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This Week in JAMA
August 26, 2009

This Week in JAMA

JAMA. 2009;302(8):825. doi:10.1001/jama.2009.1250

Variability in response to the antiplatelet agent clopidogrel is well known. To identify genes that may influence this variation, Shuldiner and colleagues Article performed a genome-wide association study of platelet aggregation in response to clopidogrel in healthy Amish persons. The authors found that the CYP2C19*2 genotype was associated with diminished platelet response to clopidogrel treatment. In an independent sample of clopidogrel-treated patients undergoing coronary intervention, the authors found that the CYP2C19*2 genotype was associated with increased risk of cardiovascular ischemic events or death during a 1-year follow-up. In an editorial, Bhatt Article discusses the implications of these findings for patient care.

Although typhoid fever is a rare disease in the United States, antimicrobial-resistant strains of Salmonella ser Typhi are a concern. Lynch and colleagues Article reviewed 1999-2006 data from the national typhoid fever surveillance and antimicrobial resistance monitoring systems and found that infection with S Typhi isolates resistant to antimicrobial agents was common and was associated with travel to the Indian subcontinent. Forty-three percent of tested isolates were resistant to at least 1 antimicrobial, 13% were multidrug resistant, and susceptibility to fluoroquinolones decreased during the study period. In an editorial, Bhutta and Threlfall Article discuss the global burden of typhoid fever and rational antimicrobial use.

Hormonal therapy added to radiation therapy in the treatment of unfavorable-risk prostate cancer is associated with increased survival among men with no or minimal comorbidity. To examine the extent to which particular comorbidities may contribute to a loss of survival benefit, Nanda and colleagues assessed the risk of all-cause mortality among 5077 men with prostate cancer treated with brachytherapy (with or without neoadjuvant hormonal therapy) and known coronary artery disease (CAD), CAD risk factors, or no comorbidity. The authors found that neoadjuvant hormonal therapy use was associated with an increased risk of all-cause mortality among men with a history of CAD-induced congestive heart failure or myocardial infarction but not among men with a single CAD risk factor or no comorbidity.

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Berger and colleagues analyzed pooled clinical and angiographic data from 11 randomized clinical trials to assess relationships among sex, clinical characteristics, disease presentation, coronary anatomy, and all-cause mortality following acute coronary syndromes (ACS). They found differences in 30-day mortality among patients with ACS that vary depending on clinical presentation and are largely explained by clinical differences at presentation and severity of angiographic findings.

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The incidence of hip fractures is an index of the osteoporosis burden in a population. In an analysis of Canadian hospital data from 1985 through 2005, Leslie and colleagues examined trends in hip fracture rates. The authors report that age-standardized rates of hip fracture in Canada have declined steadily since 1985, with a more rapid decline observed during the latter half of the study period.

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“I . . . wondered how often a physician fails to understand the value and importance of a family member, especially a husband or wife, especially at the end of life.” From “The Other Person.”

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Despite concerns about weight gain and other metabolic adverse events, advisors to the US Food and Drug Administration have recommended that the agency approve 3 antipsychotic drugs for pediatric patients with serious psychiatric disorders.

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Setting priorities for patient safety

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A moral imperative for children

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A matter of time

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Join Thomas H. Gallager, MD, Wednesday, September 16, from 2 to 3 PM eastern time to discuss the medical error review involving a woman who experienced wrong-site surgery for skin cancer. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you manage a 52-year-old woman with morbid obesity? Go to www.jama.com to read the case and submit your response, which may be selected for online publication. Submission deadline is September 6.

For your patients: Information about typhoid fever.

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