Experimental data suggest that nitric oxide inhibits platelet aggregation and modulates ischemia-reperfusion injury, and some preliminary clinical data suggest potential efficacy of inhaled nitric oxide in sickle cell disease–associated vaso-occlusive pain crisis. In a multicenter, randomized trial that enrolled 150 patients with sickle cell disease who were hospitalized with vaso-occlusive pain crisis, Gladwin and colleagues assessed the effect of up to 72 hours of inhaled nitric oxide gas compared with inhaled nitrogen placebo on time to resolution of vaso-occlusive pain. The authors report that compared with placebo, inhaled nitric oxide did not improve the time to resolution of vaso-occlusive pain crisis in patients with sickle cell disease.
The interaction of insulin with target cells is mediated by insulin receptor (INSR) gene expression. Previously, Chiefari and colleagues Article reported that the high-mobility group AT-hook 1 (HMGA1) protein is a key regulator of INSR gene expression, and they described 2 patients with a functional HMGA1 gene variant who had type 2 diabetes mellitus. In this issue, the authors report results of a case-control study from 3 populations of individuals of white European ancestry in which they examined the association of HMGA1 gene variants with type 2 diabetes. The authors identified 3 additional functional variants of the HMGA1 gene and found that presence of the gene variants was associated with type 2 diabetes mellitus in persons of white European descent. In an editorial, Garg Article discusses novel gene loci that may influence susceptibility to type 2 diabetes mellitus.
Use of antihypertensive medications in patients with a history of cardiovascular disease (CVD) or diabetes and without clinically defined hypertension has been debated. In a systematic review and meta-analysis, Thompson and colleagues Article evaluated the association between antihypertensive treatment and secondary prevention of CVD events and all-cause mortality among persons with systolic blood pressure less than 140 mm Hg or diastolic blood pressure less than 90 mm Hg. The authors found that compared with controls, patients who received antihypertensive therapy had decreased risks of stroke, myocardial infarction, congestive heart failure, composite CVD events, and CVD and all-cause mortality. In an editorial, Ventura and Lavie Article discuss pharmacologic treatment of prehypertension.
Ms A, a 25-year-old unmarried woman who is gravida 3, para 2, received a 1-year jail sentence during the second trimester of her current pregnancy. Ms A is addicted to heroin and is a long-standing cigarette smoker. Clarke and Adashi discuss the health care needs of incarcerated women who are pregnant. Among the issues they address are the management of addictions, work assignments, safety and nutritional requirements, the controversial use of restraints, and factors to consider when planning postpartum return to the correctional system.
“Having seen my dad shamelessly discuss his Christian faith with even near-strangers during my childhood—and not always with the most gracious responses—I nearly exclaimed aloud, ‘Oh no, not again!’” From “Shall We Pray?”
Scientists are exploring experimental therapies that one day might help restore neurologic function in patients with multiple sclerosis.
Biosafety and genetically modified mosquitoes
Physician incentives and academic health care quality
Systems integration in health care
Physicians' role in guardianship proceedings
Join Gabriela Schmajuk, MD, MS, on Wednesday, March 16, from 2 to 3 PM eastern time to discuss appropriate prescribing of disease-modifying antirheumatic drugs for patients with rheumatoid arthritis. To register, go to http://www.ihi.org/AuthorintheRoom.
How would you manage a 70-year-old man with Parkinson disease and atrial fibrillation who is finding the cognitive aspects of driving a challenge? Go to www.jama.com to read the case and submit your response by March 6 for possible online publication.
For your patients: Information about sleep apnea.
This Week in JAMA . JAMA. 2011;305(9):859. doi:10.1001/jama.2011.248