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April 30, 2009  Vol. 360 No. 18

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Perspective
1805-1808

Kelly Brownell and Thomas Frieden discuss recently proposed large taxes on sugared beverages. The size of the taxes, their potential for generating revenue and reducing consumption, and vigorous opposition by the beverage industry have resulted in ...

1808-1810
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The standard approach to HIV treatment in Africa is to wait until people are visibly sick, treat them with effective but poorly tolerated drugs, and then wait until they are sick again before switching regimens. Nathan Ford, Edward Mills, and Dr. ...

1811-1813

On March 18, the Cardiovascular and Renal Drugs Advisory Committee of the FDA convened to determine whether the antiarrhythmic drug dronedarone should be approved for patients with atrial fibrillation or atrial flutter. Dr. Peter Zimetbaum discusses the ...

Original Articles
1815-1826

The timing of the initiation of antiretroviral therapy in asymptomatic patients with HIV infection is unclear. In this retrospective study involving patients in North America from 1996 through 2005, the deferral of therapy until the patient's CD4+ count had fallen below one of the two thresholds of interest (a range of 351 to 500 cells or >500 cells per cubic millimeter) was associated with a relative hazard of death of 1.69 and 1.94, respectively.

1827-1838

In this randomized, controlled trial involving patients with chronic infection with hepatitis C virus (HCV) genotype 1, the addition of the HCV-specific protease inhibitor telaprevir to therapy with peginterferon and ribavirin improved the rate of sustained virologic response. Patients treated with telaprevir were more likely than those treated with peginterferon and ribavirin alone to stop treatment because of adverse events, and severe rash was the most common reason for discontinuation.

1839-1850

In this phase 2 trial in patients infected with HCV genotype 1, three regimens including telaprevir, a specific inhibitor of the HCV serine protease, were tested. One such regimen (telaprevir for 12 weeks and peginterferon and ribavirin for 24 weeks) resulted in a higher rate of sustained virologic response than the control regimen (48 weeks of peginterferon and ribavirin). Telaprevir caused severe rash in some patients.

1851-1861

In this secondary analysis of data from JUPITER, rosuvastatin, as compared with placebo, resulted in a reduced risk of symptomatic venous thromboembolism (including deep-vein thrombosis and pulmonary embolism).

Clinical Practice
1862-1869
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A 23-year-old nonsmoking woman (gravida 1, para 0) presents at 11 weeks' gestation with an 8-year history of asthma, which has worsened over the past year. She reports symptoms requiring albuterol two or three times per day and interfering with sleep. Her forced expiratory volume in 1 second is 75% of the predicted value; it increases to 88% after administration of albuterol. How should her case be managed?

Review Article
1870-1884

This review discusses important advances in fungal diagnostics and in the antifungal armamentarium as applied to aspergillus species. Recent insights concerning host defenses against aspergillus species and the immunopathogenesis of aspergillus-related diseases are presented.

Images in Clinical Medicine
1885
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An 18-year-old woman with familial hypercholesterolemia presented with a 4-year history of swelling and pain in the joints. She was born with multiple xanthomas, which grew in size as she aged. Her elder brother had had more severe xanthomatosis and had ...

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A 35-year-old man presented with a 2-day history of cramps and paresthesias in the arms, predominantly involving the fingers. He had carpopedal spasm, which was reproducible by inflating a blood-pressure cuff on his arm, and Chvostek's sign.

Case Records of the Massachusetts General Hospital
1886-1895

A 36-year-old man was admitted to the hospital because of chest pain, dysphagia, and pleural and mediastinal calcifications. He had had intermittent chest pain for 6 years after an athletic injury; dysphagia, dyspnea, and weight loss had developed over the past 2 years. Imaging studies showed pleural and mediastinal calcifications, with an esophageal stricture. Surgical procedures were performed to relieve esophageal stricture and obtain tissue for diagnosis, but symptoms recurred and biopsy specimens disclosed bony tissue with no malignant cells.

Editorials
1897-1899

The optimal time to start antiretroviral therapy in asymptomatic patients has been one of the central controversies in the care of patients with the human immunodeficiency virus (HIV) since the introduction of the first antiretroviral agent, zidovudine, ...

1899-1901

The therapy of hepatitis C began almost 25 years ago with a small trial of recombinant human interferon alfa.1 The rationale for using interferon was its broad antiviral effects and the suspicion that it might be active against the still-undiscovered ...

Clinical Decisions
1902-1906

This interactive Journal feature presents the case of a 25-year-old woman with incidentally identified HCV infection. Three possible treatment options, any of which could be considered correct, are presented. Which option do you recommend?

Correspondence
1907-1908

To the Editor: Rodriguez-Torres and colleagues (Jan. 15 issue)1 state that the rate of response to standard therapy for hepatitis C virus (HCV) infection was lower among Latino white patients than among non-Latino whites. We have concerns about the ...

1908-1910

To the Editor: Grocott et al. (Jan. 8 issue)1 measured arterial blood gases in healthy climbers breathing ambient air on Mount Everest. The authors acknowledge the potential confounding influence of the subjects' use of supplemental oxygen before the ...

1911

To the Editor: Gu and colleagues (Jan. 8 issue)1 report that in 2005, an estimated 673,000 deaths in China were attributable to smoking. The study is of timely importance. But it did not include some important variables in the analysis. First, the ...

1911-1912
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To the Editor: In the review article on endometriosis, Bulun (Jan. 15 issue)1 states that the presence of aromatase in endometriotic lesions appears to play an important role in the production of estradiol, and it is considered to be a key factor for ...

1912-1914

To the Editor: Vitamin D deficiency is rarely considered or treated in critically ill patients. However, we recently reported three cases of life-threatening hypocalcemia secondary to vitamin D deficiency,1,2 highlighting potential acute complications. ...

Book Reviews
1915

Euthanasia and Law in Europe is an examination of physician-assisted dying or physician-performed euthanasia and the laws concerning these practices in European jurisdictions where the issue has been most visible. The authors focus primarily on the ...

1915-1916
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Pancreatic Cancer is the latest title in the M.D. Anderson Solid Tumor Oncology Series from Springer. It is the second book in the series to address pancreatic cancer; the first was published in 2002. The new comprehensive work has 44 chapters by 96 ...

1916-1917

Renal-cell carcinoma, a malignant tumor that is associated with a poor prognosis, is difficult to diagnose in its early stages and difficult to treat successfully. This book provides an overview of the epidemiology, diagnosis, and management of this type ...

Corrections
1917

Multidisciplinary Management of Lung Cancer Review Article, N Engl J Med 2004:350;379-392.. In Table 4 (page 387), in the Conclusions or Results column, the therapeutic agents named should have been cisplatin and irinotecan rather than etoposide and ...

1917

Cold-Activated Brown Adipose Tissue in Healthy Men Original Article, N Engl J Med 2009:360;1500-1508.. In Table 1 (page 1502), in the Lean Subjects column, the range given for body fat (the last row of the table) should have read 9.4–25.1. The article has ...

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