Accidental needlesticks can lead to infection with hepatitis viruses, human immunodeficiency virus, and other blood-borne bacterial, viral, and fungal pathogens (DK Henderson et al, Ann Intern Med, 113:740, 1990). Re-capping used needles is the most frequent cause of needlestick injuries (J Jagger et al, N Engl J Med, 319:284, 1988; MH Becker et al, Am J Infect Control, 18:232, 1990).

Many readers have asked the Medical Letter to evaluate St. John's wort, an herbal extract now widely sold in health food stores and pharmacies, for its effectiveness and safety in the treatment of depression. St. John's wort is licensed in Germany for treatment of anxiety, depression and insomnia. In the USA, it is considered a dietary supplement and has not been evaluated by the FDA.

Full-page advertisements in The New York Times and other newspapers have promoted use of the Crystal Ear hearing aid as an inexpensive rememdy for people with impaired hearing. Some patients may be asking their physicians about these devices.

The FDA has approved the use of a transcatheter mitral valve device (MitraClip – Abbott) for percutaneous treatment of significant symptomatic degenerative mitral regurgitation (grade 3-4+) in patients who are at prohibitive risk for mitral valve surgery. It is the first percutaneous nonsurgical treatment approved for this indication.

Inavolisib (Itovebi – Genentech), an oral kinase inhibitor, has been approved by the FDA for use in combination with palbociclib and fulvestrant for treatment of endocrine-resistant, PIK3CA-mutated, hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative, locally advanced or metastatic breast cancer. This is the first approval for Itovebi; palbociclib and fulvestrant have been available for years for treatment of HR-positive, HER2-negative breast cancer.

On September 22, on the advice of its Vaccines and Related Biologic Products Advisory Committee, the FDA expanded the Emergency Use Authorization (EUA) for the Pfizer/BioNTech mRNA-based COVID-19 vaccine (Comirnaty) to include administration of a booster dose ≥6 months after a 2-dose primary series in adults who are ≥65 years old or at high risk for severe COVID-19 because of an underlying medical condition or frequent institutional or occupational exposure to SARS-CoV-2 (see Table 1). The FDA Advisory Committee recommended against authorization of a booster dose of Comirnaty...

Electronic reading machines that convert print into speech have become increasingly useful for blind, other visually impaired, or dyslexic patients. Some of these devices are available as components that can be added to a personal computer.

The Medical Letter continues to receive inquiries about the value of edetate disodium (EDTA) chelation therapy for cardiovascular disease. The last Medical Letter article on this subject was published in 1981 (volume 23, page 51). Some authors have estimated that more than 500,000 people receive this form of treatment each year (MT Grier and DG Meyers, Ann Pharmacother, 27:1504, Dec 1993).

Some readers have asked whether the widespread practice of taking aspirin to prevent first heart attacks is justifiable and, if so, what the dose should be. Only one large well-designed study has tested the use of aspirin for this purpose.

The CDC is recommending that persons at high risk of mpox (see Table 1) receive two doses of the Jynneos vaccine. The recommendation follows reports of a recent cluster of mpox cases in the US and warnings about the risk of a renewed outbreak during the spring and summer as people gather for festivals and other events. The CDC does not recommend routine immunization against mpox for the general population.