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To the Editor: Recently, the trade name for omeprazole was changed from Losec to Prilosec after several physicians noted incidents in which prescriptions written for Losec were instead dispensed with Lasix. 1 2 3 We report a similar confusion between a popular new antibiotic, the fluoroquinolone norfloxacin, and a muscle relaxant, orphenadrine. Although the trade name for norfloxacin is Noroxin, it is frequently abbreviated as \"norflox,\" which can lead to confusion with orphenadrine, the trade name for which is Norflex. We have noted two cases of such confusion. In one case, a 60-year-old woman with end-stage liver disease was prescribed norfloxacin as . . .

A 50-year-old man presented to the clinic with fever, chills, and generalized weakness that he had had for three weeks. He also noticed pain and swelling in his right hand and left elbow, a weight loss of about 4.5 kg, and occasional upper abdominal pressure. He had no nausea, vomiting, diarrhea, dyspnea, or dysuria. A 50-year-old man presented to the clinic with fever, chills, and generalized weakness that he had had for three weeks. He also noticed pain and swelling in his right hand and left elbow, a weight loss of about 4.5 kg, and occasional upper abdominal pressure. Foreword In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage A 50-year-old man presented to the clinic with fever, chills, and generalized weakness that he had had for three weeks. He also noticed pain and swelling in his right hand and left elbow, a weight loss of about 4.5 kg, and occasional pressure in the upper abdominal area. He said that he had not had nausea, vomiting, diarrhea, dyspnea, or dysuria. Response Fever is a manifestation of many infectious, collagen vascular, and malignant diseases. The weight loss and generalized weakness probably indicate a systemic disorder; his joint discomfort suggests an inflammatory arthritis. Arthritis can be a sign of either . . .

James Elder and colleagues report meta-analyses of two psoriasis genome-wide association studies with replication in additional cohorts. They make use of imputation using both the HapMap and initial 1000 Genomes Project datasets and identify three new psoriasis susceptibility loci. We carried out a meta-analysis of two recent psoriasis genome-wide association studies 1 , 2 with a combined discovery sample of 1,831 affected individuals (cases) and 2,546 controls. One hundred and two loci selected based on P value rankings were followed up in a three-stage replication study including 4,064 cases and 4,685 controls from Michigan, Toronto, Newfoundland and Germany. In the combined meta-analysis, we identified three new susceptibility loci, including one at NOS2 (rs4795067, combined P = 4 × 10 −11 ), one at FBXL19 (rs10782001, combined P = 9 × 10 −10 ) and one near PSMA6 - NFKBIA (rs12586317, combined P = 2 × 10 −8 ). All three loci were also associated with psoriatic arthritis (rs4795067, combined P = 1 × 10 −5 ; rs10782001, combined P = 4 × 10 −8 ; and rs12586317, combined P = 6 × 10 −5 ) and purely cutaneous psoriasis (rs4795067, combined P = 1 × 10 −8 ; rs10782001, combined P = 2 × 10 −6 ; and rs12586317, combined P = 1 × 10 −6 ). We also replicated a recently identified 3 association signal near RNF114 (rs495337, combined P = 2 × 10 −7 ).

To test the hypothesis that mild chronic hyperoxia treatment would improve retinal function despite a progressive decline in ocular blood flow in the DBA/2J mouse model of glaucoma. DBA/2J mice were treated with chronic mild hyperoxia (30% O2) beginning at 4.5 months of age or were untreated by giving normal room air. Retinal and choroidal blood flow (RBF and ChBF, respectively) were measured at 4, 6, and 9 months of age by MRI. Blood flow was additionally measured under hypercapnia challenge (5% CO2 inhalation) to assess vascular reactivity. Intraocular pressure (IOP) was measured using a rebound tonometer at the same time points. Scotopic flash electroretinograms (ERGs) were recorded at 9 months of age. Both ChBF and RBF were reduced and significantly affected by age (p < 0.01), but neither were significantly affected by O2-treatment (p > 0.05). ChBF significantly increased in response to hypercapnia (p < 0.01), which was also unaffected by O2-treatment. Significant effects of age (p < 0.001) and of the interaction of age with treatment (p = 0.028) were found on IOP. IOP significantly decreased in O2-treated mice at 6 months compared to 4 months of age (p < 0.001), while IOP trended to increase with age in untreated mice. The amplitude of the b-wave from ERG was significantly increased in O2-treated DBA/2J compared to the untreated mice (p = 0.012), while the a-wave and oscillatory potentials were not significantly affected (p > 0.05). This study investigated the effects of chronic mild hyperoxia on retinal function and on retinal and choroidal blood flow in a mouse model of glaucoma. Retinal function was improved in the O2-treated mice at late stage, despite a progressive decline of RBF and ChBF with age that was comparable to untreated mice.

BackgroundWe used the University of Wisconsin cohort to determine the extent to which the EULAR Sjögren’s syndrome disease activity index (ESSDAI) was associated with comorbidities that contribute to mortality.MethodsOur University of Wisconsin, Madison cohort had 111 patients with Sjögren’s Disease (SjD) by 2016 ACR/EULAR criteria and 194 control patients with sicca. Our study was performed from March 1st, 2020 through April 1st, 2023. We collected data using a standardized collection tool, including components of the Charlson Comorbidity Index (CCI). Stratifying our SjD patients by ESSDAI < 5 and ESSDAI ≥ 5, we assessed differences in comorbidities associated with mortality.ResultsAt time of SjD diagnosis, the ESSDAI ≥ 5 group had increased odds of peripheral vascular disease compared to controls (OR 10.17; 95% CI 1.18–87.87). Patients with a current ESSDAI ≥ 5 were more likely to have a myocardial infarction compared to controls (OR 9.87; 95% CI 1.17–83.49). SjD patients had increased prevalence of monoclonal gammopathy compared to controls (9.3% vs 0.5%, p < 0.001). SjD patients with high ESSDAI at diagnosis had greater prevalence of monoclonal gammopathy compared to the SjD patients with a low ESSDAI (16% vs 5%, p = .04). As reported elsewhere, the ESSDAI ≥ 5 group had increased odds of chronic pulmonary disease (OR 4.37; 95% CI 1.59–11.97).ConclusionWe found high ESSDAI scores were associated with worse cardiovascular outcomes, specifically peripheral vascular disease and myocardial infarction. Furthermore, monoclonal gammopathy was more frequent in SjD patients compared to sicca controls, supporting screening for monoclonal gammopathy in the appropriate clinical scenario.Key Points• High ESSDAI scores are associated with worse cardiovascular outcomes, specifically peripheral vascular disease and myocardial infarction.• Monoclonal gammopathy is more frequent in SjD patients than sicca controls, supporting screening for monoclonal gammopathy in the appropriate clinical scenario.

Amyloid cardiomyopathy (ACM) is a progressive and life-threatening disease caused by abnormal protein deposits within cardiac tissue. The most common forms of ACM are caused by immunoglobulin derived light chains (AL) and transthyretin (TTR). Orthotopic heart transplantation (OHT) remains the definitive treatment for patients with end stage heart failure. In this study, we perform a contemporary multicenter analysis evaluating post OHT survival in patients with ACM. We conducted a multicenter analysis of 40,044 adult OHT recipients captured in the United Network for Organ Sharing (UNOS) registry from 1987-2018. Patients were characterized as ACM or non-ACM. Baseline characteristics were obtained, and summary characteristics were calculated. Outcomes of interest included post-transplant survival, infection, treated rejection, and the ability to return to work. Racial differences in OHT survival were also analyzed. Unadjusted associations between ACM and non-ACM survival were determined using the Kaplan-Meier estimations and confounding was addressed using multivariable Cox proportional hazards models. Three hundred ninety-eight patients with a diagnosis of ACM were identified of which 313 underwent heart only OHT. ACM patients were older (61 vs 53; P < .0001) and had a higher proportion of African Americans (30.7% vs 17.6%; P < .0001). Median survival for ACM was 10.2 years vs 12.5 years in non-ACM (P = .01). After adjusting for confounding, ACM patients had a higher likelihood of death post-OHT (HR 1.39 CI: 1.14, 1.70; P = .001). African American ACM patients had a higher likelihood of survival compared to White ACM patients (HR 0.51 CI 0.31-0.85; P = .01). No difference was observed in episodes of treated rejection (OR 0.63 CI 0.23, 1.78; P = .39), hospitalizations for infections (OR 1.24 CI: 0.85, 1.81; P = .26), or likelihood of returning to work for income (OR 1.23 CI: 0.84, 1.80; P = .30). In this analysis of OHT in ACM, ACM was associated with a higher likelihood of post-OHT mortality. Racial differences in post-OHT were observed with African American patients with ACM having higher likelihood of survival compared to White patients with ACM. No differences were observed in episodes of treated rejection, hospitalization for infection, or likelihood to return to work for income.

The XEN®45 Glaucoma Treatment System (gel stent; Allergan, an AbbVie company, Irvine, CA, USA) is a minimally invasive bleb-forming surgical device that was originally approved to lower intraocular pressure by diverting the aqueous humor from the anterior chamber to the subconjunctival space (like trabeculectomy) following ab-interno placement. Since approval of the gel stent in multiple countries, the implantation technique has evolved considerably, being performed ab interno or ab externo with open or closed conjunctiva, based on patients' needs and/or surgeons' preferences. Additional technical variations that can facilitate gel stent placement and/or improve outcomes have also emerged. This article aims to increase awareness of these developments to facilitate informed decision-making and improve surgical success and outcomes for patients.