May 30, 2002
Parenteral Insulin in Relatives of Patients with Type 1 Diabetes Mellitus
Persons who are at high risk for type 1 diabetes may be identified on the basis of islet-cell antibody levels, insulin antibody levels, and genetic studies. These investigators randomly assigned 339 high-risk first- and second-degree relatives of patients with diabetes (mean age, 11.2 years) either to observation or to low-dose subcutaneous ultralente insulin twice daily, plus an annual four-day continuous intravenous infusion of insulin. By the end of the study, diabetes had been diagnosed in 69 subjects in the intervention group and 70 in the observation group, an annualized rate of progression of 15.1 percent in the intervention group and 14.6 percent in the observation group. Insulin in the dose and regimen used in this study neither delayed nor prevented type 1 diabetes in high-risk persons.
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Monoclonal Antibody in New-Onset Type 1 Diabetes Mellitus
Mechanisms that destroy beta cells in type 1 diabetes mellitus involve both cytotoxic T cells and soluble T-cell products. In the present study, 24 patients with newly diagnosed diabetes received either a single course of a nonactivating monoclonal antibody against the T-cell antigen CD3 or no antibody; all the patients were then followed for one year. Treatment with the monoclonal antibody led to sustained or improved insulin responses in 9 of 12 patients, whereas only 2 of 12 control patients had sustained insulin responses. A significant decrease in the required dose of insulin occurred in the patients treated with the monoclonal antibody. Treatment with anti-CD3 antibody may slow the deterioration in insulin production that occurs in early type 1 diabetes mellitus.
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Mast-Cell Infiltration of Airway Smooth Muscle in Asthma
Although asthma is a chronic inflammatory disease of the airways, exactly which components of inflammation relate to the expression of the asthma phenotype is not known. In this study, the number of mast cells in the airway smooth muscle was determined by biopsy of the airways of normal subjects, subjects with asthma, and subjects with eosinophilic bronchitis. There were significantly more mast cells in the airway smooth muscle of the subjects with asthma than in that of either normal subjects or subjects with eosinophilic bronchitis, a condition that is similar to asthma and therefore provides an appropriate control. These data may shift the focus of asthma research to abnormalities of airway smooth muscle and away from the general study of airway inflammation.
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Lamivudine in Children with Chronic Hepatitis B
Chronic hepatitis B can be successfully treated in adults with the antiviral agent lamivudine. In this international, randomized, double-blind, placebo-controlled trial, children with hepatitis B, some of whom had had no response to treatment with interferon, received either lamivudine or placebo for 52 weeks. The rate of virologic response was 23 percent in the lamivudine group, as compared with 13 percent in the placebo group (P=0.04). A two-year open-label extension of the trial is in progress. Neither interferon nor lamivudine is a wonder drug in this group of patients. Lamivudine is an alternative treatment with efficacy similar to that of interferon and may be easier for children with chronic hepatitis B to tolerate.
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Special Article: Nurse-Staffing Levels and Quality of Care
A shortage of nurses and cuts in nursing hours as hospitals try to save money have intensified concern that patients will be more likely to have complications or die. This study used 1997 data for 799 hospitals in 11 states to examine the relation between the level of staffing by nurses and the quality of care. It found an association between a higher proportion of registered nurses or more registered-nurse–hours per day and lower rates of specific adverse outcomes, such as upper gastrointestinal bleeding, hospital-acquired pneumonia, and shock or cardiac arrest. These findings, although subject to a variety of limitations related to the weaknesses of the available data, focus attention on the importance of adequate numbers of nurses to the protection of patients and to improvement in the quality of care.
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Current Concepts: Cryptosporidiosis
Cryptosporidium is an intracellular parasite that can infect the gastrointestinal epithelium to produce a profuse diarrhea that can be life-threatening in immunocompromised hosts. This Review Article summarizes information on the clinical manifestations, pathophysiology, and diagnosis of cryptosporidiosis. The authors emphasize measures to protect against this common infection, for which there is no effective treatment.
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