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JAMA : Journal of the American Medical Association [journal]
- JAMA patient page. Valley fever (coccidioidomycosis). [Journal Article]
- JAMA 2013 Dec 11; 310(22):2470.
- Metabolism in cancer. [Journal Article]
- JAMA 2013 Dec 11; 310(22):2462.
- Drug postmarketing studies--reply. [Comment, Letter]
- JAMA 2013 Dec 11; 310(22):2459-60.
- Drug postmarketing studies. [Comment, Letter]
- JAMA 2013 Dec 11; 310(22):2459.
- Therapy for posttraumatic stress and alcohol dependence--reply. [Comment, Letter]
- JAMA 2013 Dec 11; 310(22):2458-9.
- Differences in breast cancer survival by race--reply. [Comment, Letter]
- JAMA 2013 Dec 11; 310(22):2457.
- Therapy for posttraumatic stress and alcohol dependence. [Comment, Letter]
- JAMA 2013 Dec 11; 310(22):2457-8.
- Differences in breast cancer survival by race. [Comment, Letter]
- JAMA 2013 Dec 11; 310(22):2456-7.
- Pruritus in the older patient: a clinical review. [Journal Article, Research Support, Non-U.S. Gov't]
- JAMA 2013 Dec 11; 310(22):2443-50.
Pruritus is a common problem among elderly people and, when severe, causes as much discomfort as chronic pain. Little evidence supports pruritus treatment, limiting therapeutic possibilities and resulting in challenging management problems.To present the evidence on the etiology, diagnosis, and treatment of pruritus in the elderly and, using the best available evidence, provide an approach for generalist physicians caring for older patients with pruritus.PubMed and EMBASE databases were searched (1946-August 2013).The Cochrane Database of Systematic Reviews and the Agency for Healthcare Research and Quality Systematic Review Data Repository were also searched from their inception to August 2013. References from retrieved articles were evaluated.More than 50% of elderly patients have xerosis (dry skin). Xerosis treatment should be included in the initial therapy for pruritus in all elderly patients. Calcium channel blockers and hydrochlorothiazide are important causes of pruritic skin eruptions in older patients. Neuropathic pruritus is infrequently considered but may cause localized itching (especially in the genital area) and generalized truncal pruritus (especially in patients with diabetes mellitus). Certain skin conditions are more common in elderly patients, including scabies, bullous pemphigoid, transient acantholytic dermatosis, and mycosis fungoides, and should be considered in elderly patients with pruritus.It is important to evaluate elderly patients for dermatological, systemic, and neurological etiologies of itch. A simple-to-apply diagnostic and therapeutic algorithm can be used. Xerosis, drug reactions, and neuropathy should be considered when evaluating pruritus.
- Proton pump inhibitor and histamine 2 receptor antagonist use and vitamin B12 deficiency. [Journal Article, Research Support, Non-U.S. Gov't]
- JAMA 2013 Dec 11; 310(22):2435-42.
Proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) suppress the production of gastric acid and thus may lead to malabsorption of vitamin B12. However, few data exist regarding the associations between long-term exposure to these medications and vitamin B12 deficiency in large population-based studies.To study the association between use of PPIs and H2RAs and vitamin B12 deficiency in a community-based setting in the United States.We evaluated the association between vitamin B12 deficiency and prior use of acid-suppressing medication using a case-control study within the Kaiser Permanente Northern California population. We compared 25,956 patients having incident diagnoses of vitamin B12 deficiency between January 1997 and June 2011 with 184,199 patients without B12 deficiency. Exposures and outcomes were ascertained via electronic pharmacy, laboratory, and diagnostic databases.Risk of vitamin B12 deficiency was estimated using odds ratios (ORs) from conditional logistic regression.Among patients with incident diagnoses of vitamin B12 deficiency, 3120 (12.0%) were dispensed a 2 or more years' supply of PPIs, 1087 (4.2%) were dispensed a 2 or more years' supply of H2RAs (without any PPI use), and 21,749 (83.8%) had not received prescriptions for either PPIs or H2RAs. Among patients without vitamin B12 deficiency, 13,210 (7.2%) were dispensed a 2 or more years' supply of PPIs, 5897 (3.2%) were dispensed a 2 or more years' supply of H2RAs (without any PPI use), and 165,092 (89.6%) had not received prescriptions for either PPIs or H2RAs. Both a 2 or more years' supply of PPIs (OR, 1.65 [95% CI, 1.58-1.73]) and a 2 or more years' supply of H2RAs (OR, 1.25 [95% CI, 1.17-1.34]) were associated with an increased risk for vitamin B12 deficiency. Doses more than 1.5 PPI pills/d were more strongly associated with vitamin B12 deficiency (OR, 1.95 [95% CI, 1.77-2.15]) than were doses less than 0.75 pills/d (OR, 1.63 [95% CI, 1.48-1.78]; P = .007 for interaction).Previous and current gastric acid inhibitor use was significantly associated with the presence of vitamin B12 deficiency. These findings should be considered when balancing the risks and benefits of using these medications.