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Sleep disturbance, especially insomnia, is common, with up to 25% of the population in industrialized countries reporting severe chronic insomnia.1 Medications to improve sleep patterns are plentiful but are not always effective. New research on sleep disturbance focuses on the role of the hypothalamic-pituitary-adrenal (HPA) axis.

Use of AstraZeneca’s Crestor (rosuvastatin calcium) reduced the number of deaths, myocardial infarctions (MIs), and strokes as well as the need for bypass or angioplasty procedures by 45% in apparently healthy persons. Lead researcher Paul M. Ridker, MD, MPH, professor at Harvard Medical School, and director of the Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Boston, and colleagues presented results of the AstraZeneca-funded JUPITER (the Justification for Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin) study at the 2008 Scientific Sessions of the American Heart Association held November 8 through 12 in New Orleans. Findings were published in the November 20 issue of the New England Journal of Medicine.

Seventy percent of prescription drug users said they would be very concerned if a drug they were taking was changed to another drug in the same class without their physician's knowledge (Cover Figure). Concerns are greatly reduced, although not eliminated, if the physician is aware of and consents to the change, according to findings of a survey released by the National Consumers League (NCL).

The federal government has less authority to set Medicare drug reimbursement prices than officials at the Centers for Medicare & Medicaid Services (CMS) had thought, according to a ruling by Judge Henry H. Kennedy Jr of the US District Court in Washington, DC, in a case (Hays v Leavitt [1:08-cv-01032-HHK]) filed by a person with chronic obstructive pulmonary disease. The patient, Ilene Hays, had received a prescription for DuoNeb, a combination inhalation drug made by Mylan’s Dey subsidiary.

ABSTRACT: The treatment of pulmonary arterial hypertension(PAH) is directed at the underlying cause, such as diastolicheart failure or chronic thromboembolic disease. Patients withidiopathic PAH or PAH associated with connective-tissue diseasewho have World Health Organization (WHO) functionalclass II or III PAH should receive a trial of oral bosentan, ambrisentan,and/or sildenafil; inhaled iloprost is an alternative oran additive agent. If patients fail to respond to these interventionsor if they have WHO functional class IV PAH, considersubcutaneous or intravenous treprostinil or epoprostenol. Theuse of these latter agents is much more complicated and maybe difficult to initiate in elderly patients. (J Respir Dis. 2008;29(12):468-474)

Actinomyces odontolyticus isa rare cause of pleuropericardialinfection, with only 1 caseidentified in the literature. Inthat instance, the infectionwas believed to be secondaryto gastric surgery. We present apatient with pericarditis andpericardial tamponade causedby A odontolyticus. The infectionoccurred after an ultrasound-guided subcarinalbronchoscopic needle biopsyperformed for a suspicious mediastinalmass found on a CTscan of the chest. We describethe case presentation, the microbiologyand treatment of Aodontolyticus infection, andthe classic features of pericarditisand cardiac tamponade.

ABSTRACT: Patients with obstructive sleep apnea (OSA) are at increasedrisk for motor vehicle crashes as a result of excessivesleepiness. However, a number of factors complicate risk assessment.For example, self-reported sleepiness and the severityof OSA do not appear to be good predictors of accident risk.Many persons with OSA do not accurately perceive their levelof drowsiness-self-reported sleepiness does not correlate wellwith objective measures, such as results of the Multiple SleepLatency Test. Moreover, it is not clear whether objective testscan reliably predict accident risk in the real world, as opposedto during simulated driving. The indications for-and benefitsof-restricting driving in patients with OSA have not been established.However, there is good evidence that the use of continuouspositive airway pressure significantly reduces the riskof crashes in these patients. (J Respir Dis. 2008;29(12):459-464)

•Coccidioides species, the cause of coccidioidomycosis, are endemic to the desert soils of the southwestern United States as well as northern Mexico and limited areas of Central and South America. The organisms can become airborne with disruption of the soil, either through natural causes or activities of humans or animals. Nearly all Coccidioides infections are acquired through the inhalation of airborne arthroconidia (spores).

Otological complications associated with varicella-zostervirus infection are common; however, tympanic membraneinvolvement is rarely reported. We describe a patient withherpes zoster in whom hemorrhagic otitis media with tympanicmembrane perforation developed. To our knowledge,this is the first report of an HIV-infected patient with thisunusual presentation. [Infect Med. 2008;25:561-562]

Highlights of upcoming recommendations of the Infectious Diseases Society of America (IDSA) for the treatment of methicillin-resistant Staphylococcus aureus (MRSA) infections and community-associated urinary tract infections (CA-UTIs) were presented at the joint 48th Annual Interscience Conference of Antimicrobial Agents and Chemotherapy/ IDSA 46th Meeting, which took place in Washington, DC, from October 25 to 28. The recommendations are scheduled to be finalized and officially disseminated in the spring of 2009. Some salient points are summarized here.

Bacteremia caused by viridans streptococci frequently presentsin a subacute fashion and can lead to complicated infections.It usually manifests from an oral source and may result inseeding of the heart valves. We describe a case of viridansstreptococci bacteremia that developed after a dental procedureand was complicated by endocarditis and vertebral osteomyelitis.Symptoms and signs that may heighten suspicion forcomplicated bacteremia caused by viridans streptococci arediscussed. [Infect Med. 2008;25:552-555]

Immunocompromised hosts are at high risk for opportunisticinfections caused by endemic fungi such as Cryptococcus,Histoplasma, and Coccidioides. Moulds other than Aspergillusalso are being implicated in opportunistic fungal infections inimmunocompromised patients. Infections attributed toZygomycetes and Fusarium and Scedosporium species are beingreported with increased frequency. Because infection with theseorganisms cannot be distinguished from aspergillosis onradiographic imaging or histological examination, culture isrequired to confirm the diagnosis. Therapeutic success mayhinge on correct identification of the infectious organism.

Although many physicians are not up to speed onthe CDC 2006 recommendations on HIV screening,institution of routine voluntary testing inhealth care settings does enhance identification of undiagnosedcases of HIV infection. Furthermore, patients-especially those in high-risk groups-are generally receptiveto the opportunity to be screened for HIV infection.These were the findings from several studies on HIVtesting that were presented during a poster session at thejoint 48th Annual Interscience Conference on AntimicrobialAgents and Chemotherapy and 46th Annual Meetingof the Infectious Diseases Society of America, which tookplace in Washington, DC, from October 25 to 28, 2008.

The 17th International AIDS Conference was held in Mexico City from August 3 to 8, 2008. This conference attracted more than 20,000 participants and provided some significant new insights into HIV therapeutics.

In most HIV-infected persons, one or more dermatological conditions develop at some point during their lifetime.1 Among the spectrum of dermatological diseases, those associated with pruritus are among the most common.

In addition to standard therapy for sinusitis, suggest that patients breathe in steam from water that contains eucalyptus leaves or oil.

Change is in the air. By the time this column is published, the nation will know who will next occupy the White House; many appointees of the departing administration will most likely have already moved on to new positions; and potential appointees will be polishing their résumés and pressing the wrinkles out of their good interview suit.

What’s The “Take Home”? Elderly Man With Late-Night Confusion and Hypoglycemia