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November 14, 2002 Vol. 347 No. 20
Can adjuvant treatment with dexamethasone reduce morbidity and mortality in adults with acute bacterial meningitis? In this randomized, double-blind trial, which involved 301 patients, the outcomes were clearly better in the group that received dexamethasone for four days, in addition to antibiotics, than in the group that received placebo and antibiotics. With dexamethasone treatment, the risk of an unfavorable outcome was greatly reduced (relative risk, 0.59), and mortality was reduced from 15 percent to 7 percent.
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Studies have suggested that C-reactive protein, a marker of inflammation, may predict the risk of cardiovascular events, including coronary events. In this study of nearly 28,000 women, C-reactive protein levels were found to predict the risk of subsequent cardiovascular events independently of other known coronary risk factors. C-reactive protein and low-density lipoprotein cholesterol levels were found to be complementary in the prediction of risk.
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In women with diabetes, treatment of asymptomatic bacteriuria has been recommended to prevent complications. In this trial, 55 women with diabetes and asymptomatic bacteriuria were randomly assigned to receive antimicrobial therapy and 50 to receive placebo. After a mean follow-up of 27 months, the rates of symptomatic urinary tract infection were similar: 42 percent in the treated group and 40 percent in the placebo group. There were also no significant differences between the two groups in the rates of pyelonephritis or hospitalization for urinary tract infection, although the 95 percent confidence intervals for these differences were wide.
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Mortality from all causes is higher for persons with less education and for black persons. This study examined cause-specific mortality to estimate the relative contribution of major health problems to these educational and racial disparities in life expectancy. The diseases that contributed most to the educational disparity were smoking-related diseases. Ischemic heart disease accounted for 12 percent of the disparity, lung cancer 8 percent, stroke 6 percent, congestive heart failure 5 percent, and lung disease 5 percent. The racial disparity was not driven by mortality from smoking-related illness but by hypertension, human immunodeficiency virus infection, diabetes, and trauma.
The apparent complexity of the genetic, biochemical, and physiological changes in cancer cells threatens to stall the elucidation of the origins of cancer and the development of new treatments for malignant diseases. The authors propose a considerably simplified scheme in which only five alterations are required to transform cells from a normal to a malignant phenotype.
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Systems for reporting adverse events can reduce medical errors by uncovering remediable problems in processes of care; however, current reporting systems are neither widely used nor highly effective. Reporting systems work best when they are confidential and easy to use, provide expert analysis of reports, and give timely feedback.






