Investigators from the Centers for Disease Control and Prevention report the effect of the conjugate pneumococcal vaccine used in children on drug-resistant Streptococcus pneumoniae infections in the United States between 1999 and 2004. They found that the overall rate of infection with penicillin-nonsusceptible pneumococci decreased from 6.3 to 2.7 cases per 100,000. This decreased rate of invasive infection was observed in both children and adults. An increase in the rate of infection with drug-resistant nonvaccine serotypes was identified.

Unfractionated heparin and low-molecular-weight heparins are often used to treat acute coronary syndromes. In this study, the pentasaccharide fondaparinux was found to have efficacy equal to that of enoxaparin in terms of anti-ischemic benefits but was associated with substantially less bleeding and lower long-term morbidity and mortality.

As an adjunct to fibrinolysis in ST-elevation myocardial infarction, 7 days of enoxaparin was superior to 48 hours of unfractionated heparin. However, the enoxaparin regimen was associated with more episodes of bleeding. Considering both efficacy and safety together, this study found that the enoxaparin regimen had a net clinical benefit, as compared with the unfractionated heparin regimen.

This study shows that mice with mutant type IV collagen 1 protein are susceptible to trauma-induced hemorrhage and stroke. Building on this finding is the discovery that a variant of the human orthologue is associated with small-vessel disease and hemorrhagic stroke.

A 46-year-old woman, married for 16 years, reports having had a low level of sexual desire and minimal sexual arousal during sexual activity for the past 10 years. Sexual thoughts, fantasies, and orgasms are all extremely rare. Lubrication is sufficient to allow painless intercourse. She and her husband have an eight-year-old son who was born after in vitro fertilization for unexplained infertility. How should this patient be assessed and treated?

There are marked sex-based differences in the epidemiology, clinical manifestations, course, and treatment of disease. Although very few of these differences are understood in molecular or cellular terms, explanations must derive from the fundamental biologic differences between the sexes. This article reviews the current understanding of hormonal and genetic differences between the sexes.

A previously healthy 27-year-old man presented to his primary care physician six days after the onset of a nonproductive cough, sore throat, and a feeling of being "run down." During the preceding week, he had also begun to have a fever and diffuse abdominal pain of mild-to-moderate intensity. Two days before presentation, he noticed that his urine was dark-colored and his eyes were red and itchy, with a clear, thick discharge.