Established in 1927 by the American College of Physicians


19 August 2014 Annals of Internal Medicine Tip Sheet

Below is information about articles being published in Annals of Internal Medicine. The information is not intended to substitute for the full article as a source of information. Annals of Internal Medicine attribution is required for all coverage.

Two Ebola* virus commentaries being published online first:

1. Opinion: Ebola-stricken American volunteers deserve special treatment

American missionary workers stricken with the deadly Ebola virus while aiding infected patients in West Africa deserve special treatment, according to a commentary being published early online in Annals of Internal Medicine. As the number of Ebola virus cases surpasses 1,600 in four African countries, public attention has focused on the two infected Americans who were airlifted out of Liberia to receive a highly experimental treatment in a state-of-the-art American hospital. Many observers are left wondering why the Americans were lifted out of Liberia when others were not and why they were given a drug that had never before been given to humans. According to Nancy E. Kass, ScD, a Phoebe R. Berman Professor of Bioethics and Public Health at the Berman Institute of Bioethics and Johns Hopkins Bloomberg School of Public Health, special treatment is due the American patients because very few health professionals would likely volunteer to enter West Africa to help care for Ebola patients during this outbreak. Their selfless act of caring for sick and contagious patients who have contracted an illness with a 60 percent fatality rate is above and beyond the usual norms of good ethical conduct. Just as it would be unethical to send doctors and nurses to Africa without HazMat suits, it would be ethically unconscionable not to assure them that they would be airlifted home should they contract the deadly virus. The author also supports limiting the use of the highly experimental treatment to these two American patients, for a “very important reason.” The circumstances under which experimental medicines may be given are narrow and precise, and often worked out on an individual basis. It would be unethical to exploit the poor to test an experimental treatment during a public health outbreak.

2. Opinion: Ebola virus highly unlikely to spread in U.S.

Two American missionaries being treated for Ebola virus at Emory University Hospital in Atlanta, Ga. have prompted new fears that the deadly virus could spread in the United States. However, the author of a commentary being published in Annals of Internal Medicine says such concerns are unfounded. Even if cases are imported, the likelihood of further transmission beyond the index patient is close to zero, as hospital infection control practices are a very effective barrier. While highly infectious, Ebola is only acquired by direct contact with infected secretions, such as blood, sweat, and saliva. Most cases occur in those providing direct care to patients such as family members or health care professionals, but because bodies are still infectious after death, those involved with burial procedures may be at risk, as well. Because of modern air travel, infected persons could potentially carry the virus anywhere in the world (incubation is anywhere from 2 to 21 days). Therefore, the author warns that clinics, hospitals, and emergency rooms worldwide should be prepared to immediately isolate any patient who has a recent history of travel to West Africa and potential signs and symptoms of Ebola. These include sudden onset of fever, chills, myalgias, and malaise followed by flu-like symptoms, gastrointestinal symptoms, and finally hemorrhagic symptoms in the most severe cases. The author urges the public to utilize CDC, WHO, and other internet resources to stay abreast of new information on the current Ebola virus outbreak.

Print issue articles:

3. Longer life expected for children born and diagnosed with cystic fibrosis in 2010

Children born and diagnosed with cystic fibrosis (CF) in the United States in 2010 are expected to live longer than those born earlier, according to a study being published in Annals of Internal Medicine. CF is a life-shortening genetic disease that causes progressive damage to the lungs and other organs. In 1950, children born with CF did not live to attend elementary school. In 1966, the Cystic Fibrosis Foundation Patient Registry (CFFPR) was established. By 2010, almost half of the 26,000 living people on the CFFPR were aged 18 or older, due largely to advances in pulmonary and nutritional therapies. An updated assessment of survival is important to patients and families who want to prepare for the future. In addition, this information can help plan for the health care needs of an increasing number of patients with CF living to adulthood. Researchers reviewed the CFFPR to assess trends in survival between 2000 and 2010 and to project survival for children born and diagnosed with CF in 2010. The analysis shows that CF survival improved from 2000 to 2010 at a rate of 1.8 percent per year. The researchers project that children born and diagnosed with CF in 2010 can expect to live to about 40 years if the survival rate does not change and to 56 years if the rate continues to decrease at the same rate observed between 2000 and 2010. The authors of an accompanying editorial discuss the challenges associated with a longer lifespan for CF patients. They write that “caring for adults with CF takes a village.” Maintaining the model of care that enabled CF patients to increase their lifespan to this point will require substantial resources that a single nongovernmental organization may no longer be able to provide on its own.

4. Atypical antipsychotic drug use increases risk for acute kidney injury

Atypical antipsychotic drug use is associated with an increased risk for acute kidney injury (AKI) and other adverse outcomes, according to a study being published in Annals of Internal Medicine. Each year, millions of older adults are prescribed atypical antipsychotic drugs (quetiapine, risperidone, and olanzapine) to manage behavioral symptoms of dementia, which is not an approved indication. This type of off-label use has raised safety concerns, as these atypical antipsychotics are known to cause AKI. Researchers compared medical records for 97,777 adults aged 65 or older who received a new outpatient prescription for an oral atypical antipsychotic drug against a matched cohort of patients who had not received such a prescription to determine the risk for AKI and other adverse outcomes. Persons who had received a prescription for any three atypical antipsychotic drugs in the previous 90 days had an elevated risk for hospitalization with AKI. The drugs were also associated with increased risk for hypotension, acute urinary retention, and death. The findings support current safety concerns regarding the use of these drugs in older adults.

*Annals of Internal Medicine is part of the Emergency Access Initiative (EAI), a partnership of the National Library of Medicine, the National Network of Libraries of Medicine, and the Professional/Scholarly Publishing Division of the Association of American Publishers and other publishers. EAI provides temporary free access to full text articles from major biomedicine titles to healthcare professionals, librarians, and the public affected by disasters. As such, Annals content will be free to site visitors from the West African countries affected by the Ebola virus outbreak.