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A genomewide screen of patients with myopathy who were taking high-dose simvastatin (80 mg per day) showed a strong association between myopathy and variants of SLCO1B1, which encodes an organic anion–transporting polypeptide. Approximately 60% of the cases of myopathy could be attributed to these variants. The association was replicated in an independent study. Genotyping SLCO1B1 variants may be helpful for tailoring the dosage of statins and safety monitoring.
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By linking data from national medical registries in Norway, the investigators showed that women with a history of preeclampsia were at higher risk for subsequent end-stage renal disease than were women with a history of uncomplicated pregnancy. Women who had more preeclamptic pregnancies or who also had a low-birth-weight or preterm infant had higher relative risks for later end-stage renal disease. Preeclampsia is a marker for an increased risk of later end-stage renal disease, although the absolute risk in women who have had preeclampsia is still low.
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In this randomized, placebo-controlled trial of 133 children with polyarticular juvenile rheumatoid arthritis who had a response to a 16-week course of treatment with adalimumab, a monoclonal antibody to tumor necrosis factor, disease flares were less common when adalimumab was continued than when it was withdrawn. Fourteen patients had serious adverse events, including seven patients with serious infections.
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The authors conducted a cost-effectiveness analysis of human papillomavirus (HPV) vaccination in the United States and estimated that vaccinating 12-year-old girls would cost $43,600 per quality-adjusted life-year (QALY) gained, as compared with the current screening practice. If vaccine-induced immunity wanes after 10 years, HPV vaccination would be much less cost-effective (>$140,000 per QALY).
A healthy 58-year-old woman answers the telephone and realizes that her hearing is diminished on the left side. She notices aural fullness and loud tinnitus in the affected ear. Self-administered ear cleaning with the use of an over-the-counter kit does not relieve the symptoms. How should she be evaluated and treated?
A 26-year-old woman was admitted to this hospital because of headache, behavioral changes, abnormal movements, and inability to communicate. Seven weeks before admission, headaches developed, followed by somnolence, mood alteration, confusion, memory loss, incoherent speech, and involuntary movements. An evaluation for infection was negative. Imaging studies showed a normal brain and an ovarian mass consistent with a dermoid cyst. A diagnostic procedure was performed.
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