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October 31, 2002 Vol. 347 No. 18
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Congestive heart failure has an extremely poor prognosis. This investigation from the Framingham Heart Study tracked trends over a 50-year period in the incidence of heart failure and in survival after its onset. During this period, the incidence of heart failure declined among women but not among men, whereas survival improved among both men and women.
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The Digitalis Investigation Group previously reported no difference in mortality between patients with heart failure who received digoxin and those who received placebo. In this post hoc analysis, men and women in the trial were analyzed separately. Digoxin therapy had no effect on mortality in men but was associated with an increase in overall mortality among women (33.1 percent in the digoxin group vs. 28.9 percent in the placebo group).
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It can be difficult to distinguish pyoderma gangrenosum from other causes of cutaneous ulceration. In this study, the authors identified 95 patients with skin ulcers that resembled pyoderma gangrenosum. The ulcers were actually caused by vascular occlusive or venous disease, vasculitis, cancer, infection, drug-induced or exogenous tissue injury, or other inflammatory disorders. Most patients who received a diagnosis of pyoderma gangrenosum were treated, and 36 percent of those who were treated had exacerbation of their underlying condition or a delay in its diagnosis.
In India nearly 500,000 people die each year from tuberculosis. Recent improvements in the national tuberculosis-control program are standardizing treatment, follow-up, and mandated reporting. More than 200,000 new health workers have been trained, and about 3.4 million patients have been evaluated. Nearly 800,000 patients have been treated, with a success rate of approximately 83 percent. The cost is about $50 per patient treated.
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When ventricular septal rupture complicates acute myocardial infarction, the mortality rate is high and immediate operative intervention is indicated. This review explains that septal rupture has become less common with reperfusion therapy but that rapid diagnosis remains crucial. Doppler echocardiography is usually diagnostic and can be used to estimate the size of the left-to-right shunt.
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To stimulate more evaluation of the safety and efficacy of medications in children, two federal regulations were established. The pediatric exclusivity provision gives an additional six months of patent protection to companies that voluntarily test a medication in children, whereas the pediatric rule requires pediatric studies if a drug is important for children.






