To determine the incidence and factors associated with relapse after
initial treatment for substance abuse among health care professionals, Domino
and colleaguesArticle reviewed data from individuals enrolled
in a posttreatment monitoring program. During 11 years of follow-up, 1 or
more relapses were documented in 74 individuals. Abuse of a major opioid and
a coexisting psychiatric illness or a family history of a substance abuse
disorder were associated with an increased risk of relapse. In an editorial,
GastfriendArticle discusses the implications of these findings
for treatment of patients with substance use disorders.
In a prospective study in Tanzania, Reyburn and colleagues examined
patterns of severe malaria and mortality and the relationship to age in areas
of high, moderate, and low transmission of Plasmodium falciparum to elucidate possible long-term consequences of malaria control efforts
that delay immune acquisition. Increasing odds of severe malarial anemia were
associated with younger age, and increasing odds of cerebral malaria were
associated with older age and residence in areas with low levels of transmission.
Respiratory distress was not associated with age or transmission level. Mortality
curves were J-shaped, with lowest mortality among children 3 to 4 years of
Current recommendations for cervical cancer screening in women infected
with the human immunodeficiency virus (HIV) do not take into account human
papillomavirus (HPV) status. In a prospective study, Harris and colleagues
determined the incidence of squamous intraepithelial lesions (SILs) according
to baseline HPV DNA results and stratified by HIV serostatus and CD4 T-cell
count. They found a similar low incidence of any SILs among HIV-seronegative
and HIV-seropositive women with CD4 counts greater than 500/μL, who had
normal cervical cytology, and HPV-negative test results.
Delayed cerebral vasospasm develops in half of patients receiving surgical
or endovascular treatment of a ruptured aneurysm. Pluta and colleagues report
that intravenous sodium nitrite prevented development of delayed cerebral
vasospasm in a primate model.
Stanulla and colleagues assessed the association of thiopurine methyltransferase
(TPMT) genotype with minimal residual disease load—a
prognostic measure—before and after a cycle of mercaptopurine as part
of multiagent chemotherapy in childhood acute lymphoblastic leukemia (ALL).
They found that patients with allelic variants of TPMT conferring
lower enzyme activity had higher rates of residual disease after treatment.
Grandesso and colleagues report results of mortality and nutritional
status surveys conducted in September 2004 among internally displaced persons
at 3 sites in South Darfur, Sudan. Crude mortality rates exceeded 1 per 10 000
per day, the internationally recognized definition of “very serious.”
Acute malnutrition was common, affecting between 10.7% and 23.6% of the populations
“What did they do for you, young Jahi, when malaria coursed through
your body like a runaway train?” From “Jambo, Jahi.”
Expanded use of a new conjugate vaccine in children, adolescents, and
college freshmen is expected to markedly reduce the prevalence of invasive
meningococcal disease in the United States.
Factors that prevented the demise of academic medical centers and are
crucial to their future success.
Drug-eluting stents, glycoprotein IIb/IIIa inhibitors, and advances
in therapy modify revascularization outcomes.
New therapies for proliferative retinopathies offer promise, with potential
For your patients: Information about malaria.
This Week in JAMA . JAMA. 2005;293(12):1419. doi:10.1001/jama.293.12.1419