November 7, 2002
Autism and Measles, Mumps, and Rubella Vaccination
The measles, mumps, and rubella (MMR) vaccine contains a live, attenuated measles virus, and there have been claims that the vaccine is a cause of autism in young children. This study included all children born in Denmark from 1991 through 1998. Using national-registry data on autistic disorders, the investigators found no association between MMR vaccination and a subsequent diagnosis of autism (relative risk, 0.92; 95 percent confidence interval, 0.68 to 1.24) or a related disorder (relative risk, 0.83; 95 percent confidence interval, 0.65 to 1.07). This national cohort study, which included 537,303 children, obviated the problems of selection bias and misclassification bias. The results provide strong evidence that MMR vaccination is not a cause of autism.
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Effects of the Amount and Intensity of Exercise on Lipoproteins
Regular exercise has well-established health benefits, some of which are mediated through changes in plasma lipoproteins. This study investigated the relative importance of the amount and the intensity of regular exercise in producing changes in plasma lipoproteins. The amount of exercise per week proved to have a greater effect on lipoproteins than did the intensity of exercise. The important public health message is that exercise equivalent to jogging 17 to 18 miles per week at a moderate pace is sufficient to produce clinically meaningful changes in plasma lipoproteins. A lower amount of equally intense exercise is not as beneficial.
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Cysteinyl Leukotriene Receptor and Aspirin Sensitivity
Patients who are hypersensitive to aspirin have asthma, rhinosinusitis, and nasal polyposis. These findings have been attributed in part to the action of the cysteinyl leukotrienes at one of their receptors. Although aspirin can initiate the reaction, it can also be an effective treatment, since long-term exposure to aspirin leads to a desensitized state. In this study, the authors show that patients with aspirin-sensitive rhinosinusitis have enhanced expression of the cysteinyl leukotriene receptor CysLT1 on inflammatory cells in nasal-biopsy specimens and that desensitization with aspirin is associated with decreased expression of this receptor on these cells. Although these data elucidate another key piece in the puzzle of aspirin sensitivity, the story is not complete. The links between aspirin-regulated expression of the CysLT1 receptor on inflammatory cells and the clinical manifestations of aspirin sensitivity are still speculative.
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Brief Report: Vasculopathy Due to Varicella–Zoster Virus
Several months after having zoster on the sacrum, a 71-year-old man had a transient ischemic attack with occlusion of the right anterior cerebral artery. Six months after having zoster in the ophthalmic distribution, a 76-year-old woman had sudden loss of vision in the left eye. In both cases, the acute vascular events were caused by the varicella–zoster virus, and in both, the deficits resolved after intravenous treatment with acyclovir.
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Clinical Practice: Nondiabetic Kidney Disease
A 66-year-old man without diabetes has worsening hypertension. He has a serum creatinine level of 1.8 mg per deciliter (159 µmol per liter), proteinuria (2+), and a fasting serum low-density lipoprotein cholesterol level of 140 mg per deciliter (3.6 mmol per liter). He smokes half a pack of cigarettes per day. Ultrasonography reveals small, symmetric kidneys without hydronephrosis or cysts. How should this patient be evaluated and treated to slow the progression of kidney disease? This article reviews the classification of nondiabetic kidney disease and approaches to slowing disease progression.
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Genomic Medicine: Genomic Medicine — A Primer
This review article launches our series on genomic medicine. It provides definitions of terms commonly used in genetics, delineates the distinction between genetics and genomics, and supplies examples of the ways in which genetic information can be used in the day-to-day care of patients. The mechanisms leading to the availability of more than 100,000 proteins from only approximately 30,000 genes are described. The various common types of mutations are identified and defined, and modes of inheritance — from simple mendelian to complex to mitochondrial — are detailed.
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