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This Week in JAMA
JAMA. 2001;285:1673.
JAMA-EXPRESS
Early Statin Therapy After Acute Coronary Syndromes
Statin therapy has been used as a long-term strategy to reduce ischemic cardiovascular events in patients with stable coronary heart disease. To determine whether statin therapy initiated during the high-risk period immediately after an acute coronary syndrome would reduce ischemic events, Schwartz and colleagues (SEE ARTICLE) assigned adults with unstable angina or non–Q-wave acute myocardial infarction (MI) to receive atorvastatin or placebo between 24 and 96 hours after hospital admission. During the 16-week study, the risk of the primary combined end point (death, nonfatal acute MI, cardiac arrest with resuscitation, or recurrent symptomatic myocardial ischemia requiring emergency rehospitalization) was lower in the atorvastatin group than in the placebo group, primarily because of a significant reduction in the rate of recurrent symptomatic ischemia requiring rehospitalization. In an editorial, Sacks (SEE ARTICLE) suggests that physicians include lipid-lowering therapy in the treatment of patients hospitalized for an acute coronary event.
Neuroprotective Therapy Following Acute Ischemic Stroke
Several neuroprotective compounds have been shown to limit brain injury following acute ischemic stroke in preclinical studies, but none have been efficacious in phase 3 trials. In this multicenter trial, Sacco and colleagues (SEE ARTICLE) evaluated the efficacy of the neuroprotective drug gavestinel, an antagonist of the glycine site of the N-methyl-D-aspartate receptor, administered to patients with ischemic stroke within 6 hours of symptom onset. At the 3-month follow-up, functional outcomes in the gavestinel group were not significantly different from those in the placebo group. In an editorial, Plum (SEE ARTICLE) discusses the importance of restoring cerebral perfusion as well as preventing the progression of ischemic events that follow acute ischemic stroke.
Epidemiology of Invasive Pneumococcal Disease
A 23-valent polysaccharide pneumococcal vaccine has been available for older children and adults, and a protein-polysaccharide pneumococcal 7-valent conjugate vaccine was recently licensed for use in young children. Robinson and colleagues analyzed 1995-1998 data from the Active Bacterial Core Surveillance system to assess the burden of pneumococcal disease in the United States and estimate the impact of these new vaccines. Invasive infection with Streptococus pneumoniae was estimated to cause more than 62 000 cases and more than 6000 deaths in 1998. Incidence of pneumococcal disease was highest among children younger than 2 years and adults aged 65 years or older and was more than 2 times higher among blacks than whites. Most of the strains isolated from cases in the high-risk age groups were included in the indicated vaccines.
(SEE ARTICLE)
Immunosuppression-Related Cancers in HIV Infection
Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer occur in excess among individuals infected with HIV and are considered AIDS-defining cancers. To identify other cancers likely to be increased by the immunosuppression associated with HIV infection, Frisch and colleagues analyzed data from linked population-based AIDS and cancer registries. The incidence of non–AIDS-defining cancers among adults with HIV/AIDS exceeded the expected rate. Only 6 of the more than 60 individual cancer types studied, however, met the criteria for potential association with immunosuppression; of these, Hodgkin disease and possibly lip cancer and testicular seminoma were likely to be genuinely influenced by immunosuppression rather than by lifestyle-related exposures.
(SEE ARTICLE)
An 8-Year-Old Boy With Autism
Austin, an 8-year old boy diagnosed as having autism at age 2 years, received early intervention services and has had steady improvement in communication and social skills. Rapin discusses the classification, prevalence, possible etiologies, evaluation, and treatment of autistic disorder.
(SEE ARTICLE)
Medical News & Perspectives
In a dramatic demonstration of the potential of treatment with stem cells, researchers have succeeded in partially reversing paralysis in rats with a disease similar to amyotrophic lateral sclerosis.
(SEE ARTICLE)
From the Surgeon General
On World Health Day, April 7, WHO launches a year-long, worldwide mental health campaign. Events to be held on April 6 in the United States, with the theme "Open Doors, Open Minds," are meant to raise awareness about barriers to mental health and solutions to tackle mental and substance abuse disorders.
(SEE ARTICLE)
Peanut Protein in Breast Milk
Peanut protein was detected in the breast milk of 11 of 23 lactating women after they consumed 50 g of dry roasted peanuts, suggesting that occult exposure to peanut allergen can occur during breastfeeding, which may result in sensitization.
(SEE ARTICLE)
MSJAMA
Perspectives on clinical and research opportunities afforded by electronic medical records and consideration of privacy protection issues.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about autistic disorder.
(SEE ARTICLE)
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