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This Week in JAMA
February 6, 2008

This Week in JAMA

JAMA. 2008;299(5):489. doi:10.1001/jama.299.5.489

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 90-day periods.

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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.

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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 rich.

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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 dyspepsia.

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“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.”

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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.

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Rethinking pandemic flu advice

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Strengthen quality improvement research

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End tobacco use in mental health facilities

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Authors are encouraged to submit manuscripts for an upcoming JAMA theme issue.

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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.

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