Recent cases of inhalational anthrax following bioterrorism exposure
to anthrax spores provide new information about the clinical presentation
and course of this disease. In this issue of THE JOURNAL, Mayer and colleaguesArticle
present the cases of 2 patients with inhalational anthrax who continue in
serious but stable condition, and Borio and colleaguesArticle present the cases of
2 patients who died of inhalational anthrax. In an editorial, Lane and FauciArticle
stress the importance of obtaining an occupational and environmental history
in cases of suspected inhalational anthrax and of rapid dissemination and
sharing of epidemiologic, diagnostic, and treatment information.
Initiation of antiretroviral therapy for patients with chronic, asymptomatic
HIV infection is generally based on CD4 cell counts and plasma HIV RNA levels.
Phillips and colleaguesArticle analyzed data from therapy-naive patients starting
antiretroviral therapy who participated in 3 large cohort studies and found
that lower CD4 cell counts and higher viral load levels at baseline were not
associated with poorer virological response to antiretroviral therapy. In
a population-based study of therapy-naive patients starting antiretroviral
therapy, Hogg and colleaguesArticle found that risk of progression to AIDS and mortality
was significantly higher among patients with baseline CD4 cell counts less
than 200 cells/µL, but baseline plasma HIV RNA level was not an independent
prognostic indicator. In an editorial, PomerantzArticle discusses the implications
of these findings for initiation of antiretroviral therapy.
A variety of approaches to improve the quality of medical care are currently
available. GrolArticle summarizes the debate on methods for improving the quality
of care and, in a review of articles on popular approaches for improving professional
performance, observes that evidence regarding the impact and feasibility of
the various approaches is mixed or lacking. In an editorial, ShaneyfeltArticle emphasizes
the importance of quality improvement strategies that integrate quality improvement
into daily clinical practice by providing patient-specific recommendations
at the point of care.
"The paradox of the system of no-system is that it is becoming increasingly
systematized." From "Within the System of No-System."
Gestational diabetes mellitus: screening, diagnosis, and management.
Preliminary research findings suggest that a common medical practice
can sometimes transform a Candida albicans infection
into a life-threatening event.
Mr R has a 4-year history of cocaine addiction and, despite a recent
hospitalization for cocaine-related chest pain, continues cocaine use. Hyman
discusses the epidemiology of illicit drug use and dependence, risk factors
for drug abuse and addiction, effects of cocaine and other addictive drugs
on neural pathways, and addiction treatment.
For your patients: Information about anthrax.
This Week in JAMA. JAMA. 2001;286(20):2507. doi:10.1001/jama.286.20.2507