Zanamivir, a sialic acid analog, inhibits viral neuraminidase, an enzyme
that is necessary for the replication of both type A and type B influenza
viruses. Monto and colleagues reportArticle that daily inhalation of zanamivir during
influenza outbreaks in the 1997-1998 season was 67% efficacious in preventing
laboratory-confirmed clinical influenza among adults aged 18 to 69 years at
2 study sites. In an editorialArticle, Patriarca considers how antiviral prophylaxis
complements vaccination in achieving influenza control.
To measure the frequency of abnormalities found incidentally on brain
magnetic resonance imaging (MRI) scans in a healthy population, Katzman and
coworkers reviewed the results of brain MRI scans from 1000 healthy, asymptomatic
volunteers (mean age, 31 years) who had participated in research studies at
the National Institutes of Health. One hundred eighty scans had abnormal findings,
11 of which were classified as requiring urgent referral, including 3 with
lesions suspicious for primary brain neoplasms.
In a cohort of 5888 elderly individuals followed up for 7 years in the
Cardiovascular Health Study, Haan and colleagues found that diabetes mellitus,
several indicators of subclinical and existing cardiovascular disease, and
the APOE ∊4 genotype were each associated with
an increased risk of cognitive decline as measured by the Modified Mini-Mental
State Examination (3MSE) and the Digit Symbol Substitution Test. The rate
of decline in 3MSE scores associated with peripheral vascular disease, atherosclerosis,
and diabetes mellitus was greater in the presence of the APOE ∊4 allele than with each risk factor alone.
Based on US measles surveillance data from 1985 through 1992, Salmon
and colleagues estimated that individuals aged 5 to 19 years who received
religious and philosophical exemptions from measles immunization were 35 times
more likely to contract measles than were vaccinated youth. In a mathematical
model, changes in the number of exempt individuals would alter the incidence
of measles infection in nonexempt individuals; doubling the number of exempt
individuals would increase the incidence of measles in nonexempt individuals
from 5% to 31% depending on the contact between the 2 groups.
In this randomized controlled trial in patients with adult respiratory
distress syndrome (ARDS), Ranieri and colleaguesArticle found that after 36 to 40
hours of mechanical ventilation, mean levels of several cytokines measured
in bronchoalveolar lavage fluid and plasma had increased over baseline in
patients who received conventional mechanical ventilation, but had decreased
and were significantly lower in patients ventilated using a lung-protective
strategy. In an editorialArticle, Hudson comments that the pulmonary and systemic
release of inflammatory mediators in response to lung injury caused by mechanical
ventilation may explain in part the multiple organ failure and high mortality
rate associated with ARDS.
Brown and colleagues review the types and performance characteristics
of available serologic assays for Borrelia burgdorferi
and discuss their appropriate use for the diagnosis of Lyme disease in the
clinical setting. In an editorial, Wormser and coauthors highlight opportunities
to improve serologic testing for Lyme disease.
See Article and editorial Article
"I was the best 11-year-old clarinetist I had ever known." From "Master
Physicians′ personality traits that lead to professional success
may also lead to psychological stress. Psychiatrists offer some hints on coping.
How to use articles on the impact of computer-based clinical decision
support systems on clinician behavior and patient outcomes.
For your patients: A primer on childhood immunization.
This Week in JAMA. JAMA. 1999;282(1):5. doi:10.1001/jama.282.1.5