This Week in JAMA FREE

Zidovudine prophylaxis in the perinatal period for infants of women infected with the human immunodeficiency virus (HIV), recommended in national guidelines in 1994, has been associated with a decrease in rates of perinatal HIV transmission. In this analysis of US surveillance data through June 1998, Lindegren and colleagues reportArticle that the incidence of perinatal acquired immunodeficiency syndrome (AIDS) has declined 67% after peaking in 1992, coincident with the use of perinatal zidovudine prophylaxis and not explained by decreases in the number of infants born to mothers infected with HIV or delays in the onset of AIDS. In an editorialArticle, Mofenson asserts that complete elimination of perinatal HIV infection in the United States is possible and discusses barriers that remain.

To determine the prognostic accuracy of ambulatory blood pressure recordings for cardiovascular (CV) risk, Staessen and colleagues used data from 808 patients aged 60 years and older with systolic hypertension who were followed up for a median of 4.4 years in the Systolic Hypertension in Europe Trial. Ambulatory systolic blood pressure at the time of randomization was a significant predictor of total mortality and CV events among subjects assigned to placebo even after adjustment for blood pressure measured in the clinic.

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Despite recommendations to immunize premature infants according to chronological age, immunization of preterm infants is often delayed. Davis and coworkers report that in a cohort of infants followed up through 24 months of age, the rate of up-to-date immunization levels was generally lowest among very low-birth-weight infants at each age assessed. Rates of up-to-date immunization levels among infants with birth weights between 1500 and 2500 g and among preterm infants with birth weights greater than 2500 g were similar to rates among full-term, normal-birth-weight infants.

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Clinical evidence suggests that antiseptic-impregnated central venous catheters are effective for prevention of catheter-related bloodstream infection. Using data from published trials and case-control studies and safety data from the Food and Drug Administration, Veenstra and colleagues estimatedArticle that in a hypothetical cohort of hospitalized patients at high risk for catheter-related infections, the use of antiseptic-impregnated catheters would reduce the incidence of catheter-related bloodstream infection 2.2% and the incidence of death 0.33%. Cost savings were estimated at $196 per catheter used.

In this multicenter study of 89 patients with septic shock and 87 healthy controls, Mira and colleagues foundArticle that the frequency of the TNF2 allele, a tumor necrosis factor alpha (TNF-α) promoter polymorphism, was significantly higher among patients with septic shock compared with controls and the risk of death among patients with septic shock was significantly higher among those with the TNF2 polymorphism. In an editorialArticle, Kumar and coauthors discuss opportunities for improving outcomes of sepsis syndrome and septic shock derived from investigation of genetic polymorphisms of TNF-α and perhaps of other inflammatory immune mediators.

Based on analyses of samples of Andrew Jackson's hair, Deppisch and colleagues contest claims that Jackson's death was caused by heavy metal poisoning from common remedies.

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Chronic viral hepatitis—pretreatment evaluation and advances in therapy.

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Participants at the National Conference on Violence and Reproductive Health consider ways to encourage physicians to screen patients for domestic violence, including a systems model for clinical management.

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At the Clinical Center of the National Institutes of Health

A 78-year-old man presents with a 5-month history of a bullous disorder involving the oral mucosa and the skin on the scalp, back, and chest. Udey and Stanley discuss bullous diseases in the pemphigus group, diseases of antidesmosomal autoimmunity.

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Results of a patient survey rating physicians on style of participatory decision making and associations with gender and ethnicity.

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For your patients: Preventing transmission of HIV to newborns.

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