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Breastfeeding and allergies: time for a change in paradigm?.

Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R

New aspects in allergic contact dermatitis.

Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner

Contemporary approaches to the identification of athletes at risk for sudden cardiac death.

Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A

How to break the vicious circle of antibiotic resistances?.

Page: 560DOI: 10.1097/MCI.0b013e32831dabd1Authors: Leone, Marc; Martin, Claude

Benefits of high-protein weight loss diets: enough evidence for practice?.

Page: 566DOI: 10.1097/MCI.0b013e32831daebdAuthors: Brehm, Bonnie J a; D'Alessio, David A b

Chronic pancreatitis.

Page: 572DOI: 10.1097/MCI.0b013e32831daddaAuthors: Conwell, Darwin L; Banks, Peter A

Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment.

Page: 577DOI: 10.1097/MCI.0b013e32831dae94Authors: Alberio, Lorenzo

Long-term prognosis after deep venous thrombosis.

Page: 586DOI: 10.1097/MCI.0b013e32831daea9Authors: Shbaklo, Hadia a; Kahn, Susan R a,b

New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control.

Page: 591DOI: 10.1097/MCI.0b013e32831daed2Authors: DuPont, Herbert L a,b,c; Garey, Kevin b,c,d; Caeiro, Juan-Pablo b,c; Jiang, Zhi-Dong a

Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?.

Page: 599DOI: 10.1097/MCI.0b013e32831daeffAuthors: Ryan, Michael J a; Tuttle, Katherine R a,b

Renin inhibition: should it supplant ACE inhibitors and ARBS in high risk patients?.

Page: 606DOI: 10.1097/MCI.0b013e32831daf11Authors: Gaddam, Krishna K; Oparil, Suzanne

Diabetic polyneuropathy: an update.

Page: 613DOI: 10.1097/MCI.0b013e32831dae0bAuthors: Zochodne, Douglas W

Drug-induced myopathies.

Page: 620DOI: 10.1097/MCI.0b013e32831dae1cAuthors: Klopstock, Thomas

Evolving epidemiology of malignancies in HIV.

Page: 626DOI: 10.1097/MCI.0b013e32831dae71Authors: Bonnet, Fabrice a,b,c; Chene, Genevieve a,b

Vaccines against cervical cancer.

Page: 633DOI: 10.1097/MCI.0b013e32831dae88Authors: Rogers, Linda J; Eva, Lois J; Luesley, David Michael

Effectiveness and cost effectiveness of thrombolysis in patients with acute pulmonary embolism.

Page: 638DOI: 10.1097/MCI.0b013e32831dad76Authors: Zamanian, Roham T a,b; Gould, Michael K a,c

Update on biologics in juvenile idiopathic arthritis.

Page: 643DOI: 10.1097/MCI.0b013e32831dae32Authors: Ilowite, Norman T

Rethinking Randomized Clinical Trials for Comparative Effectiveness Research: The Need for Transformational Change.

Related Articles Rethinking Randomized Clinical Trials for Comparative Effectiveness Research: The Need for Transformational Change. Ann Intern Med. 2009 Jun 30; Authors: Luce BR, Kramer JM, Goodman SN, Connor J, Tunis S, Whicher D, Schwartz JS PMID: 19567619 [PubMed - as supplied by publisher]

Comparative Effectiveness Research: A Report From the Institute of Medicine.

Related Articles Comparative Effectiveness Research: A Report From the Institute of Medicine. Ann Intern Med. 2009 Jun 30; Authors: Sox HC, Greenfield S PMID: 19567618 [PubMed - as supplied by publisher]

ABOUT THIS JOURNAL: About This Journal

IN THIS ISSUE OF ARCHIVES OF INTERNAL MEDICINE: In This Issue of Archives of Internal Medicine

COMMENTARY: The Silent Dimension: Expressing Humanism in Each Medical Encounter

EDITORIAL: Treating Anemia With Erythropoiesis-Stimulating Agents: Effects on Quality of Life

EDITORIAL: Cost-effectiveness Analysis of an Established, Effective Procedure

REVIEW ARTICLE: The Impact of Selecting a High Hemoglobin Target Level on Health-Related Quality of Life for Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis

Background Treatment of anemia in chronic kidney disease (CKD) with erythropoietin-stimulating agents (ESAs) is commonplace. The optimal hemoglobin treatment target has not been established. A clearer understanding of the health-related quality of life (HQOL) impact of hemoglobin target levels is needed. We systematically reviewed the randomized controlled trial (RCT) data on HQOL for patients treated with low to intermediate (9.0-12.0 g/dL) and high hemoglobin target levels (>12.0 g/dL) and performed a meta-analysis of all available 36-item short-form (SF-36) RCT data. Methods We conducted a search to identify all RCTs of ESA therapy in patients with anemia associated with CKD (1966–December 2006). Inclusion criteria were (1) 30 or more participants, (2) anemic adults with CKD, (3) epoetin (alfa and beta) or darbepoetin used, (4) a control arm, and (5) reported HQOL using a validated measure. All available SF-36 data underwent meta-analysis using the weighted mean difference. Results Of 231 full texts screened, 11 eligible studies were identified. The SF-36 was used in 9 trials. Reporting of these data was generally incomplete. Data from each domain of the SF-36 were summarized. Statistically significant changes were noted in the physical function (weighted mean difference [WMD], 2.9; 95% confidence interval [CI], 1.3 to 4.5), general health (WMD, 2.7; 95% CI, 1.3 to 4.2), social function (WMD, 1.3; 95% CI, –0.8 to 3.4), and mental health (WMD, 0.4; 95% CI, 0.1 to 0.8) domains. None of the changes would be considered clinically significant. Conclusions Our study suggests that targeting hemoglobin levels in excess of 12.0 g/dL leads to small and not clinically meaningful improvements in HQOL. This, in addition to significant safety concerns, suggests that targeting treatment to hemoglobin levels that are in the range of 9.0 to 12.0 g/dL is preferred.

ORIGINAL INVESTIGATION: Cost-effectiveness of Total Knee Arthroplasty in the United States: Patient Risk and Hospital Volume

Background Total knee arthroplasty (TKA) relieves pain and improves quality of life for persons with advanced knee osteoarthritis. However, to our knowledge, the cost-effectiveness of TKA and the influences of hospital volume and patient risk on TKA cost-effectiveness have not been investigated in the United States. Methods We developed a Markov, state-transition, computer simulation model and populated it with Medicare claims data and cost and outcomes data from national and multinational sources. We projected lifetime costs and quality-adjusted life expectancy (QALE) for different risk populations and varied TKA intervention and hospital volume. Cost-effectiveness of TKA was estimated across all patient risk and hospital volume permutations. Finally, we conducted sensitivity analyses to determine various parameters' influences on cost-effectiveness. Results Overall, TKA increased QALE from 6.822 to 7.957 quality-adjusted life years (QALYs). Lifetime costs rose from $37 100 (no TKA) to $57 900 after TKA, resulting in an incremental cost-effectiveness ratio of $18 300 per QALY. For high-risk patients, TKA increased QALE from 5.713 to 6.594 QALY, yielding a cost-effectiveness ratio of $28 100 per QALY. At all risk levels, TKA was more costly and less effective in low-volume centers than in high-volume centers. Results were insensitive to variations of key input parameters within policy-relevant, clinically plausible ranges. The greatest variations were seen for the quality of life gain after TKA and the cost of TKA. Conclusions Total knee arthroplasty appears to be cost-effective in the US Medicare-aged population, as currently practiced across all risk groups. Policy decisions should be made on the basis of available local options for TKA. However, when a high-volume hospital is available, TKAs performed in a high-volume hospital confer even greater value per dollar spent than TKAs performed in low-volume centers.

INVITED COMMENTARY: Cost-effectiveness of Total Knee Arthroplasty in the United States--Invited Commentary

ORIGINAL INVESTIGATION: Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results

Background Failing to inform a patient of an abnormal outpatient test result can be a serious error, but little is known about the frequency of such errors or the processes for managing results that may reduce errors. Methods We conducted a retrospective medical record review of 5434 randomly selected patients aged 50 to 69 years in 19 community-based and 4 academic medical center primary care practices. Primary care practice physicians were surveyed about their processes for managing test results, and individual physicians were notified of apparent failures to inform and asked whether they had informed the patient. Blinded reviewers calculated a "process score" ranging from 0 to 5 for each practice using survey responses. Results The rate of apparent failures to inform or to document informing the patient was 7.1% (135 failures divided by 1889 abnormal results), with a range of 0% to 26.2%. The mean process score was 3.8 (range, 0.9-5.0). In mixed-effects logistic regression, higher process scores were associated with lower failure rates (odds ratio, 0.68; P < .001). Use of a "partial electronic medical record" (paper-based progress notes and electronic test results or vice versa) was associated with higher failure rates compared with not having an electronic medical record (odds ratio, 1.92; P = .03) or with having an electronic medical record that included both progress notes and test results (odds ratio, 2.37; P = .007). Conclusions Failures to inform patients or to document informing patients of abnormal outpatient test results are common; use of simple processes for managing results is associated with lower failure rates.

ORIGINAL INVESTIGATION: Cutaneous Malignancies Among HIV-Infected Persons

Background As the life expectancy of persons infected with human immunodeficiency virus (HIV) increases, cancers have become an important cause of morbidity and mortality. Although cutaneous cancers are the most common malignant neoplasms in the general population, little data exist among HIV-positive persons, especially regarding the impact of HIV-specific factors. Methods We evaluated the incidence rates and factors associated with the development of cutaneous malignancies among HIV-infected persons by examining data that were prospectively collected from a large HIV study that included 4490 participants (1986-2006). Poisson regression and Cox proportional hazards models were performed. Results Six percent of HIV-infected persons (n = 254) developed a cutaneous malignancy during 33 760 person-years of follow-up (mean, 7.5 years). Since the advent of highly active antiretroviral therapy (HAART), the incidence rates of cutaneous non–AIDS-defining cancers (NADCs), in particular basal cell carcinoma, have exceeded the rates of cutaneous AIDS-defining cancers such as Kaposi sarcoma. Factors associated with the development of cutaneous NADCs in the multivariate models included increasing age (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.7-2.6) and race. Compared with the white/non-Hispanic race, African Americans (HR, 0.03; 95% CI, 0.01-0.14) and other races (HR, 0.14; 95% CI, 0.03-0.57) had a lower risk of cutaneous NADCs. There were no significant associations between cutaneous NADCs and time-updated CD4 lymphocyte counts, HIV RNA levels, or receipt of HAART. Conclusions At present, the most common cutaneous malignancies among HIV-infected persons are NADCs. Cutaneous NADCs do not appear to be significantly associated with immune function or HAART but rather are related to traditional factors such as aging and skin color.

ORIGINAL INVESTIGATION: Association Between Late-Life Social Activity and Motor Decline in Older Adults

Background Loss of motor function is a common consequence of aging, but little is known about the factors that predict idiopathic motor decline. Our objective was to test the hypothesis that late-life social activity is related to the rate of change in motor function in old age. Methods Longitudinal cohort study with a mean follow-up of 4.9 years with 906 persons without stroke, Parkinson disease, or dementia participating in the Rush Memory and Aging Project. At baseline, participants rated the frequency of their current participation in common social activities from which a summary measure of social activity was derived. The main outcome measure was annual change in a composite measure of global motor function, based on 9 measures of muscle strength and 9 motor performances. Results Mean (SD) social activity score at baseline was 2.6 (0.58), with higher scores indicating more frequent participation in social activities. In a generalized estimating equation model, controlling for age, sex, and education, global motor function declined by approximately 0.05 U/y (estimate, 0.016; 95% confidence interval [CI], –0.057 to 0.041 [P = .02]). Each 1-point decrease in social activity was associated with approximately a 33% more rapid rate of decline in motor function (estimate, 0.016; 95% CI, 0.003 to 0.029 [P = .02]). The effect of each 1-point decrease in the social activity score at baseline on the rate of change in global motor function was the same as being approximately 5 years older at baseline (age estimate, –0.003; 95% CI, –0.004 to –0.002 [P<.001]). Furthermore, this amount of motor decline per year was associated with a more than 40% increased risk of death (hazard ratio, 1.44; 95% CI, 1.30 to 1.60) and a 65% increased risk of incident Katz disability (hazard ratio, 1.65; 95% CI, 1.48 to 1.83). The association of social activity with the rate of global motor decline did not vary along demographic lines and was unchanged (estimate, 0.025; 95% CI, 0.005 to 0.045 [P = .01]) after controlling for potential confounders including late-life physical and cognitive activity, disability, global cognition depressive symptoms, body composition, and chronic medical conditions. Conclusion Less frequent participation in social activities is associated with a more rapid rate of motor function decline in old age.

ORIGINAL INVESTIGATION: Nocturnal Arrhythmias Across a Spectrum of Obstructive and Central Sleep-Disordered Breathing in Older Men: Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study

Background Rates of cardiac arrhythmias increase with age and may be associated with clinically significant morbidity. We studied the association between sleep-disordered breathing (SDB) with nocturnal atrial fibrillation or flutter (AF) and complex ventricular ectopy (CVE) in older men. Methods A total of 2911 participants in the Outcomes of Sleep Disorders in Older Men Study underwent unattended polysomnography. Nocturnal AF and CVE were ascertained by electrocardiogram-specific analysis of the polysomnographic data. Exposures were (1) SDB defined by respiratory disturbance index (RDI) quartile (a major index including all apneas and hypopneas), and ancillary definitions incorporating (2) obstructive events, obstructive sleep apnea (OSA; Obstructive Apnea Hypopnea Index quartile), or (3) central events, central sleep apnea (CSA; Central Apnea Index category), and (4) hypoxia (percentage of sleep time with <90% arterial oxygen percent saturation). Multivariable logistic regression analyses were performed. Results An increasing RDI quartile was associated with increased odds of AF and CVE (P values for trend, .01 and <.001, respectively). The highest RDI quartile was associated with increased odds of AF (odds ratio [OR], 2.15; 95% confidence interval [CI], 1.19-3.89) and CVE (OR, 1.43; 95% CI, 1.12-1.82) compared with the lowest quartile. An increasing OSA quartile was significantly associated with increasing CVE (P value for trend, .01) but not AF. Central sleep apnea was more strongly associated with AF (OR, 2.69; 95% CI, 1.61-4.47) than CVE (OR, 1.27; 95% CI, 0.97-1.66). Hypoxia level was associated with CVE (P value for trend, <.001); those in the highest hypoxia category had an increased odds of CVE (OR, 1.62; 95% CI, 1.23-2.14) compared with the lowest quartile. Conclusions In this large cohort of older men, increasing severity of SDB was associated with a progressive increase in odds of AF and CVE. When SDB was characterized according to central or obstructive subtypes, CVE was associated most strongly with OSA and hypoxia, whereas AF was most strongly associated with CSA, suggesting that different sleep-related stresses may contribute to atrial and ventricular arrhythmogenesis in older men.

ORIGINAL INVESTIGATION: The Frequency of Hyperkalemia and Its Significance in Chronic Kidney Disease

Background Hyperkalemia is a potential threat to patient safety in chronic kidney disease (CKD). This study determined the incidence of hyperkalemia in CKD and whether it is associated with excess mortality. Methods This retrospective analysis of a national cohort comprised 2 103 422 records from 245 808 veterans with at least 1 hospitalization and at least 1 inpatient or outpatient serum potassium record during the fiscal year 2005. Chronic kidney disease and treatment with angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers (blockers of the renin-angiotensin-aldosterone system [RAAS]) were the key predictors of hyperkalemia. Death within 1 day of a hyperkalemic event was the principal outcome. Results Of the 66 259 hyperkalemic events (3.2% of records), more occurred as inpatient events (n = 34 937 [52.7%]) than as outpatient events (n = 31 322 [47.3%]). The adjusted rate of hyperkalemia was higher in patients with CKD than in those without CKD among individuals treated with RAAS blockers (7.67 vs 2.30 per 100 patient-months; P < .001) and those without RAAS blocker treatment (8.22 vs 1.77 per 100 patient-months; P < .001). The adjusted odds ratio (OR) of death with a moderate (potassium, ≥5.5 and <6.0 mEq/L [to convert to mmol/L, multiply by 1.0]) and severe (potassium, ≥6.0 mEq/L) hyperkalemic event was highest with no CKD (OR, 10.32 and 31.64, respectively) vs stage 3 (OR, 5.35 and 19.52, respectively), stage 4 (OR, 5.73 and 11.56, respectively), or stage 5 (OR, 2.31 and 8.02, respectively) CKD, with all P < .001 vs normokalemia and no CKD. Conclusions The risk of hyperkalemia is increased with CKD, and its occurrence increases the odds of mortality within 1 day of the event. These findings underscore the importance of this metabolic disturbance as a threat to patient safety in CKD.

RESEARCH LETTERS: Low-Molecular-Weight Heparin as an Adjunct to Thrombolysis in ST Elevation Myocardial Infarction

RESEARCH LETTERS: Patient- and Physician-Oriented Web Sites and Drug Surveillance: Bisphosphonates and Severe Bone, Joint, and Muscle Pain

EDITOR'S CORRESPONDENCE: Cold-Induced Dehydration Decreases Tissue Perfusion and Increases Blood Pressure

EDITOR'S CORRESPONDENCE: Regarding the Inverse Relationship Between Blood Pressure and Outdoor Temperature: It Is the Sun

EDITOR'S CORRESPONDENCE: Role of Vitamin B12 in Anemia in Old Age

EDITOR'S CORRESPONDENCE: Role of Vitamin B12 in Anemia in Old Age--Reply

EDITOR'S CORRESPONDENCE: Pitfalls in Diagnosing Chronic Kidney Disease From eGFR

EDITOR'S CORRESPONDENCE: Pitfalls in Diagnosing Chronic Kidney Disease From eGFR--Reply

Breastfeeding and allergies: time for a change in paradigm?.

Page: 539DOI: 10.1097/MCI.0b013e32831dae43Authors: Duncan, Joanne M; Sears, Malcolm R

New aspects in allergic contact dermatitis.

Page: 547DOI: 10.1097/MCI.0b013e32831dae50Authors: Mortz, Charlotte Gotthard; Andersen, Klaus Ejner

Contemporary approaches to the identification of athletes at risk for sudden cardiac death.

Page: 552DOI: 10.1097/MCI.0b013e32831daee4Authors: Drezner, Jonathan A

How to break the vicious circle of antibiotic resistances?.

Page: 560DOI: 10.1097/MCI.0b013e32831dabd1Authors: Leone, Marc; Martin, Claude

Benefits of high-protein weight loss diets: enough evidence for practice?.

Page: 566DOI: 10.1097/MCI.0b013e32831daebdAuthors: Brehm, Bonnie J a; D'Alessio, David A b

Chronic pancreatitis.

Page: 572DOI: 10.1097/MCI.0b013e32831daddaAuthors: Conwell, Darwin L; Banks, Peter A

Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment.

Page: 577DOI: 10.1097/MCI.0b013e32831dae94Authors: Alberio, Lorenzo

Long-term prognosis after deep venous thrombosis.

Page: 586DOI: 10.1097/MCI.0b013e32831daea9Authors: Shbaklo, Hadia a; Kahn, Susan R a,b

New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control.

Page: 591DOI: 10.1097/MCI.0b013e32831daed2Authors: DuPont, Herbert L a,b,c; Garey, Kevin b,c,d; Caeiro, Juan-Pablo b,c; Jiang, Zhi-Dong a

Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?.

Page: 599DOI: 10.1097/MCI.0b013e32831daeffAuthors: Ryan, Michael J a; Tuttle, Katherine R a,b

Renin inhibition: should it supplant ACE inhibitors and ARBS in high risk patients?.

Page: 606DOI: 10.1097/MCI.0b013e32831daf11Authors: Gaddam, Krishna K; Oparil, Suzanne

Diabetic polyneuropathy: an update.

Page: 613DOI: 10.1097/MCI.0b013e32831dae0bAuthors: Zochodne, Douglas W

Drug-induced myopathies.

Page: 620DOI: 10.1097/MCI.0b013e32831dae1cAuthors: Klopstock, Thomas

Evolving epidemiology of malignancies in HIV.

Page: 626DOI: 10.1097/MCI.0b013e32831dae71Authors: Bonnet, Fabrice a,b,c; Chene, Genevieve a,b

Vaccines against cervical cancer.

Page: 633DOI: 10.1097/MCI.0b013e32831dae88Authors: Rogers, Linda J; Eva, Lois J; Luesley, David Michael

Effectiveness and cost effectiveness of thrombolysis in patients with acute pulmonary embolism.

Page: 638DOI: 10.1097/MCI.0b013e32831dad76Authors: Zamanian, Roham T a,b; Gould, Michael K a,c

Update on biologics in juvenile idiopathic arthritis.

Page: 643DOI: 10.1097/MCI.0b013e32831dae32Authors: Ilowite, Norman T

Internal_Medicine RSS : Gourt

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Breastfeeding and allergies: time for a change in paradigm?.

New aspects in allergic contact dermatitis.

Contemporary approaches to the identification of athletes at risk for sudden cardiac death.

How to break the vicious circle of antibiotic resistances?.

Benefits of high-protein weight loss diets: enough evidence for practice?.

Chronic pancreatitis.

Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment.

Long-term prognosis after deep venous thrombosis.

New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control.

Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?.

Renin inhibition: should it supplant ACE inhibitors and ARBS in high risk patients?.

Diabetic polyneuropathy: an update.

Drug-induced myopathies.

Evolving epidemiology of malignancies in HIV.

Vaccines against cervical cancer.

Effectiveness and cost effectiveness of thrombolysis in patients with acute pulmonary embolism.

Update on biologics in juvenile idiopathic arthritis.

Rethinking Randomized Clinical Trials for Comparative Effectiveness Research: The Need for Transformational Change.

Comparative Effectiveness Research: A Report From the Institute of Medicine.

ABOUT THIS JOURNAL: About This Journal

IN THIS ISSUE OF ARCHIVES OF INTERNAL MEDICINE: In This Issue of Archives of Internal Medicine

COMMENTARY: The Silent Dimension: Expressing Humanism in Each Medical Encounter

EDITORIAL: Treating Anemia With Erythropoiesis-Stimulating Agents: Effects on Quality of Life

EDITORIAL: Cost-effectiveness Analysis of an Established, Effective Procedure

REVIEW ARTICLE: The Impact of Selecting a High Hemoglobin Target Level on Health-Related Quality of Life for Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis

ORIGINAL INVESTIGATION: Cost-effectiveness of Total Knee Arthroplasty in the United States: Patient Risk and Hospital Volume

INVITED COMMENTARY: Cost-effectiveness of Total Knee Arthroplasty in the United States--Invited Commentary

ORIGINAL INVESTIGATION: Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results

ORIGINAL INVESTIGATION: Cutaneous Malignancies Among HIV-Infected Persons

ORIGINAL INVESTIGATION: Association Between Late-Life Social Activity and Motor Decline in Older Adults

ORIGINAL INVESTIGATION: Nocturnal Arrhythmias Across a Spectrum of Obstructive and Central Sleep-Disordered Breathing in Older Men: Outcomes of Sleep Disorders in Older Men (MrOS Sleep) Study

ORIGINAL INVESTIGATION: The Frequency of Hyperkalemia and Its Significance in Chronic Kidney Disease

RESEARCH LETTERS: Low-Molecular-Weight Heparin as an Adjunct to Thrombolysis in ST Elevation Myocardial Infarction

RESEARCH LETTERS: Patient- and Physician-Oriented Web Sites and Drug Surveillance: Bisphosphonates and Severe Bone, Joint, and Muscle Pain

EDITOR'S CORRESPONDENCE: Cold-Induced Dehydration Decreases Tissue Perfusion and Increases Blood Pressure

EDITOR'S CORRESPONDENCE: Regarding the Inverse Relationship Between Blood Pressure and Outdoor Temperature: It Is the Sun

EDITOR'S CORRESPONDENCE: Role of Vitamin B12 in Anemia in Old Age

EDITOR'S CORRESPONDENCE: Role of Vitamin B12 in Anemia in Old Age--Reply

EDITOR'S CORRESPONDENCE: Pitfalls in Diagnosing Chronic Kidney Disease From eGFR

EDITOR'S CORRESPONDENCE: Pitfalls in Diagnosing Chronic Kidney Disease From eGFR--Reply

Breastfeeding and allergies: time for a change in paradigm?.

New aspects in allergic contact dermatitis.

Contemporary approaches to the identification of athletes at risk for sudden cardiac death.

How to break the vicious circle of antibiotic resistances?.

Benefits of high-protein weight loss diets: enough evidence for practice?.

Chronic pancreatitis.

Heparin-induced thrombocytopenia: some working hypotheses on pathogenesis, diagnostic strategies and treatment.

Long-term prognosis after deep venous thrombosis.

New advances in Clostridium difficile infection: changing epidemiology, diagnosis, treatment and control.

Elevations in serum creatinine with RAAS blockade: why isn't it a sign of kidney injury?.

Renin inhibition: should it supplant ACE inhibitors and ARBS in high risk patients?.

Diabetic polyneuropathy: an update.

Drug-induced myopathies.

Evolving epidemiology of malignancies in HIV.

Vaccines against cervical cancer.

Effectiveness and cost effectiveness of thrombolysis in patients with acute pulmonary embolism.

Update on biologics in juvenile idiopathic arthritis.

Permanent Internal Medicine Job in Close To New York City & Boston Excellent Earnings Partnership Connecticut with The Curare Group, Inc.