Thyroidal production of triiodothyronine (T3) is absent in patients with athyreosis. Whether this has adverse clinical consequences is not clear, and results of studies of combined levothyroxine (LT4) and T3 therapy vs LT4 alone to improve symptoms of hypothyroidism have been inconclusive. In this issue, Jonklaas and colleagues report results of a prospective study of 50 euthyroid patients who had assessments of thyroid hormone levels before and 16 weeks after undergoing total thyroidectomy, with the objective of determining whether LT4 therapy alone could
restore T3 levels to normal. The authors found that LT4 monotherapy was associated with normal T3 levels in athyreotic patients. In an editorial, Cooper discusses thyroid physiology and thyroid hormone replacement and the clinical challenge posed by biochemically euthyroid but symptomatic patients.
Annual mass azithromycin administration reduces, but does not eliminate, ocular Chlamydia trachomatis infection in endemic areas. In a cluster-randomized clinical trial, Melese and colleagues tested the hypothesis that biannual mass azithromycin treatment of villagers aged 1 year or older in hyperendemic areas of Ethiopia could eliminate ocular C trachomatis infection in preschool-aged children. The authors report that the prevalence of infection at 24 months was significantly lower in the villages receiving biannual treatment compared with those treated annually. In an editorial, Mabey and Solomon discuss efforts to reduce—and perhaps eliminate—C trachomatis infection and blinding trachoma in endemic regions of the world.
Peberdy and colleagues analyzed national registry data to assess whether patient survival following in-hospital cardiac arrest differs during nights and weekends compared with day/evenings and weekdays.
In analyses that controlled for patient, event, and hospital characteristics,
the authors found that rates of survival to discharge were lower for cardiac arrests occurring during the night compared with those occurring during the day/evening. Among cardiac arrests occurring during day/evening hours, patient survival was higher on weekdays than weekends. Among cardiac arrests occurring during the night, survival was similar on weekdays and on weekends.
In a systematic review of randomized clinical trials and prospective cohort investigations studying dialysis for patients with acute renal failure, Pannu and colleagues critically evaluate the current evidence guiding provision of dialysis. The authors summarize what is known about patient mortality, length of stay, chronic dialysis dependence,
blood pressure and hypotension, and bleeding complications in relation to indications and timing of dialysis; and dialysis modalities, dialysis dose, anticoagulation, dialysis membranes, and dialysate composition.
The authors identify areas for future research and conclude with recommendations for treating patients with severe acute renal failure.
The accuracy of the patient history, physical examination findings,
and laboratory and imaging results in the diagnosis of lower limb osteomyelitis in patients with diabetes.
“[D]eath is death, no matter when or where it occurs,
no matter the victim or victims, no matter human or animal—it hurts.” From “Sammy.”
Physicians have been slow to adopt brief, inexpensive, and effective interventions to help patients with excessive alcohol use. But experts believe recent developments might lead to wider implementation.
Addressing racial inequities in health care.
Appreciation for JAMA’s peer reviewers and authors.
Join Stephen Shortell, PhD, on March 19, 2008, from 2 to 3 PM eastern time to discuss improving patient safety. To register,
go to http://www.ihi.org/AuthorintheRoom.
Dr DeAngelis summarizes and comments on this week's issue.
Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
How would you manage a 74-year-old man who has moderate daily alcohol use, memory loss, and progressive neuropathy? Go to www.jama.com to read the case and submit your response. Your response may be selected for online publication. Submission deadline is February 27.
For your patients: Information about osteomyelitis.
This Week in JAMA . JAMA. 2008;299(7):727. doi:10.1001/jama.299.7.727