The risks and benefits of standard antidepressants for patients with bipolar disorder are not well understood. In this randomized, placebo-controlled trial of patients with bipolar disorder, all of whom received a mood stabilizer, adjunctive treatment with an antidepressant did not reduce the symptoms of bipolar depression or increase the risk of mania.

In patients infected with HIV, the duration of combination antiretroviral therapy has been shown to be associated with the risk of myocardial infarction (MI). In an analysis of data from 23,437 patients, a significant association with risk of MI was found for protease-inhibitor therapy but not for therapy with nonnucleoside reverse-transcriptase inhibitors. This association may be partly explained by the effects of protease inhibitors on serum lipid levels.

Some types of neuropathy are caused by mutant dynamin proteins, which prevent the fusion of mitochondria. In this article, an infant with severe and lethal neuropathy was found to have elongated, tubular mitochondria and peroxisomes and to carry a mutation in the gene encoding dynamin-like protein 1. The mutant protein seemed to prevent mitochondrial and peroxisomal fission.

In this national survey of 3167 physicians, 83% reported receiving food or beverages paid for by a company that makes drugs or other medical products, 78% drug samples, 35% reimbursement for professional meetings, and 28% payments for consulting, speaking, or enrolling patients in clinical trials. Family practitioners met most frequently with industry representatives, and cardiologists were most likely to receive payments.

A 48-year-old man reports that he snores loudly and falls asleep when sedentary. A diagnosis of obstructive sleep apnea is made, and treatment with continuous positive airway pressure (CPAP) is recommended. CPAP has been shown to improve cognitive function and sleep quality, although beneficial effects on survival have not been clearly documented. The patient's tolerance of CPAP is often a limiting factor.

A 46-year-old woman was evaluated at the Center for Cancer Risk Analysis because of her recent diagnoses of endometrial, ovarian, and colon cancers. A routine Papanicolaou smear had disclosed an atypical glandular cell; endometrial curettage disclosed endometrioid carcinoma; and at hysterectomy, small bilateral ovarian tumors and a colon cancer were found. There was a maternal history of endometrial, breast, and colon cancers and colonic polyps.

Some adjuvants contain ligands that bind to a specific class of dendritic-cell receptors called toll-like receptors. Binding of ligand to toll-like receptors was thought to initiate the immune response and underlie the adjuvant effect. A recent study questions this assumption.

Emergency orotracheal intubation is indicated in any situation that requires definitive control of the airway. This video demonstrates how to perform orotracheal intubation. Specific indications are discussed, along with contraindications, troubleshooting, and complications.