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In This Issue of Archives of Internal Medicine
August 14, 2006

In This Issue of Archives of Internal Medicine

Arch Intern Med. 2006;166(15):1541. doi:10.1001/archinte.166.15.1541

Cytisine for Smoking Cessation

Cytisine has been used for 40 years to treat tobacco dependence in Eastern Europe, but because efficacy trials were never published in English, a potentially effective treatment for the condition that causes the largest number of avoidable deaths in developed countries remained unnoticed in the English-language literature. In this issue, Etter provides a meta-analysis of placebo-controlled trials that suggests that cytisine may be effective for smoking cessation. These results need to be confirmed by state-of-the art trials, but this meta-analysis opens a new line of research in the field of tobacco dependence.

See page 1553

Low Serum Testosterone and Mortality in Male Veterans

Low serum testosterone levels are common in aging men and are associated with decreased muscle mass and bone mineral density, increased adiposity, and insulin resistance. Shores et al used a clinical database to identify men 40 years or older who had low, normal, or equivocal (both low and normal) testosterone levels. Risks for all-cause mortality were estimated using Cox proportional hazards regression models for a follow-up period of up to 8 years. Compared with men with normal testosterone levels, men with low testosterone had an 88% increased mortality risk after controlling for age, medical morbidity, and other clinical covariates. To minimize the effect of acute illness on the results, an additional analysis was done excluding men who died within the first year, and low testosterone levels continued to be associated with a significantly increased mortality risk.

See page 1660

Etiology and Outcome of Fever After a Stay in the Tropics

The clinical spectrum and the outcome of 1842 episodes of imported fever were prospectively investigated at an outpatient and inpatient referral facility for tropical diseases in Belgium. The main regions of exposure were sub-Saharan Africa (68%) and the Southeast Asia-Pacific region (12.5%). Tropical infections predominated (39%), with malaria being the leading cause by far, but cosmopolitan infections were also frequently seen (34%). The pattern and the relative frequency of tropical diseases was highly destination specific but depended also on the type of traveler, the delay between exposure and fever onset, and the setting where patients were first seen. Morbidity associated with tropical pathologic conditions was extensive. Plasmodium falciparum malaria was both the leading cause of mortality and the only tropical disease causing death in the study population. The etiology of fever often remained unknown (25%), in which case the outcome was invariably favorable.

See page 1642

Liver-Related Deaths in Persons Infected With the Human Immunodeficiency Virus

In a prospective cohort study of 23 441 HIV-infected persons, the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study Group investigated 181 liver-related deaths, which were the most frequent cause of non-AIDS-related deaths. A strong association between immunodeficiency, intravenous drug use, hepatitis C and active hepatitis B virus infections, and risk of liver-related deaths was found. Furthermore, multivariable analyses adjusted for the most recent CD4 cell count showed a 9% increased risk of liver-related mortality per year of mono or dual antiretroviral therapy prior to combination therapy and an 11% increased risk per year of combination antiretroviral therapy.

See page 1632

Use of Flexible Sigmoidoscopy to Screen for Colorectal Cancer in HIV-Infected Patients 50 Years of Age and Older

Because patients with human immunodeficiency virus (HIV) are chronically immunosuppressed and are at increased risk for developing various types of non-AIDS defining malignancies, Bini et al hypothesized that colonic neoplasms would be more common in HIV-infected patients than in those without HIV. Among a large cohort of asymptomatic patients at average risk for colorectal cancer who underwent screening flexible sigmoidoscopy, the prevalence of neoplastic lesions (adenomas or adenocarcinomas) in the distal colon was significantly higher in the 165 HIV-infected patients than in the 2217 control subjects (25.5% vs 13.1%; P<.001). In addition, the authors found that proximal colonic neoplasms on follow-up colonoscopy in those who had a positive flexible sigmoidoscopy finding were more common in HIV-infected patients after adjusting for age, sex, and race/ethnicity (odds ratio, 1.88; 95% confidence interval, 1.02-3.46). These findings demonstrate that colonic neoplasms are more common on flexible sigmoidoscopy in patients with HIV and highlight the need for colorectal cancer screening in this population.

See page 1626