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Use of C-Reactive Protein to Target Statin Therapy for the Prevention of Coronary Events
Elevated levels of C-reactive protein, even in the absence of hyperlipidemia, are associated with an increased risk of coronary events. Statin therapy can reduce C-reactive protein levels. In this study of 5742 subjects without known coronary disease, the risk of coronary events increased with the level of C-reactive protein. Treatment with lovastatin reduced C-reactive protein levels and the risk of coronary events, even when lipid levels were normal.
These results may provide a new method for targeting statin therapy to persons who stand to benefit most from it. Even among persons with normal lipid levels, those who have elevated levels of C-reactive protein will probably benefit from statin therapy.
Related Editorial
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Long-Term Effects of Indomethacin in Extremely-Low-Birth-Weight Infants
Preterm infants often receive indomethacin prophylaxis to reduce the frequency of patent ductus arteriosus and prevent severe periventricular and intraventricular hemorrhage. In this study, infants with birth weights ranging from 500 to 999 g were randomly assigned to receive indomethacin or placebo. Indomethacin reduced the incidence of patent ductus arteriosus and severe intracranial hemorrhage, but there were no differences in the rate of survival or neurosensory impairment at 18 months.
The results of this study confirm that indomethacin has short-term benefits in extremely-low-birth-weight infants, but there was no improvement in survival or neurologic development. The argument against prophylaxis would be stronger if the infants who would benefit from treatment could be identified soon after birth.
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Transfusion-Transmitted Malaria in the United States
Although uncommon, malaria is still acquired in the United States through the transfusion of infected blood. This report describes 93 patients with malaria acquired by transfusion from 1963 to 1999. Plasmodium falciparum was the most common causative species, and 11 percent of the 93 infected patients died.
Since there is no approved laboratory test to screen blood for malaria, prevention depends on the exclusion of potentially infected donors on the basis of information obtained by interview. This means that about 3 percent of all blood donations should not be used because of the potential risk of transmission of malaria.
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Before (Upper Panel) and After (Lower Panel).
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Nephropathy and Establishment of a Renal Reservoir of HIV during Primary Infection
Nephropathy associated with human immunodeficiency virus type 1 (HIV-1) infection is the most common cause of chronic renal disease in patients with HIV-1 infection. This clinical and pathological study of a patient with HIV-1 infection demonstrates that nephropathy can occur during primary infection and that highly active antiretroviral therapy can result in resolution of the nephropathy. However, the expression of HIV-1 persisted in renal epithelial cells during treatment, indicating that the kidney may be an important reservoir of the virus.
The clinical course and serial renal biopsies in this patient provide convincing evidence that antiretroviral-drug therapy can lead to healing of nephropathy. Nonetheless, viral DNA was detected in biopsy specimens obtained both before and after treatment, leading to the conclusion that the kidneys -- like peripheral-blood mononuclear cells and cells in the reproductive tract -- can serve as a reservoir for the virus, helping to explain why the infection is almost impossible to eradicate.
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Medical Progress: Advances in Mechanical Ventilation
Mechanical ventilation is a critical intervention in the care of many seriously ill patients. The primary objectives are to decrease the work of breathing and to reverse hypoxemia and acute respiratory acidosis. The most common indications for mechanical ventilation are acute respiratory failure, coma, chronic obstructive pulmonary disease, and neuromuscular disorders. This concise review discusses current approaches to mechanical ventilation, including types of ventilation and methods of weaning the patient from the ventilator.
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Drug Therapy: Side Effects of Adjuvant Treatment of Breast Cancer
Many women with breast cancer receive adjuvant chemotherapy (usually with multiple cytotoxic drugs), tamoxifen, radiation therapy, or combinations of the three treatments. This review summarizes the short- and long-term side effects of adjuvant regimens and the steps that can be taken to ameliorate them.
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