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In This Issue of JAMA
November 3, 2015


JAMA. 2015;314(17):1771-1773. doi:10.1001/jama.2014.12061

In a randomized, open-label trial that enrolled 300 children infected with human immunodeficiency virus (HIV) who had been exposed to nevirapine and had achieved viral suppression with ritonavir-boosted lopinavir–based therapy, Coovadia and colleagues found that switching to efavirenz-based therapy did not result in higher rates of viral rebound or viral failure. In an Editorial, Yogev discusses treatment of pediatric HIV infection.


Kantor and colleagues evaluated trends in prescription drug use among US adults in an analysis of National Health and Nutrition Examination Survey data (1999-2012; 37 959 participants total). Among the findings were significant increases in overall prescription drug use and polypharmacy, which persisted after adjustment for changes in the age distribution of the population.

Author Video Interview and Continuing Medical Education

In a meta-analysis of data from 8 clinical trials (2423 patients total) that compared endovascular thrombectomy with standard medical care among patients with acute ischemic stroke, Badhiwala and colleagues found that endovascular thrombectomy was associated with improved functional outcomes and higher rates of angiographic revascularization, but no difference in occurrence of symptomatic intracranial hemorrhage or all-cause mortality at 90 days. In an Editorial, Wardlaw and Dennis discuss unresolved questions regarding thrombectomy for patients with acute ischemic stroke.


Continuing Medical Education

Pertussis infection is associated with encephalopathy and seizures in infants. In an analysis of Danish medical registry data, Olsen and colleagues found that compared with the general pediatric population, the 10-year cumulative risk of epilepsy was increased among children with hospital-diagnosed pertussis infections; however, the absolute risk of epilepsy was low.

In a study that included necropsy data from 36 mammalian species, sequencing of the elephant genome with identification of cancer-related genes and exposure of elephant and human lymphocytes to ionizing radiation and doxorubicin, Abegglen and colleagues found that compared with other species, elephants appear to have a lower-than-expected rate of cancer, potentially related to their having multiple copies of the tumor suppressor gene, TP53. In an Editorial, Greaves and Ermini discuss evolutionary adaptations to cancer risk.


Clinical Review & Education

An article in JAMA Ophthalmology reported that compared with usual care, measurement of hemoglobin A1c (HbA1c) and personalized diabetes risk assessments performed during retinal ophthalmologic visits did not result in reductions in patients’ HbA1c levels at 1 year. In this From the JAMA Network article, Vijan and Fagerlin discuss challenges in communicating diabetes-related risks and improving glycemic control.

Hirsutism affects 5% to 11% of women of reproductive age. This JAMA Clinical Evidence Synopsis summarizes a Cochrane review of 157 randomized trials examining the efficacy of medical therapies for hirsutism. Oral contraceptive pills, particularly formulations with antiandrogenic activity, are associated with improvement in mild hirsutism. Flutamide and spironolactone show some benefit in more severe cases.

This JAMA Clinical Guideline Synopsis summarizes the 2012 American Urological Association guideline: Evaluation of Patients with Asymptomatic Microhematuria. After exclusion of benign causes and assessment of renal function, cystoscopy (for patients older than age 35 years and those with risk factors for malignancy) and imaging of the upper urinary tract are recommended.