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This Week in JAMA
JAMA. 2003;290:295.
Brain Overgrowth in the First Year of Life in Autism
To determine whether pathological brain overgrowth precedes the initial clinical signs of autism, Courchesne and colleagues (SEE ARTICLE) reviewed medical record growth data from the first year of life of children aged 2 to 5 years with autism spectrum disorder. Compared with normative data from healthy infants, head circumference in children with autism spectrum disorder was significantly smaller at birth and increased from the 25th percentile to the 84th percentile by 6 to 14 months. In an editorial, (SEE ARTICLE) Lainhart notes that it is not clear whether increased rate of head growth in infancy, which may precede clinical recognition of autism, also precedes the actual onset of the disorder.
Pelvic Floor Electrical Stimulation for Incontinence
Pelvic floor electrical stimulation has been widely used for the treatment of urinary incontinence. In this randomized controlled trial among women aged 40 to 78 years with stress or mixed urinary incontinence, Goode and colleagues (SEE ARTICLE) found that reduction in incontinence episodes in the group that received clinic-based behavioral training plus pelvic floor electrical stimulation was not significantly different from that in the group that received clinic-based behavioral training alone. Reductions in incontinence episodes in both clinic-based behavioral training groups were significantly greater than in the group that received self-administered behavioral treatment using a self-help booklet (control condition). In an editorial, Resnick and Griffiths (SEE ARTICLE) discuss the generalizability and clinical implications of the study results and research questions raised by the study.
Prognostic Biomarkers and Outcomes in ESRD
Cardiac causes account for 40% to 45% of all deaths among patients with end-stage renal disease (ESRD). deFilippi and colleagues conducted a prospective cohort study to investigate the association between 2 prognostic biomarkers in acute coronary syndromes—cardiac troponin T (cTnT) and C-reactive protein (CRP)—and long-term risk of all-cause mortality and cardiac pathology among patients with ESRD who did not have symptoms of myocardial ischemia. Increasing cTnT and CRP levels at study entry were independently associated with increased risk of death during a mean follow-up of 827 days. Elevated levels of cTnT were significantly associated with increased risk of multivessel coronary artery disease assessed by coronary angiography.
(SEE ARTICLE)
IRB Review of a Multicenter Genetic Epidemiology Study
The current system of institutional review board (IRB) assessment of human subjects protection was developed primarily for clinical trials conducted at single sites. Multicenter studies involve approval by each local IRB in the study. In a survey of cystic fibrosis centers participating in a multicenter genetic epidemiology study, Cutting and colleagues found that local IRB assessment of risk and type of review required, types and numbers of consent forms, whether assent was required for children, and time to approval varied considerably. Consent forms often failed to include items necessary for genetic studies and information consistent with DNA banking guidelines.
(SEE ARTICLE)
Critically Ill Patients With SARS
In this issue of THE JOURNAL, case series reported by Fowler and colleagues (SEE ARTICLE) and by Lew and colleagues (SEE ARTICLE) describe the clinical features and outcomes of patients with severe acute respiratory syndrome (SARS) who were critically ill and treated in intensive care units (ICUs)—38 of 196 hospitalized patients in the Toronto area and 46 of 199 hospitalized patients in Hong Kong. Most of the critically ill patients in both series met diagnostic criteria for acute respiratory distress syndrome (ARDS). Mortality at 28 days after ICU admission was 34% in the Toronto series , and mortality at 28 days after symptom onset was 37% in the Hong Kong series. In an editorial, Rubenfeld (SEE ARTICLE) discusses current clinical questions and controversies in the care of patients with ARDS of all etiologies, including SARS.
A Piece of My Mind
"There's only one thing that really and truly scares me." From "A Mutual Anxiety."
(SEE ARTICLE)
Medical News & Perspectives
An epidemic of Ebola hemorrhagic fever that has continued in a remote region of Africa since October 2001 raises questions about how health officials should respond to this kind of outbreak.
(SEE ARTICLE)
CLINICIAN'S CORNER
A Man With Temporal Lobe Epilepsy
Clinical Crossroads
Mr C is a 48-year-old man with temporal lobe epilepsy associated with complex neurologic and psychiatric symptoms. Devinsky discusses the clinical features (Figure 1), diagnosis, and treatment of temporal lobe epilepsy.
(SEE ARTICLE)
Multiple Sclerosis Risk After Optic Neuritis
From the Archives Journals
Levin and Lessell discuss the clinical implications of risk factors for multiple sclerosis after optic neuritis identified in a 10-year follow-up study recently published in the Archives of Ophthalmology.
(SEE ARTICLE)
JAMA Patient Page
For your patients: Information about stress incontinence.
(SEE ARTICLE)
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