Investigators have hypothesized that inflammation may have a role in
the development of hypertension. Sesso and colleaguesArticle report
results of a prospective cohort study of women whose blood pressure
was in the normal range at enrollment and who had no history of hypertension
or antihypertensive therapy. Levels of C-reactive protein were measured at
baseline and served as a marker of systemic inflammation. After an average
of 7.8 years of follow-up, women whose baseline C-reactive protein levels
were elevated had a higher likelihood of a new diagnosis of hypertension.
In an editorial, GrundyArticle discusses the relationship of
inflammation to hypertension and the potential pathologic processes that could
contribute to the observed association.
Some patients with hypothyroidism who receive thyroxine (T4)
replacement continue to report hypothyroid symptoms. Clyde and colleaguesArticle report results of a randomized trial comparing T4 therapy
alone with therapy with a reduced dose of T4 and the addition of
liothyronine, the biologically active form of thyroid hormone, triiodothyronine
(T3). Both treatment regimens resulted in normal serum thyrotropin
levels. There were no significant differences in body weight, blood pressure,
or serum lipid levels between the 2 groups or compared with baseline. Both
groups reported improved quality of life, but neither treatment regimen demonstrated
superiority. In an editorial, CooperArticle discusses the ongoing
challenge of providing thyroid replacement that mimics normal physiology.
Identification of risk factors for colon polyps and advanced colon cancer
in asymptomatic individuals could facilitate identification of individuals
at highest risk. Lieberman and colleagues conducted a prospective, cross-sectional
study to assess the association of heredity and a number of lifestyle variables
on disease risk among patients who had undergone colonoscopy. Colon cancer
in a first-degree relative and current cigarette and alcohol use were positively
associated with advanced colon cancer, but higher cereal fiber and vitamin
D intake and daily use of nonsteroidal anti-inflammatory drugs were not. Only
current or past smoking distinguished participants with hyperplastic polyps
from those without.
The incidence of reported cases of pertussis has increased since the
1980s, but it is unclear whether this is a result of an increase in disease
or improved recognition or surveillance. Tanaka and colleagues reviewed data
from 2 US databases to describe characteristics and incidence of infant pertussis
between 1980 and 1999. They report an increase in incidence in the 1990s,
particularly among infants younger than 4 months, and little change in disease
severity or the number of cases requiring hospitalization compared with cases
reported in the 1980s.
Methicillin-resistant Staphylococcus aureus (MRSA)
infections are no longer limited to patients with a history of hospitalization
or long-term care residence. Little is known about potential molecular differences
between community-associated and health care–associated infections.
Naimi and colleagues report demographic and clinical features and isolate
microbiological and molecular characteristics from patients diagnosed with
MRSA infections. Patients with community-associated MRSA infections were significantly
younger and more likely to have skin and soft tissue infections and less likely
to have respiratory and urinary tract infections than patients with health
care–associated infections. Isolates from the 2 types of MRSA infection
could be distinguished by their unique antibiotic sensitivities and molecular
Tensions between health authorities on both sides of the US-Canadian
border are mounting as consumers in the United States increasingly turn to
Canadian pharmacies for low-cost prescription medications.
Reductions in ICU morality and nosocomial infections were documented
in critically ill patients with acute exacerbations of COPD and pulmonary
Cooper and colleagues surveyed medical school deans and medical society
executives regarding their perceptions of physician shortage and the effect
of these on medical education.
Effects and prevention of fetal alcohol spectrum disorder.
For your patients: Information about hypothyroidism.
This Week in JAMA. JAMA. 2003;290(22):2907. doi:10.1001/jama.290.22.2907