV-1 infection.

N Engl J Med. 2010 Mar 4;362(9):854; author reply 855

Authors: Parienti JJ

PMID: 20200393 [PubMed - in process]

On-pump versus off-pump CABG.

N Engl J Med. 2010 Mar 4;362(9):851; author reply 853-4

Authors: Puskas JD, Mack MJ, Smith CR

PMID: 20200392 [PubMed - in process]

A crisis in late pregnancy.

N Engl J Med. 2010 Mar 4;362(9):857; author reply 858

Authors: Hancock EW

PMID: 20200395 [PubMed - in process]

Effects of obesity and smoking on U.S. life expectancy.

N Engl J Med. 2010 Mar 4;362(9):855-6; author reply 856-7

Authors: Peto R, Whitlock G, Jha P

PMID: 20200394 [PubMed - in process]

Capecitabine and oxaliplatin for advanced esophagogastric cancer.

N Engl J Med. 2010 Mar 4;362(9):858-9

Authors: Cunningham D, Okines AF, Ashley S

PMID: 20200397 [PubMed - in process]

Repair of mitral-valve prolapse.

N Engl J Med. 2010 Mar 4;362(9):857

Authors: Bouzas-Mosquera A, Alvarez-Garcia N, Peteiro J

PMID: 20200396 [PubMed - in process]

Surveys of physicians and electronic health information.

N Engl J Med. 2010 Mar 4;362(9):859-60

Authors: Hesse BW, Moser RP, Rutten LJ

PMID: 20200398 [PubMed - in process]

Darbepoetin alfa and chronic kidney disease.

N Engl J Med. 2010 Feb 18;362(7):654-5; author reply 655

Authors: Locatelli F, Del Vecchio L, Casartelli D

PMID: 20187259 [PubMed - in process]

Darbepoetin alfa and chronic kidney disease.

N Engl J Med. 2010 Feb 18;362(7):653-4; author reply 655

Authors: Minnerup J, Schäbitz WR

PMID: 20187258 [PubMed - in process]

Thiazide diuretics.

N Engl J Med. 2010 Feb 18;362(7):659-60; author reply 660

Authors: Smith SM

PMID: 20187262 [PubMed - in process]

Rasagiline in Parkinson's disease.

N Engl J Med. 2010 Feb 18;362(7):658; author reply 658-9

Authors: Schwarzschild MA

PMID: 20187261 [PubMed - in process]

Darbepoetin alfa and chronic kidney disease.

N Engl J Med. 2010 Feb 18;362(7):654; author reply 655

Authors: Hampl H, Kovesdy CP, Kalantar-Zadeh K

PMID: 20187260 [PubMed - in process]

Market exclusivity for biologics.

N Engl J Med. 2010 Feb 18;362(7):661; author reply 661-2

Authors: Pollock A, Zagari M

PMID: 20187263 [PubMed - in process]

Civil-Military Collaboration in the Initial Medical Response to the Earthquake in Haiti.

N Engl J Med. 2010 Feb 24;

Authors: Auerbach PS, Norris RL, Menon AS, Brown IP, Kuah S, Schwieger J, Kinyon J, Helderman TN, Lawry L

PMID: 20181962 [PubMed - as supplied by publisher]

Be Not Afraid.

N Engl J Med. 2010 Feb 24;

Authors: Nichols LM

PMID: 20181965 [PubMed - as supplied by publisher]

The FDA and Safe Use of Long-Acting Beta-Agonists in the Treatment of Asthma.

N Engl J Med. 2010 Feb 24;

Authors: Chowdhury BA, Dal Pan G

PMID: 20181964 [PubMed - as supplied by publisher]

Rapid Medical Relief -- Project Medishare and the Haitian Earthquake.

N Engl J Med. 2010 Feb 25;

Authors: Ginzburg E, O'Neill WW, Goldschmidt-Clermont PJ, de Marchena E, Pust D, Green BA

PMID: 20181963 [PubMed - as supplied by publisher]

Serving two masters--conflicts of interest in academic medicine.

N Engl J Med. 2010 Feb 25;362(8):669-71

Authors: Lo B

PMID: 20181969 [PubMed - in process]

Images in clinical medicine. Abdominal-wall abscess.

N Engl J Med. 2010 Feb 25;362(8):e24

Authors: Rajagopalan S, Loudon M

PMID: 20181968 [PubMed - in process]

Can States Pick Up the Health Reform Torch?

N Engl J Med. 2010 Feb 25;

Authors: Rosenbaum S

PMID: 20181967 [PubMed - as supplied by publisher]

Health Care Volunteers and Disaster Response -- First, Be Prepared.

N Engl J Med. 2010 Feb 24;

Authors: Merchant RM, Leigh JE, Lurie N

PMID: 20181966 [PubMed - as supplied by publisher]

Timing of initiation of antiretroviral drugs during tuberculosis therapy.

N Engl J Med. 2010 Feb 25;362(8):697-706

Authors: Abdool Karim SS, Naidoo K, Grobler A, Padayatchi N, Baxter C, Gray A, Gengiah T, Nair G, Bamber S, Singh A, Khan M, Pienaar J, El-Sadr W, Friedland G, Abdool Karim Q

BACKGROUND: The rates of death are high among patients with coinfection with tuberculosis and the human immunodeficiency virus (HIV). The optimal timing for the initiation of antiretroviral therapy in relation to tuberculosis therapy remains controversial. METHODS: In an open-label, randomized, controlled trial in Durban, South Africa, we assigned 642 patients with both tuberculosis and HIV infection to start antiretroviral therapy either during tuberculosis therapy (in two integrated-therapy groups) or after the completion of such treatment (in one sequential-therapy group). The diagnosis of tuberculosis was based on a positive sputum smear for acid-fast bacilli. Only patients with HIV infection and a CD4+ cell count of less than 500 per cubic millimeter were included. All patients received standard tuberculosis therapy, prophylaxis with trimethoprim-sulfamethoxazole, and a once-daily antiretroviral regimen of didanosine, lamivudine, and efavirenz. The primary end point was death from any cause. RESULTS: This analysis compares data from the sequential-therapy group and the combined integrated-therapy groups up to September 1, 2008, when the data and safety monitoring committee recommended that all patients receive integrated antiretroviral therapy. There was a reduction in the rate of death among the 429 patients in the combined integrated-therapy groups (5.4 deaths per 100 person-years, or 25 deaths), as compared with the 213 patients in the sequential-therapy group (12.1 per 100 person-years, or 27 deaths); a relative reduction of 56% (hazard ratio in the combined integrated-therapy groups, 0.44; 95% confidence interval, 0.25 to 0.79; P=0.003). Mortality was lower in the combined integrated-therapy groups in all CD4+ count strata. Rates of adverse events during follow-up were similar in the two study groups. CONCLUSIONS: The initiation of antiretroviral therapy during tuberculosis therapy significantly improved survival and provides further impetus for the integration of tuberculosis and HIV services. (ClinicalTrials.gov number, NCT00398996.)

PMID: 20181971 [PubMed - in process]

Lasofoxifene in postmenopausal women with osteoporosis.

N Engl J Med. 2010 Feb 25;362(8):686-96

Authors: Cummings SR, Ensrud K, Delmas PD, LaCroix AZ, Vukicevic S, Reid DM, Goldstein S, Sriram U, Lee A, Thompson J, Armstrong RA, Thompson DD, Powles T, Zanchetta J, Kendler D, Neven P, Eastell R,

BACKGROUND: The effects of lasofoxifene on the risk of fractures, breast cancer, and cardiovascular disease are uncertain. METHODS: In this randomized trial, we assigned 8556 women who were between the ages of 59 and 80 years and had a bone mineral density T score of -2.5 or less at the femoral neck or spine to receive once-daily lasofoxifene (at a dose of either 0.25 mg or 0.5 mg) or placebo for 5 years. Primary end points were vertebral fractures, estrogen receptor (ER)-positive breast cancer, and nonvertebral fractures; secondary end points included major coronary heart disease events and stroke. RESULTS: Lasofoxifene at a dose of 0.5 mg per day, as compared with placebo, was associated with reduced risks of vertebral fracture (13.1 cases vs. 22.4 cases per 1000 person-years; hazard ratio, 0.58; 95% confidence interval [CI], 0.47 to 0.70), nonvertebral fracture (18.7 vs. 24.5 cases per 1000 person-years; hazard ratio, 0.76; 95% CI, 0.64 to 0.91), ER-positive breast cancer (0.3 vs. 1.7 cases per 1000 person-years; hazard ratio, 0.19; 95% CI, 0.07 to 0.56), coronary heart disease events (5.1 vs. 7.5 cases per 1000 person-years; hazard ratio, 0.68; 95% CI, 0.50 to 0.93), and stroke (2.5 vs. 3.9 cases per 1000 person-years; hazard ratio, 0.64; 95% CI, 0.41 to 0.99). Lasofoxifene at a dose of 0.25 mg per day, as compared with placebo, was associated with reduced risks of vertebral fracture (16.0 vs. 22.4 cases per 1000 person-years; hazard ratio, 0.69; 95% CI, 0.57 to 0.83) and stroke (2.4 vs. 3.9 cases per 1000 person-years; hazard ratio, 0.61; 95% CI, 0.39 to 0.96) Both the lower and higher doses, as compared with placebo, were associated with an increase in venous thromboembolic events (3.8 and 2.9 cases vs. 1.4 cases per 1000 person-years; hazard ratios, 2.67 [95% CI, 1.55 to 4.58] and 2.06 [95% CI, 1.17 to 3.60], respectively). Endometrial cancer occurred in three women in the placebo group, two women in the lower-dose lasofoxifene group, and two women in the higher-dose lasofoxifene group. Rates of death per 1000 person-years were 5.1 in the placebo group, 7.0 in the lower-dose lasofoxifene group, and 5.7 in the higher-dose lasofoxifene group. CONCLUSIONS: In postmenopausal women with osteoporosis, lasofoxifene at a dose of 0.5 mg per day was associated with reduced risks of nonvertebral and vertebral fractures, ER-positive breast cancer, coronary heart disease, and stroke but an increased risk of venous thromboembolic events. (ClinicalTrials.gov number, NCT00141323.)

PMID: 20181970 [PubMed - in process]

Graves' ophthalmopathy.

N Engl J Med. 2010 Feb 25;362(8):726-38

Authors: Bahn RS

PMID: 20181974 [PubMed - in process]

Permethrin and ivermectin for scabies.

N Engl J Med. 2010 Feb 25;362(8):717-25

Authors: Currie BJ, McCarthy JS

PMID: 20181973 [PubMed - in process]

An algorithm for tuberculosis screening and diagnosis in people with HIV.

N Engl J Med. 2010 Feb 25;362(8):707-16

Authors: Cain KP, McCarthy KD, Heilig CM, Monkongdee P, Tasaneeyapan T, Kanara N, Kimerling ME, Chheng P, Thai S, Sar B, Phanuphak P, Teeratakulpisarn N, Phanuphak N, Nguyen HD, Hoang TQ, Le HT, Varma JK

BACKGROUND: Tuberculosis screening is recommended for people with human immunodeficiency virus (HIV) infection to facilitate early diagnosis and safe initiation of antiretroviral therapy and isoniazid preventive therapy. No internationally accepted, evidence-based guideline addresses the optimal means of conducting such screening, although screening for chronic cough is common. METHODS: We consecutively enrolled people with HIV infection from eight outpatient clinics in Cambodia, Thailand, and Vietnam. For each patient, three samples of sputum and one each of urine, stool, blood, and lymph-node aspirate (for patients with lymphadenopathy) were obtained for mycobacterial culture. We compared the characteristics of patients who received a diagnosis of tuberculosis (on the basis of having one or more specimens that were culture-positive) with those of patients who did not have tuberculosis to derive an algorithm for screening and diagnosis. RESULTS: Tuberculosis was diagnosed in 267 (15%) of 1748 patients (median CD4+ T-lymphocyte count, 242 per cubic millimeter; interquartile range, 82 to 396). The presence of a cough for 2 or 3 weeks or more during the preceding 4 weeks had a sensitivity of 22 to 33% for detecting tuberculosis. The presence of cough of any duration, fever of any duration, or night sweats lasting 3 or more weeks in the preceding 4 weeks was 93% sensitive and 36% specific for tuberculosis. In the 1199 patients with any of these symptoms, a combination of two negative sputum smears, a normal chest radiograph, and a CD4+ cell count of 350 or more per cubic millimeter helped to rule out a diagnosis of tuberculosis, whereas a positive diagnosis could be made only for the 113 patients (9%) with one or more positive sputum smears; mycobacterial culture was required for most other patients. CONCLUSIONS: In persons with HIV infection, screening for tuberculosis should include asking questions about a combination of symptoms rather than only about chronic cough. It is likely that antiretroviral therapy and isoniazid preventive therapy can be started safely in people whose screening for all three symptoms is negative, whereas diagnosis in most others will require mycobacterial culture.

PMID: 20181972 [PubMed - in process]

Another selective estrogen-receptor modulator for osteoporosis.

N Engl J Med. 2010 Feb 25;362(8):752-4

Authors: Becker C

PMID: 20181977 [PubMed - in process]

Case records of the Massachusetts General Hospital. Case 6-2010. A 37-year-old man with a lesion on the tongue.

N Engl J Med. 2010 Feb 25;362(8):740-8

Authors: Flynn TR, Hunter GJ, Johnson MM

PMID: 20181976 [PubMed - in process]

Images in clinical medicine. Processus supracondylaris humeri.

N Engl J Med. 2010 Feb 25;362(8):739

Authors: Billmann F

PMID: 20181975 [PubMed - in process]

Management of lung nodules detected by volume CT scanning.

N Engl J Med. 2010 Feb 25;362(8):757; author reply 758-9

Authors: Nair VS

PMID: 20181979 [PubMed - in process]

Traffic control for BRCA1.

N Engl J Med. 2010 Feb 25;362(8):755-6

Authors: Foulkes WD

PMID: 20181978 [PubMed - in process]

Revascularization for renal-artery stenosis.

N Engl J Med. 2010 Feb 25;362(8):762; author reply 763-4

Authors: Staub D, Uthoff H, Jaeger KA

PMID: 20181982 [PubMed - in process]

Rituximab, B-lymphocyte depletion, and beta-cell function.

N Engl J Med. 2010 Feb 25;362(8):761; author reply 761

Authors: Nagafuchi S, Katsuta H, Anzai K

PMID: 20181981 [PubMed - in process]

A novel antibody associated with autoimmune pancreatitis.

N Engl J Med. 2010 Feb 25;362(8):759; author reply 760-1

Authors: Landman GW

PMID: 20181980 [PubMed - in process]

Acquired autoimmune polyglandular syndrome, thymoma, and an AIRE defect.

N Engl J Med. 2010 Feb 25;362(8):764-6

Authors: Cheng MH, Fan U, Grewal N, Barnes M, Mehta A, Taylor S, Husebye ES, Murphy EJ, Anderson MS

PMID: 20181983 [PubMed - in process]

Returning Home to Haiti -- Providing Medical Care after the Earthquake.

N Engl J Med. 2010 Feb 19;

Authors: Delonnay PB

PMID: 20173033 [PubMed - as supplied by publisher]

Interactive medical case. Stalking the diagnosis.

N Engl J Med. 2010 Feb 11;362(6):e16

Authors: Vaidya A, Morris CA, Ross JJ

PMID: 20175296 [PubMed - in process]

FDA drug information that never reaches clinicians.

N Engl J Med. 2010 Feb 11;362(6):562-3; author reply 563

Authors: Cook GE, Sasich LD, Sukkari SR

PMID: 20175263 [PubMed - in process]

FDA drug information that never reaches clinicians.

N Engl J Med. 2010 Feb 11;362(6):561-2; author reply 563

Authors: Collins C

PMID: 20175262 [PubMed - in process]

Antibiotic prophylaxis and recurrent urinary tract infection in children.

N Engl J Med. 2010 Feb 11;362(6):556; author reply 556-7

Authors: Szmigielska A, Krzemien G, Roszkowska-Blaim M

PMID: 20175261 [PubMed - in process]

FDA drug information that never reaches clinicians.

N Engl J Med. 2010 Feb 11;362(6):561; author reply 563

Authors: Casoy J

PMID: 20175299 [PubMed - in process]

Phosphodiesterase inhibitors for pulmonary hypertension.

N Engl J Med. 2010 Feb 11;362(6):559-60; author reply 560

Authors: Galiè N, Rubin LJ, Simonneau G

PMID: 20175298 [PubMed - in process]

Antibiotic prophylaxis and recurrent urinary tract infection in children.

N Engl J Med. 2010 Feb 11;362(6):555-6; author reply 556-7

Authors: Skurnik D, Pier GB, Andremont A

PMID: 20175297 [PubMed - in process]

FDA drug information that never reaches clinicians.

N Engl J Med. 2010 Feb 11;362(6):562; author reply 563

Authors: Messerli FH, Bangalore S

PMID: 20175300 [PubMed - in process]

Recovering from Disaster -- Partners in Health and the Haitian Earthquake.

N Engl J Med. 2010 Feb 17;

Authors: Kidder T

PMID: 20164478 [PubMed - as supplied by publisher]

Protecting the Children of Haiti.

N Engl J Med. 2010 Feb 17;

Authors: Balsari S, Lemery J, Williams TP, Nelson BD

PMID: 20164477 [PubMed - as supplied by publisher]

The GHESKIO Field Hospital and Clinics after the Earthquake in Haiti -- Dispatch 3 from Port-au-Prince.

N Engl J Med. 2010 Feb 17;

Authors: Pape JW, Rouzier V, Ford H, Joseph P, Johnson WD, Fitzgerald DW

PMID: 20164476 [PubMed - as supplied by publisher]

Weighing Risks and Benefits of Liraglutide -- The FDA's Review of a New Antidiabetic Therapy.

N Engl J Med. 2010 Feb 17;

Authors: Parks M, Rosebraugh C

PMID: 20164475 [PubMed - as supplied by publisher]

Looking back, moving forward.

N Engl J Med. 2010 Feb 18;362(7):569-74

Authors: Skinner J, Staiger D, Fisher ES

PMID: 20164482 [PubMed - in process]

Prosthetic-valve dehiscence.

N Engl J Med. 2010 Feb 18;362(7):e20

Authors: Lopez-Campos JL, Vieyra-Herrera G

PMID: 20164481 [PubMed - in process]

Five Next Steps for a New National Program for Comparative-Effectiveness Research.

N Engl J Med. 2010 Feb 17;

Authors: Vanlare JM, Conway PH, Sox HC

PMID: 20164480 [PubMed - as supplied by publisher]

The Complexity That Killed Health Care Reform (Again).

N Engl J Med. 2010 Feb 17;

Authors: Kastor J

PMID: 20164479 [PubMed - as supplied by publisher]

Dose of Prophylactic Platelet Transfusions and Prevention of Hemorrhage.

N Engl J Med. 2010 Feb 18;362(7):600-613

Authors: Slichter SJ, Kaufman RM, Assmann SF, McCullough J, Triulzi DJ, Strauss RG, Gernsheimer TB, Ness PM, Brecher ME, Josephson CD, Konkle BA, Woodson RD, Ortel TL, Hillyer CD, Skerrett DL, McCrae KR, Sloan SR, Uhl L, George JN, Aquino VM, Manno CS, McFarland JG, Hess JR, Leissinger C, Granger S

BACKGROUND: We conducted a trial of prophylactic platelet transfusions to evaluate the effect of platelet dose on bleeding in patients with hypoproliferative thrombocytopenia. METHODS: We randomly assigned hospitalized patients undergoing hematopoietic stem-cell transplantation or chemotherapy for hematologic cancers or solid tumors to receive prophylactic platelet transfusions at a low dose, a medium dose, or a high dose (1.1x10(11), 2.2x10(11), or 4.4x10(11) platelets per square meter of body-surface area, respectively), when morning platelet counts were 10,000 per cubic millimeter or lower. Clinical signs of bleeding were assessed daily. The primary end point was bleeding of grade 2 or higher (as defined on the basis of World Health Organization criteria). RESULTS: In the 1272 patients who received at least one platelet transfusion, the primary end point was observed in 71%, 69%, and 70% of the patients in the low-dose group, the medium-dose group, and the high-dose group, respectively (differences were not significant). The incidences of higher grades of bleeding, and other adverse events, were similar among the three groups. The median number of platelets transfused was significantly lower in the low-dose group (9.25x10(11)) than in the medium-dose group (11.25x10(11)) or the high-dose group (19.63x10(11)) (P=0.002 for low vs. medium, P<0.001 for high vs. low and high vs. medium), but the median number of platelet transfusions given was significantly higher in the low-dose group (five, vs. three in the medium-dose and three in the high-dose group; P<0.001 for low vs. medium and low vs. high). Bleeding occurred on 25% of the study days on which morning platelet counts were 5000 per cubic millimeter or lower, as compared with 17% of study days on which platelet counts were 6000 to 80,000 per cubic millimeter (P<0.001). CONCLUSIONS: Low doses of platelets administered as a prophylactic transfusion led to a decreased number of platelets transfused per patient but an increased number of transfusions given. At doses between 1.1x10(11) and 4.4x10(11) platelets per square meter, the number of platelets in the prophylactic transfusion had no effect on the incidence of bleeding. (ClinicalTrials.gov number, NCT00128713.) Copyright 2010 Massachusetts Medical Society.

PMID: 20164484 [PubMed - as supplied by publisher]

A map to bad policy -- hospital efficiency measures in the dartmouth atlas.

N Engl J Med. 2010 Feb 18;362(7):569-74

Authors: Bach PB

PMID: 20164483 [PubMed - in process]

Case 5-2010 -- A 51-Year-Old Man with HIV Infection, Proteinuria, and Edema.

N Engl J Med. 2010 Feb 18;362(7):636-46

Authors: Radhakrishnan J, Uppot RN, Colvin RB

PMID: 20164488 [PubMed - in process]

Fulminant ulcerative colitis.

N Engl J Med. 2010 Feb 18;362(7):635

Authors: Swaminath A, Feingold D

PMID: 20164487 [PubMed - in process]

Small renal mass.

N Engl J Med. 2010 Feb 18;362(7):624-34

Authors: Gill IS, Aron M, Gervais DA, Jewett MA

PMID: 20164486 [PubMed - in process]

Newborn-Care Training and Perinatal Mortality in Developing Countries.

N Engl J Med. 2010 Feb 18;362(7):614-623

Authors: Carlo WA, M D SS, Jehan I, Chomba E, Tshefu A, Garces A, Sailajan , Parida A, Althabe F, McClure EM, Derman RJ, Goldenberg RL, Bose C, Krebs NF, Panigrahi P, Buekens P, Chakraborty H, Hartwell TD, Wright LL,

BACKGROUND: Of the 3.7 million neonatal deaths and 3.3 million stillbirths each year, 98% occur in developing countries. An evaluation of community-based interventions designed to reduce the number of these deaths is needed. METHODS: With the use of a train-the-trainer model, local instructors trained birth attendants from rural communities in six countries (Argentina, Democratic Republic of Congo, Guatemala, India, Pakistan, and Zambia) in the World Health Organization Essential Newborn Care course (which focuses on routine neonatal care, resuscitation, thermoregulation, breast-feeding, "kangaroo" [skin-to-skin] care, care of the small baby, and common illnesses) and (except in Argentina) in a modified version of the American Academy of Pediatrics Neonatal Resuscitation Program (which teaches basic resuscitation in depth). The Essential Newborn Care intervention was assessed among 57,643 infants with the use of a before-and-after design. The Neonatal Resuscitation Program intervention was assessed as a cluster-randomized, controlled trial involving 62,366 infants. The primary outcome was neonatal death in the first 7 days after birth. RESULTS: The 7-day follow-up rate was 99.2%. After birth attendants were trained in the Essential Newborn Care course, there was no significant reduction from baseline in the rate of neonatal death from all causes in the 7 days after birth (relative risk with training, 0.99; 95% confidence interval [CI], 0.81 to 1.22) or in the rate of perinatal death; there was a significant reduction in the rate of stillbirth (relative risk with training, 0.69; 95% CI, 0.54 to 0.88; P=0.003). In clusters of births in which attendants had been randomly assigned to receive training in the Neonatal Resuscitation Program, as compared with control clusters, there was no reduction in the rates of neonatal death in the 7 days after birth, stillbirth, or perinatal death. CONCLUSIONS: The rate of neonatal death in the 7 days after birth did not decrease after the introduction of Essential Newborn Care training of community-based birth attendants, although the rate of stillbirths was reduced. Subsequent training in the Neonatal Resuscitation Program did not significantly reduce the mortality rates. (ClinicalTrials.gov number, NCT00136708.) Copyright 2010 Massachusetts Medical Society.

PMID: 20164485 [PubMed - as supplied by publisher]

A Peptide-based erythropoietin-receptor agonist for pure red-cell aplasia.

N Engl J Med. 2010 Feb 18;362(7):656-7

Authors: Focosi D, Macdougall IC, Casadevall N, Eckardt KU

PMID: 20164491 [PubMed - in process]

Vaccination against HPV-16 for Vulvar Intraepithelial Neoplasia.

N Engl J Med. 2010 Feb 18;362(7):655-6

Authors: Villada IB, Kenter GG, van der Burg SH, Melief CJ

PMID: 20164490 [PubMed - in process]

Darbepoetin Alfa and Chronic Kidney Disease.

N Engl J Med. 2010 Feb 18;362(7):653-655

Authors: Wright RJ, Kanagasundaram NS, Quinton R, Minnerup J, Schäbitz WR, Hampl H, Kovesdy CP, Kalantar-Zadeh K, Locatelli F, Del Vecchio L, Casartelli D, Pfeffer MA, Eckardt KU, Toto R

PMID: 20164489 [PubMed - as supplied by publisher]

Market exclusivity for biologics.

N Engl J Med. 2010 Feb 18;362(7):661-2

Authors: Wheadon DE, Pollock A, Zagari M, Engelberg AB, Kesselheim AS

PMID: 20164494 [PubMed - in process]

Thiazide diuretics.

N Engl J Med. 2010 Feb 18;362(7):659-60

Authors: Cowtan T, Smith SM, Ernst ME, Moser M

PMID: 20164493 [PubMed - in process]

Rasagiline in Parkinson's disease.

N Engl J Med. 2010 Feb 18;362(7):657-9

Authors: Youdim MB, Schwarzschild MA, Olanow CW, Rascol O

PMID: 20164492 [PubMed - in process]

Histopathological features of the kidney after acute renal failure from melamine.

N Engl J Med. 2010 Feb 18;362(7):662-4

Authors: Sun N, Shen Y, He LJ

PMID: 20164495 [PubMed - in process]

Intensity of continuous renal-replacement therapy.

N Engl J Med. 2010 Feb 4;362(5):467; author reply 467-8

Authors: du Cheyron D, Parienti JJ

PMID: 20162765 [PubMed - in process]

Intensity of continuous renal-replacement therapy.

N Engl J Med. 2010 Feb 4;362(5):466-7; author reply 467-8

Authors: Legrand M, Payen D

PMID: 20162764 [PubMed - in process]

Ankle-brachial index and peripheral arterial disease.

N Engl J Med. 2010 Feb 4;362(5):471; author reply 471-2

Authors: Vierron E, Halimi JM, Giraudeau B

PMID: 20162767 [PubMed - in process]

Functional status of elderly adults receiving dialysis.

N Engl J Med. 2010 Feb 4;362(5):468-9; author reply 469

Authors: Tavares AR, Vieira CP, Souza PA

PMID: 20162766 [PubMed - in process]