Avian influenza A (H5N1) spread to Turkey in late 2005. These investigators report on the clinical characteristics of 8 of the 12 patients with WHO-confirmed H5N1 infection in Turkey in January 2006, including all the patients who died. Establishing the diagnosis of H5N1 infection was quite challenging and was successfully achieved with the use of a real-time polymerase-chain-reaction assay.

In 2005, multiple cases of avian influenza A (H5N1) virus infection were identified in Indonesia. Three case clusters are reported, involving eight patients with a 50% rate of death, although mild disease was also seen. The outbreak was caused by clade 2 H5N1 virus, and no antiviral resistance was identified.

In this randomized trial of fetal pulse oximetry, there were no significant differences in the rates of cesarean delivery (overall or for the indication of a nonreassuring fetal heart rate) or in the conditions of infants at birth between women whose clinicians were made aware of the oximetry results and women whose clinicians were not. These findings do not support the use of fetal pulse oximetry in women in labor.

In this trial, patients with acute coronary syndromes undergoing an early invasive approach were randomly assigned to treatment with heparin or enoxaparin plus a glycoprotein IIb/IIIa inhibitor, bivalirudin plus a glycoprotein IIb/IIIa inhibitor, or bivalirudin alone. Rates of ischemic events at 30 days were similar for all three groups, whereas major bleeding was significantly reduced in the group receiving bivalirudin alone. The trial suggests that bivalirudin monotherapy may be similar in efficacy to standard therapy, although bivalirudin monotherapy is associated with a reduced risk of bleeding. Pretreatment with a thienopyridine seems to be necessary if bivalirudin monotherapy is used.

This article considers how doctors learn to reason in the clinical environment and recommends practical approaches that clinical teachers can use to promote the development of strong diagnostic reasoning skills in their students.

This review surveys the data on the increase in the prevalence of asthma in recent decades and finds evidence of a plateau in many Western countries. The authors examine the evidence of possible causal relations to factors such as air pollution, obesity, diet, and exposure to infections, antibiotics, and allergens, including exposures at very young ages. The most strongly supported preventive measure is the avoidance of passive and active exposure to smoke.

A 35-year-old woman in her second pregnancy was found to have hypertension and glycosuria at 17 weeks' gestation, which persisted despite medication. She was admitted to the hospital. She had had gestational diabetes during her first pregnancy. Serum electrolytes were normal except for a potassium level of 2.6 mmol per liter. Additional laboratory testing and a diagnostic procedure were performed.

Molecular pathways that modulate neurotoxicity of the -amyloid peptide have been delineated; these are controlled by another pathway that modulates aging.