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This Week in JAMA
JAMA. 1999;281:1671.
Preimplantation Diagnosis of Sickle Cell Anemia
Xu and colleagues report the first successful use of preimplantation genetic diagnosis for a couple who both carry the recessive mutation for sickle cell anemia. To detect the sickle cell mutation, polymerase chain reaction and restriction enzyme analysis were performed on single blastomeres removed from embryos 3 days after in vitro fertilization. On day 4, 2 unaffected embryos (1 shown in Figure 1) and 1 carrier embryo were transferred to the uterus and a normal pregnancy and delivery of unaffected twins followed.
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Poor Outcomes of Adolescent-Onset Depression
The morbidity and mortality associated with adolescent-onset major depressive disorder (MDD) are serious and sustained. Weissman and colleagues report that adolescents with MDD had a significantly higher rate of suicide attempts, psychiatric and medical hospitalizations, and impaired social functioning during 10 to 15 years of follow-up compared with healthy control subjects. Only 37% of individuals with adolescent-onset MDD survived without an episode of MDD in adulthood compared with 69% of controls.
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Anemia in Older Persons Indicates Underlying Disease
World Health Organization (WHO) criteria for anemia, derived from data on young persons, may also be appropriate for elderly patients. In a sample of persons aged 85 years or older, Izaks and coworkers found that the 5-year mortality risk was 1.84 overall for persons with anemia according to WHO criteria compared with those with a normal hemoglobin concentration and 2.21 for persons without self-reported disease at baseline.
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Diagnostic Markers for Acute Coronary Syndromes
In this study of patients with acute coronary syndromes and those with stable coronary artery disease (CAD) without evidence of ischemia, Holvoet and colleagues found that C-reactive protein and troponin I were poor markers for unstable angina, but the combination of malondialdehyde-modified low-density lipoprotein level, which may indicate endothelial injury or plaque instability, and troponin I, a marker of myocardial cell injury, provided excellent discrimination between stable CAD and acute coronary syndromes.
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Cytokines May Mediate Health Benefits of Exercise
Regular physical activity may decrease the risk of cardiovascular disease by altering the production of specific immune mediators. Smith and coworkers found a significant decrease in levels of atherogenic cytokines and a significant increase in atheroprotective cytokines in blood mononuclear cells of patients at risk of ischemic heart disease after participation in a 6-month exercise program.
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Grand Rounds: Hypertrophic Cardiomyopathy
In this Grand Rounds from the Clinical Center of the National Institutes of Health, Fananapazir presents the case of a 28-year-old woman with midcavity obstructive hypertrophic cardiomyopathy, which is characterized by extreme narrowing of the left ventricular chamber at the level of the papillary muscles on angiography. He discusses advances in the understanding of the genetics and pathophysiology underlying hypertrophic cardiomyopathy and new approaches to clinical management.
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Contempo 1999
Using patient-oriented outcomes to guide treatment of diabetes mellitus.
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From the
JAMA Web Sites
Maintenance treatment of patients with human immunodeficiency virus infection: failed strategies and new possibilities.
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Medical News & Perspectives
Florence Wald, a prime mover in introducing hospice care to the United States, discusses her work and recent efforts with hospice programs in prisons.
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Special Communication
Analysis of the recent market withdrawal of 5 drugs: lessons about ensuring drug safety.
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Anthrax as a Bioweapon
First in a series of consensus statements from the Working Group on Civilian Biodefense on medical and public health management after the use of biological agents as weapons.
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JAMA-EXPRESS
Announcing JAMA-EXPRESS—6 weeks from manuscript submission to print and 4 weeks to full-text online release.
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JAMA Patient Page
For your patients: Facts about sickle cell anemia.
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