Staph risk runs in families, especially among siblings

1. Staph risk runs in families, especially among siblings
Abstract: http://www.annals.org/article.aspx?doi=10.7326/M15-2762
URL goes live when the embargo lifts

Having a first-degree relative, especially a sibling, with a history of staph infection significantly increases a person's risk for the disease, regardless of sex of the family member, comorbid conditions, or direct contamination. The results of a large national study are published in Annals of Internal Medicine.

The incidence of Staphylococcus aureus bacteremia, or staph infection, has increased over the past few decades, with antibiotic resistance adding to the problem. Animal studies have shown a link between host genetics and staph infection, but whether human host genetics in general are associated with the risk for acquiring staph infection is unclear. This knowledge could have important implications for influencing future therapeutic interventions and strategies.

Researchers reviewed a national registry in Denmark to determine whether a history of S. aureus bacteremia in first-degree relatives is associated with an increased risk for microbiologically confirmed S. aureus bacteremia. They found that having a first-degree relative hospitalized with confirmed staph infection significantly increased a person's risk for the disease. The risk was significantly higher if the infected patient was a sibling than a parent. According to the researchers, the results are unlikely to be explained by direct transmission of the pathogen because more than 80 percent of exposed individuals acquiring staph were infected with a strain genetically different from the infected relative.

Note: For an embargoed PDF, please contact Cara Graeff. The lead author, Dr. Louise Bruun Østergaard, can be contacted directly at l_bruun@hotmail.com or (+45)28726461.

2. Rare condition mimics deep venous thrombosis
Abstract: http://www.annals.org/article.aspx?doi=10.7326/L15-0532
URL goes live when the embargo lifts

A rare condition characterized by unilateral lower extremity swelling can be mistaken for deep venous thrombosis (DVT), even by experienced clinicians. A case report is published in Annals of Internal Medicine.

DVT is usually easy for clinicians to identify due to its distinctive presentation, but a rare condition called adventitial cystic disease may mimic DVT symptoms. Authors describe the case of a 31-year-old woman who presented to the ER with painless, progressive right lower extremity swelling and tingling. Suspecting DVT, clinicians administered low-molecular-weight heparin therapy and discharged the patient home with arrangements for urgent Doppler ultrasonography as an outpatient. Further examination revealed that the patient did not have DVT, but adventitial cystic disease. Simple drainage of the cyst can be an effective treatment, but surgical resection is preferred given the risk for recurrence after aspiration. The patient tolerated surgery well and her symptoms resolved.

Note: For an embargoed PDF or contact information for one of the authors, please contact Cara Graeff.

3. Annals Graphic Medicine tackles the issue of high drug costs
Free content: http://www.annals.org/article.aspx?doi=10.7326/G16-0003
URL goes live when the embargo lifts

A new Annals Graphic Medicine feature entitled The Price of Progress highlights the issue of rising prescription drug costs. Annals Graphic Medicine uses the creativity of the graphic novel format to address medically relevant topics. These free features are often poignant and thought-provoking. A complete list of topics is available at http://www.annals.org/graphicmedicine.

Note: For an embargoed PDF, please contact Cara Graeff. For an interview with the author, Dr. Grace Farris, please contact Jennifer Kritz at jkritz@bidmc.harvard.edu.

Also new in this issue:

Use of Decision Models in the Development of Evidence-Based Clinical Preventive Services Recommendations: Methods of the U.S. Preventive Services Task Force
Douglas K. Owens, MD, MS; Evelyn P. Whitlock, MD, MPH; Jillian Henderson, PhD, MPH; Michael P. Pignone, MD, MPH; Alex H. Krist, MD, MPH; Kirsten Bibbins-Domingo, PhD, MD, MAS; Susan J. Curry, PhD; Karina W. Davidson, PhD, MASc; Mark Ebell, MD, MS; Matthew W. Gillman, MD, SM; David C. Grossman, MD, MPH; Alex R. Kemper, MD, MPH, MS; Ann E. Kurth, PhD, RN, MSN, MPH; Michael Maciosek, PhD; Albert L. Siu, MD, MSPH; and Michael L. LeFevre, MD, MPH; on behalf of the U.S. Preventive Services Task Force
Research and Reporting Methods

A Windbreaker's Warmth
Jamie K. Lim, BSc, Boston University School of Medicine, Boston, Massachusetts
On Being a Doctor

Brain Anatomy: Thoughts From the Inside
William T. Pordy, MD, New York, New York
On Being a Patient

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