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Excess Thyroid Hormone and Fetal Survival
Little is known about fetal effects of exposure to excess thyroid hormone
(TH). Anselmo and colleagues investigated the effects by studying pregnancy
outcomes among euthyroid members of an Azorean family who have mutations in
the TH-receptor gene, high levels of TH, and resistance to thyroid hormone.
They found that affected mothers had increased rates of miscarriage compared
with unaffected mothers. Unaffected infants—vs affected infants—born
to affected mothers had a lower birth weight and suppressed levels of thyroid-stimulating
hormone consistent with fetal thyrotoxicosis.
Long-term Efficacy of Bivalirudin During PCI
In a previously reported randomized trial of patients undergoing percutaneous
coronary intervention (PCI), patients who received bivalirudin with provisional
glycoprotein IIb/IIIa (Gp IIb/IIIa) inhibition had a lower risk of postprocedural
bleeding, but similar risks of acute ischemic events as those receiving heparin
plus planned Gp IIb/IIIa blockade. To assess the durability of the treatment,
Lincoff and colleagues performed prospective follow-up of the patients. At
6 months, there were no differences by treatment group for myocardial infarction
or repeat revascularization, and mortality rates did not differ significantly
at 1 year.
Contagiousness of Varicella in Vaccinated Persons
Some reports suggest that varicella in a vaccinated person—eg,
breakthrough varicella—is less contagious than varicella in an unvaccinated
individual. Seward and colleagues used data from a varicella active surveillance
project to examine varicella transmission within households and to estimate
vaccine effectiveness. Overall, they found that vaccinated cases were half
as contagious as unvaccinated cases, but if the vaccinated primary case had
50 or more lesions, contagiousness was similar to that of unvaccinated cases.
Vaccine effectiveness was estimated at 78.9% for all disease, and 100% and
92% for severe and moderate disease, respectively.
Safety and Immunogenicity of a Streptococcal Vaccine
Potential progress toward a group A streptococcal vaccine is detailed
by Kotloff and colleagues,Articlewho report on the safety
and immunogenicity of ascending doses of a streptococcal vaccine candidate
in healthy adults. The volunteers received 3 spaced injections of either a
50-, 100- or 200-µg dose and were followed up for 1 year, during which
no serious adverse effects were documented. The 200-µg dose induced
a significant type-specific immune response and postvaccination bactericidal
activity was documented in more than half the participants. In an editorial,
PichicheroArticlediscusses the challenges in developing a
group A streptococcus vaccine.
Streptococcus pneumoniae and Staphylococcus aureus are common in the respiratory tract of children.
Regev-Yochay and colleagues assessed whether these organisms compete to the
extent that the presence of one suppresses the other. If so, widespread use
of the pneumococcal conjugate vaccine could change the upper respiratory tract
flora in children. The authors collected nasopharyngeal and nasal swabs from
children and adults seen at primary care clinics. They found an inverse relationship
between S aureus and S pneumoniae carriage in children, which persisted in analyses controlling for
age and was not present in adults.
A Piece of My Mind
"I know how tedious science can be, how exhausting it is to meticulously
pore over sheets of data, to run statistics, and to write up articles when
you know that only a handful of colleagues will read the results." From "For
the Obscure Researcher."
Medical News & Perspectives
Researchers say that more understanding of vitamin E's biological effects
is needed to determine its role in maintaining health and fighting diseases
such as cardiovascular disease and cancer.
Eliminating Ocular Chlamydia
Data from Ethiopia suggest that biannual mass azithromycin administration
could eliminate ocular chlamydia from this hyperendemic area.
Evidence-based treatment strategies for acne.
ICU Visitation Policies
Berwick and Kotagal argue that restricted visitation in ICUs is "neither
caring, compassionate, nor necessary" and challenge hospitals to implement
open visitation policies.
JAMA Patient Page
For your patients: Information about acne.
This Week in JAMA. JAMA. 2004;292(6):657. doi:10.1001/jama.292.6.657
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