Interesting Articles: A Weekly Review of the "Big Five" Medical Journals

This is a collection of articles I have found interesting in the weekly editions of the "big five" medical journals: NEJM, JAMA, Annals, Lancet and BMJ (a few more journals are included occasionally). The review is a weekly feature of Clinical Cases and Images - Blog. Please see the end of the post for a suggested time-efficient way to stay up-to-date with the medical literature.


HIV Integrase Inhibitors — Out of the Pipeline and into the Clinic.
NEJM Volume 359:416-418 July 24, 2008 Number 4

Since 2003, nine new drugs and three new drug classes, including HIV integrase inhibitors, were approved for HIV treatment. HIV integrase was a natural target for HIV chemotherapy because of both its central role in the HIV life cycle and the absence of a human homologue. Raltegravir is the first compound of this class to be approved for clinical use.


Sildenafil Treatment of Women With Antidepressant-Associated Sexual Dysfunction: It Helped.
JAMA. 2008;300(4):395-404.

Antidepressant-associated sexual dysfunction is a common adverse effect that frequently results in stopping medications. Forty-nine patients were randomly assigned to take sildenafil (Viagra) or placebo at a flexible dose starting at 50 mg adjustable to 100 mg before sexual activity. Sildenafil treatment of sexual dysfunction in women taking SRIs was associated with a reduction in adverse sexual effects.


Tuberculosis Among Foreign-Born Persons in the United States: Focus on individuals from sub-Saharan Africa and Southeast Asia.
JAMA. 2008;300(4):405-412.

Foreign-born persons accounted for 57% of all tuberculosis (TB) cases in the United States in 2006. A total of 47,000 cases of TB disease were reported among foreign-born persons in the United States from 2001 through 2006, of which 28% were among recent entrants (within 2 years of US entry). TB case rates remained higher than among US-born persons—even more than 20 years after arrival. 53% of TB cases among foreign-born persons occurred among the population born in sub-Saharan Africa and Southeast Asia. The relative yield of finding and treating latent TB infection is particularly high among individuals from most countries of sub-Saharan Africa and Southeast Asia.


Cytomegalovirus Reactivation in Critically Ill Immunocompetent Patients: Important to Consider in DDx.
JAMA. 2008;300(4):413-422.

Cytomegalovirus (CMV) infection is associated with adverse clinical outcomes in immunosuppressed persons. The authors prospectively assessed CMV plasma DNAemia by thrice-weekly real-time polymerase chain reaction (PCR) and clinical outcomes in a cohort of 120 CMV-seropositive, immunocompetent adults admitted to ICU. Cytomegalovirus viremia occurred in 33%. CMV infection at any level was associated with hospitalization or death by 30 days. These findings suggest that reactivation of CMV occurs frequently in critically ill immunocompetent patients and is associated with prolonged hospitalization or death. CMV prophylaxis in this setting may be warranted.


A time efficient way to stay up-to-date with medical literature

"How do you eat in elephant? In small bites." The same rule probably applies to staying current with the ever expanding avalanche of medical literature. One can try the following approach:

1. Subscribe to the RSS feeds of the 5 major medical journals (NEJM, JAMA, BMJ, Lancet and Annals) plus 2-3 subpecialty journals in your field of interest.

Medical Journals tab: A screenshot of iGoogle with RSS feeds from the major medical journals.

2. Read the journal on the day it is published online, for example, NEJM on Wednesdays.

3. Use text-to-speech to listen to the articles you do not have time to read.

4. Listen to journal podcasts. Click here to subscribe the podcasts of the 4 major journals in iGoogle.

5 Tips to Stay Up-to-Date with Medical Literature
Make Your Own "Medical Journal" with iGoogle Personalized Page
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt, public domain.

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