New England Journal of Medicine

April 24, 2008 FULL TABLE OF CONTENTS | THIS WEEK IN THE JOURNAL | AUDIO SUMMARY

Contaminated Heparin Associated with Adverse Clinical Events and Activation of the Contact System There is an urgent need to determine whether oversulfated chondroitin sulfate (OSCS), which has contaminated heparin supplies worldwide, is the cause of severe anaphylactoid-like reactions. This study shows that the OSCS found in contaminated lots of unfractionated heparin directly activates the kinin–kallikrein pathway in human plasma, which can lead to the generation of bradykinin, a potent vasoactive mediator.

April 23, 2008 (DOI: 10.1056/NEJMoa0803200), in Print June 5, 2008

Stents versus Bypass Grafting for Left Main Coronary Artery Disease The risk of death and the composite outcome of death, Q-wave myocardial infarction, or stroke did not differ significantly between the two groups. The risk of target-vessel revascularization was higher in the group that received stents. CME Exam

Published Online March 31, 2008 (DOI: 10.1056/NEJMoa0801441)

Home AEDs for Sudden Cardiac Arrest Patients with previous anterior-wall myocardial infarction were randomly assigned either to have an automated external defibrillator (AED) at home for management of cardiac arrest or to receive standard treatment. At a median follow-up of 3 years, there was no significant difference between the two groups in mortality from any cause.

Published Online April 1, 2008 (DOI: 10.1056/NEJMoa0801651)

Pyruvate Kinase Deficiency and Malaria Erythrocytes from patients with pyruvate kinase deficiency are resistant to invasion by Plasmodium falciparum. These data suggest that mutations in the gene encoding pyruvate kinase may confer resistance to malaria.

Published Online April 16, 2008 (DOI: 10.1056/NEJMoa072464)

Mutations in the Iodotyrosine Deiodinase Gene and Hypothyroidism DEHAL1, the gene encoding iodotyrosine deiodinase in the thyroid, allows for the reuse of iodide for thyroid hormone synthesis. The authors identified four patients from three unrelated families with three unique mutations; all had a dramatic reduction of in vitro iodotyrosine deiodinase activity.

Ezetimibe Use in the United States and Canada Ezetimibe lowers low-density lipoprotein cholesterol, but no studies have documented a clinical benefit from the drug. Nevertheless, this study shows the growing use of ezetimibe in the United States, to a much greater extent than in Canada, where direct-to-consumer advertising of prescription drugs is prohibited. CME Exam

Published Online March 30, 2008 (DOI: 10.1056/NEJMsa0801461)

Artesunate for the Treatment of Severe Falciparum Malaria A 35-year-old man presents with a febrile illness after travel in West Africa, and severe malaria is diagnosed. Treatment with artesunate is recommended. Artesunate is a member of a class of antimalarial agents called artemisinins, and it is at least as effective against severe malaria as quinine, with fewer side effects. Free Full Text CME Exam

A Man with Rheumatoid Arthritis and Lymphadenopathy A 46-year-old man with rheumatoid arthritis had anorexia and generalized lymphadenopathy. One month earlier, diffuse lymphadenopathy had developed in his neck, axillae, and groin. Serum protein electrophoresis disclosed a monoclonal spike in the gamma region.

Mast Cells and Pancreatic Cancer Mast cells fuel the growth of islet-cell tumors in a mouse model.

Trying Times at the FDA In recent years, the FDA has faced serious challenges to its ability to ensure the safety of the country’s medical devices and drugs. What can be done? Stuart Schweitzer writes that one approach is to attempt to boost the FDA’s efficiency. Free Full Text

Playing “Kick the FDA” — Risk-free to Players but Hazardous to Public Health Kicking the FDA has become a popular sport for the press and legislators. Dr. Alastair Wood argues that it is time to demand that the critics assume their own share of responsibility for the recent problems. Free Full Text

Eliminating Blinding Trachoma In the developing world, trachoma remains the leading infectious cause of blindness. Dr. Joseph Cook writes that the early results achieved with the use of the SAFE strategy and azithromycin mass treatment suggest that elimination of blinding trachoma by 2020 is entirely possible. (View slide presentation.) Free Full Text

Two Doses of Azithromycin to Eliminate Trachoma in a Tanzanian Community These authors found that one or two rounds of high-coverage mass treatment with azithromycin may be sufficient to eliminate ocular C. trachomatis in communities with moderate levels of infection. Had WHO recommendations on antibiotic use been followed, three or possibly five annual rounds of mass treatment would have been offered. Free Full Text