Zidovudine prophylaxis in the perinatal period for infants of women
infected with the human immunodeficiency virus (HIV), recommended in national
guidelines in 1994, has been associated with a decrease in rates of perinatal
HIV transmission. In this analysis of US surveillance data through June 1998,
Lindegren and colleagues reportArticle that the incidence of perinatal acquired immunodeficiency
syndrome (AIDS) has declined 67% after peaking in 1992, coincident with the
use of perinatal zidovudine prophylaxis and not explained by decreases in
the number of infants born to mothers infected with HIV or delays in the onset
of AIDS. In an editorialArticle, Mofenson asserts that complete elimination of perinatal
HIV infection in the United States is possible and discusses barriers that
To determine the prognostic accuracy of ambulatory blood pressure recordings
for cardiovascular (CV) risk, Staessen and colleagues used data from 808 patients
aged 60 years and older with systolic hypertension who were followed up for
a median of 4.4 years in the Systolic Hypertension in Europe Trial. Ambulatory
systolic blood pressure at the time of randomization was a significant predictor
of total mortality and CV events among subjects assigned to placebo even after
adjustment for blood pressure measured in the clinic.
Despite recommendations to immunize premature infants according to chronological
age, immunization of preterm infants is often delayed. Davis and coworkers
report that in a cohort of infants followed up through 24 months of age, the
rate of up-to-date immunization levels was generally lowest among very low-birth-weight
infants at each age assessed. Rates of up-to-date immunization levels among
infants with birth weights between 1500 and 2500 g and among preterm infants
with birth weights greater than 2500 g were similar to rates among full-term,
Clinical evidence suggests that antiseptic-impregnated central venous
catheters are effective for prevention of catheter-related bloodstream infection.
Using data from published trials and case-control studies and safety data
from the Food and Drug Administration, Veenstra and colleagues estimatedArticle that
in a hypothetical cohort of hospitalized patients at high risk for catheter-related
infections, the use of antiseptic-impregnated catheters would reduce the incidence
of catheter-related bloodstream infection 2.2% and the incidence of death
0.33%. Cost savings were estimated at $196 per catheter used.
In this multicenter study of 89 patients with septic shock and 87 healthy
controls, Mira and colleagues foundArticle that the frequency of the TNF2 allele, a tumor necrosis factor alpha (TNF-α) promoter polymorphism,
was significantly higher among patients with septic shock compared with controls
and the risk of death among patients with septic shock was significantly higher
among those with the TNF2 polymorphism. In an editorialArticle,
Kumar and coauthors discuss opportunities for improving outcomes of sepsis
syndrome and septic shock derived from investigation of genetic polymorphisms
of TNF-α and perhaps of other inflammatory immune mediators.
Based on analyses of samples of Andrew Jackson's hair, Deppisch and
colleagues contest claims that Jackson's death was caused by heavy metal poisoning
from common remedies.
Chronic viral hepatitis—pretreatment evaluation and advances in
Participants at the National Conference on Violence and Reproductive
Health consider ways to encourage physicians to screen patients for domestic
violence, including a systems model for clinical management.
At the Clinical Center of the National Institutes
A 78-year-old man presents with a 5-month history of a bullous disorder
involving the oral mucosa and the skin on the scalp, back, and chest. Udey
and Stanley discuss bullous diseases in the pemphigus group, diseases of antidesmosomal
Results of a patient survey rating physicians on style of participatory
decision making and associations with gender and ethnicity.
For your patients: Preventing transmission of HIV to newborns.
This Week in JAMA. JAMA. 1999;282(6):505. doi:10.1001/jama.282.6.505