CHICAGO—Results from a clinical trial indicate that the medication tolvaptan may be a promising addition to standard therapy for treating patients hospitalized for heart failure, according to a study in the April 28 issue of the Journal of the American Medical Association (JAMA).

Hospitalizations for heart failure are common in the United States, with 995,000 hospital discharges for heart failure in 2001, according to background information in the article. Pharmacological management of systemic congestion in heart failure (buildup of excess fluid in the lungs and some other body tissues) is often inadequate; the 6-month postdischarge readmission rates are as high as 50 percent. Although diuretics are the mainstay therapy for congestion, their use has been associated with hypotension (abnormally low blood pressure), electrolyte abnormalities and worsening kidney function. The medication tolvaptan is thought to help treat heart failure without adversely affecting electrolytes and kidney function.

Mihai Gheorghiade, M.D., of Northwestern University Feinberg School of Medicine, Chicago, and investigators with the Acute and Chronic Therapeutic Impact of a Vasopressin Antagonist in Congestive Heart Failure (ACTIV in CHF) trial evaluated the clinical effects of tolvaptan in patients hospitalized for heart failure. This randomized, double blind, placebo-controlled trial was conducted at 45 centers in the United States and Argentina, and enrolled 319 patients who were hospitalized for heart failure and who had persistent signs and symptoms of systemic congestion despite standard therapy.

After admission, patients were randomized to receive 30, 60, or 90 mg of oral tolvaptan or placebo in addition to standard therapy, including diuretics. The study drug was continued for up to 60 days.

CHICAGO—Pregnant women who are exposed to dental radiography may be more likely to give birth to an infant who weighs less than normal, according to a study in the April 28 issue of the Journal of the American Medical Association (JAMA).

According to background information in the article, the link between radiation and low birth weight (LBW) babies has been established with medical x-rays, but not dental x-ray radiation. "Because dental diagnostic radiography results in measurable radiation doses to the hypothalamus-pituitary-thyroid axis and not the reproductive organs or the fetus, it provides an opportunity to test the role of the hypothalamus-pituitary-thyroid axis in the radiation-LBW association," the authors write.

Philippe P. Hujoel, Ph.D., and colleagues from the University of Washington, Seattle, analyzed data from Washington Dental Services, a non-profit dental insurance company in Washington State, for women who received dental treatment between January 1993 and December 2000. Those records were then linked to birth certificates. There were 1,117 low birth weight infants (defined as weighing less than 2,500 grams or 5.5 pounds) born to women with Washington Dental Service insurance during that time period. A total of 4,468 normal birth weight (NBW) infants were selected as the control group for this study.

The investigators estimated the amount of radiation exposure based on the dental x-ray studies performed and published radiation dosages. (For example, a full mouth 21 x-ray series has a typical dose of 1.6 mGy [milligray] of radiation, whereas a series of 4 "bitewing" x-rays has a dose of 0.22 mGy). For their analysis, the authors categorized the cumulative radiation exposure into three dose groups: 0 mGy (no dental x-rays), 0.1-0.4 mGy, and higher than 0.4 mGy (which corresponded to the 90th percentile of the cumulative radiation doses among women who had at least one dental x-ray.)

Among the women who delivered a LBW infant, 1.9 percent (n = 21, including 10 LBW infants born at term) had higher than 0.4 mGy radiation dose, compared with 1.0 percent of women with NBW infants. When compared to women with no known dental diagnostic x-rays during pregnancy, a radiation dose of more than 0.4 mGy was associated with an increased adjusted odds for LBW of 2.27, and an increased adjusted odds for term LBW of 3.61.

CHICAGO—People infected with anthrax continued to report health problems, poor life adjustment, and psychological distress one year after their exposure, according to a study in the April 28 issue of the Journal of the American Medical Association (JAMA).

In 2001, bioterrorist activities involving the U.S. Postal Service infected 22 individuals with Bacillus anthracis (anthrax), according to background information in the article. Six survivors had inhalational anthrax and 11 cutaneous anthrax disease. Little is known about potential long-term health effects of bioterrorism-related anthrax infection.

Dori B. Reissman, M.D., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a cross-sectional health assessment approximately 1 year after the 2001 onset of anthrax infection to better characterize the somatic (affecting the body) symptoms, health status, and functional capacity of the bioterrorism-related anthrax survivors.

The study included assessment of 15 of 16 adult survivors from September through December 2002 using a clinical interview, a medical review-of-system questionnaire, 2 standardized self-administered questionnaires, and a review of available medical records.

The researchers found that the anthrax survivors reported symptoms affecting multiple body systems, significantly greater psychological distress, and significantly reduced health-related quality-of-life indices compared with U.S. referent populations. "Eight survivors (53 percent) had not returned to work since their infection. Comparing disease manifestations, inhalational survivors reported significantly lower overall physical health than cutaneous survivors. Available medical records could not explain the persisting health complaints," the authors write.

The most common health complaints included respiratory tract problems (e.g., chronic cough), fatigue, joint complaints (e.g., swelling, pain), and cognitive impairment (e.g., memory problems). The most frequently reported psychological distress symptoms included depression, anxiety, obsessive-compulsive, and hostility.

The researchers write that these finding are "similar to findings reported after exposure to other types of traumatic events and highlights the importance of measuring these dimensions as standard practice. Many factors may contribute to the distress variance reported by the anthrax survivors, including differences in exposure characteristics, sociocultural and occupational considerations, and perceived inequities of case management."

DENTAL X-RAYS & LOW-BIRTH WEIGHT BABIES