Tobacco smoking is a known risk factor for periodontal disease.
To explore whether cannabis smoking may be a risk factor for periodontal
disease, Thomson and colleagues analyzed data
from a longitudinal prospective cohort study that included several
self-reported assessments of tobacco and cannabis use in young adulthood
and dental examinations at ages 26 and 32 years. The authors report
that after controlling for tobacco smoking, irregular dental care,
and dental plaque, regular (at least weekly) cannabis use in young
adulthood was associated with an increased risk of periodontal disease
that was independent of tobacco use. In an editorial, Hujoel discusses factors that may contribute to destructive
periodontal disease and the interrelationships between periodontal
disease and several chronic diseases.
Current guidelines recommend that patients hospitalized for
acute coronary syndrome receive clopidogrel therapy for at least a
month and up to a year. To determine whether patients are at increased
short-term risk for adverse events when clopidogrel therapy is stopped,
Ho and colleagues calculated rates of all-cause mortality or acute
myocardial infarction in a retrospective cohort of patients with acute
coronary syndrome who were treated either medically or with percutaneous
coronary intervention and discharged with clopidogrel. The authors
found a higher incidence of death and acute myocardial infarction
during the initial 90 days after stopping clopidogrel than in later
Disease staging with mediastinoscopy is recommended for patients
with suspected lung cancer, but less invasive methods of staging would
be preferable. In a study of 138 consecutive patients with suspected
lung cancer, Wallace and colleagues compared the diagnostic accuracy
of 3 methods of minimally invasive endoscopic staging (and combinations
thereof). The authors found that endobronchial ultrasound-guided fine-needle
aspiration (EBUS-FNA) was more sensitive than blind transbronchial
needle aspiration (69% vs 36%, respectively), and the combination
of EBUS-FNA and transesophageal endoscopic ultrasound-guided fine-needle
aspiration had the highest estimated sensitivity (93%; 95% confidence
interval, 81%-99%) for detection of lymph node involvement.
A number of patient and lesion-related factors are associated
with restenosis following carotid endarterectomy, but little attention
has been focused on the histology of the initial atherosclerotic plaque.
In the Athero-Express study, carotid plaques from patients undergoing
primary carotid endarterectomy were examined histologically, and the
patients had duplex ultrasound examinations 1 year after surgery to
assess carotid artery restenosis. Hellings and colleagues report that
patients whose plaques demonstrated low macrophage infiltration and
a small or absent lipid core were at increased risk of restenosis
compared with patients whose plaques were inflammatory and lipid
Ms C is a 32-year-old woman who has a 1-year history of epigastric
pain and pressure that occur daily, last several hours, and are associated
with early satiety and feelings of nausea. Lacy and Cash discuss the
epidemiology, pathophysiology, diagnosis, and treatment of functional
“Although many have commented on the demise of the art
of medicine in our increasingly technologically driven field, I would
argue that never before has it been so important.” From “The
Interpreter of Facts.”
Although a number of organizations and companies are working
to accelerate the use of electronic medical records, affordability,
privacy concerns, and other unresolved issues are slowing widespread
adoption by hospitals, physicians, and patients.
Rethinking pandemic flu advice
Strengthen quality improvement research
End tobacco use in mental health facilities
Authors are encouraged to submit manuscripts for an upcoming JAMA theme issue.
How would you manage a 74-year-old man who has moderate daily
alcohol use, memory loss, and progressive neuropathy? Go to www.jama.com to read the case and submit your response. Your response may be
selected for online publication. Submission deadline is February 27.
For your patients: Information about periodontal disease.
This Week in JAMA . JAMA. 2008;299(5):489. doi:10.1001/jama.299.5.489