Polymorphisms of Adrenergic Receptors and Heart Failure

Sustained activation of the sympathetic nervous system contributes to the development and progression of heart failure. This study examined two polymorphisms in the ₁- and _2C-adrenergic receptors, which are associated with an increase in sympathetic activity. In black subjects, these polymorphisms, particularly when both were present, markedly increased the risk of heart failure.

There is substantial variation among persons in the development and progression of heart failure. This study identifies genetic factors that may contribute to this variation.

Related Editorial

Alteplase for Submassive Pulmonary Embolism

Thrombolysis is known to be effective in the treatment of patients with massive pulmonary embolism, but its efficacy is less certain in patients with submassive pulmonary embolism. In this large, randomized trial, the combination of heparin and alteplase was found to be superior to heparin and placebo in the treatment of such patients.

The superiority of heparin plus alteplase over heparin alone was due primarily to a reduced need for secondary thrombolytic therapy. Since there was no increased risk of serious bleeding with the combination therapy, it should be considered for use in the absence of contraindications.

Related Perspective

Endogenous Antimicrobial Peptides in Atopic Dermatitis

Staphylococcal infections of the skin are more common in patients with atopic dermatitis than they are in normal persons or patients with psoriasis. In this study, the investigators hypothesized that the elevated rate of skin infections in atopic dermatitis could be attributed to reduced levels of the endogenous antimicrobial peptides LL-37 and human -defensin 2. They found that the levels of these peptides were lower in skin from patients with atopic dermatitis.

These data provide evidence that a deficiency of endogenous antimicrobial peptides in the skin may account for the increased role of infections in patients with atopic dermatitis. Proof of the concept will require the demonstration that up-regulation of these peptides leads to fewer skin infections.

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Special Article: Screening Extended Families for Genetic Hemoglobin Disorders

This article reports a feasible strategy for identifying and counseling carriers of recessively inherited diseases in developing countries. The basis of the approach is testing the extended family of a person with an index case, usually a child with the disease.

In Pakistan, where consanguineous marriage and the genes for -thalassemia and hemoglobin S are common, more than 5000 babies with transfusion-dependent -thalassemia are born annually. In a country with an average annual income of $420, screening for genetic diseases by methods used in industrialized countries is impractical. This article describes a practical method for identifying carriers and suggests that it is possible to reduce the incidence of costly genetic disorders through counseling.

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Clinical Practice: Otitis Media

An otherwise healthy 17-month-old boy had a cold accompanied by two days of rhinorrhea, cough, and fever (temperature of up to 38.8°C). On day 5, he became fussy and woke up crying several times during the night. The following day he was afebrile, and a physical examination was normal except for findings of a slightly red left tympanic membrane with no middle-ear fluid and a bulging right tympanic membrane with white fluid behind it, obscuring the umbo. How should he be treated?

Medical Progress: Helicobacter pylori Infection

H. pylori is one of the most common bacterial infections in human beings, and its discovery 20 years ago altered the diagnosis and treatment of gastroduodenal disease. This review considers current knowledge about the epidemiology and transmission of H. pylori, as well as the role of this infectious agent in the pathogenesis of upper gastrointestinal tract disease. Diagnostic approaches, indications for therapy, and measures of therapeutic efficacy are reviewed.

The 1998 U.S. guidelines recommend testing for H. pylori only if treatment is intended. The primary indications for testing and subsequent therapy include active peptic ulcer disease, a history of documented peptic ulcer, or gastric mucosa-associated lymphoid-tissue lymphoma.

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