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In This Issue of JAMA
May 5, 2015


JAMA. 2015;313(17):1689-1691. doi:10.1001/jama.2014.11721

Clostridium difficile infection (CDI)—a common health care–associated infection in US hospitals—has a recurrence rate of 25% to 30%. In a multicenter randomized, dose-ranging study that enrolled 173 patients with first episode or first recurrence of CDI who had successfully completed treatment with metronidazole, vancomycin, or both, Gerding and colleagues found that compared with placebo, oral administration of spores from a nontoxigenic C difficile strain (M3) was well tolerated and appeared to be safe. The authors report the nontoxigenic C difficile strain colonized the gastrointestinal tract and CDI recurrence was reduced through 6 weeks’ follow-up.

Author Video Interview and Continuing Medical Education

In an open-label study, Poordad and colleagues assessed rates of sustained virologic response in 312 treatment-naive or 103 treatment-experienced patients with chronic hepatitis C virus (HCV) genotype 1 infection without cirrhosis who received 12 weeks’ treatment with an oral fixed-dose combination of daclatasvir, asunaprevir, and beclabuvir. The authors report that at posttreatment week 12, sustained virologic response was achieved by 92% of treatment-naive patients and 89% of patients previously treated for HCV infection. In an Editorial, Conjeevaram discusses progress toward eradication of HCV infection and highlights the need to improve accessibility and affordability of new drug regimens.

Editorial and Related Article

Continuing Medical Education

An estimated 20% of patients with chronic hepatitis C virus (HCV) infection will develop cirrhosis, which is associated with increased risk of serious disease sequelae and a reduced response to treatment regimens that include interferon. In an open-label, uncontrolled study that enrolled 202 adult patients with HCV infection and compensated cirrhosis (112 treatment-naive patients and 90 treatment-experienced patients), Muir and colleagues found that treatment with a 12-week oral fixed-dose regimen of daclatasvir, asunaprevir, and beclabuvir, with or without ribavirin, achieved high rates of sustained virologic response at posttreatment week 12.

Editorial and Related Article

Author Audio Interview

Clinical Review & Education

Delirium is very common among elderly hospitalized patients. Results of a randomized placebo-controlled study published in JAMA Psychiatry suggested that ramelteon—a melatonin agonist—may provide protection against delirium in elderly hospitalized patients. In this From The JAMA Network article, Perkisas and Vandewoude discuss current—less than optimal—approaches to treat symptoms of delirium in hospitalized patients and the potential benefit of adding an active melatonergic drug to a multicomponent dementia prevention strategy.

A previously healthy 32-year-old man presented with a 27-kg weight loss over the course of 1 year, dyspnea, nonproductive cough, subjective fevers, night sweats, and painful hematuria. He had tattoos placed 3 years prior to presentation and reported a 1-year history of skin lesions confined to the tattoos. Skin examination revealed numerous red to violaceous macules and papules along the tattoos. A metabolic panel showed elevated ionized calcium. Computed tomography of the abdomen showed unilateral hydronephrosis with an obstructive nephrolith. Bilateral hilar lymphadenopathy was noted on chest radiography. What would you do next?

In this JAMA Diagnostic Test Interpretation article, Basaria presents a 54-year-old man with type 2 diabetes and hypertension who reports a 5-month history of fatigue, weight gain, interrupted sleep, and daytime somnolence. The patient has normal libido but manages occasional erectile dysfunction successfully with a phosphodiesterase-5 inhibitor. A morning total testosterone level was 279 ng/dL (laboratory normal range, 300-900 ng/dL), which prompted referral to an endocrinologist. Physical examination revealed an obese man without cushingoid features or gynecomastia. Visual fields, testes size, and muscle strength were all normal. A repeat morning testosterone level was 289 ng/dL. How would you interpret the test results?