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This Week in JAMA
February 1, 2006

This Week in JAMA

JAMA. 2006;295(5):469. doi:10.1001/jama.295.5.469
Relapse of Depression During Pregnancy

Although supporting evidence is limited, the emotional well-being common during pregnancy is often thought to provide protection from psychiatric disorders during the prenatal period. In a prospective longitudinal study of depression during pregnancy, Cohen and colleagues assessed risk of depression relapse in women who discontinued antidepressant medication compared with women who continued antidepressant use. The authors found that 43% of the women experienced a relapse of depression during pregnancy. Twenty-six percent of women who maintained their medication throughout pregnancy relapsed compared with 68% of women who discontinued medication.

Bone Marrow Transplantation for SCID

Bone marrow transplantation using stem cells from a related HLA-identical donor is the preferred treatment for patients with severe combined immune deficiency (SCID). For patients without a related HLA-identical donor, information on the efficacy and safety of alternative donor strategies is needed. Grunebaum and colleagues reviewed outcomes of patients with SCID receiving stem cells from related HLA-identical donors, HLA-mismatched related donors, and HLA-matched unrelated donors. The authors found that among patients without a related, identical donor, those who received an HLA-matched unrelated transplant had superior engraftment, immune reconstitution, and survival and a higher risk of acute graft-vs-host disease than patients who received a graft from an HLA-mismatched related donor.

South African Blood Safety Policy and Prevalence of HIV in Blood Donations

The high prevalence of human immunodeficiency virus 1 (HIV-1) in South Africa poses significant transfusion transmission risks. Heyns and colleaguesArticle report the effect of a donor selection policy and education program, which involved closure of blood donor clinics in high HIV prevalence areas, on the prevalence of HIV-1 in blood donations. Comparing preprogram and postprogram years, the authors found that the policy was associated with a decline in HIV-1 risk from transfusion but resulted in undercollection of blood donations from the majority black population. In an editorial, Bekker and WoodArticle discuss South African blood donation policy and the inappropriateness of using race as a surrogate for high-risk behaviors.

Stem Cell Transplantation for Refractory Lupus

Immunosuppressive therapies ameliorate the manifestations of systemic lupus erythematosus (SLE) in many but not all patients. Burt and colleaguesArticle report results of a single-arm, nonrandomized clinical trial involving patients with SLE refractory to standard therapies and organ- or life-threatening visceral involvement. Forty-eight of 50 patients in their study received cyclophosphamide and antithymocyte globulin treatment followed by autologous nonmyeloablative hematopoietic stem cell transplantation. During a mean follow-up of 29 months, overall survival was 84% and the investigators estimate that the patients had a 50% probability of 5-year disease-free survival. Stabilization or reversal of organ dysfunction and improvement in serologic markers of disease were also documented. In an editorial, Petri and BrodskyArticle discuss the benefits and risks of high-dose cyclophosphamide and stem cell transplantation for severe refractory SLE.

Medical News & Perspectives

Evidence is emerging that smoking and nicotine exposure offer unique benefits to individuals with certain mental illnesses. Research probing this phenomenon may point the way to new treatments for these disorders and for smoking cessation.

Clinician's corner

Clinical evaluation and medical treatment of peripheral arterial disease.

Pandemic Influenza

Legal and ethical issues in a medical response to pandemic influenza.

Author in the Room

Join Olga Jonasson, MD, in a teleconference on February 15, 2006, to discuss a randomized trial comparing watchful waiting vs standard open tension-free surgical repair for treating inguinal hernia.

For more information and to register for “Author in the Room,” please visit http://www.ihi.org/authorintheroom.

JAMA Patient Page

For your patients: Information about peripheral arterial disease.