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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2003;163(1):11. doi:10.1001/archinte.163.1.11.
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DIFFERENCES IN BREAST CANCER STAGE, TREATMENT, AND SURVIVAL BY RACE AND ETHNICITY

Differences in breast cancer stage and survival by race and ethnicity have previously been identified, though few studies evaluating women in different racial and ethnic subgroups have been reported. In this retrospective population-based cohort study, Li et al evaluated the relationships between 17 different races and ethnicities and breast cancer stage, treatment, and mortality. Blacks, American Indians, Hawaiians, Indians and Pakistanis, Mexicans, South and Central Americans, and Puerto Ricans had a 1.4- to 3.6-fold greater risk of stage IV breast cancer compared with non-Hispanic whites. Blacks, American Indians, Hawaiians, Vietnamese, Mexicans, South and Central Americans, and Puerto Ricans had a 20% to 200% greater risk of mortality following a breast cancer diagnosis. Li et al identified important differences in breast cancer stage, treatments, and mortality by race and ethnicity. Breast cancer survival may be improved by targeting socioeconomic factors that likely underlie these differences.

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C-REACTIVE PROTEIN AS A PREDICTOR FOR INCIDENT DIABETES MELLITUS AMONG MIDDLE-AGED MEN

The association between C-reactive protein and incident diabetes was investigated in 2052 initially nondiabetic middle-aged men who were followed up for an average of 7.2 years. During follow-up, 101 cases of incident diabetes occurred. Men with C-reactive protein levels in the highest quartile had a 2.7-times higher risk of developing diabetes compared with men in the lowest quartile after adjustment for age and survey. Further adjustment for body mass index, smoking, and systolic blood pressure significantly attenuated the association.

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DEMYSTIFYING IDIOPATHIC INTERSTITIAL PNEUMONIA

Careful histopathologic evaluation has shown the diagnosis of idiopathic interstitial pneumonia to be more heterogeneous than once thought. Its subclassification, based on clinicopathological criteria, has important therapeutic and prognostic implications. The most important distinction is the presence of usual interstitial pneumonia, the histopathologic pattern seen in idiopathic pulmonary fibrosis, because this condition has a distinctly worse response to therapy and prognosis. A structured, clinicopathological approach to the diagnosis of idiopathic interstitial pneumonia, with particular attention to the identification of idiopathic pulmonary fibrosis, ensures proper therapy and enhances prognosis.

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USE OF SELECTIVE SEROTONIN REUPTAKE INHIBITORS AND RISK OF UPPER GASTROINTESTINAL TRACT BLEEDING

In a population-based cohort study, the risk for upper gastrointestinal (GI) tract bleeding was investigated in users of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants. During periods of SSRI use without use of any other drugs associated with upper GI bleeding, the relative risk of upper GI bleeding was 3.6, corresponding to a rate difference of 3.1 per 1000 treatment-years. Combined use of SSRIs and nonsteroidal anti-inflammatory drugs increased the risk to 12.2 and combined use of SSRI and low-dose aspirin to 5.2. For non-SSRIs, the risk for upper GI bleeding was 2.3, whereas antidepressants with no action on the serotonin receptor had no significant effect on the risk. The risk returned to unity after termination of SSRI use, while the risk in users of non-SSRIs was similarly increased during periods of use and nonuse. The authors conclude that use of SSRIs increases the risk for upper GI bleeding with a potentiating effect of concurrent nonsteroidal anti-inflammatory drug or low-dose aspirin use, whereas use of other types of antidepressants probably does not increase the risk.

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MARKED IMPROVEMENT IN NOCTURNAL GASTROESOPHAGEAL REFLUX IN A LARGE COHORT OF PATIENTS WITH OBSTRUCTIVE SLEEP APNEA TREATED WITH CONTINUOUS POSITIVE AIRWAY PRESSURE

This study assessed 331 patients with obstructive sleep apnea to determine the prevalence of nocturnal gastroesophageal reflux (nGER) symptoms and the impact of continuous positive airway pressure (CPAP) on their reflux. Of the 331 patients, 204 (62%) had nGER symptoms and were recommended CPAP treatment for their sleep apnea and were followed up for an average of 39 months. At follow-up, nGER symptoms were reassessed. There was a 48% improvement in nGER symptom scores in patients compliant with CPAP compared with no improvement in those who did not use CPAP. The improvement in reflux scores was strongly correlated with CPAP: higher CPAP was associated with greater improvement (correlation coefficient, 0.7).

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