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In This Issue of Archives of Internal Medicine
June 25, 2007

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2007;167(12):1225. doi:10.1001/archinte.167.12.1225
Sex Steroids and All-Cause and Cause-Specific Mortality in Men

Despite recent data indicating that sex steroid levels in men are related to metabolic outcomes that could convey higher risk of premature death, few large-scale studies have examined the association between sex steroids and mortality. Araujo et al examined whether total or free testosterone, dihydrotestosterone, and sex hormone-binding globulin are related to all-cause or cause-specific mortality in 1686 men (aged 40-70 years) from the Massachusetts Male Aging Study. During 15 years of follow-up, 395 deaths occurred. In multivariate-adjusted models, higher free testosterone (P = .02) and lower dihydrotestosterone (P = .04) levels were significantly associated with ischemic heart disease mortality, although the latter association was not robust to differences in model selection. Low free testosterone level was significantly related to respiratory death (P<.002), although the biological mechanism is not known.

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Use of Antidepressants and Rates of Hip Bone Loss in Older Women

Serotonin transporters have recently been described in bone, raising the possibility that medications that block serotonin reuptake could affect bone metabolism. In a cohort of older women (mean age, 78.5 years), Diem et al compared rates of bone loss at the hip in women taking no antidepressant medications, those taking selective serotonin reuptake inhibitors, and those taking tricyclic antidepressant medications. After adjustment for potential confounders, mean total hip bone mineral density decreased 0.47% per year in women taking no antidepressants compared with 0.82% per year in those taking selective serotonin reuptake inhibitors (P<.001) and 0.47% per year in those taking tricyclic antidepressant medications (P = .99).

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Predicting Poor Outcome From Acute Upper Gastrointestinal Hemorrhage

In this prospective, multisite cohort study of 391 patients admitted for acute upper gastrointestinal (GI) bleeding, 2 clinical prediction rules were derived and internally validated: 1 for GI bleeding–specific poor outcomes (rebleeding, need for urgent surgery to control bleeding, and death) and 1 for any poor outcome (the previous 3 outcomes plus new or worsened comorbidity subsequent to hospital admission). Independent predictors of poor outcome were Acute Physiology and Chronic Health Evaluation (APACHE) II score of 11 or greater, esophageal varices, signs of recent hemorrhage found during upper endoscopy, and unstable comorbidity on admission. In the derivation set, only 1 (1%) of 92 patients with no risk factors experienced a GI bleeding–specific poor outcome; only 6 (6%) of 97 patients experienced any poor outcome. Risks in the validation set were comparable. Both clinical prediction rules can be applied at the bedside and may enhance management efficiency of patients presenting with acute upper GI bleeding.

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One-Year Outcomes and Health Care Utilization in Survivors of Severe Acute Respiratory Syndrome

In this prospective and observational study, to evaluate the 1-year outcomes in survivors of severe acute respiratory syndrome (SARS) and their family caregivers, Tansey et al evaluated 117 SARS survivors from Toronto, Canada. The enrolled SARS survivors were young (median age, 42 years), and most were women (67%) and health care workers (65%). At 1 year after discharge from hospital, pulmonary function measures were in the normal range, but 18% of patients had a significant reduction in distance walked in 6 minutes. By 1 year, 17% of patients had not returned to work. Fifty-one patients required 668 visits to psychiatry or psychology practitioners. During the SARS epidemic, informal caregivers reported a decline of 1.6 SD below normal on the mental component score of the Medical Outcomes Study 36-Item Short Form Health Survey. Most SARS survivors had good physical recovery from their illness, but some patients and their caregivers reported a significant reduction in mental health 1 year later. Strategies to ameliorate the psychological burden of an epidemic on the patient and family caregiver should be considered as part of future pandemic planning.

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Lower Risk of Tuberculosis in Obesity

While undernutrition is well associated with tuberculosis, few studies have examined systematically the effect of obesity. Among a prospective cohort of 42 116 elderly subjects in Hong Kong, obese subjects were at significantly lower risk of developing active tuberculosis compared with normal-weight subjects, even after adjustment for a series of potential confounders. A strong linear protective effect was observed predominantly for pulmonary, but not extrapulmonary, tuberculosis. Further studies are indicated to explore the underlying mechanisms, potential clinical utilities, and possible epidemiological consequences.

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