Table of Contents

Observational studies have shown that a low folate level is associated with poor hearing. In this study, the investigators randomly assigned 728 older adults to receive daily folic acid or placebo for 3 years. The study took place in a country that does not mandate folic acid enrichment of food. The patients had high homocysteine levels but no known ear conditions. Folic acid reduced hearing loss by 0.7 dB, a just noticeable amount.

In this 16-year prospective study, 11 711 male health professionals with hypertension reported their average alcohol consumption every 4 years. Hypertensive men who consumed 10 to 14 grams of alcohol (about 1 drink) or more per day had a lower risk for myocardial infarction than those abstaining from alcohol. Alcohol intake did not predict all-cause mortality or deaths due to cardiovascular disease.

Despite effective vaccination programs for measles, mumps, and rubella in the United States and Canada, outbreaks continue to occur in susceptible subpopulations, such as foreign-born persons. The authors measured levels of antibodies to measles, mumps, and rubella in 1480 persons in Montréal, Québec, Canada. Thirty-six percent were susceptible to at least 1 of the infections. Adult immigrants may benefit from targeted vaccination programs.

Increasing the racial and ethnic diversity of the physician workforce is a national priority. However, we have limited knowledge of the professional experiences of minority physicians. The authors interviewed physicians of African descent about how they experience race in the workplace. Race is a pervasive influence in the work lives of physicians of African descent.

Rituximab, a monoclonal anti-CD20 antibody, is increasingly being used to treat idiopathic thrombocytopenic purpura (ITP). However, the efficacy of ritixumab against ITP and its safety are uncertain. In this review, Arnold and colleagues determined that in light of the poor-quality evidence, physicians should avoid indiscriminate use of rituximab.

Reversible cerebral vasoconstriction syndromes (RCVS) are characterized by reversible multifocal narrowing of the cerebral arteries. Such syndromes are invariably heralded by sudden severe (thunderclap) headaches with or without associated neurologic deficits. In this review, based on a comprehensive nonsystematic review of the literature as well as the authors' collective experience, the authors describe their current understanding of RCVS and summarize its key clinical, laboratory, and imaging features.

In 2005, the U.S. Food and Drug Administration (FDA) approved the first racially or ethnically targeted medication for treating heart failure in black patients, citing the need to address racial disparities in health as a factor in their decision. The authors of this article contend that the FDA decision incorrectly interpreted trial results that claimed differential drug response by race, while ignoring a substantial body of evidence on the causes of racial disparities in health and health care.

Some critics of the FDA's approval of the fixed combination of hydralazine hydrochloride and isosorbide dinitrate do not recognize that the decision to approve the drug only for black patients reflected careful analyses of 2 previous trials in racially mixed, but mostly white, patient populations. Both of these trials showed little or no overall effect of hydralazine hydrochloride–isosorbide dinitrate but hinted at a substantial effect in subsets of black patients.

While noise, infection, head trauma, and ototoxic drugs cause some variation, most hearing loss in the developed world is simply “age-related.” Such hearing loss is sensorineural and is associated with loss of hair cells and other cellular elements in the cochlea. In this issue, Durga and colleagues explore the effect of folate supplementation on age-related hearing loss.

Relationships between diet and chronic disease have become the focus of many analytic studies in nutritional epidemiology over the past several decades. In this issue, Beulens and colleagues present a prospective analysis of the relationship between alcohol intake and cardiovascular events among men with hypertension in the Health Professionals Follow-Up Study.

Even as ground is broken in our nation's capital for the new Martin Luther King Jr. memorial, African Americans are less likely than whites to feel that the United States is making significant progress toward achieving King's dream of racial equality. African-American physicians are no less likely to experience this lack of equality than African-Americans in the general public.

This issue of Annals contains the inaugural installment of a new section, “In the Clinic.” The goal of “In the Clinic” is to better connect Annals to clinical practice. This section focuses on a single, common clinical condition relevant to internal medicine practice. This month's focus is on type 2 diabetes.

In this issue, In the Clinic provides a practical, clinical overview of type 2 diabetes that addresses screening, prevention, diagnosis, evaluation, treatment, and practice improvement. Readers can complete the accompanying CME quiz for up to 1.5 credits.