Statin therapy has been used as a long-term strategy to reduce ischemic
cardiovascular events in patients with stable coronary heart disease. To determine
whether statin therapy initiated during the high-risk period immediately after
an acute coronary syndrome would reduce ischemic events, Schwartz and colleaguesArticle
assigned adults with unstable angina or non–Q-wave acute myocardial
infarction (MI) to receive atorvastatin or placebo between 24 and 96 hours
after hospital admission. During the 16-week study, the risk of the primary
combined end point (death, nonfatal acute MI, cardiac arrest with resuscitation,
or recurrent symptomatic myocardial ischemia requiring emergency rehospitalization)
was lower in the atorvastatin group than in the placebo group, primarily because
of a significant reduction in the rate of recurrent symptomatic ischemia requiring
rehospitalization. In an editorial, SacksArticle suggests that physicians include
lipid-lowering therapy in the treatment of patients hospitalized for an acute
Several neuroprotective compounds have been shown to limit brain injury
following acute ischemic stroke in preclinical studies, but none have been
efficacious in phase 3 trials. In this multicenter trial, Sacco and colleaguesArticle
evaluated the efficacy of the neuroprotective drug gavestinel, an antagonist
of the glycine site of the N-methyl-D-aspartate receptor,
administered to patients with ischemic stroke within 6 hours of symptom onset.
At the 3-month follow-up, functional outcomes in the gavestinel group were
not significantly different from those in the placebo group. In an editorial,
PlumArticle discusses the importance of restoring cerebral perfusion as well as preventing
the progression of ischemic events that follow acute ischemic stroke.
A 23-valent polysaccharide pneumococcal vaccine has been available for
older children and adults, and a protein-polysaccharide pneumococcal 7-valent
conjugate vaccine was recently licensed for use in young children. Robinson
and colleagues analyzed 1995-1998 data from the Active Bacterial Core Surveillance
system to assess the burden of pneumococcal disease in the United States and
estimate the impact of these new vaccines. Invasive infection with Streptococus pneumoniae was estimated to cause more than 62 000
cases and more than 6000 deaths in 1998. Incidence of pneumococcal disease
was highest among children younger than 2 years and adults aged 65 years or
older and was more than 2 times higher among blacks than whites. Most of the
strains isolated from cases in the high-risk age groups were included in the
Kaposi sarcoma, non-Hodgkin lymphoma, and invasive cervical cancer occur
in excess among individuals infected with HIV and are considered AIDS-defining
cancers. To identify other cancers likely to be increased by the immunosuppression
associated with HIV infection, Frisch and colleagues analyzed data from linked
population-based AIDS and cancer registries. The incidence of non–AIDS-defining
cancers among adults with HIV/AIDS exceeded the expected rate. Only 6 of the
more than 60 individual cancer types studied, however, met the criteria for
potential association with immunosuppression; of these, Hodgkin disease and
possibly lip cancer and testicular seminoma were likely to be genuinely influenced
by immunosuppression rather than by lifestyle-related exposures.
Austin, an 8-year old boy diagnosed as having autism at age 2½
years, received early intervention services and has had steady improvement
in communication and social skills. Rapin discusses the classification, prevalence,
possible etiologies, evaluation, and treatment of autistic disorder.
In a dramatic demonstration of the potential of treatment with stem
cells, researchers have succeeded in partially reversing paralysis in rats
with a disease similar to amyotrophic lateral sclerosis.
On World Health Day, April 7, WHO launches a year-long, worldwide mental
health campaign. Events to be held on April 6 in the United States, with the
theme "Open Doors, Open Minds," are meant to raise awareness about barriers
to mental health and solutions to tackle mental and substance abuse disorders.
Peanut protein was detected in the breast milk of 11 of 23 lactating
women after they consumed 50 g of dry roasted peanuts, suggesting that occult
exposure to peanut allergen can occur during breastfeeding, which may result
Perspectives on clinical and research opportunities afforded by electronic
medical records and consideration of privacy protection issues.
For your patients: Information about autistic disorder.
This Week in JAMA. JAMA. 2001;285(13):1673. doi:10.1001/jama.285.13.1673