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This Week in JAMA
August 27, 2008

This Week in JAMA

JAMA. 2008;300(8):875. doi:10.1001/jama.300.8.875

In an analysis of data from the Health Professionals Follow-up Study, Strate and colleagues assessed whether nut, corn, and popcorn consumption is associated with diverticulitis and diverticular bleeding in patients without known diverticular disease. The authors found no evidence that consumption of nuts, corn, or popcorn increases the risk of diverticulosis or diverticular complications during 18 years of follow-up in individuals without known diverticular disease.

Ayurveda is a traditional medical system that originated in India and is used by persons worldwide. High levels of lead, mercury, and arsenic have been found in ayurvedic medicines manufactured in South Asia and sold in retail stores, but the prevalence of metals in ayurvedic medicines sold via the Internet and in ayurvedic medicines manufactured in the United States is not known. In an analysis of a random sample of ayurvedic medicines available via the Internet, Saper and colleagues found that one-fifth of both US-manufactured and Indian-manufactured ayurvedic medicines contained lead, mercury, and arsenic at levels that exceeded one or more standards for acceptable daily metal intake.

Hyperuricemia is common in patients with new-onset essential hypertension, and evidence from animal models suggests that elevated uric acid levels may be in the causal pathway. In a randomized, placebo-controlled, crossover trial involving 30 hyperuremic adolescents with newly diagnosed hypertension, Feig and colleagues assessed whether lowering uric acid levels with allopurinol (200 mg twice daily for 4 weeks) would be associated with reductions in blood pressure. The authors report that compared with placebo, allopurinol was associated with significant reductions in casual and 24-hour ambulatory blood pressure.

Many professional societies endorse tight glucose control in all critically ill adults. This recommendation is based largely on results from 1 clinical trial, which demonstrated that tight glucose control was associated with decreased mortality in a surgical intensive care unit. Subsequent studies have been inconclusive, and there is now controversy as to whether tight glucose control is warranted for all critically ill adults. Wiener and colleagues Article pooled and analyzed data from 29 clinical trials in which adult patients in intensive care units were randomly assigned to tight vs usual glucose control. The authors report that tight glucose control was not associated with a significant reduction in hospital mortality but was associated with an increased risk of hypoglycemia. In an editorial, Finfer and Delaney Article discuss the complexities of glucose control in critically ill patients.

The Centers for Disease Control and Prevention (CDC) has recommended HIV testing for all persons aged 13 to 64 years, a policy that requires persons who do not wish to know their HIV status to actively “opt-out” of testing. Bartlett and colleagues review the rationale for the CDC recommendation and discuss progress and challenges to implementation.

“[W]hy would I not stop all these heroic and futile treatments and just let Pamela die in peace and with dignity?” From “Seventy-two Hours.”

An alliance of influential nonprofit organizations and federal and state agencies is attempting to alleviate the ongoing nursing shortage by improving the capacity of US nursing schools to increase enrollment.

Enhancing the US Food and Drug Administration guidance on pharmacovigilance

Single-patient rooms for patient-centered care

Food safety for the 21st century

Yellow fever

Join H. George Nurnberg, MD, September 17 from 2 to 3 PM eastern time to discuss sildenafil for women with antidepressant-associated sexual dysfunction. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 39-year-old man with HIV-associated lipodystrophy? Go to www.jama.com, read the case, and submit your response, which may be selected for online publication. Submission deadline is August 27.

For your patients: Information about yellow fever.