Widespread use of antiviral therapy can lead to drug resistance, and resistance to neuraminidase inhibitors has been documented in type A influenza. During an influenza B epidemic in Japan, Hatakeyama and colleaguesArticle assessed the prevalence and transmissibility of influenza B viruses with reduced sensitivity to neuraminidase inhibitors and identified genetic mutations associated with neuraminidase resistance. The authors identified influenza B viruses with reduced sensitivity to neuraminidase inhibitors from both neuraminidase-treated and untreated patients. The transmission of these mutant viruses appeared to have been person to person within the same family and possibly through community contacts. In an editorial, Moscona and McKimm-BreschkinArticle discuss what is known about neuraminidase inhibitor-resistant influenza and what the implications are for the development of new antiviral therapies and their clinical use.
Inflammatory and vascular processes are believed to be involved in generating the migraine symptom complex, and there is some evidence that combination therapy, which addresses both mechanisms, may be more effective than monotherapy. Brandes and colleagues assessed the efficacy and safety of a fixed-dose tablet containing 85 mg of sumatriptan succinate and 500 mg of naproxen sodium vs each as monotherapy or placebo in 2 controlled trials of patients with migraine. The authors evaluated headache and other symptoms at 2 hours after dosing and relief of pain through 24 hours. They report that sumatriptan-naproxen as a single tablet resulted in superior clinical benefits and was associated with an acceptable adverse event profile compared with either monotherapy or placebo.
Statin therapy has been associated with reductions in the incidence and severity of sepsis in animal studies and observational studies of patients. In an analysis of data from a national prospective study of patients with end-stage renal disease who were initiating dialysis, Gupta and colleagues assessed whether statin use was associated with a reduction in hospitalizations for sepsis in this high-risk population. During a mean 3.4 years of follow-up, the authors found that patients who received statin therapy had significantly fewer sepsis-related hospitalizations compared with patients not prescribed statins.
Assessment of the effects of postmenopausal hormone therapy (HT) on cardiovascular disease risk have been inconsistent across observational studies and randomized clinical trials. To assess whether age and years since menopause when initiating HT accounts for some of the variance in coronary heart disease (CHD) risk, Rossouw and colleagues performed a secondary analysis of data from the Women's Health Initiative randomized controlled trials of HT. The authors found that women who initiated HT closer to menopause tended to have reduced CHD risk, whereas women more distant from menopause tended to have an increased risk of CHD, although these trends did not reach statistical significance. Hormone therapy was associated with a statistically significant increased risk of stroke regardless of age or the time since menopause.
“Our world sometimes presents us with situations that cannot be simplistically categorized as pro-choice or pro-life, and other patients across the nation will be faced with decisions like the ones we made on that fateful day.” From “A Question of Faith.”
Brain scans are providing scientists with a window on the mechanisms underlying addiction, and genetic testing may help physicians better target treatments.
Synovial white blood cell count and percent polymorphonuclear cells predict the likelihood of septic arthritis pending Gram stain and culture results.
In assessing adult stem cell trials, it should be acknowledged that tissue from a parous woman is likely a chimera of cells from her and her fetuses.
Join Jan Lewis Brandes, MD, April 16, 2007, from 2 to 3 PM eastern time to discuss the treatment of migraine in primary care. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about septic arthritis.
This Week in JAMA . JAMA. 2007;297(13):1405. doi:10.1001/jama.297.13.1405