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In This Issue of JAMA
April 4, 2017


JAMA. 2017;317(13):1291-1293. doi:10.1001/jama.2016.13064

The sedating agent dexmedetomidine can suppress inflammatory reactions and may have less risk of agitation and delirium than other sedatives. In a randomized clinical trial, Kawazoe and colleagues randomized 201 consecutive adult patients with sepsis requiring mechanical ventilation for at least 24 hours to receive sedation with or without dexmedetomidine. They found no difference in mortality or ventilator-free days.


Early low-dose hydrocortisone treatment has been reported to improve respiration and survival in preterm infants, but corticosteroids may have adverse effects on the developing brain. Baud and colleagues evaluated 379 preterm infants who had been randomized to receive hydrocortisone or placebo and did not find a statistically significant difference in neurodevelopment at 2 years of age. In an Editorial, Marlow explains why more research is needed to confirm that low-dose hydrocortisone is safe and effective for the prevention of bronchopulmonary dysplasia.



Some investigators have suggested that a substantial proportion of the increased incidence of thyroid cancer in the United States may be attributed to the detection of small, indolent tumors that are unlikely to cause symptoms or require treatment. Lim and colleagues analyzed cancer registry data for 77 276 patients and compared trends in thyroid cancer incidence and mortality by tumor characteristics at diagnosis. From 1974 to 2013, the overall incidence of thyroid cancer increased 3.6% annually, with increases in incidence and mortality for advanced-stage papillary thyroid cancer.

Exercise is associated with improved survival in the general population, but individuals with hypertrophic cardiomyopathy who participate in competitive athletics are at risk for sudden cardiac death. In a randomized clinical trial by Saberi and colleagues of 136 patients with hypertrophic cardiomyopathy, 16 weeks of moderate-intensity exercise training, compared with usual activity, resulted in a statistically significant but small increase in exercise capacity. In an Editorial, Owens and Cappola caution that the findings of this trial are preliminary, and they recommend larger studies with longer durations of follow-up to assess the safety of recreational exercise for patients with hypertrophic cardiomyopathy.


Clinical Review & Education

Identifying individuals with obsessive-compulsive disorder can be challenging because they may be reluctant to disclose thoughts or behaviors they perceive as shameful or embarrassing. Hirschtritt and colleagues discuss the features of obsessive-compulsive disorder and review the clinical management of patients.


An article in JAMA Neurology described the clinical, laboratory, imaging, and pathological findings of 11 infants with congenital Zika syndrome. In a From The JAMA Network article, Lucey and colleagues anticipate the global health and economic implications of Zika virus infection for the coming year.

This JAMA Clinical Challenge article by Herc and colleagues presents a man with fever, extreme weakness, fatigue, progressive confusion, and jaundice after a trip to Sierra Leone. Laboratory tests suggested renal impairment. What would you do next?