JAMA : the journal of the American Medical Association
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The US Food and Drug Administration (FDA) has issued warnings that use of antidepressant medications poses a small but significantly increased risk of suicidal ideation/suicide attempt for children and adolescents. ⋯ Relative to placebo, antidepressants are efficacious for pediatric MDD, OCD, and non-OCD anxiety disorders, although the effects are strongest in non-OCD anxiety disorders, intermediate in OCD, and more modest in MDD. Benefits of antidepressants appear to be much greater than risks from suicidal ideation/suicide attempt across indications, although comparison of benefit to risk varies as a function of indication, age, chronicity, and study conditions.
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Randomized Controlled Trial Multicenter Study
Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial.
Cardiogenic shock complicating acute myocardial infarction (MI) remains a common and lethal disorder despite aggressive use of early revascularization. Systemic inflammation, including expression of inducible nitric oxide synthase (NOS) and generation of excess nitric oxide, is believed to contribute to the pathogenesis and inappropriate vasodilatation of persistent cardiogenic shock. Preliminary, single-center studies suggested a beneficial effect of NOS inhibition on hemodynamics, renal function, and survival in patients with cardiogenic shock. ⋯ Tilarginine, 1-mg/kg bolus and 5-hour infusion, did not reduce mortality rates in patients with refractory cardiogenic shock complicating MI despite an open infarct artery. Early mortality rates in this patient group are high. Further research is needed to develop effective therapies for patients with cardiogenic shock following acute MI.
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Mrs A, an active 60-year-old woman, has a history of degenerative osteoarthritis of her knee with pain that has progressed over the past 8 years. She has undergone arthroscopic surgery for a meniscal tear and has taken nonsteroidal anti-inflammatory drugs (NSAIDs), glucosamine, and chondroitin sulfate occasionally, but generally does not like taking medications. She is open to other therapeutic approaches and wants to know if acupuncture can help the pain, improve function, and stop her condition from progressing. The evidence for the effectiveness of acupuncture for knee pain and other common treatments, including exercise, NSAIDs, glucosamine and chondroitin, and intra-articular knee injections are compared, and costs and methods of acupuncture and selecting an acupuncturist are discussed.