ShortCuts-This Week in the Journals

June 4, 2007

Shortcut 6Much of the week in the media was spent discussing XDR TB. Andrew Speaker, a man on his way to his wedding in Santorini Greece (the picture of his wedding is to the right) managed to evade US security multiple times. The story is convoluted with many people telling different versions. ItSpeaker appears that he has smear negative, culture positive XDR-TB. His now father-in-law is a TB researcher, who insists that his new son-in-law did not catch it from his lab. Most importantly, when officials learned that Mr. Speaker had re-entered New York State, he was told to report immediately to Bellevue Hospital where he stayed for 72 hours. He did not take the subway to get there. Read a post about XDR-TB from our archive.

Is it just me or does lyme disease seem passé these days? Just a few years ago everyone was clamoring for the lyme vaccine and 12 month courses of antibiotics after a tick bite. The American Academy of Neurology last week published new guidelines on neuro-lyme and post-lyme syndrome. These guidelines were endorsed by the Infectious Disease Society of America (IDSA). They recommend oral doxycycline unless there is brain or spinal cord involvement which should be treated with ceftriaxone, cefotaxime or penicilllin g for 2 weeks. Most importantly there is a strong statement against prolonged antibiotics for post-lyme syndrome.

The British Medical Journal has an interesting article extolling the use of skin biopsy as a safe and cheap diagnostic tool to evaluate small fiber neuropathy. Generally small fiber neuropathy causes such symptoms as burning, prickling, or deep and aching pains in the feet. They quote the positive predictive value for diagnosing small fiber neuropathy ~93%; specificity is 97% and sensitivity ranges from 69% to 82%. It can diagnose changes earlier than emg or sural nerve biopsy and can predict progression to full neuropathy.

This week’s JAMA is a full issue devoted to malaria edited by Gianna Zuccotti who many of you know as the program director at Memorial Sloan Kettering.

The NEJM this week has 2 articles that favor surgery for low back pain; the first for sciatica and the second for lumbar degenerative spondylolisthesis.

Finally Michael Moore’s latest movie Sicko opened at Cannes last week. The film will likely add to the enormously negative press the US healthcare industry has received over the last several years. To quote Michael Moore “If people ask, we tell them ‘Sicko’ is a comedy about 45 million people with no health care in the richest country on Earth.” Just what the doctor ordered, a good kick in the pants when our profession is already down for the count…Sicko

-Neil Shapiro, MD, Editor-in-Chief Clinical Correlations