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This Week in JAMA
December 15, 2004

This Week in JAMA

JAMA. 2004;292(23):2809. doi:10.1001/jama.292.23.2809
Interferon for Hepatitis C in HIV-Infected Patients

Hepatitis C virus (HCV) infection is common in patients also infected with human immunodeficiency virus (HIV), but effective HCV treatment is lacking. Carrat and colleaguesArticle report results of a randomized trial comparing safety and efficacy of peginterferon alfa-2b plus ribavirin vs standard interferon alfa-2b plus ribavirin in HIV-HCV coinfected patients treated for 48 weeks. They found that significantly more patients in the peginterferon plus ribavirin group had undetectable serum HCV-RNA at a 72-week follow-up examination than patients who had received standard interferon alfa-2b. Tolerability was similar for both regimens. In an editorial, Manns and WedemeyerArticle discuss results from 3 clinical trials comparing these treatment regimens and the need for new therapies.

Antihypertensives and CVD in Older Women

Options for antihypertensive therapy are many, but there are limited data addressing the superiority of certain combination therapies vs monotherapies to prevent hypertension-related cardiovascular disease (CVD) complications. Wassertheil-Smoller and colleagues assessed CVD morbidity and mortality in women aged 50 to 79 years and with no prior history of CVD disease at baseline in relation to their antihypertensive therapy. During 5.6 years of follow-up, monotherapy with diuretics was superior to monotherapy with other agents in preventing CVD complications. Combination therapy with a calcium channel blocker plus diuretic was associated with a higher risk of CVD mortality than the combination of a β-blocker plus diuretic. Risks were similar for combined therapy with either an angiotensin-converting enzyme inhibitor plus diuretic or a β-blocker plus diuretic.

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Obesity and Clinician Counseling Among Immigrants

Adopting a sedentary lifestyle and poor dietary habits may increase the risk of obesity in immigrants to the United States, but few studies have addressed acculturation and obesity in immigrants. Goel and colleagues used national data to assess the prevalence of obesity in immigrants vs US-born adults, the association of obesity with duration of US residence, and the likelihood of diet and exercise counseling by clinicians. The authors found a lower overall prevalence of obese immigrants vs US-born adults; however, the prevalence of obesity in immigrants approached that of US-born adults after 15 years of living in the United States. Immigrants reported receiving significantly less diet and exercise counseling.

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Heavy Metals in Ayurvedic Medicine Products

Heavy metal intoxication has been documented in association with Ayurvedic herbal medicine products (HMPs). Saper and colleagues determined the prevalence and concentration of heavy metals in Ayurvedic HMPs sold in Boston-area South Asian grocery stores and computed the estimated daily ingestion of the heavy metals relative to regulatory standards. Lead, arsenic, and mercury were found in 20% of the products tested. If the products were taken as recommended, users would consume potentially toxic levels of these metals.

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Implantable Defibrillators and Mortality

Implantable cardioverter defibrillator (ICD) therapy prevents sudden cardiac death in patients with prior myocardial infarction and depressed ejection fraction, but convincing evidence of a survival benefit in patients with nonischemic cardiomyopathy (NICM) is lacking. In a meta-analysis of data derived from randomized trials of therapies to prevent mortality in NICM, Desai and colleagues found a significant reduction in mortality with ICD therapy compared with medical therapy.

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Medical News & Perspectives

New research suggests that deficits in mitochondrial genes may be a common underlying cause of traits associated with the metabolic syndrome.

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Resident Burnout

Residents report high levels of burnout, but the causes are not clear. In an editorial, Lim and Golub discuss the need for scientific rigor in research in graduate medical education.

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Clinician’s corner

The Rational Clinical Examination
Simple examination maneuvers identify women with low bone mineral density or occult vertebral fractures.

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Treatment of Mixed Dementia

Clinical Review
Diagnosis, pathophysiology, and pharmacotherapy of mixed dementia.

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JAMA Patient Page

For your patients: Information about cardiomyopathy.

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