Animal studies and several patient case series have suggested a possible association between in utero exposure to the antiepileptic drug valproate and autism. In a population-based study of 655 615 Danish children born from 1996 to 2006 and followed up for a mean 8.8 years (range, 4-14 years), Christensen and colleagues examined whether prenatal exposure to valproate was associated with an increased risk of autism spectrum disorders. The authors report that maternal use of valproate during pregnancy was associated with an increased risk of autism spectrum disorder and childhood autism in the offspring, even after adjusting for autism risk factors and maternal epilepsy. In an editorial, Meador and Loring discuss risks of in utero exposure to valproate.
See Article, Editorial, and
Whether perioperative β-blockade is effective and safe for patients undergoing noncardiac surgery is not clear. London and colleagues evaluated exposure to β-blockers on the day of or the day after major noncardiac surgery in a population-based sample of 136 745 patients treated at 104 Veterans Health Administration hospitals between January 1, 2005, and August 31, 2010. Analyses included classification of patients based on revised cardiac risk index (CRI) predictors and propensity-score matching. The authors found that perioperative exposure to β-blockers was associated with lower rates of 30-day all-cause mortality and cardiac morbidity among patients with 2 or more revised CRI factors who underwent nonvascular surgery.
Sequelae of childhood bacterial meningitis include seizure disorders, motor deficits, and cognitive impairment. To examine the relationship between childhood meningitis and functioning in adulthood, Roed and colleagues assessed educational achievement and economic self-sufficiency among 2924 adults who had bacterial meningitis in childhood and compared attainment of these goals with those achieved by individuals matched on age and sex and by siblings of the study participants. The authors found that bacterial meningitis in childhood was associated with lower educational achievement and economic self-sufficiency in adulthood, particularly among individuals with a childhood history of pneumococcal or Haemophilus influenzae meningitis.
Diagnosing an Ectopic Pregnancy
In a systematic review and meta-analysis of 14 studies (including 12 101 patients) reporting on the diagnosis of ectopic pregnancy, Crochet and colleagues assessed the accuracy and precision of patient history, clinical examination, laboratory values, and sonography. The authors found that patient history and clinical examination alone are insufficient to indicate or exclude the possibility of an ectopic pregnancy. Transvaginal sonography is the single best diagnostic modality in this setting. Quantitative (serial) serum human chorionic gonadotropin testing can be a useful addition to the evaluation.
Patients exposed months ago to contaminated injectable steroids continue to be diagnosed with fungal injections, and some are developing adverse events related to long-term antifungal therapy.
ACGME clinical learning environment review program
DSM-5— notable revisions
Stemming global trade in substandard medicines
“I felt the support of the many hands of fellow colleagues and trainees on my shoulders as I turned to face Jim.” From “One Last Teaching Moment.”
Join Justin B. Dimick, MD, MPH, Wednesday, May 15, from 2 to 3 PM eastern time to discuss bariatric surgery complications before and after establishing centers of excellence for the procedure. To register, go to http://www.ihi.org/AuthorintheRoom.
Dr Bauchner summarizes and comments on this week's issue.
Go to www.jama.com.
For your patients: Information about low back pain.
Theme Issue on Child Health
This Week in JAMA. JAMA. 2013;309(16):1655. doi:10.1001/jama.2012.145385