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Atorvastatin and Acute Kidney Injury After Cardiac Surgery
Observational data suggest a reduced risk of postoperative acute kidney injury (AKI) associated with preoperative statin treatment. In a randomized, placebo-controlled trial involving 199 patients who underwent cardiac surgery and were naive to statin treatment and 416 patients taking statins prior to study enrollment, Billings and colleagues found that compared with placebo, high-dose perioperative atorvastatin did not reduce the risk of AKI—either among patients naive to statin treatment or among patients with prior statin use. In an Editorial, Bellomo discusses perioperative statins in patients undergoing cardiac surgery and the risk of AKI.
RBC Transfusion and Necrotizing Enterocolitis in VLBW Infants
The pathogenesis of necrotizing enterocolitis (NEC)—a leading cause of mortality among preterm infants—is unclear, with conflicting data regarding the role of red blood cell (RBC) transfusion and anemia. In a secondary analysis of data from a prospective study that enrolled 600 very low-birth-weight (VLBW) infants—of whom 319 had RBC transfusion exposure and 44 developed NEC—Patel and colleagues found that severe anemia but not RBC transfusion was associated with an increased risk of NEC.
Insulin Glargine vs Insulin Degludec/Liraglutide
Achieving optimal glycemic control is a challenge for many patients with type 2 diabetes, even with insulin therapy. In a multicenter, randomized, open-label trial that enrolled 557 patients with type 2 diabetes that was uncontrolled with insulin glargine plus metformin, Lingvay and colleagues found that 26 weeks of treatment with a fixed ratio of insulin degludec/liraglutide—to a maximum dose of 50 units of degludec and 1.8 mg of liraglutide—resulted in reductions in hemoglobin A1c (HbA1c) levels that were noninferior to those achieved with up-titration—with no maximum dose—of insulin glargine. Secondary analyses indicated significantly greater HbA1c reduction with insulin degludec/liraglutide.
Continuing Medical Education
Clinical Review & Education
Screening for Impaired Visual Acuity in Older Adults
This US Preventive Services Task Force (USPSTF) Recommendation Statement by Siu and colleagues addresses primary care visual acuity screening for asymptomatic adults aged 65 years or older. Based on a review of the evidence, the USPSTF concluded that the evidence is insufficient to assess the balance of benefits and harms of screening for visual acuity impairment associated with uncorrected refractive error, cataracts, or age-related macular degeneration. In an Editorial, Lee discusses visual acuity screening among asymptomatic older adults.
Editorial and Related Article
Author Audio Interview and Continuing Medical Education
Vision Impairment Screening in Older Adults: Evidence Report
Chou and colleagues summarize findings from the US Preventive Services Task Force review and analysis of recent data (2008 to January 2016) regarding the diagnostic accuracy and benefits and harms of primary care screening of asymptomatic older adults for impaired visual acuity. The authors report that screening can identify persons with visual acuity impairment; however, the evidence review found that visual acuity improvement and other clinical outcomes did not differ significantly among older persons undergoing visual acuity screening compared with those not screened.
Sudden Onset of Generalized Pustules in a Newborn
A 3-day-old infant developed a widespread pustular rash on his face and trunk. The mother had no history of syphilis, genital herpes, varicella, or vaginal candidiasis. On examination, the infant was alert and afebrile, and some lesions had a “flea-bitten” appearance. Cultures of the pustular content were negative. What would you do next?
Gonadotropic Interpretation for a Young Man
A 25-year-old man presented with a concern of low energy and an interest in testosterone replacement therapy. The patient denied symptoms of low libido or sexual dysfunction. Examination revealed bilateral descended atrophic testes. Blood tests and a semen analysis were performed. How would you interpret the test results?
Highlights. JAMA. 2016;315(9):839–841. doi:10.1001/jama.2015.14136
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