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This Week in JAMA
August 11, 2004

This Week in JAMA

JAMA. 2004;292(6):657. doi:10.1001/jama.292.6.657
Excess Thyroid Hormone and Fetal Survival

Little is known about fetal effects of exposure to excess thyroid hormone (TH). Anselmo and colleagues investigated the effects by studying pregnancy outcomes among euthyroid members of an Azorean family who have mutations in the TH-receptor gene, high levels of TH, and resistance to thyroid hormone. They found that affected mothers had increased rates of miscarriage compared with unaffected mothers. Unaffected infants—vs affected infants—born to affected mothers had a lower birth weight and suppressed levels of thyroid-stimulating hormone consistent with fetal thyrotoxicosis.

Article
Long-term Efficacy of Bivalirudin During PCI

In a previously reported randomized trial of patients undergoing percutaneous coronary intervention (PCI), patients who received bivalirudin with provisional glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibition had a lower risk of postprocedural bleeding, but similar risks of acute ischemic events as those receiving heparin plus planned Gp IIb/IIIa blockade. To assess the durability of the treatment, Lincoff and colleagues performed prospective follow-up of the patients. At 6 months, there were no differences by treatment group for myocardial infarction or repeat revascularization, and mortality rates did not differ significantly at 1 year.

Article
Contagiousness of Varicella in Vaccinated Persons

Some reports suggest that varicella in a vaccinated person—eg, breakthrough varicella—is less contagious than varicella in an unvaccinated individual. Seward and colleagues used data from a varicella active surveillance project to examine varicella transmission within households and to estimate vaccine effectiveness. Overall, they found that vaccinated cases were half as contagious as unvaccinated cases, but if the vaccinated primary case had 50 or more lesions, contagiousness was similar to that of unvaccinated cases. Vaccine effectiveness was estimated at 78.9% for all disease, and 100% and 92% for severe and moderate disease, respectively.

Article
Safety and Immunogenicity of a Streptococcal Vaccine

Potential progress toward a group A streptococcal vaccine is detailed by Kotloff and colleagues,Articlewho report on the safety and immunogenicity of ascending doses of a streptococcal vaccine candidate in healthy adults. The volunteers received 3 spaced injections of either a 50-, 100- or 200-µg dose and were followed up for 1 year, during which no serious adverse effects were documented. The 200-µg dose induced a significant type-specific immune response and postvaccination bactericidal activity was documented in more than half the participants. In an editorial, PichicheroArticlediscusses the challenges in developing a group A streptococcus vaccine.

Association of

Streptococcus pneumoniae and Staphylococcus aureus are common in the respiratory tract of children. Regev-Yochay and colleagues assessed whether these organisms compete to the extent that the presence of one suppresses the other. If so, widespread use of the pneumococcal conjugate vaccine could change the upper respiratory tract flora in children. The authors collected nasopharyngeal and nasal swabs from children and adults seen at primary care clinics. They found an inverse relationship between S aureus and S pneumoniae carriage in children, which persisted in analyses controlling for age and was not present in adults.

Article
A Piece of My Mind

"I know how tedious science can be, how exhausting it is to meticulously pore over sheets of data, to run statistics, and to write up articles when you know that only a handful of colleagues will read the results." From "For the Obscure Researcher."

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Medical News & Perspectives

Researchers say that more understanding of vitamin E's biological effects is needed to determine its role in maintaining health and fighting diseases such as cardiovascular disease and cancer.

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Eliminating Ocular Chlamydia

Data from Ethiopia suggest that biannual mass azithromycin administration could eliminate ocular chlamydia from this hyperendemic area.

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CLINICIAN'S CORNER

Evidence-based treatment strategies for acne.

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ICU Visitation Policies

Berwick and Kotagal argue that restricted visitation in ICUs is "neither caring, compassionate, nor necessary" and challenge hospitals to implement open visitation policies.

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JAMA Patient Page

For your patients: Information about acne.

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