Hospitalizations of Children for Influenza

In Hong Kong, the seasons for influenza and respiratory syncytial virus (RSV) infection sometimes do not overlap, so that a relatively accurate estimate can be made of the effects of influenza-related acute respiratory disease in children. Using data from a well-defined population, these researchers found high rates of hospitalization attributable to influenza in children: 278.5 per 10,000 children younger than one year of age and 218.4 per 10,000 children one to less than two years of age in 1998.

Influenza has substantial effects in children that are not widely appreciated. Findings such as these may prompt consideration of the need for influenza vaccination in children.

Related Editorial

Celecoxib versus Diclofenac plus Omeprazole to Reduce the Risk of Recurrent Ulcer Bleeding in Patients with Arthritis

This randomized, controlled trial compared treatment with celecoxib and treatment with diclofenac plus omeprazole in patients with arthritis and ulcer bleeding. The rates of recurrent ulcer bleeding during six months of follow-up were similar in the two groups (4.9 percent in the celecoxib group and 6.4 percent in the diclofenac-plus-omeprazole group).

Treatment with a COX-2–selective NSAID was not inferior to treatment with the combination of a nonselective NSAID and a proton-pump inhibitor in reducing the risk of recurrent ulcer bleeding. However, the rates of recurrent ulcer bleeding were substantial in both groups.

Related Editorial

Alkaptonuria

Alkaptonuria is caused by mutations in the HGO gene and a deficiency of homogentisate 1,2-dioxygenase, which lead to an accumulation of homogentisic acid (HGA), ochronosis, and connective-tissue destruction. There is no effective therapy for the disorder. This study of the natural history of alkaptonuria examines findings in 58 patients, 57 of whom had detectable HGO mutations. The data are intended to serve as a base line for future trials of therapy. Nitisinone, which inhibits the enzyme that produces HGA, was administered briefly in two patients; urinary HGA levels decreased and plasma tyrosine levels increased without apparent adverse effects.

Although nitisinone reduced HGA production in two patients, the long-term safety and efficacy of this treatment are unknown.

Tetrahydrobiopterin Responsiveness and Hyperphenylalaninemia

Patients with hyperphenylalaninemia due to phenylalanine hydroxylase deficiency require low-phenylalanine diets, even those with mild disease. This study explored the responsiveness of 38 such patients to the cofactor tetrahydrobiopterin. Tetrahydrobiopterin significantly lowered blood phenylalanine concentrations in most of the 10 patients with mild hyperphenylalaninemia and the 21 with mild phenylketonuria, but had no effect in the 7 with classic phenylketonuria. Seven mutations were probably and six were potentially associated with tetrahydrobiopterin responsiveness.

Tetrahydrobiopterin responsiveness is common in patients with mild hyperphenylalaninemia phenotypes.

Related Perspective

Special Article: Descriptions of Benefits and Risks in Consent Forms for Phase 1 Oncology Trials

Phase 1 trials of chemotherapeutic agents have been criticized because it is believed that the consent forms investigators use promise benefits and ignore risks. This study of 272 consent forms obtained from 37 academic cancer centers and six large pharmaceutical companies does not bear out the concern that consent forms for studies of experimental treatments for cancer are inadequate or ethically flawed.

Mechanisms of Disease: Hydrophobic Surfactant Proteins in Lung Function and Disease

Pulmonary surfactants consist of phospholipids and the hydrophobic proteins surfactant protein B and surfactant protein C. These surfactants keep the alveoli in the lung open to the atmosphere. Mutations in the genes encoding these proteins cause a variety of pulmonary syndromes. The pulmonary diseases associated with some of these mutations exemplify the consequences of the accumulation of misfolded proteins in tissue.

Legal Issues in Medicine: Independent External Review of HMOs' Medical-Necessity Decisions

A patient who was denied coverage for a specialized surgical procedure successfully sued her health maintenance organization (HMO). In its appeal to the U.S. Supreme Court, the HMO argued that as an ERISA plan (an employer health plan regulated by the federal Employee Retirement Income Security Act), it was exempt from an Illinois law requiring external review in disputes about the medical necessity of treatment. The Court ruled that the insurance aspects of ERISA plans are not exempt from state laws and that the HMO must offer external review.

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