NEJM â Collection Updates for Global Health

CORRESPONDENCE: Responses to 2009 H1N1 Vaccine in Children 3 to 17 Years of Age

Adriano Arguedas, M.D., Carolina Soley, M.D., and Kelly Lindert, M.D. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

To the Editor: The current 2009 pandemic influenza A (H1N1) virus is associated with substantial morbidity in children, with 45% of hospitalizations occurring in patients under 18 years of age.1...

EDITORIAL: Rotavirus Vaccine â A Powerful Tool to Combat Deaths from Diarrhea

Mathuram Santosham, M.D., M.P.H. — Thu, 28Â JanÂ 2010 00:00:00 -05:00

Rotavirus infection, the leading cause of severe childhood diarrhea in both developed and developing countries, results in over half a million deaths each year.1 Currently, two rotavirus vaccines (Rotarix [GlaxoSmithKline...

ORIGINAL ARTICLE: Effect of Rotavirus Vaccination on Death from Childhood Diarrhea in Mexico

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: A phased introduction of a monovalent rotavirus vaccine occurred in Mexico from February 2006 through May 2007. We assessed the effect of vaccination on deaths from diarrhea in Mexican...

ORIGINAL ARTICLE: Effect of Human Rotavirus Vaccine on Severe Diarrhea in African Infants

Thu, 28Â JanÂ 2010 00:00:00 -05:00

Background: Rotavirus is the most common cause of severe gastroenteritis among young children worldwide. Data are needed to assess the efficacy of the rotavirus vaccine in African children.

Methods: We conducted...

PERSPECTIVE: Ranking 37th â Measuring the Performance of the U.S. Health Care System

Thu, 14Â JanÂ 2010 00:00:00 -05:00

Evidence that other countries perform better than the United States in ensuring the health of their populations is a sure prod to the reformist impulse. The World Health Report 2000,...

CORRESPONDENCE: Intravenous Zanamivir for Oseltamivir-Resistant 2009 H1N1 Influenza

Thu, 07Â JanÂ 2010 00:00:00 -05:00

To the Editor: A 10-year-old girl with acute lymphoblastic leukemia was transferred to our hospital on August 31. The patient required mechanical ventilation for worsening lobar pneumonia, despite the administration...

CORRESPONDENCE: A Community Cluster of Oseltamivir-Resistant Cases of 2009 H1N1 Influenza

Thu, 07Â JanÂ 2010 00:00:00 -05:00

To the Editor: Oseltamivir-resistant infection with the 2009 pandemic influenza A (H1N1) virus has so far been described only rarely and is conferred by the H275Y substitution in the neuraminidase...

ORIGINAL ARTICLE: Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Background: While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information...

ORIGINAL ARTICLE: Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California

Thu, 07Â JanÂ 2010 00:00:00 -05:00

Background: Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women.

Methods: Statewide surveillance for patients who were hospitalized...

ORIGINAL ARTICLE: Outbreak of 2009 Pandemic Influenza A (H1N1) at a New York City School

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Background: In April 2009, an outbreak of novel swine-origin influenza A (2009 H1N1 influenza) occurred at a high school in Queens, New York. We describe the outbreak and characterize the...

ORIGINAL ARTICLE: Household Transmission of 2009 Pandemic Influenza A (H1N1) Virus in the United States

Thu, 31Â DecÂ 2009 00:00:00 -05:00

Background: As of June 11, 2009, a total of 17,855 probable or confirmed cases of 2009 pandemic influenza A (H1N1) had been reported in the United States. Risk factors for...

PERSPECTIVE: Australia's Winter with the 2009 Pandemic Influenza A (H1N1) Virus

Thu, 31Â DecÂ 2009 00:00:00 -05:00

When the World Health Organization declared a âpublic health emergency of international concernâ on April 25, 2009, after the emergence in Mexico of pandemic influenza A (H1N1) virus, Australia activated...

CORRESPONDENCE: Bacterial Pathogens and Death during the 1918 Influenza Pandemic

Thu, 24Â DecÂ 2009 00:00:00 -05:00

To the Editor: A review of recut lung-tissue specimens and published autopsy series from the 1918 influenza pandemic suggests that secondary bacterial pneumonia1 was an important cause of death, consistent...

EDITORIAL: The Need for Science in the Practice of Public Health

Nicole Lurie, M.D., M.S.P.H. — Thu, 24Â DecÂ 2009 00:00:00 -05:00

When H5N1 avian influenza emerged in 1997, much of the world began planning for an eventual pandemic. Most planners expected the pandemic to begin in Asia and believed the virus...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 40-2009 â A 29-Year-Old Man with Fever and Respiratory Failure

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Dr. Wilson Tak-Yu Kwong (Medicine): A 29-year-old man was admitted in July 2009 to the critical care unit of this hospital because of fever and respiratory failure.

The patient had been...

ORIGINAL ARTICLE: Clinical Features of the Initial Cases of 2009 Pandemic Influenza A (H1N1) Virus Infection in China

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Background: The first case of 2009 pandemic influenza A (H1N1) virus infection in China was documented on May 10. Subsequently, persons with suspected cases of infection and contacts of those...

EDITORIAL: Pandemic Influenza Vaccine Policy â Considering the Early Evidence

Kathleen M. Neuzil, M.D., M.P.H. — Thu, 17Â DecÂ 2009 00:00:00 -05:00

âPolicy decisions regarding influenza rest on judgments about the behavior of the virus, the impact of the disease and our ability to interdict its course. But the virus is capricious,...

OTHER POINTS OF VIEW: Diagnostic Testing for 2009 Pandemic Influenza A (H1N1) Virus Infection in Hospitalized Patients

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Establishing a diagnosis of 2009 pandemic influenza A (H1N1) virus infection in hospitalized patients can be challenging, especially in patients presenting late in their clinical course. Although real-time reverse-transcriptase polymerase...

CORRESPONDENCE: Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Thu, 17Â DecÂ 2009 00:00:00 -05:00

To the Editor: Faix et al. (Aug. 13 issue)1 highlight the moderate sensitivity of rapid antigen tests as compared with reverse-transcriptaseâpolymerase-chain-reaction (RT-PCR) assays in detecting the 2009 pandemic influenza A...

ORIGINAL ARTICLE: Trial of 2009 Influenza A (H1N1) Monovalent MF59-Adjuvanted Vaccine

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Background: The 2009 pandemic influenza A (H1N1) virus has emerged to cause the first pandemic of the 21st century. Development of effective vaccines is a public health priority.

Methods: We conducted...

ORIGINAL ARTICLE: A Novel Influenza A (H1N1) Vaccine in Various Age Groups

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Background: There is an urgent need for a vaccine that is effective against the 2009 pandemic influenza A (H1N1) virus.

Methods: A split-virus, inactivated candidate vaccine against the 2009 H1N1 virus...

ORIGINAL ARTICLE: Response to a Monovalent 2009 Influenza A (H1N1) Vaccine

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Background: A novel 2009 influenza A (H1N1) virus is responsible for the first influenza pandemic in 41 years. A safe and effective vaccine is needed. A randomized, observer-blind, parallel-group trial...

OTHER POINTS OF VIEW: When to Consider the Use of Antibiotics in the Treatment of 2009 H1N1 InfluenzaâAssociated Pneumonia

Thu, 10Â DecÂ 2009 00:00:00 -05:00

We are now facing a pandemic caused by an epidemiologically distinct, novel virus, the 2009 pandemic influenza A (H1N1) virus (swine flu), against which few persons born since 1970 have...

OTHER POINTS OF VIEW: Antiviral Treatment for Patients Hospitalized with 2009 Pandemic Influenza A (H1N1)

Thu, 03Â DecÂ 2009 00:00:00 -05:00

With the 2009 H1N1 pandemic well under way, many clinicians are providing care to patients with influenza. Previously, although antiviral treatment was recommended,12 clinicians may not always have prescribed it...

CORRESPONDENCE: Emergence of Oseltamivir-Resistant Pandemic H1N1 Virus during Prophylaxis

Thu, 03Â DecÂ 2009 00:00:00 -05:00

To the Editor: Neuraminidase inhibitors (oseltamivir and zanamivir) are recommended for treatment of severe illness caused by the 2009 pandemic influenza A (H1N1) virus, and their use has also been...

EDITORIAL: HIV Vaccine Trial Results â An Opening for Further Research

Raphael Dolin, M.D. — Thu, 03Â DecÂ 2009 00:00:00 -05:00

HIV-AIDS has emerged as an enormous, worldwide public health problem over the past 25 years. An estimated 33 million persons are infected with human immunodeficiency virus type 1 (HIV-1), and...

ORIGINAL ARTICLE: Vaccination with ALVAC and AIDSVAX to Prevent HIV-1 Infection in Thailand

Thu, 03Â DecÂ 2009 00:00:00 -05:00

Background: The development of a safe and effective vaccine against the human immunodeficiency virus type 1 (HIV-1) is critical to pandemic control.

Methods: In a community-based, randomized, multicenter, double-blind, placebo-controlled efficacy...

PERSPECTIVE: The Emergency Use Authorization of Peramivir for Treatment of 2009 H1N1 Influenza

Thu, 03Â DecÂ 2009 00:00:00 -05:00

On October 23, 2009, Food and Drug Administration (FDA) Commissioner Margaret Hamburg issued an Emergency Use Authorization (EUA) for peramivir for intravenous injection (BioCryst Pharmaceuticals). Peramivir is an unapproved investigational...

PERSPECTIVE: Communal Responsibility for Health Care â The Example of Benefit Assessment in Germany

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Many German observers are bewildered over the U.S. health care reform debate. Most Europeans see affordable health insurance for everyone as a fundamental element of a stable and prosperous society...

CORRESPONDENCE: Pathological Changes Associated with the 2009 H1N1 Virus

Thu, 12Â NovÂ 2009 00:00:00 -05:00

To the Editor: Between April 23, 2009, and May 15, 2009, we performed 15 autopsies on deceased patients in whom probable influenza had been diagnosed either clinically or macroscopically. Small...

EDITORIAL: Preparing for 2009 H1N1 Influenza

Richard P. Wenzel, M.D., and Michael B. Edmond, M.D., M.P.H. — Thu, 12Â NovÂ 2009 00:00:00 -05:00

In 1743, when disease was presumed to be astral in origin, European newspapers reported on a contagious influence (influenza in Italian) that was being visited on the citizens of Rome....

ORIGINAL ARTICLE: Cross-Reactive Antibody Responses to the 2009 Pandemic H1N1 Influenza Virus

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Background: A new pandemic influenza A (H1N1) virus has emerged, causing illness globally, primarily in younger age groups. To assess the level of preexisting immunity in humans and to evaluate...

ORIGINAL ARTICLE: Hospitalized Patients with 2009 H1N1 Influenza in the United States, AprilâJune 2009

Thu, 12Â NovÂ 2009 00:00:00 -05:00

Background: During the spring of 2009, a pandemic influenza A (H1N1) virus emerged and spread globally. We describe the clinical characteristics of patients who were hospitalized with 2009 H1N1 influenza...

ORIGINAL ARTICLE: Critical Care Services and 2009 H1N1 Influenza in Australia and New Zealand

The ANZIC Influenza Investigators — Thu, 12Â NovÂ 2009 00:00:00 -05:00

Background: Planning for the treatment of infection with the 2009 pandemic influenza A (H1N1) virus through health care systems in developed countries during winter in the Northern Hemisphere is hampered...

PERSPECTIVE: Defeating Rotavirus? The Global Recommendation for Rotavirus Vaccination

Thu, 12Â NovÂ 2009 00:00:00 -05:00

This past April, the World Health Organization (WHO) Strategic Advisory Group of Experts (SAGE) on Immunization announced a global recommendation that rotavirus vaccines be included in national immunization programs. The...

PERSPECTIVE: Novel H1N1 Influenza and Respiratory Protection for Health Care Workers

Thu, 05Â NovÂ 2009 00:00:00 -05:00

Your hospital has been seeing a large number of patients with influenza-like symptoms, many of whom turn out to be infected with the novel H1N1 influenza A virus. You have...

CLINICAL PRACTICE: Bacterial Diarrhea

Herbert L. DuPont, M.D. — Thu, 15Â OctÂ 2009 00:00:00 -05:00

A 47-year-old man reports a 1-week history of diarrhea, with grossly bloody stools for the past 5 days. He reports no history of travel, contacts with sick persons, or underlying...

CORRESPONDENCE: Indigenous Australians and Living Kidney Donation

Natasha M. Rogers, M.D., Paul D. Lawton, M.D., and Matthew D. Jose, M.D., Ph.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

To the Editor: Indigenous Australians comprise 2.5% of the total population of Australia, but like other minority groups worldwide, rates of chronic kidney disease are higher among this indigenous group...

EDITORIAL: â The Importance of an Endosymbiont

Achim Hoerauf, M.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

The prevalence of filarial infections in the tropics is second only to that of geohelminth (soil-transmitted helminth) infections. Filarial infections in humans include the various forms of lymphatic filariasis (Wuchereria...

ORIGINAL ARTICLE: A Randomized Trial of Doxycycline for Infection

Thu, 08Â OctÂ 2009 00:00:00 -05:00

Background: Mansonella perstans infection is common in areas of Africa where Wuchereria bancrofti, a causative agent of lymphatic filariasis, is endemic. M. perstans is refractory to standard antifilarial therapies. The...

PERSPECTIVE: Poverty, Wealth, and Access to Pandemic Influenza Vaccines

Thu, 17Â SepÂ 2009 00:00:00 -05:00

On June 11, 2009, Margaret Chan, director general of the World Health Organization (WHO), declared that the status of the influenza A (H1N1) pandemic had reached phase 6 â active...

CORRESPONDENCE: Medical End-of-Life Practices under the Euthanasia Law in Belgium

Thu, 10Â SepÂ 2009 00:00:00 -05:00

To the Editor: The legalization of physician-assisted death for terminally ill patients is a controversial medical and societal issue.1 In Belgium, where euthanasia was legalized in 2002, we conducted a...

BOOK REVIEW:

Thu, 20Â AugÂ 2009 00:00:00 -05:00

The study of the relation between infectious diseases and national security is hardly a new endeavor. In this book, Andrew Price-Smith reminds us that Thucydides, in his 5th-century publication The...

CORRESPONDENCE: 5-Year Survival of Patients with AIDS Receiving Antiretroviral Therapy in Haiti

Thu, 20Â AugÂ 2009 00:00:00 -05:00

To the Editor: We report 5-year outcomes of 910 adults with human immunodeficiency virus (HIV) infection who consecutively initiated antiretroviral therapy according to guidelines of the World Health Organization (WHO)...

PERSPECTIVE: Urbanization â An Emerging Humanitarian Disaster

Thu, 20Â AugÂ 2009 00:00:00 -05:00

In 2008, the proportion of the world's population living in urban areas crossed the 50% mark. The current rates of urbanization suggest that in China, 870 million people â more...

CORRESPONDENCE: Rapid-Test Sensitivity for Novel Swine-Origin Influenza A (H1N1) Virus in Humans

Thu, 13Â AugÂ 2009 00:00:00 -05:00

To the Editor: The Naval Health Research Center serves as the Navy hub for the Department of Defense's Global Emerging Infections Surveillance and Response System (GEIS), in which it monitors...

ORIGINAL ARTICLE: Pneumonia and Respiratory Failure from Swine-Origin Influenza A (H1N1) in Mexico

Thu, 13Â AugÂ 2009 00:00:00 -05:00

Background: In late March 2009, an outbreak of a respiratory illness later proved to be caused by novel swine-origin influenza A (H1N1) virus (S-OIV) was identified in Mexico. We describe...

ORIGINAL ARTICLE: Severe Respiratory Disease Concurrent with the Circulation of H1N1 Influenza

Thu, 13Â AugÂ 2009 00:00:00 -05:00

Background: In the spring of 2009, an outbreak of severe pneumonia was reported in conjunction with the concurrent isolation of a novel swine-origin influenza A (H1N1) virus (S-OIV), widely known...

CORRESPONDENCE: Artemisinin-Resistant Malaria in Asia

Harald Noedl, M.D., Ph.D., Duong Socheat, M.D., and Wichai Satimai, M.D. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

To the Editor: Artemisinin-based combination therapies have recently been introduced in virtually all countries in which malaria is endemic, thereby making such drugs the most essential class of antimalarial agents....

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Platelets, Pyrexia, and Plasmodia

Doron C. Greenbaum, Ph.D., and Garret A. FitzGerald, M.D. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

Platelets have long been known to interact cooperatively with erythrocytes in thrombogenesis, both generally and in patients with sickle cell disease.1 Recently, the molecular mechanisms by which neutrophils can bridge...

EDITORIAL: Malaria Control â Addressing Challenges to Ambitious Goals

Carlos C. Campbell, M.D., M.P.H. — Thu, 30Â JulÂ 2009 00:00:00 -05:00

Over the past 5 years, we have witnessed remarkable progress in malaria control. In Africa, the approach has been to âscale up for impactâ1 by rapidly deploying insecticide-treated nets and...

ORIGINAL ARTICLE: Protection against a Malaria Challenge by Sporozoite Inoculation

Thu, 30Â JulÂ 2009 00:00:00 -05:00

Background: An effective vaccine for malaria is urgently needed. Naturally acquired immunity to malaria develops slowly, and induction of protection in humans can be achieved artificially by the inoculation of...

ORIGINAL ARTICLE: Artemisinin Resistance in Malaria

Thu, 30Â JulÂ 2009 00:00:00 -05:00

Background: Artemisinin-based combination therapies are the recommended first-line treatments of falciparum malaria in all countries with endemic disease. There are recent concerns that the efficacy of such therapies has declined...

EDITORIAL: Typhoid Vaccines Ready for Implementation

Myron M. Levine, M.D., D.T.P.H. — Thu, 23Â JulÂ 2009 00:00:00 -05:00

Enteric fevers encompass typhoid fever caused by Salmonella enterica serotype Typhi (S. Typhi) and paratyphoid fever caused by serotype Paratyphi A or B (S. Paratyphi). These human-restricted pathogens are acquired...

ORIGINAL ARTICLE: A Cluster-Randomized Effectiveness Trial of Vi Typhoid Vaccine in India

Thu, 23Â JulÂ 2009 00:00:00 -05:00

Background: Typhoid fever remains an important cause of illness and death in the developing world. Uncertainties about the protective effect of Vi polysaccharide vaccine in children under the age of...

REVIEW ARTICLE: Historical Perspective â Emergence of Influenza A (H1N1) Viruses

Shanta M. Zimmer, M.D., and Donald S. Burke, M.D. — Thu, 16Â JulÂ 2009 00:00:00 -05:00

On April 17, 2009, officials at the Centers for Disease Control and Prevention (CDC) confirmed two cases of swine influenza in children living in neighboring counties in California.1 Here we...

PERSPECTIVE: The Persistent Legacy of the 1918 Influenza Virus

Thu, 16Â JulÂ 2009 00:00:00 -05:00

It is not generally appreciated that descendents of the H1N1 influenza A virus that caused the catastrophic and historic pandemic of 1918â1919 have persisted in humans for more than 90...

CORRESPONDENCE: Spread of a Novel Influenza A (H1N1) Virus via Global Airline Transportation

Thu, 09Â JulÂ 2009 00:00:00 -05:00

To the Editor: Throughout March and April 2009, international air travelers departing from Mexico were unknowingly transporting a novel influenza A (H1N1) virus1 to cities around the world. We analyzed...

PERSPECTIVE: Geographic Dependence, Surveillance, and Origins of the 2009 Influenza A (H1N1) Virus

Thu, 09Â JulÂ 2009 00:00:00 -05:00

In April 2009, a new strain of human H1N1 influenza A virus was identified in Mexico. According to the World Health Organization (www.who.int/csr/don/2009_05_25), as of May 25, 2009, the virus...

PERSPECTIVE: Managing and Reducing Uncertainty in an Emerging Influenza Pandemic

Thu, 09Â JulÂ 2009 00:00:00 -05:00

The early phases of an epidemic present decision makers with predictable challenges1 that have been evident as the current novel influenza A (H1N1) virus has spread. The scale of the...

EDITORIAL: Implications of the Emergence of a Novel H1 Influenza Virus

Robert B. Belshe, M.D. — Thu, 18Â JunÂ 2009 00:00:00 -05:00

In this issue of the Journal, there are two reports of recent transmissions of swine influenza viruses in humans. One group of viruses, described by Shinde et al.,1 are triple...

EDITORIAL: H1N1 Influenza A Disease â Information for Health Professionals

Thu, 18Â JunÂ 2009 00:00:00 -05:00

In the first 2 weeks in April, cases of infection with an untypable influenza A virus began to be identified in Mexico and southern California.1 Although the exact sequence of...

PERSPECTIVE: The Signature Features of Influenza Pandemics â Implications for Policy

Thu, 18Â JunÂ 2009 00:00:00 -05:00

Vast amounts of time and resources are being invested in planning for the next influenza pandemic, and one may indeed have already begun. Data from past pandemics can provide useful...

CORRESPONDENCE: Antibodies against H5 and H9 Avian Influenza among Poultry Workers in China

Ming Wang, M.D., Chuan-Xi Fu, Ph.D., and Bo-Jian Zheng, M.D., Ph.D. — Thu, 11Â JunÂ 2009 00:00:00 -05:00

To the Editor: Human infection with the H5N1 or H9N2 avian influenza virus has been reported in the city of Guangzhou in southern China.12 To assess the risk of avian...

ORIGINAL ARTICLE: Zika Virus Outbreak on Yap Island, Federated States of Micronesia

Thu, 11Â JunÂ 2009 00:00:00 -05:00

Background: In 2007, physicians on Yap Island reported an outbreak of illness characterized by rash, conjunctivitis, and arthralgia. Although serum from some patients had IgM antibody against dengue virus, the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 18-2009 â A 24-Year-Old Woman with AIDS and Tuberculosis with Progressive Cough, Dyspnea, and Wasting

Douglas Wilson, M.B., Ch.B., RocÃo M. Hurtado, M.D., and Subba Digumarthy, M.D. — Thu, 04Â JunÂ 2009 00:00:00 -05:00

Dr. Anne Griffin (Medicine and Pediatrics): A 24-year-old woman with the acquired immunodeficiency syndrome (AIDS) and pulmonary tuberculosis was admitted to a hospital in South Africa that is affiliated with...

ORIGINAL ARTICLE: Overseas Screening for Tuberculosis in U.S.-Bound Immigrants and Refugees

Thu, 04Â JunÂ 2009 00:00:00 -05:00

Background: In 2007, a total of 57.8% of the 13,293 new cases of tuberculosis in the United States were diagnosed in foreign-born persons, and the tuberculosis rate among foreign-born persons...

ORIGINAL ARTICLE: The Diarylquinoline TMC207 for Multidrug-Resistant Tuberculosis

Thu, 04Â JunÂ 2009 00:00:00 -05:00

Background: The diarylquinoline TMC207 offers a new mechanism of antituberculosis action by inhibiting mycobacterial ATP synthase. TMC207 potently inhibits drug-sensitive and drug-resistant Mycobacterium tuberculosis in vitro and shows bactericidal activity...

PERSPECTIVE: The Global Burden of Tuberculosis â Combating Drug Resistance in Difficult Times

Thu, 04Â JunÂ 2009 00:00:00 -05:00

According to the 13th annual tuberculosis report of the World Health Organization (WHO) â published on World TB Day, March 24, 2009 â there were an estimated 9.27 million new...

PERSPECTIVE: Globalized Clinical Trials and Informed Consent

Thu, 14Â MayÂ 2009 00:00:00 -05:00

The increasing globalization of clinical research trials calls for more effective ethical and legal rules to protect both research subjects and scientific integrity.1 Some observers noted more than a decade...

BOOK REVIEW:

Thu, 30Â AprÂ 2009 00:00:00 -05:00

Euthanasia and Law in Europe is an examination of physician-assisted dying or physician-performed euthanasia and the laws concerning these practices in European jurisdictions where the issue has been most visible....

PERSPECTIVE: Rationing Antiretroviral Therapy in Africa â Treating Too Few, Too Late

Thu, 30Â AprÂ 2009 00:00:00 -05:00

The past 6 years have seen striking advances in access to antiretroviral therapy in Africa. From 2002 onward, the international drive to scale up antiretroviral treatment gained considerable momentum, most...

BOOK REVIEW:

Thu, 23Â AprÂ 2009 00:00:00 -05:00

In this book, Ian Whitmarsh interprets data from an investigation of the genetics of asthma in Barbados. It has been shown that asthma is influenced by many factors, both genetic...

PERSPECTIVE: The Weapons That Kill Civilians â Deaths of Children and Noncombatants in Iraq, 2003â2008

Thu, 16Â AprÂ 2009 00:00:00 -05:00

Armed violence, such as that in the ongoing conflict in Iraq, is a threat to global health.1 It causes serious injuries and deaths of civilians, makes orphans of children, traumatizes...

BOOK REVIEW:

Thu, 09Â AprÂ 2009 00:00:00 -05:00

Sustainable health, which mirrors the concept of sustainable development, is about good health for the current generation that does not come at the expense of good health for future generations....

BOOK REVIEW:

Thu, 09Â AprÂ 2009 00:00:00 -05:00

Clinical research in developing countries has generated considerable discussion. Especially controversial are the use of a placebo instead of the best proven treatment as a control, and the availability of...

IMAGES IN CLINICAL MEDICINE: Lupoid Leishmaniasis

Taoufik Zaz, M.D. and Hamida Turki, M.D. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

A 52-year-old woman from southern Tunisia presented with a 2-year history of an asymptomatic, thick, reddish plaque on her right ear. The lesion began as multiple erythematous papules that later...

CORRESPONDENCE: Effectiveness of One Dose of SA 14-14-2 Vaccine against Japanese Encephalitis

Rashmi Kumar, M.D., Piyush Tripathi, M.Sc., and Anwar Rizvi, B.M.S. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

To the Editor: Japanese encephalitis remains a major cause of viral encephalitis in Asia, imposing a significant burden on poor rural families. Vaccination is an important element of disease control....

EDITORIAL: From India to the World â A Better Way to Prevent Cervical Cancer

Mark Schiffman, M.D., M.P.H., and Sholom Wacholder, Ph.D. — Thu, 02Â AprÂ 2009 00:00:00 -05:00

In this issue of the Journal, Sankaranarayanan et al.1 report the results of a randomized clinical trial of screening for cervical cancer involving more than 130,000 women in India. The...

ORIGINAL ARTICLE: HPV Screening for Cervical Cancer in Rural India

Thu, 02Â AprÂ 2009 00:00:00 -05:00

Background: In October 1999, we began to measure the effect of a single round of screening by testing for human papillomavirus (HPV), cytologic testing, or visual inspection of the cervix...

CORRESPONDENCE: Cytokine Induction after Laboratory-Acquired West Nile Virus Infection

Thu, 19Â MarÂ 2009 00:00:00 -05:00

To the Editor: We report a case of laboratory-acquired West Nile virus infection after a needlestick injury in a 29-year-old, immunocompetent female scientist in South Africa, who was not infected...

CORRESPONDENCE: Melamine and Nephrolithiasis in Children in Taiwan

Thu, 12Â MarÂ 2009 00:00:00 -05:00

To the Editor: The adverse renal effects of melamine-tainted formula have raised international concern. To address public concerns about melamine, the department of health in Taiwan initiated services to screen...

CORRESPONDENCE: Ultrasonographic Evaluation of Melamine-Exposed Children in Hong Kong

Thu, 12Â MarÂ 2009 00:00:00 -05:00

To the Editor: The recent melamine contamination of infant formula and milk products in China placed thousands of children in China and neighboring regions at risk for renal-stone formation and...

EDITORIAL: Melamine, Powdered Milk, and Nephrolithiasis in Chinese Infants

Craig B. Langman, M.D. — Thu, 12Â MarÂ 2009 00:00:00 -05:00

Melamine, a synthetic nitrogenous product found in many industrial goods and even in fertilizer destined for use in growing crops for human consumption, was recently found to have been added...

ORIGINAL ARTICLE: Melamine-Contaminated Powdered Formula and Urolithiasis in Young Children

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Background: A recent epidemic of melamine contamination of baby formula in China has been associated with the development of urinary tract stones, though the clinical manifestations and predisposing factors are...

PERSPECTIVE: Rotavirus Vaccines â Early Success, Remaining Questions

Thu, 12Â MarÂ 2009 00:00:00 -05:00

In 2006, the results of pivotal clinical trials of two new rotavirus vaccines â RotaTeq (Merck) and Rotarix (GlaxoSmithKline) â were published, and high efficacy (85 to 98%) against severe...

PERSPECTIVE: A Lion in Our Village â The Unconscionable Tragedy of Cholera in Africa

Thu, 12Â MarÂ 2009 00:00:00 -05:00

Inexcusably, the completely preventable ancient scourge of cholera rages among poverty-stricken and displaced people today, with as many as one in five persons with severe illness dying for lack of...

PERSPECTIVE: Global Transmission of Oseltamivir-Resistant Influenza

Thu, 05Â MarÂ 2009 00:00:00 -05:00

Seemingly from one influenza season to the next, we have lost the use of our leading antiviral influenza drug because of resistance. This winter, the circulating strain of seasonal influenza...

SOUNDING BOARD: Ethical and Scientific Implications of the Globalization of Clinical Research

Thu, 19Â FebÂ 2009 00:00:00 -05:00

Economic globalization is an important development of the past half century. Proponents of globalization highlight the benefits of greater economic growth and prosperity; critics point to the exacerbation of economic...

BOOK REVIEW:

Thu, 12Â FebÂ 2009 00:00:00 -05:00

The Borden Institute, an agency of the U.S. Army Medical Department Center and School that publishes military textbooks for the Army Medical Department, commonly solicits case reports from the field...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 4-2009 â A 39-Year-Old Pregnant Woman with Fever after a Trip to Africa

Patrick Duff, M.D., William H. Barth, Jr., M.D., and Miriam D. Post, M.D. — Thu, 29Â JanÂ 2009 00:00:00 -05:00

A 39-year-old woman in the first trimester of her first pregnancy was seen in the obstetrics and gynecology clinic of this hospital at 14 weeks of gestation because of a...

SPECIAL ARTICLE: A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population

Thu, 29Â JanÂ 2009 00:00:00 -05:00

Background: Surgery has become an integral part of global health care, with an estimated 234 million operations performed yearly. Surgical complications are common and often preventable. We hypothesized that a...

SPECIAL ARTICLE: Mortality Attributable to Smoking in China

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Background: Smoking is a risk factor for many diseases and has been increasingly prevalent in economically developing regions of the world. We aimed to estimate the number of deaths attributable...

ORIGINAL ARTICLE: A Strategy to Control Transmission of in China

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Background: Schistosoma japonicum causes an infection involving humans, livestock, and snails and is a significant cause of morbidity in China.

Methods: We evaluated a comprehensive control strategy in two intervention villages...

PERSPECTIVE: Toward the Elimination of Schistosomiasis

Thu, 08Â JanÂ 2009 00:00:00 -05:00

Schistosomiasis remains one of the world's most prevalent diseases. Despite more than a century of control efforts and the introduction of highly effective antischistosomal drug therapy in the 1980s, the...

PERSPECTIVE: Melamine and the Global Implications of Food Contamination

Thu, 25Â DecÂ 2008 00:00:00 -05:00

Food contamination, whether accidental or intentional, has been a sad, recurrent theme throughout recorded history, going back some 8000 years and described in the Old Testament. However, a new dimension...

IMAGES IN CLINICAL MEDICINE: Periungual Tungiasis

Michael Muehlstaedt, M.D. — Thu, 11Â DecÂ 2008 00:00:00 -05:00

A healthy 35-year-old man presented with small eggs and a brownish lesion on the medial edge of his right big toe (Panel A). Two weeks before presentation, he had returned...

CORRESPONDENCE: Evidence of Artemisinin-Resistant Malaria in Western Cambodia

Thu, 11Â DecÂ 2008 00:00:00 -05:00

To the Editor: Although artemisinins are potent and rapidly acting antimalarial drugs, their widespread use for treating patients with Plasmodium falciparum malaria raises the question of emerging drug resistance.12 Artemisinin...

EDITORIAL: Real-World Therapies and the Problem of Vivax Malaria

J. Kevin Baird, Ph.D. — Thu, 11Â DecÂ 2008 00:00:00 -05:00

Wellems and Miller1 wrote of two worlds of malaria: one, of the residents of rural tropical areas in which the disease is endemic, and the other, of travelers to those...

EDITORIAL: A Hopeful Beginning for Malaria Vaccines

William E. Collins, Ph.D., and John W. Barnwell, M.P.H., Ph.D. — Thu, 11Â DecÂ 2008 00:00:00 -05:00

An effective human malaria vaccine has been sought for over 70 years, with little success.1 A successful malaria vaccine used in conjunction with other control interventions would help reduce and...

ORIGINAL ARTICLE: A Trial of Combination Antimalarial Therapies in Children from Papua New Guinea

Thu, 11Â DecÂ 2008 00:00:00 -05:00

Background: Malaria control is difficult where there is intense year-round transmission of multiple plasmodium species, such as in Papua New Guinea.

Methods: Between April 2005 and July 2007, we conducted an...

ORIGINAL ARTICLE: Safety and Immunogenicity of RTS,S/AS02D Malaria Vaccine in Infants

Thu, 11Â DecÂ 2008 00:00:00 -05:00

Background: The RTS,S/AS malaria vaccine is being developed for delivery through the World Health Organization's Expanded Program on Immunization (EPI). We assessed the feasibility of integrating RTS,S/AS02D into a standard...

ORIGINAL ARTICLE: Efficacy of RTS,S/AS01E Vaccine against Malaria in Children 5 to 17 Months of Age

Thu, 11Â DecÂ 2008 00:00:00 -05:00

Background: Plasmodium falciparum malaria is a pressing global health problem. A previous study of the malaria vaccine RTS,S (which targets the circumsporozoite protein), given with an adjuvant system (AS02A), showed...

PERSPECTIVE: Circumcision â A Surgical Strategy for HIV Prevention in Africa

Thu, 04Â DecÂ 2008 00:00:00 -05:00

In a radical departure from earlier strategies, public health officials are now arguing that circumcision of men should be a key weapon in the fight against infection with the human...

PERSPECTIVE: Slowing the Growth of Health Care Costs â Learning from International Experience

Thu, 23Â OctÂ 2008 00:00:00 -05:00

High health care expenditures and the growing number of people without health insurance set the United States apart from all other industrialized countries. The United States spends twice per capita...

EDITORIAL: Monovalent Oral Poliovirus Vaccines â A Good Tool but Not a Total Solution

Ellie Ehrenfeld, Ph.D., and Konstantin Chumakov, Ph.D. — Thu, 16Â OctÂ 2008 00:00:00 -05:00

The polio eradication campaign initiated in 1988 by the World Health Organization (WHO) led to an impressive decline in cases of paralytic poliomyelitis around the world. The eradication strategy involved...

ORIGINAL ARTICLE: Effectiveness of Immunization against Paralytic Poliomyelitis in Nigeria

Thu, 16Â OctÂ 2008 00:00:00 -05:00

Background: The number of cases of paralytic poliomyelitis has declined in Nigeria since the introduction of newly licensed monovalent oral poliovirus vaccines and new techniques of vaccine delivery. Understanding the...

ORIGINAL ARTICLE: Monovalent Type 1 Oral Poliovirus Vaccine in Newborns

Thu, 16Â OctÂ 2008 00:00:00 -05:00

Background: In 1988, the World Health Assembly resolved to eradicate poliomyelitis. Although substantial progress toward this goal has been made, eradication remains elusive. In 2004, the World Health Organization called...

CORRESPONDENCE: Antigenically Distinct MF59-Adjuvanted Vaccine to Boost Immunity to H5N1

Thu, 09Â OctÂ 2008 00:00:00 -05:00

To the Editor: Antigenically distinct avian influenza A (H5N1) viruses are widely dispersed.1 Clade 1 H5N1 viruses previously predominated in Indochina. Indonesian, Eurasian, and African viruses are clustered in a...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Insights into Inflammation and Influenza

Cameron Simmons, Ph.D., and Jeremy Farrar, M.D., D.Phil. — Thu, 09Â OctÂ 2008 00:00:00 -05:00

The emergence of highly pathogenic avian influenza H5N1 viruses in Asia and their spread globally have delivered a timely reminder of the public health and clinical challenges an influenza pandemic...

BOOK REVIEW:

Thu, 02Â OctÂ 2008 00:00:00 -05:00

The world's poorest people face formidable health challenges. According to the Population Reference Bureau, the average life expectancy in sub-Saharan Africa is 49 years, which lags far behind the North...

CORRESPONDENCE: Dengue Hemorrhagic Fever Transmitted by Blood Transfusion

Thu, 02Â OctÂ 2008 00:00:00 -05:00

To the Editor: Dengue, the most common vectorborne viral infection worldwide,1 is predominantly transmitted by the Aedes aegypti mosquito. We describe a well-documented cluster of blood transfusionâassociated dengue infections in...

IMAGES IN CLINICAL MEDICINE: Hyperinfection

Stephen R. Gorman, D.O., M.S. and Donald E. Craven, M.D. — Thu, 11Â SepÂ 2008 00:00:00 -05:00

A 46-year-old man with Raynaud's disease who emigrated from Cambodia 30 years ago presented with a 2-month history of myalgias, exertional dyspnea, and an elevated level of creatine kinase. An...

PERSPECTIVE: Talking Dirty â The Politics of Clean Water and Sanitation

Thu, 21Â AugÂ 2008 00:00:00 -05:00

In the wake of Cyclone Nargis, which devastated the Myanmar delta in early May, and the seismic earthquake that shook China shortly thereafter, access to safe drinking water and proper...

CORRESPONDENCE: Treatment Outcomes in Extensively Resistant Tuberculosis

Edward D. Chan, M.D., Matthew J. Strand, Ph.D., and Michael D. Iseman, M.D. — Thu, 07Â AugÂ 2008 00:00:00 -05:00

To the Editor: Extensively drug-resistant tuberculosis, which is defined as tuberculosis that is resistant to rifampin, isoniazid, a fluoroquinolone, and a second-line injectable agent, poses a major challenge for global...

EDITORIAL: Facing Extensively Drug-Resistant Tuberculosis â A Hope and a Challenge

Mario C. Raviglione, M.D. — Thu, 07Â AugÂ 2008 00:00:00 -05:00

As of June 2008, a total of 49 countries worldwide reported to the World Health Organization (WHO) at least one case of extensively drug-resistant tuberculosis. Since its first description in...

CLINICAL PROBLEM-SOLVING: Beware of First Impressions

Thu, 07Â AugÂ 2008 00:00:00 -05:00

A 64-year-old Filipino man presented to a Baltimore hospital with a 4-month history of worsening midback pain, progressive leg weakness, and intermittent bladder and bowel incontinence. He had no fever...

CLINICAL PRACTICE: Malaria Prevention in Short-Term Travelers

David O. Freedman, M.D. — Thu, 07Â AugÂ 2008 00:00:00 -05:00

A family of three persons is planning a safari to southern Africa. The itinerary includes 3 days in Cape Town, South Africa, 3 days in Kruger National Park, South Africa,...

ORIGINAL ARTICLE: Comprehensive Treatment of Extensively Drug-Resistant Tuberculosis

Thu, 07Â AugÂ 2008 00:00:00 -05:00

Background: Extensively drug-resistant tuberculosis has been reported in 45 countries, including countries with limited resources and a high burden of tuberculosis. We describe the management of extensively drug-resistant tuberculosis and...

PERSPECTIVE: The President's Emergency Plan for AIDS Relief â Is the Emergency Over?

Thu, 07Â AugÂ 2008 00:00:00 -05:00

In his 2003 State of the Union Address, President George W. Bush asked Congress to commit $15 billion over the next 5 years for the President's Emergency Plan for AIDS...

BOOK REVIEW:

Thu, 31Â JulÂ 2008 00:00:00 -05:00

Whether acupuncture from China, Ayurvedic therapies from India, or homeopathy in Europe, in her scholarly book, Roberta Bivins presents the belief systems that gave rise to such ancient practices and...

ORIGINAL ARTICLE: Lack of Effectiveness of Cellulose Sulfate Gel for the Prevention of Vaginal HIV Transmission

Thu, 31Â JulÂ 2008 00:00:00 -05:00

Background: Women make up more than 50% of adults living with human immunodeficiency virus (HIV) infection or the acquired immunodeficiency syndrome (AIDS) in sub-Saharan Africa. Thus, female-initiated HIV prevention methods...

EDITORIAL: Breast-Feeding, Antiretroviral Prophylaxis, and HIV

Glenda E. Gray, M.B., B.Ch., and Haroon Saloojee, M.B., B.Ch. — Thu, 10Â JulÂ 2008 00:00:00 -05:00

More than 200,000 of the 500,000 new human immunodeficiency virus (HIV) infections that occur each year in children are the result of transmission of the virus through the mother's breast...

ORIGINAL ARTICLE: Effects of Early, Abrupt Weaning on HIV-free Survival of Children in Zambia

Thu, 10Â JulÂ 2008 00:00:00 -05:00

Background: In low-resource settings, many programs recommend that women who are infected with the human immunodeficiency virus (HIV) stop breast-feeding early. We conducted a randomized trial to evaluate whether abrupt...

ORIGINAL ARTICLE: Extended Antiretroviral Prophylaxis to Reduce Breast-Milk HIV-1 Transmission

Thu, 10Â JulÂ 2008 00:00:00 -05:00

Background: Effective strategies are urgently needed to reduce mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) through breast-feeding in resource-limited settings.

Methods: Women with HIV-1 infection who were breast-feeding infants...

CLINICAL PROBLEM-SOLVING: A Gut Feeling

Thu, 03Â JulÂ 2008 00:00:00 -05:00

A 72-year-old man presented with a 3-month history of watery diarrhea. This condition was associated with intermittent fevers, abdominal pain, and weight loss of 15 lb (6.8 kg). The patient...

ORIGINAL ARTICLE: A Population Study of Endomyocardial Fibrosis in a Rural Area of Mozambique

Thu, 03Â JulÂ 2008 00:00:00 -05:00

Background: Endomyocardial fibrosis is the most common restrictive cardiomyopathy worldwide. It has no specific treatment and carries a poor prognosis, since most patients present with advanced heart failure. On the...

EDITORIAL: Beyond Health Care â Socioeconomic Status and Health

Lisa Berkman, Ph.D., and Arnold M. Epstein, M.D. — Thu, 05Â JunÂ 2008 00:00:00 -05:00

The article by Mackenbach et al. in this issue of the Journal1 documents the extraordinary pervasiveness of socioeconomic inequalities in health as well as the varying magnitude of risks among...

SPECIAL ARTICLE: Socioeconomic Inequalities in Health in 22 European Countries

Thu, 05Â JunÂ 2008 00:00:00 -05:00

Background: Comparisons among countries can help to identify opportunities for the reduction of inequalities in health. We compared the magnitude of inequalities in mortality and self-assessed health among 22 countries...

PERSPECTIVE: A New Attack on Malaria

Thu, 05Â JunÂ 2008 00:00:00 -05:00

This past October, at a scientific conference in Seattle, Bill and Melinda Gates issued a challenge that rocked the international health community. The leaders of the world's richest charitable foundation...

PERSPECTIVE: Driven to a Fiery Death â The Tragedy of Self-Immolation in Afghanistan

Thu, 22Â MayÂ 2008 00:00:00 -05:00

Afghanistan, a country with 32 million residents, has been engaged in constant conflict for the past 30 years. This instability and insecurity have resulted in a stark economic climate and...

EDITORIAL: A Malaria Fingerprint in the Human Genome?

Johanna P. Daily, M.D., and Pardis Sabeti, M.D., Ph.D. — Thu, 24Â AprÂ 2008 00:00:00 -05:00

Malaria, a tremendously successful pathogen that is responsible for more than 300 million cases and 1 million deaths annually,1 has had a large impact on the shape of the human...

IMAGES IN CLINICAL MEDICINE: Hemoglobinuria with Malaria

Martin Tombe, M.D. — Thu, 24Â AprÂ 2008 00:00:00 -05:00

An otherwise healthy 30-year-old man had been ill for 2 days when he presented with a temperature of 39Â°C and reported passing dark urine (his case was noted in Bhatt...

CLINICAL THERAPEUTICS: Artesunate for the Treatment of Severe Falciparum Malaria

Philip J. Rosenthal, M.D. — Thu, 24Â AprÂ 2008 00:00:00 -05:00

A previously well, American-born 35-year-old man presents with a 5-day history of fever and progressive dyspnea and a 2-day history of jaundice. An evaluation 3 days before his presentation led...

ORIGINAL ARTICLE: Pyruvate Kinase Deficiency and Malaria

Thu, 24Â AprÂ 2008 00:00:00 -05:00

Malaria that is caused by Plasmodium falciparum is a significant global health problem. Genetic characteristics of the host influence the severity of disease and the ultimate outcome of infection, and...

PERSPECTIVE: Eliminating Blinding Trachoma

Thu, 24Â AprÂ 2008 00:00:00 -05:00

Trachoma, a chronic bacterial keratoconjunctivitis, has always been inextricably linked with poverty. It would not even be mentioned in the curricula of many U.S. medical schools today if not for...

IMAGES IN CLINICAL MEDICINE:

Do Hyun Park, M.D., Ph.D. and Hyun-Young Son, M.D. — Thu, 17Â AprÂ 2008 00:00:00 -05:00

A 62-year-old man reported having had fatigue, fever, and cramping abdominal pain for 7 days. He also reported that he had recently eaten raw pond smelt (Hypomesus olidus). The results...

HEALTH LAW, ETHICS, AND HUMAN RIGHTS: Perspectives on Medical Outsourcing and Telemedicine â Rough Edges in a Flat World?

Sanjiv N. Singh, J.D., and Robert M. Wachter, M.D. — Thu, 10Â AprÂ 2008 00:00:00 -05:00

Low-cost labor, time zone differences, and telecommunication advances have âflattenedâ the world of business and services1; however, health care has been relatively insulated from these world-flattening forces until recently. In...

ORIGINAL ARTICLE: Effect of Herpes Simplex Suppression on Incidence of HIV among Women in Tanzania

Thu, 10Â AprÂ 2008 00:00:00 -05:00

Background: Infection with herpes simplex virus type 2 (HSV-2) is associated with an increased risk of acquiring infection with the human immunodeficiency virus (HIV). This study tested the hypothesis that...

IMAGES IN CLINICAL MEDICINE: Ascariasis

Myoung Kuk Jang, M.D. and Ki Sung Lee, M.D. — Thu, 03Â AprÂ 2008 00:00:00 -05:00

A 60-year-old woman presented to the outpatient clinic with vague abdominal discomfort that had developed over the previous several weeks. There was no abdominal tenderness. Laboratory evaluation was notable for...

PERSPECTIVE: In Search of New Ideas for Global Health

Thu, 27Â MarÂ 2008 00:00:00 -05:00

The recent failure of another potential vaccine against human immunodeficiency virus (HIV) underscores the enormous challenges of tackling diseases whose heaviest burden falls on the developing world. A quarter of...

PERSPECTIVE: Taking Your Child's Breath Away â The Extension of Asthma's Global Reach

Thu, 20Â MarÂ 2008 00:00:00 -05:00

On a clear summer day, as Michael runs through the fields playing with his friends, the view from his farm is spectacular. You can look past the hills where his...

SPECIAL ARTICLE: A Nationally Representative CaseâControl Study of Smoking and Death in India

Thu, 13Â MarÂ 2008 00:00:00 -05:00

Background: The nationwide effects of smoking on mortality in India have not been assessed reliably.

Methods: In a nationally representative sample of 1.1 million homes, we compared the prevalence of smoking...

PERSPECTIVE: Worlds Apart â Tuberculosis in India and the United States

Thu, 13Â MarÂ 2008 00:00:00 -05:00

The British Romantic poet John Keats, trained as a physician and licensed by the Society of Apothecaries, gave himself this accurate prognosis in 1820 after an episode of hemoptysis. He...

PERSPECTIVE: Tuberculosis in Africa â Combating an HIV-Driven Crisis

Thu, 13Â MarÂ 2008 00:00:00 -05:00

Africa is facing the worst tuberculosis epidemic since the advent of the antibiotic era. Driven by a generalized human immunodeficiency virus (HIV) epidemic and compounded by weak health care systems,...

ORIGINAL ARTICLE: Severe Anemia in Malawian Children

Thu, 28Â FebÂ 2008 00:00:00 -05:00

Background: Severe anemia is a major cause of sickness and death in African children, yet the causes of anemia in this population have been inadequately studied.

Methods: We conducted a caseâcontrol...

SPECIAL ARTICLE: Violence-Related Mortality in Iraq from 2002 to 2006

Iraq Family Health Survey Study Group — Thu, 31Â JanÂ 2008 00:00:00 -05:00

Background: Estimates of the death toll in Iraq from the time of the U.S.-led invasion in March 2003 until June 2006 have ranged from 47,668 (from the Iraq Body Count)...

PERSPECTIVE: Estimating Excess Mortality in Post-Invasion Iraq

Thu, 31Â JanÂ 2008 00:00:00 -05:00

There is no set formula for accurately tallying deaths from humanitarian crises. When a population becomes destabilized, estimation of mortality is likely to be severely challenged. In the case of...

REVIEW ARTICLE: Update on Avian Influenza A (H5N1) Virus Infection in Humans

Thu, 17Â JanÂ 2008 00:00:00 -05:00

The unprecedented epizootic of avian influenza A (H5N1) viruses among birds continues to cause human disease with high mortality and to pose the threat of a pandemic. This review updates...

PERSPECTIVE: âWesternizingâ Women's Risks? Breast Cancer in Lower-Income Countries

Thu, 17Â JanÂ 2008 00:00:00 -05:00

Recent media reports have highlighted the increasing incidence of breast cancer in low- and middle-income countries. Although the disease continues to be most prominent in affluent countries, the risks of...

PERSPECTIVE: HIV in India â A Downsized Epidemic

Thu, 10Â JanÂ 2008 00:00:00 -05:00

In 2006, the Joint United Nations Program on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimated that 5.7 million people in India were infected with the human immunodeficiency virus...

SOUNDING BOARD: Rapid Expansion of the Health Workforce in Response to the HIV Epidemic

Thu, 13Â DecÂ 2007 00:00:00 -05:00

The World Health Organization (WHO) estimates that there is now a global deficit of more than 4 million trained health workers. The shortages in health workers are critical in 57...

EDITORIAL: Corticosteroids for Acute Bacterial Meningitis

Brian M. Greenwood, M.D. — Thu, 13Â DecÂ 2007 00:00:00 -05:00

Death and long-term disabilities are common outcomes of acute bacterial meningitis, especially in developing countries, even when highly effective antibiotic therapy is given. Therefore, improvement in the outcomes of acute...

ORIGINAL ARTICLE: Corticosteroids for Bacterial Meningitis in Adults in Sub-Saharan Africa

Thu, 13Â DecÂ 2007 00:00:00 -05:00

Background: In sub-Saharan Africa, bacterial meningitis is common and is associated with a high mortality. Adjuvant therapy with corticosteroids reduces mortality among adults in the developed world, but it has...

ORIGINAL ARTICLE: Dexamethasone in Vietnamese Adolescents and Adults with Bacterial Meningitis

Thu, 13Â DecÂ 2007 00:00:00 -05:00

Background: It is uncertain whether all adults with bacterial meningitis benefit from treatment with adjunctive dexamethasone.

Methods: We conducted a randomized, double-blind, placebo-controlled trial of dexamethasone in 435 patients over the...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 35-2007 â A 30-Year-Old Man with Inflammatory Bowel Disease and Recent Onset of Fever and Bloody Diarrhea

Thu, 15Â NovÂ 2007 00:00:00 -05:00

Dr. Patrick S. Yachimski (Gastroenterology): A 30-year-old Moroccan man was admitted to this hospital because of fever, abdominal pain, and bloody diarrhea.

The patient had a history of inflammatory bowel disease...

PERSPECTIVE: Closing the Affordability Gap for Drugs in Low-Income Countries

Thu, 15Â NovÂ 2007 00:00:00 -05:00

The cost of treating human immunodeficiency virus (HIV) infection is decreasing. Nonetheless, tenofovirâemtricitabineâefavirenz, the standard first-line treatment in North America and Europe, is prescribed rarely in low- and middle-income countries....

ORIGINAL ARTICLE: Hepatitis A Vaccine versus Immune Globulin for Postexposure Prophylaxis

Thu, 25Â OctÂ 2007 00:00:00 -05:00

Background: Hepatitis A vaccine administered to persons after exposure to the hepatitis A virus has not been compared directly with immune globulin, which is known to be highly effective in...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 29-2007 â A 51-Year-Old Man with Gastric Cancer and Lung Nodules

Edward T. Ryan, M.D., Suzanne L. Aquino, M.D., and Richard L. Kradin, M.D. — Thu, 20Â SepÂ 2007 00:00:00 -05:00

Dr. Allison L. McDonough (Internal Medicine): A 51-year-old man with a history of gastric cancer was admitted to the hospital because of a new pulmonary lesion.

The patient had been in...

PERSPECTIVE: Putting Typhoid Vaccination on the Global Health Agenda

Thu, 13Â SepÂ 2007 00:00:00 -05:00

Although typhoid fever, caused by infection with Salmonella enterica serovar Typhi (often called S. typhi), long ago ceased to be a public health problem in industrialized countries, it is still...

REVIEW ARTICLE: Control of Neglected Tropical Diseases

Thu, 06Â SepÂ 2007 00:00:00 -05:00

The neglected tropical diseases are a group of 13 major disabling conditions that are among the most common chronic infections in the world's poorest people. A blueprint for the control...

PERSPECTIVE: Immigrants and Health Care â At the Intersection of Two Broken Systems

Thu, 09Â AugÂ 2007 00:00:00 -05:00

At a primary care clinic in Montgomery County, Maryland, where I volunteer, the patients are uninsured immigrants from Latin America or West Africa. Many are day laborers, house cleaners, or...

CLINICAL PROBLEM-SOLVING: A Growing Problem â A 36-year-old pregnant woman at 21 weeks of gestation presented with a 4-week history of a dry, nonproductive cough

Wendy W. Yeh, M.D., Sanjay Saint, M.D., M.P.H., and Steven E. Weinberger, M.D. — Thu, 02Â AugÂ 2007 00:00:00 -05:00

A 36-year-old pregnant woman at 21 weeks of gestation presented with a 4-week history of a dry, nonproductive cough. The patient said she had no fever, chills, dyspnea, chest pain,...

ORIGINAL ARTICLE: Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening

Thu, 02Â AugÂ 2007 00:00:00 -05:00

Background: Epidemiologic studies of the prevalence of rheumatic heart disease have used clinical screening with echocardiographic confirmation of suspected cases. We hypothesized that echocardiographic screening of all surveyed children would...

PERSPECTIVE: Rheumatic Heart Disease in Developing Countries

Thu, 02Â AugÂ 2007 00:00:00 -05:00

Only 30 or 40 years ago, rheumatic fever was a common topic in the Journal. A PubMed search for articles on rheumatic fever published between 1967 and 1976 returned 55...

ORIGINAL ARTICLE: Injectable Paromomycin for Visceral Leishmaniasis in India

Thu, 21Â JunÂ 2007 00:00:00 -05:00

Background: Visceral leishmaniasis (kala-azar) affects large, rural, resource-poor populations in South Asia, Africa, and Brazil. Safe, effective, and affordable new therapies are needed. We conducted a randomized, controlled, phase 3...

PERSPECTIVE: Providing the Providers â Remedying Africa's Shortage of Health Care Workers

Thu, 21Â JunÂ 2007 00:00:00 -05:00

Dr. Cyril Nkabinde, an intern at Prince Mshiyeni Memorial Hospital in Durban, South Africa, grew up dreaming of becoming a doctor â an ambition he inherited from his mother, whose...

PERSPECTIVE: The Tail End of Guinea Worm â Global Eradication without a Drug or a Vaccine

Thu, 21Â JunÂ 2007 00:00:00 -05:00

Guinea worm disease, or dracunculiasis â Latin for âaffliction with little dragonsâ â is a plague so ancient that it has been found in Egyptian mummies and has been proposed...

PERSPECTIVE: Introducing HPV Vaccine in Developing Countries â Key Challenges and Issues

Thu, 10Â MayÂ 2007 00:00:00 -05:00

More than any other cancer, cervical cancer reflects striking global health inequity. It is the second most common cancer among women worldwide, with about 493,000 new cases diagnosed annually (see...

PERSPECTIVE: China and HIV â A Window of Opportunity

Thu, 03Â MayÂ 2007 00:00:00 -05:00

Last December in Wuhan, China, two middle-aged rural women who had become infected with HIV in the 1990s struggled to describe to foreign visitors how China's new HIV-treatment program had...

ORIGINAL ARTICLE: Randomized, Placebo-Controlled Trial of Inactivated Poliovirus Vaccine in Cuba

The Cuba IPV Study Collaborative Group — Thu, 12Â AprÂ 2007 00:00:00 -05:00

Background: After poliomyelitis has been eradicated, access to live polioviruses will be highly restricted and the use of oral poliovirus vaccine (OPV) will probably be discontinued. Countries using OPV must...

PERSPECTIVE: Making Smoking History Worldwide

Thu, 12Â AprÂ 2007 00:00:00 -05:00

It seemed impossible at first. But in 2004, Ireland made history as the first country to implement a comprehensive smoking ban in indoor workplaces, including restaurants and bars. Defying dire...

PERSPECTIVE: Tobacco Tightrope â Balancing Disease Prevention and Economic Development in China

Thu, 12Â AprÂ 2007 00:00:00 -05:00

During the past 20 years, as smoking rates have fallen in high-income countries, the tobacco industry has found new and bigger markets in the developing world. One third of current...

ORIGINAL ARTICLE: Vitamins and Perinatal Outcomes among HIV-Negative Women in Tanzania

Thu, 05Â AprÂ 2007 00:00:00 -05:00

Background: Prematurity and low birth weight are associated with high perinatal and infant mortality, especially in developing countries. Maternal micronutrient deficiencies may contribute to these adverse outcomes.

Methods: In a double-blind...

PERSPECTIVE: Making Motherhood Safe in Developing Countries

Thu, 05Â AprÂ 2007 00:00:00 -05:00

This year marks the 20th anniversary of the Safe Motherhood Conference in Nairobi, an event that launched a global initiative to reduce maternal mortality in developing countries. At that time,...

PERSPECTIVE: Tuberculosis and HIV in India

Thu, 22Â MarÂ 2007 00:00:00 -05:00

Tuberculosis is the most common HIV-related opportunistic infection in India, and caring for patients with both diseases is a major public health challenge. India has about 1.8 million new cases...

PERSPECTIVE: HIV in India â The Challenges Ahead

Thu, 22Â MarÂ 2007 00:00:00 -05:00

On April 1, 2007, India will launch a new phase of its National AIDS Control Program (NACP). Its goals include reducing the number of new human immunodeficiency virus (HIV) infections...

PERSPECTIVE: HIV in India â A Complex Epidemic

Thu, 15Â MarÂ 2007 00:00:00 -05:00

Since the human immunodeficiency virus (HIV) was found in Chennai in 1986, India has had an AIDS epidemic.1 In many respects, however, its extent and complexities have only recently begun...

ORIGINAL ARTICLE: Reduction of HIV-1 RNA Levels with Therapy to Suppress Herpes Simplex Virus

Thu, 22Â FebÂ 2007 00:00:00 -05:00

Background: Epidemiologic data suggest that infection with herpes simplex virus type 2 (HSV-2) is associated with increased genital shedding of human immunodeficiency virus type 1 (HIV-1) RNA and HIV-1 transmissibility.

Methods:...

PERSPECTIVE: Chikungunya Outbreaks â The Globalization of Vectorborne Diseases

Thu, 22Â FebÂ 2007 00:00:00 -05:00

In 2006, an outbreak of chikungunya fever â an arthralgic disease caused by a mosquito-borne alphavirus â swept over a number of islands in the Indian Ocean (the Comoros, Mauritius,...

PERSPECTIVE: XDR Tuberculosis â Implications for Global Public Health

Thu, 15Â FebÂ 2007 00:00:00 -05:00

In early 2005, physicians at a rural hospital in KwaZulu-Natal, a province of South Africa, were concerned by a high rate of rapid death among patients infected with the human...

PERSPECTIVE: Improving Global Health â Margaret Chan at the WHO

Thu, 15Â FebÂ 2007 00:00:00 -05:00

When Dr. Margaret Chan of China was elected director-general of the World Health Organization (WHO) this past November, some observers suspected that the Chinese government had backed her candidacy in...

PERSPECTIVE: Thailand and the Compulsory Licensing of Efavirenz

Thu, 08Â FebÂ 2007 00:00:00 -05:00

Of the many medicines for human immunodeficiency virus (HIV) infection, efavirenz, a nonnucleoside reverse-transcriptase inhibitor that became available in the late 1990s, is one of the most important. For the...

PERSPECTIVE: Taking TRIPS to India â Novartis, Patent Law, and Access to Medicines

Thu, 08Â FebÂ 2007 00:00:00 -05:00

In August and September 2006, patients with cancer, lawyers for patient advocacy groups, and representatives of nongovernmental organizations (NGOs) converged on the offices of Novartis in Mumbai, India, to protest...

PERSPECTIVE: Pakistani Physicians and the Repatriation Equation

Thu, 01Â FebÂ 2007 00:00:00 -05:00

In Pakistan, students who are accepted into medical school are congratulated â only half-jokingly â on three counts: that they will become doctors, that they will become certified by the...

PERSPECTIVE: Doctors and Soccer Players â African Professionals on the Move

Thu, 01Â FebÂ 2007 00:00:00 -05:00

On June 22, 2006, the nation of Ghana erupted. SUVs flew through the streets of Accra with flag-waving celebrants jammed through sunroofs. Crowds led by shirtless drummers banging garbage-can tops...

REVIEW ARTICLE: International Aeromedical Evacuation

Peter G. Teichman, M.D., M.P.A., Yoel Donchin, M.D., and Raphael J. Kot, M.D. — Thu, 18Â JanÂ 2007 00:00:00 -05:00

Worldwide, when the needs of injured or ill patients exceed what local clinics and hospitals can provide, urgent evacuation by air to the nearest well-equipped medical facility becomes the key...

PERSPECTIVE: Obesity and Diabetes in the Developing World â A Growing Challenge

Thu, 18Â JanÂ 2007 00:00:00 -05:00

Globally, the prevalence of chronic, noncommunicable diseases is increasing at an alarming rate. About 18 million people die every year from cardiovascular disease, for which diabetes and hypertension are major...

PERSPECTIVE: The Preventive Polypill â Much Promise, Insufficient Evidence

Thu, 18Â JanÂ 2007 00:00:00 -05:00

The rapidly increasing global burdens of cardiovascular disease and diabetes call for interventions that have a population-wide effect, as well as interventions that identify and protect individual patients who have...

PERSPECTIVE: Expanding Priorities â Confronting Chronic Disease in Countries with Low Income

Thu, 18Â JanÂ 2007 00:00:00 -05:00

In a ceremony held at the New York Public Library on June 26, 2006, Microsoft founder and global health philanthropist Bill Gates expressed his belief that âthere is no reason...

PERSPECTIVE: The Eradication of Polio â Progress and Challenges

Thu, 14Â DecÂ 2006 00:00:00 -05:00

Six years after the original 2000 target date for the global eradication of polio, public health workers are encountering several stumbling blocks. Poliovirus circulation persists in countries where the virus...

PERSPECTIVE: HIV Injustice in Libya â Scapegoating Foreign Medical Professionals

Thu, 14Â DecÂ 2006 00:00:00 -05:00

On December 19, 2006, a Libyan court is scheduled to announce its verdict in the trial of five Bulgarian nurses and one Palestinian doctor who have languished in prison for...

PERSPECTIVE: HIVâAIDS in Tanzania â Realities on the Ground

Thu, 30Â NovÂ 2006 00:00:00 -05:00

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REVIEW ARTICLE: The Asthma Epidemic

Waltraud Eder, M.D., Markus J. Ege, M.D., M.P.H., and Erika von Mutius, M.D. — Thu, 23Â NovÂ 2006 00:00:00 -05:00

The prevalence and incidence of asthma are very high in the Western world. There is widespread concern that the prevalence of asthma is still rising in developed countries, but the...

ORIGINAL ARTICLE: Three Indonesian Clusters of H5N1 Virus Infection in 2005

Thu, 23Â NovÂ 2006 00:00:00 -05:00

Background: Since 2003, the widespread ongoing epizootic of avian influenza A (H5N1) among poultry and birds has resulted in human H5N1 cases in 10 countries. The first case of H5N1...

ORIGINAL ARTICLE: Avian Influenza A (H5N1) Infection in Eastern Turkey in 2006

Thu, 23Â NovÂ 2006 00:00:00 -05:00

Background: An outbreak of highly pathogenic avian influenza A (H5N1) that had previously been detected throughout Asia, with major economic and health repercussions, extended to eastern Turkey in late December...

PERSPECTIVE: H5N1 Influenza â Continuing Evolution and Spread

Thu, 23Â NovÂ 2006 00:00:00 -05:00

There is no question that there will be another influenza pandemic someday. We simply don't know when it will occur or whether it will be caused by the H5N1 avian...

ORIGINAL ARTICLE: Return of Chloroquine Antimalarial Efficacy in Malawi

Thu, 09Â NovÂ 2006 00:00:00 -05:00

Background: In 1993, Malawi became the first country in Africa to replace chloroquine with the combination of sulfadoxine and pyrimethamine for the treatment of malaria. At that time, the clinical...

PERSPECTIVE: Malaria â Time to Act

Thu, 09Â NovÂ 2006 00:00:00 -05:00

In the wealthier parts of the world, the death of a child from an infectious disease is a rare tragedy. In poor countries, it is commonplace. In rural sub-Saharan Africa,...

CLINICAL PROBLEM-SOLVING: The Missing Piece

Thu, 02Â NovÂ 2006 00:00:00 -05:00

A 21-year-old man presented to the emergency department after a 2-day history of increasing pain in the right lower quadrant. The pain was dull and nonradiating, was not exacerbated by...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 32-2006 â A 3-Year-Old Girl with Fever after a Visit to Africa

Thu, 19Â OctÂ 2006 00:00:00 -05:00

Dr. Christine M. Cserti: A 3-year-old girl was admitted to this hospital because of fever and parasites in the peripheral blood.

Three weeks earlier, the patient and her 5-year-old brother and...

PERSPECTIVE: America's New Refugees â Seeking Affordable Surgery Offshore

Thu, 19Â OctÂ 2006 00:00:00 -05:00

The mainstream media have begun to highlight the plight of some new refugees: seriously ill Americans who receive treatment at advanced private hospitals in low-income countries. These patients are not...

EDITORIAL: Rapid Detection of Tuberculosis and Drug-Resistant Tuberculosis

Michael D. Iseman, M.D., and Leonid B. Heifets, M.D. — Thu, 12Â OctÂ 2006 00:00:00 -05:00

Tuberculosis remains one of the major unresolved global health problems, and the situation is worsening in many parts of the world, primarily because of the association between tuberculosis and the...

ORIGINAL ARTICLE: Microscopic-Observation Drug-Susceptibility Assay for the Diagnosis of TB

Thu, 12Â OctÂ 2006 00:00:00 -05:00

Background: New diagnostic tools are urgently needed to interrupt the transmission of tuberculosis and multidrug-resistant tuberculosis. Rapid, sensitive detection of tuberculosis and multidrug-resistant tuberculosis in sputum has been demonstrated in...

ORIGINAL ARTICLE: Transmission of Human Herpesvirus 8 by Blood Transfusion

Thu, 28Â SepÂ 2006 00:00:00 -05:00

Background: Whether human herpesvirus 8 (HHV-8) is transmissible by blood transfusion remains undetermined. We evaluated the risk of HHV-8 transmission by blood transfusion in Uganda, where HHV-8 is endemic.

Methods: We...

PERSPECTIVE: The Continuing Risk of Transfusion-Transmitted Infections

Thu, 28Â SepÂ 2006 00:00:00 -05:00

In 2002, as mosquitoes carried West Nile virus across the United States, infecting 4200 people, 23 confirmed cases of transfusion-transmitted infection and 7 related deaths were reported.1 This was a...

SPECIAL ARTICLE: Cost-Effectiveness of HIV Treatment in Resource-Poor Settings â The Case of CÃ´te d'Ivoire

Thu, 14Â SepÂ 2006 00:00:00 -05:00

Background: As antiretroviral therapy is increasingly used in settings with limited resources, key questions about the timing of treatment and use of diagnostic tests to guide clinical decisions must be...

PERSPECTIVE: Global Health â The GatesâBuffett Effect

Thu, 14Â SepÂ 2006 00:00:00 -05:00

Standing before a giant AIDS ribbon, Bill and Melinda Gates greeted some 26,000 researchers and public health workers on the opening night of last month's conference hosted by the International...

PERSPECTIVE: Message from Toronto â Deliver AIDS Treatment and Prevention

Thu, 14Â SepÂ 2006 00:00:00 -05:00

The clear message from the XVI International AIDS Conference in Toronto in August was that the growth of the pandemic continues to outpace the broad and expanding efforts to control...

ORIGINAL ARTICLE: Marburg Hemorrhagic Fever Associated with Multiple Genetic Lineages of Virus

Thu, 31Â AugÂ 2006 00:00:00 -05:00

Background: An outbreak of Marburg hemorrhagic fever was first observed in a gold-mining village in northeastern Democratic Republic of the Congo in October 1998.

Methods: We investigated the outbreak of Marburg...

PERSPECTIVE: Control of Japanese Encephalitis â Within Our Grasp?

Thu, 31Â AugÂ 2006 00:00:00 -05:00

The second half of 2005 saw one of the largest outbreaks of Japanese encephalitis that has occurred in northern India in recent years. Cases were first reported in the state...

PERSPECTIVE: Marburg Hemorrhagic Fever â The Forgotten Cousin Strikes

Thu, 31Â AugÂ 2006 00:00:00 -05:00

More than 30 years after the discovery of Marburg virus as the causative agent of an outbreak of severe viral hemorrhagic fever in Germany and the former Yugoslavia in 1967,...

PERSPECTIVE: Chagas' Disease â Can We Stop the Deaths?

Thu, 24Â AugÂ 2006 00:00:00 -05:00

Nearly 100 years since its discovery by the Brazilian physician Carlos Chagas, the protozoan parasite Trypanosoma cruzi remains perhaps the most common cause of myocarditis worldwide. The lethality of Chagas'...

IMAGES IN CLINICAL MEDICINE: Loiasis

Thomas Weitzel, M.D. and Tomas Jelinek, M.D. — Thu, 17Â AugÂ 2006 00:00:00 -05:00

A 14-year-old female refugee from Cameroon was admitted to our clinic for a medical checkup two weeks after arriving in Germany. Her medical history was notable only for multiple episodes...

PERSPECTIVE: Getting Serious about Cholera

Thu, 17Â AugÂ 2006 00:00:00 -05:00

Deaths from cholera are again making news, this time in Angola. According to the World Health Organization (WHO), Angola had reported 46,758 cases of cholera, including 1893 deaths, as of...

PERSPECTIVE: AIDS in 2006 â Moving toward One World, One Hope?

Thu, 17Â AugÂ 2006 00:00:00 -05:00

For the past two decades, AIDS experts â clinicians, epidemiologists, policymakers, activists, and scientists â have gathered every two years to confer about what is now the world's leading infectious...

PERSPECTIVE: No Refuge for the Ailing

Thu, 03Â AugÂ 2006 00:00:00 -05:00

The still, oppressive heat of the afternoon seems to magnify the queue of waiting patients. A young woman separates herself from the crowd.

âExcuse me, Doctor, how long will you be?â

I...

PERSPECTIVE: Transmission of from Health Care Workers

Thu, 13Â JulÂ 2006 00:00:00 -05:00

The Centers for Disease Control and Prevention (CDC) recently reported the transmission of Mycobacterium tuberculosis from a health care worker to patients in New York City.1 Several aspects of the...

EDITORIAL: Influenza Control

W. Paul Glezen, M.D. — Thu, 06Â JulÂ 2006 00:00:00 -05:00

Influenza is an uncontrolled epidemic disease that occurs every winter. Epidemics, which vary in severity, are measured by excess mortality, but influenza is always the leading cause of acute respiratory...

EDITORIAL: Iodine Nutrition â More Is Better

Robert D. Utiger, M.D. — Thu, 29Â JunÂ 2006 00:00:00 -05:00

In normal adults, the daily production rate of the two biologically active thyroid hormones, tetraiodothyronine (which is better known as thyroxine and has four iodine atoms) and triiodothyronine (which has...

ORIGINAL ARTICLE: Effect of Iodine Intake on Thyroid Diseases in China

Thu, 29Â JunÂ 2006 00:00:00 -05:00

Background: Iodine is an essential component of thyroid hormones; either low or high intake may lead to thyroid disease. We observed an increase in the prevalence of overt hypothyroidism, subclinical...

EDITORIAL: Cholera â Still Teaching Hard Lessons

Richard L. Guerrant, M.D. — Thu, 08Â JunÂ 2006 00:00:00 -05:00

At first glance, the report by Saha et al.1 in this issue of the Journal demonstrates the important finding that a single dose of azithromycin is effective in the treatment...

ORIGINAL ARTICLE: Single-Dose Azithromycin for the Treatment of Cholera in Adults

Thu, 08Â JunÂ 2006 00:00:00 -05:00

Background: Single-dose azithromycin is effective in the treatment of severe cholera in children, but its effectiveness in adults has not been evaluated.

Methods: We conducted a double-blind, randomized trial comparing the...

PERSPECTIVE: The HIVâAIDS Pandemic at 25 â The Global Response

Thu, 08Â JunÂ 2006 00:00:00 -05:00

On June 5, 1981, when the Centers for Disease Control reported five cases of Pneumocystis carinii pneumonia in young homosexual men in Los Angeles,1 few suspected it heralded a pandemic...

PERSPECTIVE: One Disease, Two Epidemics â AIDS at 25

Thu, 08Â JunÂ 2006 00:00:00 -05:00

Twenty-five years have passed since the first cases of AIDS were recognized. During the first two decades, the epidemiology and clinical presentation of the disease were established, and potent antiviral...

PERSPECTIVE: Fighting HIV â Lessons from Brazil

Thu, 11Â MayÂ 2006 00:00:00 -05:00

In Brazil this past February, during the week before Carnaval, the pre-Lenten bacchanal of parades and street parties, citizens who ventured out to catch a bus, buy a beer, or...

PERSPECTIVE: The New Medical âMissionariesâ â Grooming the Next Generation of Global Health Workers

Thu, 27Â AprÂ 2006 00:00:00 -05:00

Noelle Benzekri is a first-year medical student with a mission. Even before the 27-year-old New York native spent a year as a clinic assistant and polio vaccinateur in Senegal, she...

PERSPECTIVE: The South Asian Earthquake Six Months Later â An Ongoing Crisis

Thu, 27Â AprÂ 2006 00:00:00 -05:00

The magnitude 7.6 earthquake that struck northern Pakistan and India on October 8, 2005, was the world's third-deadliest natural disaster of the past 25 years, surpassed only by the 2004...

IMAGES IN CLINICAL MEDICINE:

Michael D. Brown, M.D. — Thu, 30Â MarÂ 2006 00:00:00 -05:00

A 55-year-old man presented with intermittent, crampy pain in the right lower quadrant of the abdomen. The pain had started two days after his return from a two-week trip to...

EDITORIAL: Vaccines against Avian Influenza â A Race against Time

Gregory A. Poland, M.D. — Thu, 30Â MarÂ 2006 00:00:00 -05:00

Avian influenza A (H5N1) virus poses an important pandemic threat. A study by the Congressional Budget Office estimates that the consequences of a severe pandemic could, in the United States,...

ORIGINAL ARTICLE: Safety and Immunogenicity of an Inactivated Subvirion Influenza A (H5N1) Vaccine

Thu, 30Â MarÂ 2006 00:00:00 -05:00

Background: Influenza A (H5N1) viruses could cause a severe worldwide epidemic, with high attack rates, large numbers of deaths and hospitalizations, and wide disruption. Effective vaccines against these viruses in...

PERSPECTIVE: Preventing Cervical Cancer in the Developing World

Thu, 16Â MarÂ 2006 00:00:00 -05:00

The Pap smear has transformed cervical cancer from a leading killer to a rare disease in the United States. But few countries have the resources and infrastructure necessary to run...

PERSPECTIVE: Chronic Kidney Disease in the Developing World

Thu, 09Â MarÂ 2006 00:00:00 -05:00

The attention being paid globally to chronic kidney disease is attributable to five factors: the rapid increase in its prevalence, the enormous cost of treatment, recent data indicating that overt...

PERSPECTIVE: The Growing Burden of Chronic Kidney Disease in Pakistan

Thu, 09Â MarÂ 2006 00:00:00 -05:00

A Pakistani tailor, the sole breadwinner for a family of eight, had received diagnoses of type 2 diabetes and hypertension at 31 years of age. For the next 15 years,...

IMAGES IN CLINICAL MEDICINE: Microgametes

Rebekah Karplus, M.D. and Stephanie P. Johnston, M.S. — Thu, 09Â MarÂ 2006 00:00:00 -05:00

A 31-year-old woman, 33 weeks pregnant, presented with a fever (40Â°C) and chills 2 months after returning from a trip to Brazil. A mixed infection of Plasmodium malariae and P....

REVIEW ARTICLE: Management of Crush-Related Injuries after Disasters

Thu, 09Â MarÂ 2006 00:00:00 -05:00

Disasters can rarely be anticipated, much less prevented. After both natural disasters (e.g., earthquakes, hurricanes, tornadoes, and landslides) and man-made catastrophes (e.g., wars, mining accidents, and terrorist attacks), injuries to...

PERSPECTIVE: Antiviral Resistance in Influenza Viruses â Implications for Management and Pandemic Response

Thu, 23Â FebÂ 2006 00:00:00 -05:00

The Centers for Disease Control and Prevention (CDC) recently issued an alert instructing clinicians to avoid using M2 ion-channel inhibitors (amantadine and rimantadine) during the current influenza season because amantadine...

PERSPECTIVE: The Words Count â Radiology and Medical Linguistics

Thu, 16Â FebÂ 2006 00:00:00 -05:00

Thanks to European Union (EU) regulations, I, an Irishman, was recently permitted to pursue a radiology fellowship in France. Though free movement of labor within the EU is legal, it...

PERSPECTIVE: International Teleradiology

Thu, 16Â FebÂ 2006 00:00:00 -05:00

Imagine two patients arriving in the emergency department of a Maine hospital at midnight. The first has a presentation consistent with pulmonary embolism; the second, appendicitis. A decade ago, the...

PERSPECTIVE: The âDis-locationâ of U.S. Medicine â The Implications of Medical Outsourcing

Thu, 16Â FebÂ 2006 00:00:00 -05:00

When a patient in Altoona, Pa., needs an emergency brain scan in the middle of the night, a doctor in Bangalore, India, is asked to interpret the results. Spurred by...

PERSPECTIVE: Volunteering Overseas â Lessons from Surgical Brigades

Thu, 02Â FebÂ 2006 00:00:00 -05:00

Dr. Mark Migliori's approach to international surgical care is minimalist. With another surgeon, two anesthesiologists, and two or three nurses, he travels to a rural hospital in Guatemala. The group...

PERSPECTIVE: Unfinished Business â Expanding HIV Testing in Developing Countries

Thu, 02Â FebÂ 2006 00:00:00 -05:00

When the Group of Eight (G8) major industrial countries (France, the United States, Britain, Germany, Japan, Italy, Canada, and Russia) made a commitment in July 2005 to work toward universal...

EDITORIAL: Dissecting Racial and Ethnic Differences

Neil Risch, Ph.D. — Thu, 26Â JanÂ 2006 00:00:00 -05:00

It is well known that disease does not affect the population equally. Assessing variation in the rates of disease according to demographic factors such as sex and race or ethnicity...

PERSPECTIVE: Crisis in Niger â Outpatient Care for Severe Acute Malnutrition

Thu, 19Â JanÂ 2006 00:00:00 -05:00

In July 2005, an international aid agency was preparing to distribute supplementary food rations at a therapeutic feeding center near Maradi, Niger. Fearing that few people would show up, aid...

PERSPECTIVE: Noma â The Ulcer of Extreme Poverty

Thu, 19Â JanÂ 2006 00:00:00 -05:00

In 2001, my research team was visiting a farming community in northwestern Nigeria, where word quickly spread to neighboring villages that foreign doctors were examining the mouths of sick children....

ORIGINAL ARTICLE: Spectrum of Disease and Relation to Place of Exposure among Ill Returned Travelers

Thu, 12Â JanÂ 2006 00:00:00 -05:00

Background: Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited...

PERSPECTIVE: The Burden of Illness in International Travelers

Thu, 12Â JanÂ 2006 00:00:00 -05:00

In 2004, 763 million people crossed international borders, reflecting an increase of 73 percent over the course of 15 years.1 International travel has rebounded since the attacks of September 11,...

EDITORIAL: The Promise of New Rotavirus Vaccines

Roger I. Glass, M.D., Ph.D. and Umesh D. Parashar, M.B., B.S., M.P.H. — Thu, 05Â JanÂ 2006 00:00:00 -05:00

Rotavirus disease kills approximately half a million children annually in developing countries and accounts for one third of hospitalizations for diarrhea worldwide.1 In 1999, global efforts to control the tremendous...

ORIGINAL ARTICLE: Safety and Efficacy of a Pentavalent HumanâBovine (WC3) Reassortant Rotavirus Vaccine

Thu, 05Â JanÂ 2006 00:00:00 -05:00

Background: Rotavirus is a leading cause of childhood gastroenteritis and death worldwide.

Methods: We studied healthy infants approximately 6 to 12 weeks old who were randomly assigned to receive three oral...

ORIGINAL ARTICLE: Safety and Efficacy of an Attenuated Vaccine against Severe Rotavirus Gastroenteritis

Thu, 05Â JanÂ 2006 00:00:00 -05:00

Background: The safety and efficacy of an attenuated G1P[8] human rotavirus (HRV) vaccine were tested in a randomized, double-blind, phase 3 trial.

Methods: We studied 63,225 healthy infants from 11 Latin...

IMAGES IN CLINICAL MEDICINE: Eye Worm

Amita Gupta, M.D. and Sanjay Kedhar, M.D. — Thu, 22Â DecÂ 2005 00:00:00 -05:00

A healthy 43-year-old Nigerian man living in the United States noticed something wiggling in his right eye while he was driving. He went to his optometrist, who saw an opaque,...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 39-2005 â A 63-Year-Old Woman with a Positive Serologic Test for Syphilis and Persistent Eosinophilia

Thu, 22Â DecÂ 2005 00:00:00 -05:00

Dr. Jennifer Phillips (Internal Medicine): A 63-year-old woman was seen by infectious-disease specialists at this hospital because of a positive serologic test for syphilis and persistent peripheral-blood eosinophilia.

The patient was...

ORIGINAL ARTICLE: Oseltamivir Resistance during Treatment of Influenza A (H5N1) Infection

Thu, 22Â DecÂ 2005 00:00:00 -05:00

Influenza A (H5N1) virus with an amino acid substitution in neuraminidase conferring high-level resistance to oseltamivir was isolated from two of eight Vietnamese patients during oseltamivir treatment. Both patients died...

PERSPECTIVE: Robert Koch, the Nobel Prize, and the Ongoing Threat of Tuberculosis

Stefan H.E. Kaufmann, Ph.D. — Thu, 08Â DecÂ 2005 00:00:00 -05:00

âDuring my wandering through medicine, I encountered sites where gold was lying around. It needs a lot of serendipity to distinguish gold from ignobility; this however is not a particular...

EDITORIAL: Scaling Up Treatment â Why We Can't Wait

Jim Yong Kim, M.D., Ph.D., and Charlie Gilks, D.Phil., F.R.C.P. — Thu, 01Â DecÂ 2005 00:00:00 -05:00

Many arguments have been raised over the years to justify not moving rapidly forward with antiretroviral treatment programs for people living with the human immunodeficiency virus (HIV) and AIDS in...

ORIGINAL ARTICLE: Antiretroviral Therapy in a Thousand Patients with AIDS in Haiti

Thu, 01Â DecÂ 2005 00:00:00 -05:00

Background: The one-year survival rate of adults and children with the acquired immunodeficiency syndrome (AIDS), without antiretroviral therapy, has been about 30 percent in Haiti. Antiretroviral therapy has recently become...

PERSPECTIVE: The Origins of Pandemic Influenza â Lessons from the 1918 Virus

Thu, 24Â NovÂ 2005 00:00:00 -05:00

The completion of the genetic sequencing of the 1918 influenza A virus by Taubenberger et al.1 and the subsequent recovery of the virus by Tumpey et al.2 using reverse genetic...

SPECIAL ARTICLE: Cost-Effectiveness of Cervical-Cancer Screening in Five Developing Countries

Thu, 17Â NovÂ 2005 00:00:00 -05:00

Background: Cervical-cancer screening strategies that involve the use of conventional cytology and require multiple visits have been impractical in developing countries.

Methods: We used computer-based models to assess the cost-effectiveness of...

PERSPECTIVE: The Promise of Global Cervical-Cancer Prevention

Mark Schiffman, M.D., M.P.H., and Philip E. Castle, Ph.D., M.P.H. — Thu, 17Â NovÂ 2005 00:00:00 -05:00

Cytologic screening has significantly reduced the rates of cervical cancer in many developed countries. However, cervical cancer remains a leading form of cancer among women living in low-resource regions of...

PERSPECTIVE: Betting on a Malaria Vaccine

Susan Okie, M.D. — Thu, 03Â NovÂ 2005 00:00:00 -05:00

Sometime within the next two years, clinical researchers are expected to begin inoculating at least 2000 African infants in the largest trial ever undertaken of an experimental vaccine for malaria....

EDITORIAL: Fatal Flows â Doctors on the Move

Lincoln C. Chen, M.D., and Jo Ivey Boufford, M.D. — Thu, 27Â OctÂ 2005 00:00:00 -05:00

The movement of physicians from poor to rich countries is a growing obstacle to global health. Ghana, with 0.09 physician per thousand population, sends doctors to the United Kingdom, which...

SPECIAL ARTICLE: The Metrics of the Physician Brain Drain

Fitzhugh Mullan, M.D. — Thu, 27Â OctÂ 2005 00:00:00 -05:00

Background: There has been substantial immigration of physicians to developed countries, much of it coming from lower-income countries. Although the recipient nations and the immigrating physicians benefit from this migration,...

PERSPECTIVE: Aiding and Abetting â Nursing Crises at Home and Abroad

Sreekanth Chaguturu, M.D., and Snigdha Vallabhaneni, B.A. — Thu, 27Â OctÂ 2005 00:00:00 -05:00

After what seemed like years of teleconferencing, protocol revisions, international travel, and training sessions, the staff at the HIV clinical care and research site in India, where we had worked...

PERSPECTIVE: Evacuated Populations â Lessons from Foreign Refugee Crises

Thu, 13Â OctÂ 2005 00:00:00 -05:00

The terms âmalfeasanceâ and ânegligenceâ have been bandied about by many who are frustrated by the official response to Hurricane Katrina. Beginning with the evacuation orders before the hurricane's landfall,...

PERSPECTIVE: Climate Change and Human Health

Paul R. Epstein, M.D., M.P.H. — Thu, 06Â OctÂ 2005 00:00:00 -05:00

In 1998, Hurricane Mitch dropped six feet of rain on Central America in three days. In its wake, the incidence of malaria, dengue fever, cholera, and leptospirosis soared. In 2000,...

REVIEW ARTICLE: Avian Influenza A (H5N1) Infection in Humans

Thu, 29Â SepÂ 2005 00:00:00 -05:00

An unprecedented epizootic avian influenza A (H5N1) virus that is highly pathogenic has crossed the species barrier in Asia to cause many human fatalities and poses an increasing pandemic threat....

PERSPECTIVE: Compliance, Caricature, and Culturally Aware Care

Debra Malina, Ph.D. — Thu, 29Â SepÂ 2005 00:00:00 -05:00

The referrals were always the same. Febrile seizures, noncompliant mother, noncompliant mother, noncompliant mother, noncompliant mother.

So reports a California nurse who visited Lia Lee, the epileptic Hmong girl at the...

EDITORIAL: Azithromycin versus Penicillin G Benzathine for Early Syphilis

King K. Holmes, M.D., Ph.D. — Thu, 22Â SepÂ 2005 00:00:00 -05:00

The demonstration in Tanzania of equivalent efficacy of azithromycin and penicillin G benzathine for treating early syphilis and presumed early latent syphilis (rapid plasma reagin titer, â¥1:8) represents a potentially...

ORIGINAL ARTICLE: Single-Dose Azithromycin versus Penicillin G Benzathine for the Treatment of Early Syphilis

Thu, 22Â SepÂ 2005 00:00:00 -05:00

Background: Pilot studies suggest that a single, 2-g oral dose of azithromycin may be an alternative to a 2.4-MU intramuscular dose of penicillin G benzathine in the prevention and treatment...

PERSPECTIVE: A Sad Day for Science at the FDA

Alastair J.J. Wood, M.D., Jeffrey M. Drazen, M.D., and Michael F. Greene, M.D. — Thu, 22Â SepÂ 2005 00:00:00 -05:00

The Food and Drug Administration (FDA) has again postponed issuing a decision about making emergency contraception available to women without a prescription. This decision â or nondecision â deserves serious...

HEALTH POLICY REPORT: The Effect of China's One-Child Family Policy after 25 Years

Therese Hesketh, Ph.D., Li Lu, M.D., and Zhu Wei Xing, M.P.H. — Thu, 15Â SepÂ 2005 00:00:00 -05:00

China's one-child family policy has had a great effect on the lives of nearly a quarter of the world's population for a quarter of a century. When the policy was...

HEALTH POLICY REPORT: Privatization and Its Discontents â The Evolving Chinese Health Care System

David Blumenthal, M.D., M.P.P., and William Hsiao, Ph.D. — Thu, 15Â SepÂ 2005 00:00:00 -05:00

For the first-time visitor, China is breathtaking â a land of extraordinary vitality, unimaginable size, and outlandish contrasts. Its cities hum with energy, purpose, and impenetrable traffic jams choking inadequate...

SPECIAL ARTICLE: Major Causes of Death among Men and Women in China

Thu, 15Â SepÂ 2005 00:00:00 -05:00

Background: With China's rapid economic development, the disease burden may have changed in the country. We studied the major causes of death and modifiable risk factors in a nationally representative...

EDITORIAL: Enlightened Self-Interest and the Control of Tuberculosis

Barry R. Bloom, Ph.D., and Joshua A. Salomon, Ph.D. — Thu, 08Â SepÂ 2005 00:00:00 -05:00

Given the great humanitarian tradition of the United States, it is curious that no category of government spending ranks below foreign aid in polls of the American public.1 Americans are...

SPECIAL ARTICLE: Domestic Returns from Investment in the Control of Tuberculosis in Other Countries

Thu, 08Â SepÂ 2005 00:00:00 -05:00

Background: We hypothesized that investments to improve the control of tuberculosis in selected high-incidence countries would prove to be cost saving for the United States by reducing the incidence of...

EDITORIAL: Intravenous Fluids â Getting the Balance Right

Thu, 01Â SepÂ 2005 00:00:00 -05:00

Acute infections are a major cause of illness and death in children worldwide. In Africa, 50 percent of in-hospital deaths of children occur within 24 hours of admission, and shock...

REVIEW ARTICLE: Dengue in Travelers

Annelies Wilder-Smith, M.D., Ph.D., and Eli Schwartz, M.D. — Thu, 01Â SepÂ 2005 00:00:00 -05:00

Dengue virus infection is increasingly recognized as one of the world's major emerging infectious diseases.123 Dengue is endemic in most tropical and subtropical countries, many of which are popular tourist...

ORIGINAL ARTICLE: Comparison of Three Fluid Solutions for Resuscitation in Dengue Shock Syndrome

Thu, 01Â SepÂ 2005 00:00:00 -05:00

Background: Dengue shock syndrome is characterized by severe vascular leakage and disordered hemostasis and progresses to death in 1 to 5 percent of cases. Although volume replacement is recognized as...

PERSPECTIVE: Patents versus Patients? Antiretroviral Therapy in India

Diane V. Havlir, M.D., and Scott M. Hammer, M.D. — Thu, 25Â AugÂ 2005 00:00:00 -05:00

Legislation passed by the government of India rarely draws international attention, let alone global outrage. But in December 2004, to comply with the requirement of the World Trade Organization (which...

PERSPECTIVE: Making Antimalarial Agents Available in the United States

Alan Magill, M.D., and Claire Panosian, M.D. — Thu, 28Â JulÂ 2005 00:00:00 -05:00

Tales of malaria abound among travelers to Africa, and this account is typical. Someone who is far away from reliable health care is suddenly flattened by heat and a raging...

PERSPECTIVE: Making Antimalarial Agents Available in Africa

Kenneth J. Arrow, Ph.D., Hellen Gelband, M.H.S., and Dean T. Jamison, Ph.D. — Thu, 28Â JulÂ 2005 00:00:00 -05:00

An infant in rural Africa has fever. Acetaminophen does not work. The fever spikes, and the father makes his way to the local kiosk and buys malaria medicine â chloroquine...

IMAGES IN CLINICAL MEDICINE: Gnathostomiasis â Neuroimaging of Larval Migration

Pasiri Sithinamsuwan, M.D. and Parnsiri Chairangsaris, M.D. — Thu, 14Â JulÂ 2005 00:00:00 -05:00

An 18-year-old man presented with symptoms that evolved over the course of three days and included fever, radicular back pain, vertigo, ataxia, headache, and left-sided hemiparesis. He reported that he...

PERSPECTIVE: Marburg and Ebola â Arming Ourselves against the Deadly Filoviruses

C.J. Peters, M.D. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

As of May 26, 2005, the Angolan Ministry of Health had reported 399 cases of Marburg hemorrhagic fever, 335 of which were fatal. Even as this unprecedented spread of filovirus...

IMAGES IN CLINICAL MEDICINE: Myiasis Due to (Human Botfly)

Francisco M. Marty, M.D. and Kristen R. Whiteside, B.S. — Thu, 09Â JunÂ 2005 00:00:00 -05:00

A 65-year-old man presented with skin lesions on his chest and left arm and shoulder six weeks after returning from a vacation in Belize at the beach and in the...

EDITORIAL: Is This Clinical Trial Fully Registered? â A Statement from the International Committee of Medical Journal Editors

Thu, 09Â JunÂ 2005 00:00:00 -05:00

In September 2004, the members of the International Committee of Medical Journal Editors (ICMJE) published a joint editorial aimed at promoting registration of all clinical trials.1 We stated that we...

PERSPECTIVE: Saving the Children â Improving Childhood Cancer Treatment in Developing Countries

Raul C. Ribeiro, M.D., and Ching-Hon Pui, M.D. — Thu, 26Â MayÂ 2005 00:00:00 -05:00

Unprecedented gains have been made in the cure rates for childhood cancer during the past four decades. This progress reflects steady improvement in treatment protocols, a multidisciplinary approach to patient...

PERSPECTIVE: Marburg Hemorrhagic Fever in Angola â Fighting Fear and a Lethal Pathogen

Nestor Ndayimirije, M.D., and Mary Kay Kindhauser, M.A. — Thu, 26Â MayÂ 2005 00:00:00 -05:00

On March 21, 2005, the Centers for Disease Control and Prevention (CDC) in Atlanta confirmed the presence of Marburg virus in 9 of 12 patient samples of tissue and blood...

IMAGES IN CLINICAL MEDICINE: Chromoblastomycosis

Michael Brown, M.R.C.P., Ph.D. and Geoffrey Pasvol, F.R.C.P., D.Phil. — Thu, 19Â MayÂ 2005 00:00:00 -05:00

A 67-year-old man was admitted to the hospital with a 12-year history of swelling of his left leg. He had emigrated to the United Kingdom from Jamaica at the age...

SPECIAL ARTICLE: An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan

Thu, 19Â MayÂ 2005 00:00:00 -05:00

Background: There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective...

PERSPECTIVE: Perinatal Mortality in Developing Countries

Jelka Zupan, M.D. — Thu, 19Â MayÂ 2005 00:00:00 -05:00

Each year, 10.7 million children under the age of five years die â 4 million during the first four weeks of life. Another 3.3 million are stillborn. And these are...

PERSPECTIVE: Preparing for the Next Pandemic

Michael T. Osterholm, Ph.D., M.P.H. — Thu, 05Â MayÂ 2005 00:00:00 -05:00

Annual influenza epidemics are like Minnesota winters â all are challenges, but some are worse than others. No matter how well we prepare, some blizzards take quite a toll. Each...

PERSPECTIVE: A New Colonialism? â Conducting Clinical Trials in India

Samiran Nundy, M.Chir., and Chandra M. Gulhati, M.D., D.T.M.&H. — Thu, 21Â AprÂ 2005 00:00:00 -05:00

In January 2005, the government of India enacted a new rule that allows foreign pharmaceutical companies and other interested parties to conduct trials of new drugs in India at the...

REVIEW ARTICLE: Effectiveness of Antimalarial Drugs

J. Kevin Baird, Ph.D. — Thu, 14Â AprÂ 2005 00:00:00 -05:00

The opening of the Panama Canal in 1914 initiated an era in which efforts to control malaria were aimed at the anopheline mosquito. The World Health Organization's Global Malaria Eradication...

PERSPECTIVE: A Nutrition Paradox â Underweight and Obesity in Developing Countries

Benjamin Caballero, M.D., Ph.D. — Thu, 14Â AprÂ 2005 00:00:00 -05:00

A few years ago, I was visiting a primary care clinic in the slums of SÃ£o Paulo. The waiting room was full of mothers with thin, stunted young children, exhibiting...

REVIEW ARTICLE: Blast Injuries

Thu, 31Â MarÂ 2005 00:00:00 -05:00

Although information about terrorism has emphasized chemical, biologic, and radiation events,12345 most terrorist attacks have involved explosive devices. To date, the number of lives lost, the number of people injured,...

PERSPECTIVE: Veterans' Mental Health in the Wake of War

Matthew J. Friedman, M.D., Ph.D. — Thu, 31Â MarÂ 2005 00:00:00 -05:00

Some aspects of the psychological experiences of war bind veterans together across temporal and national boundaries. Consider Hotspur's traumatic nightmares in Shakespeare's King Henry IV, Part I, the challenges confronting...

PERSPECTIVE: The Public Health Emergency in Indonesia â One Patient at a Time

Hilarie H. Cranmer, M.D., M.P.H. — Thu, 10Â MarÂ 2005 00:00:00 -05:00

When my team arrived on the east coast of Sumatra, Indonesia, two weeks after the tsunami, dry land was scarce. Although the largest settlement camps had formed around mosques and...

PERSPECTIVE: Tsunami in Thailand â Disaster Management in a District Hospital

Thu, 10Â MarÂ 2005 00:00:00 -05:00

On the morning of December 26, 2004, a magnitude 9.0 earthquake occurred off the west coast of Sumatra. The tsunami that followed swept across the Indian Ocean, devastating areas of...

EDITORIAL: Disaster, Water, Cholera, Vaccines, and Hope

Jeffrey M. Drazen, M.D., and Mark S. Klempner, M.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

The world is now all too familiar with images of the destruction caused by the tsunami that struck Southeast Asia on December 26 of last year. In a natural disaster,...

ORIGINAL ARTICLE: Effectiveness of Mass Oral Cholera Vaccination in Beira, Mozambique

Thu, 24Â FebÂ 2005 00:00:00 -05:00

Background: New-generation, orally administered cholera vaccines offer the promise of improved control of cholera in sub-Saharan Africa. However, the high prevalence of human immunodeficiency virus (HIV) infection in many cholera-affected...

PERSPECTIVE: Generic HIV Drugs â Enlightened Policy for Global Health

Mark A. Wainberg, Ph.D. — Thu, 24Â FebÂ 2005 00:00:00 -05:00

The 2000 International AIDS Conference in Durban, South Africa, focused the world's attention on disparities between rich and poor countries with respect to access to antiretroviral drugs. At that time,...

ORIGINAL ARTICLE: Fatal Avian Influenza A (H5N1) in a Child Presenting with Diarrhea Followed by Coma

Thu, 17Â FebÂ 2005 00:00:00 -05:00

In southern Vietnam, a four-year-old boy presented with severe diarrhea, followed by seizures, coma, and death. The cerebrospinal fluid contained 1 white cell per cubic millimeter, normal glucose levels, and...

PERSPECTIVE: Women, Inequality, and the Burden of HIV

Bisola O. Ojikutu, M.D., M.P.H., and Valerie E. Stone, M.D., M.P.H. — Thu, 17Â FebÂ 2005 00:00:00 -05:00

Driving through KwaZulu-Natal, South Africa, one is struck by the lush farmland and beautiful coast. Beyond this panorama, however, lie rural communities such as Umbumbulu, with its unemployment rate of...

PERSPECTIVE: Population and Development â Shifting Paradigms, Setting Goals

Allan Rosenfield, M.D., and Karyn Schwartz — Thu, 17Â FebÂ 2005 00:00:00 -05:00

At the first United Nationsâsponsored international conference on population â held in Bucharest, Romania, in 1974 â the United States and other Western nations advocated the implementation of programs aimed...

PERSPECTIVE: Recovering from the Tsunami

William H. Frist, M.D. — Thu, 03Â FebÂ 2005 00:00:00 -05:00

The media reports on the tsunami that hit South Asia the day after Christmas did little to prepare me for what I saw firsthand when I visited Sri Lanka and...

PERSPECTIVE: After the Tsunami â Facing the Public Health Challenges

Michael VanRooyen, M.D., M.P.H., and Jennifer Leaning, M.D., S.M.H. — Thu, 03Â FebÂ 2005 00:00:00 -05:00

The tsunami that struck 11 countries in South Asia on the morning of December 26, 2004, resulted in a natural disaster of apocalyptic proportions. The sheer scope and severity of...

EDITORIAL: Avian Influenza and Pandemics â Research Needs and Opportunities

Klaus StÃ¶hr, Ph.D. — Thu, 27Â JanÂ 2005 00:00:00 -05:00

As the year 2004 progressed, so did conditions favoring the start of an influenza pandemic. The first warning came in January, when Thailand and Vietnam reported fatal human cases of...

ORIGINAL ARTICLE: Probable Person-to-Person Transmission of Avian Influenza A (H5N1)

Thu, 27Â JanÂ 2005 00:00:00 -05:00

Background: During 2004, a highly pathogenic avian influenza A (H5N1) virus caused poultry disease in eight Asian countries and infected at least 44 persons, killing 32; most of these persons...

PERSPECTIVE: The Threat of an Avian Influenza Pandemic

Arnold S. Monto, M.D. — Thu, 27Â JanÂ 2005 00:00:00 -05:00

There have been three influenza pandemics during the past century â in 1918, 1957, and 1968. Although the severity of the epidemics and the primary age groups affected varied, each...

PERSPECTIVE: Achieving the Millennium Development Goals â The Case of Malaria

Jeffrey D. Sachs, Ph.D. — Thu, 13Â JanÂ 2005 00:00:00 -05:00

Malaria currently kills up to 3 million people per year worldwide, most of them children in sub-Saharan Africa.1 Yet the disease is utterly treatable and highly preventable. Now, the international...

EDITORIAL: Bacterial Infections â A Major Cause of Death among Children in Africa

E. Kim Mulholland, M.D., and Richard A. Adegbola, Ph.D. — Thu, 06Â JanÂ 2005 00:00:00 -05:00

For the past 25 years, since the United Nations Children's Fund (UNICEF) has been publishing estimates of mortality among children worldwide, the international medical community has been aware of the...

ORIGINAL ARTICLE: Bacteremia among Children Admitted to a Rural Hospital in Kenya

Thu, 06Â JanÂ 2005 00:00:00 -05:00

Background: There are few epidemiologic data on invasive bacterial infections among children in sub-Saharan Africa. We studied every acute pediatric admission to a rural district hospital in Kenya to examine...

PERSPECTIVE: Affirmative Action, Cuban Style

Fitzhugh Mullan, M.D. — Thu, 23Â DecÂ 2004 00:00:00 -05:00

âI feel as if I'm standing on the backs of all my ancestors. This is a huge opportunity for me,â Teresa Glover, a 27-year-old medical student, told me during a...

PERSPECTIVE: Caught in Colombia's Crossfire

Brigg Reilley, M.P.H., and Silvia Morote, M.D. — Thu, 16Â DecÂ 2004 00:00:00 -05:00

It is an accepted part of a doctor's job to awaken at night to an emergency call. But in many parts of Colombia, such a visit is often reason for...

PERSPECTIVE: Beyond Humanitarian Bandages â Confronting Genocide in Sudan

Jerry Fowler, J.D. — Thu, 16Â DecÂ 2004 00:00:00 -05:00

The basic contours of what is happening in the Darfur region of western Sudan have been extensively documented. In May, I traveled to Chad, Sudan's neighbor to the west, and...

Ingrid T. Katz, M.D., M.H.S., and Alexi A. Wright, M.D. — Thu, 16Â DecÂ 2004 00:00:00 -05:00

On November 4, 2004, the Nobel Prizeâwinning humanitarian-aid organization MÃ©decins sans FrontiÃ¨res (MSF, or Doctors without Borders) announced that it was discontinuing operations in Iraq, owing to escalating violence against...

PERSPECTIVE: Running Like Water â The Omnipresence of Hepatitis E

Suzanne U. Emerson, Ph.D., and Robert H. Purcell, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

Hepatitis E virus (HEV), originally identified as the culprit in massive waterborne epidemics of acute hepatitis in Asia, is now commanding attention in regions of Sudan and Iraq. And once...

PERSPECTIVE: Avian Influenza â A Challenge to Global Health Care Structures

Thu, 02Â DecÂ 2004 00:00:00 -05:00

The largest, most devastating outbreak of an infectious disease in modern history occurred in 1918, when a highly virulent influenza A (H1N1) virus spread throughout the world and killed between...

PERSPECTIVE: Westward Ho? â The Spread of West Nile Virus

Lyle R. Petersen, M.D., M.P.H., and Edward B. Hayes, M.D. — Thu, 25Â NovÂ 2004 00:00:00 -05:00

West Nile virus, a mosquito-borne flavivirus, was first isolated from a febrile patient in the West Nile region of Uganda in 1937. For the next 60 years, it remained a...

EDITORIAL: New Steps toward Eliminating Blinding Trachoma

Silvio P. Mariotti, M.D. — Thu, 04Â NovÂ 2004 00:00:00 -05:00

Despite long-standing efforts to control it, trachoma remains the leading cause of preventable blindness in the world. According to the most recent estimates, some 84 million people have active trachoma...

ORIGINAL ARTICLE: Mass Treatment with Single-Dose Azithromycin for Trachoma

Thu, 04Â NovÂ 2004 00:00:00 -05:00

Background: 04110433.xml Trachoma, caused by repeated ocular infection with Chlamydia trachomatis, is an important cause of blindness. Current recommended dosing intervals for mass azithromycin treatment for trachoma are based on...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Genomics and Malaria Control

Kenneth D. Vernick, Ph.D., and Andrew P. Waters, Ph.D. — Thu, 28Â OctÂ 2004 00:00:00 -05:00

Two thirds of the global population is at risk for malaria. However, about 90 percent of deaths from this disease occur in sub-Saharan Africa, where 1.5 million to 2.5 million...

ORIGINAL ARTICLE: Dexamethasone for the Treatment of Tuberculous Meningitis in Adolescents and Adults

Thu, 21Â OctÂ 2004 00:00:00 -05:00

Background: Tuberculous meningitis kills or disables more than half of those affected with the disease. Previous studies have been too small to determine whether adjunctive treatment with corticosteroids can reduce...

PERSPECTIVE: Tuberculous Meningitis

Peter R. Donald, M.D., and Johan F. Schoeman, M.D. — Thu, 21Â OctÂ 2004 00:00:00 -05:00

As is vividly illustrated by the report by Thwaites et al. in this issue of the Journal (pages 1741â1751), tuberculous meningitis continues to exact a devastating toll in developed and...

ORIGINAL ARTICLE: Pure Red-Cell Aplasia and Epoetin Therapy

Thu, 30Â SepÂ 2004 00:00:00 -05:00

Background: Between 1988 and 1998, antibody-associated pure red-cell aplasia was reported in three patients who had undergone treatment with recombinant human erythropoietin (epoetin). Between 1998 and 2000, 13 such cases...

PERSPECTIVE: Eradicating Polio

David L. Heymann, M.D., and R. Bruce Aylward, M.D. — Thu, 23Â SepÂ 2004 00:00:00 -05:00

During the past 12 months, poliovirus has been spreading to states in Nigeria that were previously free of poliomyelitis. Moreover, global surveillance for acute flaccid paralysis1 â involving the genomic...

PERSPECTIVE: Despite the Odds â Providing Reproductive Health Care to Afghan Women

Sima Samar, M.D. — Thu, 09Â SepÂ 2004 00:00:00 -05:00

The majority of women in Afghanistan have never seen a doctor. Twenty-three years of war destroyed the few existing health care facilities, and women's health has suffered from the violence...

PERSPECTIVE: Cultural Competence â Marginal or Mainstream Movement?

Joseph R. Betancourt, M.D., M.P.H. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

As the United States becomes increasingly diverse, physicians will see patients from a variety of sociocultural backgrounds on a daily basis. Culture plays a large role in shaping health-related values,...

PERSPECTIVE: Culture and Depression

Arthur Kleinman, M.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

In many parts of Chinese society, the experience of depression is physical rather than psychological. Many depressed Chinese people do not report feeling sad, but rather express boredom, discomfort, feelings...

REVIEW ARTICLE: Hookworm Infection

Thu, 19Â AugÂ 2004 00:00:00 -05:00

Hookworm infection in humans is caused by an infection with the helminth nematode parasites Necator americanus and Ancylostoma duodenale and is transmitted through contact with contaminated soil. It is one...

PERSPECTIVE: Antiretroviral Medications â From Thailand to Africa

Robert Steinbrook, M.D. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

The international AIDS conference highlighted the substantial progress that Thailand has made in reducing the frequency of mother-to-child transmission of HIV and providing antiretroviral treatment. Now, Krisana Kraisintu, the Thai...

PERSPECTIVE: After Bangkok â Expanding the Global Response to AIDS

Robert Steinbrook, M.D. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

The progress that has been made in the global response to AIDS is real â but inadequate. An estimated 1 million people throughout the world are now using antiretroviral medications...

PERSPECTIVE: Diagnosing Genocide â The Case of Darfur

Jennifer Leaning, M.D., S.M.H. — Thu, 19Â AugÂ 2004 00:00:00 -05:00

In the desperate and urgent debate about what to do next in Darfur, Sudan (see map) â where a regional conflict has forced 1.3 million people from their homes and...

PERSPECTIVE: Doctors and Torture

Robert Jay Lifton, M.D. — Thu, 29Â JulÂ 2004 00:00:00 -05:00

There is increasing evidence that U.S. doctors, nurses, and medics have been complicit in torture and other illegal procedures in Iraq, Afghanistan, and Guantanamo Bay. Such medical complicity suggests still...

EDITORIAL: Antiretroviral Agents â How Best to Protect Infants from HIV and Save Their Mothers from AIDS

Hoosen Coovadia, M.D. — Thu, 15Â JulÂ 2004 00:00:00 -05:00

Preventing transmission of human immunodeficiency virus type 1 (HIV-1) and caring for those already infected are essential services in any comprehensive program, and enhancing the mutually beneficial effect of each...

ORIGINAL ARTICLE: Intrapartum Exposure to Nevirapine and Subsequent Maternal Responses to Nevirapine-Based Antiretroviral Therapy

Thu, 15Â JulÂ 2004 00:00:00 -05:00

Background: A single intrapartum dose of nevirapine for the prevention of mother-to-child transmission of human immunodeficiency virus (HIV) leads to the selection of resistance mutations. Whether there are clinically significant...

ORIGINAL ARTICLE: Single-Dose Perinatal Nevirapine plus Standard Zidovudine to Prevent Mother-to-Child Transmission of HIV-1 in Thailand

Thu, 15Â JulÂ 2004 00:00:00 -05:00

Background: Although zidovudine prophylaxis decreases the rate of transmission of the human immunodeficiency virus (HIV) type 1 substantially, a large number of infants still become infected. We hypothesized that the...

PERSPECTIVE: Syphilis Control â A Continuing Challenge

Edward W. Hook III, M.D., and Rosanna W. Peeling, Ph.D. — Thu, 08Â JulÂ 2004 00:00:00 -05:00

Syphilis. The name of this widespread and ancient disease is familiar to health care providers worldwide. This name recognition, however, belies the complexity of the disease, as well as the...

PERSPECTIVE: HIV and AIDS in the Former Soviet Bloc

Mark G. Field, Ph.D. — Thu, 08Â JulÂ 2004 00:00:00 -05:00

As compared with most nations affected by the human immunodeficiency virus (HIV) and AIDS, the countries of the former Soviet Bloc encountered the disease rather late. The first public announcement...

PERSPECTIVE: The AIDS Epidemic in 2004

Robert Steinbrook, M.D. — Thu, 08Â JulÂ 2004 00:00:00 -05:00

As the AIDS pandemic enters its 24th year, the number of people living with human immunodeficiency virus (HIV) infection continues to increase steadily (see Figure).1 Two thirds of infected persons...

PERSPECTIVE: Cardiovascular Disease in Non-Western Countries

K. Srinath Reddy, D.M. — Thu, 10Â JunÂ 2004 00:00:00 -05:00

Concern about increasing rates of death and disability due to cardiovascular disease in non-Western countries is often met with skepticism: Do they really constitute a serious public health problem? With...

ORIGINAL ARTICLE: Public Health Measures to Control the Spread of the Severe Acute Respiratory Syndrome during the Outbreak in Toronto

Thu, 03Â JunÂ 2004 00:00:00 -05:00

Background: Toronto was the site of North America's largest outbreak of the severe acute respiratory syndrome (SARS). An understanding of the patterns of transmission and the effects on public health...

PERSPECTIVE: Planning for Epidemics â The Lessons of SARS

Robert A. Weinstein, M.D. — Thu, 03Â JunÂ 2004 00:00:00 -05:00

In terms of sheer drama, the emergence of the severe acute respiratory syndrome (SARS) rivaled the most exotic Michael Crichton thriller. A novel viral strain spread in âwet marketsâ from...

PERSPECTIVE: Smoking Ban â Made in Ireland, for Home Use and for Export

N. Gerry McElvaney, M.D. — Thu, 27Â MayÂ 2004 00:00:00 -05:00

On March 29, 2004, the Irish government implemented a law banning smoking in the workplace. This was the first law of its kind in Europe and represented the culmination of...

PERSPECTIVE: The Battle for Access â Health Care in Afghanistan

Thu, 06Â MayÂ 2004 00:00:00 -05:00

Recent rounds on the infectious disease ward in Mir Wais Hospital, in Kandahar, Afghanistan, found a young farmhand recuperating from meningitis sitting with the two friends who had accompanied him...

ORIGINAL ARTICLE: Laboratory-Acquired Severe Acute Respiratory Syndrome

Thu, 22Â AprÂ 2004 00:00:00 -05:00

The outbreak of severe acute respiratory syndrome (SARS) in Singapore ended in late May 2003.1 The Centers for Disease Control and Prevention (CDC) removed its travel alerts for Toronto, Hong...

ORIGINAL ARTICLE: Evidence of Airborne Transmission of the Severe Acute Respiratory Syndrome Virus

Thu, 22Â AprÂ 2004 00:00:00 -05:00

Background: There is uncertainty about the mode of transmission of the severe acute respiratory syndrome (SARS) virus. We analyzed the temporal and spatial distributions of cases in a large community...

PERSPECTIVE: Political Violence and Public Health in Haiti

Paul Farmer, M.D., Ph.D. — Thu, 08Â AprÂ 2004 00:00:00 -05:00

In 1991, a violent military coup unseated Haiti's first democratically elected government. An estimated 5000 people died, and hundreds of thousands more were displaced during the three years when military...

ORIGINAL ARTICLE: Avian Influenza A (H5N1) in 10 Patients in Vietnam

Thu, 18Â MarÂ 2004 00:00:00 -05:00

Background: Recent outbreaks of avian influenza A (H5N1) in poultry throughout Asia have had major economic and health repercussions. Human infections with this virus were identified in Vietnam in January...

PERSPECTIVE: Earthquake Relief â The U.S. Medical Response in Bam, Iran

Jay J. Schnitzer, M.D., Ph.D., and Susan M. Briggs, M.D., M.P.H. — Thu, 18Â MarÂ 2004 00:00:00 -05:00

The magnitude-6.6 earthquake in Bam, Iran, struck at 5:26 a.m. local time on December 26, 2003, while most people were asleep in their homes. It destroyed much of the city....

PERSPECTIVE: Crossing the Species Barrier â One Small Step to Man, One Giant Leap to Mankind

Mark S. Klempner, M.D., and Daniel S. Shapiro, M.D. — Thu, 18Â MarÂ 2004 00:00:00 -05:00

On first setting foot on the moon, Neil Armstrong famously proclaimed that he had taken âOne small step for man, one giant leap for mankind.â With minor adjustments, he could...

PERSPECTIVE: Improving Online Access to Medical Information for Low-Income Countries

Barbara Aronson — Thu, 04Â MarÂ 2004 00:00:00 -05:00

Over the past two years, the World Health Organization (WHO) has worked with publishing partners (including the Journal) to improve online access to scientific resources as a way of supporting...

PERSPECTIVE: Getting Polio Eradication Back on Track in Nigeria

Ebrahim Samba, M.D., Francis Nkrumah, M.D., M.P.H., and Rose Leke, M.D. — Thu, 12Â FebÂ 2004 00:00:00 -05:00

The recent cancellation of polio-vaccination campaigns in several key northern Nigerian states where poliomyelitis is endemic1 has focused attention on this African country, which reported more cases of the disease...

ORIGINAL ARTICLE: The Detection of Monkeypox in Humans in the Western Hemisphere

Thu, 22Â JanÂ 2004 00:00:00 -05:00

Background: During May and June 2003, an outbreak of febrile illness with vesiculopustular eruptions occurred among persons in the midwestern United States who had had contact with ill pet prairie...

PERSPECTIVE: Poxvirus Zoonoses â Putting Pocks into Context

Sharon E. Frey, M.D., and Robert B. Belshe, M.D. — Thu, 22Â JanÂ 2004 00:00:00 -05:00

Naturally occurring poxvirus infections affect humans and many species of animals and insects. Smallpox, the dreaded disease caused by the only human-specific orthopoxvirus pathogen, variola, was successfully eradicated in the...

ORIGINAL ARTICLE: A Trial of Antiparasitic Treatment to Reduce the Rate of Seizures Due to Cerebral Cysticercosis

Thu, 15Â JanÂ 2004 00:00:00 -05:00

Background: Neurocysticercosis is the main cause of adult-onset seizures in the developing world. Whether therapy with antiparasitic agents results in improved seizure control has been questioned because of the lack...

PERSPECTIVE: Influenza Vaccine â Outmaneuvering Antigenic Shift and Drift

John Treanor, M.D. — Thu, 15Â JanÂ 2004 00:00:00 -05:00

The winter of 2003â2004 will be remembered as a year in which stories about influenza dominated the news and patients young and old clamored for influenza vaccination. This intense interest...

PERSPECTIVE: Tapeworms and Seizures â Treatment and Prevention

James H. Maguire, M.D. — Thu, 15Â JanÂ 2004 00:00:00 -05:00

It may come as a surprise that a lowly tapeworm is responsible for as many as 10 percent of cases in which a patient presents with seizures to an emergency...

REVIEW ARTICLE: The Severe Acute Respiratory Syndrome

Thu, 18Â DecÂ 2003 00:00:00 -05:00

The severe acute respiratory syndrome (SARS) is responsible for the first pandemic of the 21st century. Within months after its emergence in Guangdong Province in mainland China, it had affected...

PERSPECTIVE: Dispatch from India

Atul Gawande, M.D., M.P.H. — Thu, 18Â DecÂ 2003 00:00:00 -05:00

The puzzle was how the surgeons in India do it. Take a town like Nanded, 400 miles east of Mumbai (as Bombay is now called), in the center of India....

PERSPECTIVE: SARS â One Year Later

Donald E. Low, M.D., and Allison McGeer, M.D. — Thu, 18Â DecÂ 2003 00:00:00 -05:00

It was just over a year ago, in November 2002, that the first case of what was to become known as the severe acute respiratory syndrome (SARS) was identified in...

ORIGINAL ARTICLE: Delayed Onset of Malaria â Implications for Chemoprophylaxis in Travelers

Thu, 16Â OctÂ 2003 00:00:00 -05:00

Background: Most antimalarial agents used by travelers act on the parasite's blood stage and therefore do not prevent late-onset illness, particularly that due to species that cause relapsing malaria. We...

PERSPECTIVE: Two Worlds of Malaria

Thomas E. Wellems, M.D., Ph.D., and Louis H. Miller, M.D. — Thu, 16Â OctÂ 2003 00:00:00 -05:00

Cases of malaria acquired by international travelers from industrialized countries probably number 25,000 annually; of these, about 10,000 are reported, and 150 are fatal. These numbers are growing because of...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2003 â A 50-Year-Old Colombian Man with Fever and Seizures

Thu, 21Â AugÂ 2003 00:00:00 -05:00

A 50-year-old man was admitted to the hospital because of fever, a seizure, and confusion.

The patient was a native of Colombia who had traveled to the United States six weeks...

PERSPECTIVE: SARS â Looking Back over the First 100 Days

Jeffrey M. Drazen, M.D. — Thu, 24Â JulÂ 2003 00:00:00 -05:00

Each winter, a number of surveillance networks are put in place to detect unusual outbreaks of severe respiratory disease. Last winter, although there had been some minor activity, nothing serious...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 22-2003 â A 22-Year-Old Man with Chills and Fever after a Stay in South America

Johanna P. Daily, M.D., and Mary Ann Waldron, M.T.(A.S.C.P.) — Thu, 17Â JulÂ 2003 00:00:00 -05:00

A 22-year-old man was examined in the clinic because of fever, chills, and thrombocytopenia.

Five months earlier, the patient, who was late in planning a six-week trip to South America, had...

EDITORIAL: Faster . . . but Fast Enough? Responding to the Epidemic of Severe Acute Respiratory Syndrome

Julie Louise Gerberding, M.D., M.P.H. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

Severe acute respiratory syndrome (SARS) was diagnosed in more than 1800 patients in 17 countries (including the United States and Canada) between February 1 and March 31, 2003. During this...

EDITORIAL: SARS, the Internet, and the

Jeffrey M. Drazen, M.D., and Edward W. Campion, M.D. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

On the Ides of March 2003, a physician was in transit from New York to Singapore by way of Germany. In Germany he was hospitalized and quarantined with a respiratory...

ORIGINAL ARTICLE: Identification of Severe Acute Respiratory Syndrome in Canada