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Use and Outcomes of Intracytoplasmic Sperm Injection
Intracytoplasmic sperm injection (ICSI) is increasingly used in assisted reproduction involving patients without severe male factor infertility and without evidence of benefit compared with conventional in vitro fertilization (IVF). Boulet and colleagues assessed US trends in ICSI use in an analysis of 1996-2012 registry data from nearly 1.4 million fresh IVF cycles. The authors found that ICSI use doubled between 1996 and 2012, with the largest relative increase in cycles without a diagnosis of male factor infertility, and ICSI was not associated with improved reproductive outcomes, irrespective of a diagnosis of male factor infertility.
Author Video Interview
Hospitalization for Pneumonia and Subsequent Risk of CVD
Whether infection increases the subsequent risk of cardiovascular disease (CVD) is not clear. In an analysis of data from 2 community-based observational cohort studies (5888 participants ≥65 years at enrollment in one study and 15 792 participants between the ages of 45 and 64 years at enrollment in the other), Corrales-Medina and colleagues found that hospitalization for pneumonia was associated with both short- and long-term risk of incident CVD disease.
HSCT in Patients With Relapsing-Remitting Multiple Sclerosis
No therapy has demonstrated significant reversal of neurological disability in patients with multiple sclerosis. In a study involving 151 patients treated with autologous nonmyeloablative hematopoietic stem cell transplantation (HSCT) between 2003 and 2014, Burt and colleagues found that among those with relapsing-remitting multiple sclerosis, HSCT was associated with improvements in neurological disability and quality of life during a median follow-up of 24 months. In an Editorial, Hauser discusses unresolved questions regarding the role of HSCT in relapsing-remitting multiple sclerosis.
Author Audio Interview
Clinical Review & Education
Surgery for Drug-Resistant Focal Epilepsy
Approximately 30% to 35% of patients with seizures have drug-resistant epilepsy—defined as a failure to respond to appropriate doses of 2 or more antiepileptic drugs. In a review of 55 articles reporting outcomes of resective surgery for focal, drug-resistant epilepsy, Jobst and Cascino found that surgery was more likely than continued medical therapy to reduce seizure activity. Associations of surgery with long-term cognitive, psychiatric, quality of life, and psychosocial outcomes were less clear.
Continuing Medical Education
Antibiotics for Acute Otitis Media
Medical opinion has vacillated on the use of antibiotics for treatment of acute otitis media. A recent article in JAMA Pediatrics reported earlier resolution of middle ear fluid with antibiotic vs placebo treatment of acute otitis media in children. In this From The JAMA Network article, Pichichero discusses beneficial effects of antibiotics in children with acute otitis media.
Treatments for Endometriosis
This JAMA Clinical Evidence Synopsis by Brown and Farquhar summarizes a Cochrane review of 140 randomized trials (13 599 patients) that assessed treatments for endometriosis. Among the findings were that the levonorgestrel-releasing intrauterine device, gonadotropin-releasing hormone analogues (GnRHa), and laparoscopic ablation or excision are associated with relief of endometriosis-associated pain. Treatment with laparoscopic excision or ablation or GnRHa improves clinical pregnancy rates.
A Rash in a Patient With AIDS
A man with a history of mild psoriasis and a recent diagnosis of AIDS presented with an intensely pruritic and diffuse rash with thick tan crusts. Removal of a crust revealed a smooth, red, and moist undersurface. What would you do next?
Highlights. JAMA. 2015;313(3):219–221. doi:10.1001/jama.2014.11525
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