Xu and colleagues report the first
successful use of preimplantation genetic diagnosis for a couple who
both carry the recessive mutation for sickle cell anemia. To detect the
sickle cell mutation, polymerase chain reaction and restriction enzyme
analysis were performed on single blastomeres removed from embryos 3
days after in vitro fertilization. On day 4, 2 unaffected embryos
(1 shown in Figure 1) and 1 carrier embryo were transferred to the uterus
and a normal pregnancy and delivery of unaffected twins followed.
The morbidity and mortality associated with adolescent-onset
major depressive disorder (MDD) are serious and sustained. Weissman and
colleagues report that adolescents with MDD had a significantly higher
rate of suicide attempts, psychiatric and medical hospitalizations, and
impaired social functioning during 10 to 15 years of follow-up compared
with healthy control subjects. Only 37% of individuals with
adolescent-onset MDD survived without an episode of MDD in adulthood
compared with 69% of controls.
World Health Organization (WHO) criteria for anemia,
derived from data on young persons, may also be appropriate for elderly
patients. In a sample of persons aged 85 years or older, Izaks and
coworkers found that the 5-year mortality risk was 1.84 overall for
persons with anemia according to WHO criteria compared with those with
a normal hemoglobin concentration and 2.21 for persons without
self-reported disease at baseline.
In this study of patients with acute coronary syndromes and
those with stable coronary artery disease (CAD) without evidence of
ischemia, Holvoet and colleagues found that C-reactive protein and
troponin I were poor markers for unstable angina, but the combination
of malondialdehyde-modified low-density lipoprotein level, which may
indicate endothelial injury or plaque instability, and troponin I, a
marker of myocardial cell injury, provided excellent discrimination
between stable CAD and acute coronary syndromes.
Regular physical activity may decrease the risk of
cardiovascular disease by altering the production of specific immune
mediators. Smith and coworkers found a significant decrease in levels
of atherogenic cytokines and a significant increase in atheroprotective
cytokines in blood mononuclear cells of patients at risk of ischemic
heart disease after participation in a 6-month exercise program.
In this Grand Rounds from the
Clinical Center of the National Institutes of Health, Fananapazir
presents the case of a 28-year-old woman with midcavity obstructive
hypertrophic cardiomyopathy, which is characterized by extreme
narrowing of the left ventricular chamber at the level of the papillary
muscles on angiography. He discusses advances in the
understanding of the genetics and pathophysiology underlying
hypertrophic cardiomyopathy and
new approaches to clinical management.
Using patient-oriented outcomes to guide treatment of diabetes
Maintenance treatment of patients with human
immunodeficiency virus infection: failed strategies and new
Florence Wald, a prime mover in introducing hospice
care to the United States, discusses her work and recent efforts with
hospice programs in prisons.
AnalysisArticle of the recent market withdrawal of 5 drugs: lessons
about ensuring drug safety.Article
First in a series of consensus statements
from the Working Group on Civilian Biodefense on medical and public
health management after the use of
biological agents as weapons.
Announcing JAMA-EXPRESS—6 weeks from manuscript
submission to print and 4 weeks to full-text online release.
For your patients: Facts about sickle cell anemia.
This Week in JAMA. JAMA. 1999;281(18):1671. doi:10.1001/jama.281.18.1671