Micronutrient deficiencies are common early in human immunodeficiency virus (HIV) infection and are associated with accelerated disease progression. Baum and colleagues examined the effect of daily oral micronutrient supplementation (B vitamins, vitamins C and E [multivitamin]; selenium alone; or multivitamin plus selenium) compared with placebo on disease progression in a randomized trial that enrolled 878 Botswana adults who were antiretroviral therapy (ART) naive. The authors report that participants who received the combined multivitamin plus selenium supplement had a reduced risk of immune system decline, morbidity, and disease progression compared with participants who received placebo.
Author Video Interview, Continuing Medical Education
Resistance or intolerance to therapy is common in children with Crohn disease, and few studies have evaluated new drugs for refractory disease in children. In a randomized trial that enrolled 56 children aged 2 to 18 years with refractory Crohn disease, Lazzerini and colleagues found that compared with placebo, use of thalidomide—a drug with immunomodulatory properties—resulted in improved clinical remission at 8 weeks of treatment and longer-term maintenance of remission during open-label follow-up.
Induced hypothermia is beneficial in global cerebral hypoxemia and associated with favorable effects in animal models of meningitis. In a multicenter randomized trial that enrolled 98 comatose adults with bacterial meningitis, Mourvillier and colleagues assessed the effect of induced hypothermia (cooling to 32°C to 34°C for 48 hours) vs standard care on patient outcome. The trial was stopped early because of excess mortality in the hypothermia group. The authors report that therapeutic hypothermia did not improve outcomes in patients with severe bacterial meningitis.
An association between fluoroquinolone use and increased risk of retinal detachment has been reported. To further explore this association, Pasternak and colleagues analyzed linked Danish health care and administrative registry data (1997-2011) representing nearly 749 000 episodes of fluoroquinolone use and more than 5.5 million episodes of nonuse (controls). The authors found no increased risk of retinal detachment among individuals who used fluoroquinolones compared with those who did not. In an Editorial, Brett discusses the challenge of reconciling conflicting findings from observational studies.
Clinical Review & Education
The World Medical Association Declaration of Helsinki, first published 50 years ago, specifies ethical principles for medical research involving human subjects. The seventh revision of the Declaration is published in this issue. Two Viewpoints highlight key revisions, including compensation and treatment for research-related injuries, and the dissemination of research results and discuss the remaining challenges relating to informed consent, research posing net risks, and research in poor communities.
Related Viewpoint 1, 2
A 57-year-old woman who received bisphosphonate therapy for treatment of metastatic renal carcinoma reports discomfort and an open sore around the teeth in her lower jaw. On examination, the teeth are mobile and an area of mandibular bone is exposed. What would you do next?