November 22, 2001
Nonsteroidal Antiinflammatory Drugs and Alzheimer's Disease
In this prospective cohort study of 6989 subjects 55 years old or older, the risk of Alzheimer's disease was reduced significantly among those who were long-term users of nonsteroidal antiinflammatory drugs. There was no significant reduction in risk among those with less than 24 months' cumulative use of these medications, and there was no evidence of a protective effect against the development of vascular dementia. Nonsteroidal antiinflammatory drugs may protect against the development of Alzheimer's disease. A strength of this study is that all data on drug prescriptions were documented in an automated pharmacy data base.
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Protease Inhibitors and Reduced Mortality in Children with HIV-1
In a cohort of 1028 children and adolescents infected with human immunodeficiency virus type 1 (HIV-1), the use of combination therapy including protease inhibitors increased from 7 percent in 1996 to 73 percent in 1999. Over the four-year period, mortality declined from 5.3 percent to 0.7 percent. This analysis was adjusted for multiple potentially confounding variables; the authors estimate that the use of combination therapy including protease inhibitors in HIV-1–infected children reduces the risk of death by 67 percent. These data confirm the effectiveness in children of the newer therapies for HIV-1 infection. The results emphasize the need for access to this care for all children infected with HIV-1.
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Safety of Influenza Vaccination in Adults and Children with Asthma
This double-blind, placebo-controlled trial involved 2032 patients with asthma. The participants received the inactivated influenza vaccine and placebo in random order, with a mean of 22 days between injections. The frequency of exacerbations of asthma was similar in the two weeks after influenza vaccination (28.8 percent) and after the placebo injection (27.7 percent). Influenza is associated with substantial morbidity in persons with asthma. Few patients with asthma receive the influenza vaccine, apparently in part because of concern that it may cause a flare of disease. This study shows that the influenza vaccine is safe to administer to adults and children with asthma, including those with severe asthma.
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Birth of a Healthy Infant after Aneuploidy Was Ruled Out by Comparative Genomic Hybridization before Implantation
Embryos that are transferred after in vitro fertilization frequently fail to implant in the uterus; in many cases, this failure is due to chromosomal abnormalities in the embryo. The current methods of diagnosis of aneuploidy cannot detect many chromosomal abnormalities. This report on the case of a 38-year-old woman with a long history of infertility describes the use of comparative genomic hybridization to determine that all the chromosomes of a single embryo were free of aneuploidy, resulting in the birth of a healthy infant. The use of comparative genomic hybridization to obtain a complete embryo karyotype before transfer may improve rates of implantation and, ultimately, live births to women with infertility caused by recurrent implantation failure due to aneuploidy.
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Clinical Practice: Influenza Vaccination for Healthy Young Adults
A healthy 33-year-old woman who works in an office asks whether she should receive influenza vaccine. What should she be advised? This Clinical Practice article reviews current recommendations regarding influenza vaccination for healthy adults as well as those at higher risk.
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Drug Therapy: Fenoldopam — A Selective Peripheral Dopamine-Receptor Agonist
Fenoldopam is a peripherally acting dopamine-receptor agonist that has vasodilator and diuretic actions. Given intravenously, it is an effective treatment for patients with severe hypertension, including those with hypertensive encephalopathy and perioperative hypertension. This review summarizes the pharmacologic characteristics of fenoldopam and its efficacy as a treatment for patients with severe hypertension.
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