Breast cancer is an uncommon disease in men. As a result, the diagnosis may not initially be considered. Understanding the common benign and malignant entities affecting the male breast is critical for timely and accurate diagnosis in the primary care setting. Most patients present with a palpable breast mass or pain. The usual etiology is gynecomastia, the most common breast condition in males, but breast cancer must always be excluded through careful imaging evaluation when physical examination findings are suspicious or inconclusive. Imaging of the male breast generally relies on mammography and ultrasound, with mammography employed as the initial imaging modality of choice and ultrasound when a mass is detected or suspected. Here we describe the normal male breast anatomy and present an evaluation algorithm for the male patient with breast signs or symptoms. The most common benign and malignant entities are described.

The association between children's short nighttime sleep duration and obesity has been well documented. In this prospective cohort study, the authors examined whether preschool-aged children with earlier bedtimes had a lower risk for adolescent obesity. Preschool-aged children with early weekday bedtimes (8:00 p.m. or earlier) were one-half as likely as children with late bedtimes (after 9:00 p.m.) to be obese as adolescents. This risk was not modified by the emotional climate of the home, as measured by observed mother-child interactions. Pediatricians should encourage parents to establish a routine of early bedtimes for young children and support parents in their efforts to overcome potential barriers.

Without adequate vigilance, blood-borne pathogens can pose a substantial risk to hemodialysis patients. This report, spearheaded by a team from the CDC, describes a dialysis patient who mysteriously became infected with hepatitis B virus (HBV) even though no other patients at the facility were known to have an active infection. Investigation revealed that an HIV-positive hemodialysis patient with transplant-related immunosuppression experienced HBV reverse seroconversion and reactivation. This sequence of events -- and the associated errors in infection control and viral testing -- provide a valuable lesson in how to avoid similar failures going forward.

The authors report a study to determine whether HPV-16/18 vaccination influences the outcome of infections present at vaccination and the rate of infection and disease following treatment of lesions.

Many clinical guidelines caution against the combined use of opioids and benzodiazepines, yet overdose deaths and emergency department visits involving the coingestion of these drugs are increasing. This study used IMS Health Total Patient Tracker data to describe projected trends of patients receiving opioids and benzodiazepines in the U.S. from 2002 to 2014. During this period, the projected number of patients receiving opioids and benzodiazepines increased by 8% and 31%, and the annual proportion of opioid recipients dispensed a benzodiazepine concomitantly increased from 6.8% to 9.6%. Concomitancy was more common in patients receiving opioids for ≥90 days, women, and the elderly.

The influence on Chronic Rhinosinusitis (CRS) of multiple important epidemiologic factors, including race, has not been investigated. In a retrospective cohort study of 995 patients with CRS treated at a large urban tertiary care referral center, African-American patients with CRS were more likely to report hyposmia as a symptom of CRS. African-American patients with CRS who failed medical therapy and required surgical intervention had a significantly higher frequency of nasal polyposis and aspirin-exacerbated respiratory disease and a higher disease severity index on computational tomography imaging compared to Caucasian CRS cases. The increased polyposis in African-Americans was associated with increased hospitalization for asthma. African-Americans with refractory CRS manifest a greater severity of disease and increased health care utilization.

Presurgery emotional distress has had variable associations with outcomes of surgery in past narrative reviews. This meta-analysis was designed to evaluate overall strengths of relation between presurgical emotional distress and key postsurgical pain outcomes (i.e., pain intensity, analgesic use, functional impairment) and to identify moderators that might explain effect size heterogeneity between studies. High presurgery emotional distress levels were associated with significantly more postsurgical pain, analgesic use, and impairment following surgery, with small to medium average effect sizes. Considering emotional distress within presurgical assessment protocols may aid in identifying vulnerable patients who can benefit from interventions targeting distress reductions.

A study in PLOS Medicine showed that adults who participated in diabetes prevention programs lost weight and had improved blood glucose, blood pressure and cholesterol levels. Researchers analyzed 44 published studies involving 9,000 program participants and found greater health benefits among those who were enrolled in programs that kept in contact with participants even after the core program sessions have been completed.

A retrospective cohort study in Respirology found that patients with resistant hypertension and sleep apnea had a higher risk of ischemic heart events and congestive heart failure, compared with those with nonresistant hypertension. The findings, based on 470,386 adults with hypertension, also showed an association between resistant hypertension and an increased risk of sleep apnea.

A study in the journal Circulation found TV watching for 2.5 hours to five hours per day increased the risk of a fatal blood clot by 70%, while more than five hours daily increased the risk by 250%. Japanese researchers said the risk was independent of physical exercise.

Fourteen regions in 16 states, including Arkansas, Michigan, New York, Oklahoma and Pennsylvania, will test the Comprehensive Primary Care Plus, the CMS' new medical home model program focused on providers' use of population health and analytics capabilities. Eligible practices have until Sept. 15 to apply for CPC+ participation.

The growing trend of opioid dependence has led to an increase of over 3,000% in medical services among privately insured patients identified as opioid dependents over the past seven years, according to a study from Fair Health, a nonprofit databank firm. Researchers found the overall number of medical services provided to opioid dependents, such as laboratory tests and office visits, rose to nearly 7 million in 2014 from about 217,000 in 2007.

As the number of suspected Zika virus transmissions by mosquito rose to 14 in Florida, the CDC issued a travel advisory for pregnant women traveling to Miami, where the cases of local transmission are believed to have occurred. Florida Gov. Rick Scott has also requested the CDC send an emergency response team to assist in the investigation of the cases.