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December 5, 2002 Vol. 347 No. 23
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There are two approaches to the treatment of atrial fibrillation: rate control, allowing atrial fibrillation to persist, and rhythm control, with cardioversion and antiarrhythmic drugs. This North American study found that, contrary to prevailing practice, rhythm control offered no survival advantage and was associated with higher rates of adverse drug effects than rate control.
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This study is the European counterpart of the North American study of atrial fibrillation reported in this issue of the Journal. Although the European study was smaller, the findings in the two studies were quite similar. Rate control was not inferior to rhythm control and should be regarded as appropriate for the management of persistent atrial fibrillation.
In Papua New Guinea, approximately 2500 residents participated in a prospective, four-year study of the effects of a single dose of antifilarial drugs given annually for four years. The proportion of microfilariae-positive infections decreased by 86 to 98 percent, and the frequency of hydrocele declined from 15 percent to 5 percent.
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There is considerable variation in the patterns of resistance to antituberculosis drugs around the world. This decision-analysis study incorporated data on region-specific drug-resistance profiles. The results show that detecting and treating latent tuberculosis in new immigrants to the United States with the appropriate regimens was cost-saving in the case of immigrants from seven regions and was highly cost effective for immigrants from other developing nations.
A 44-year-old man who recently immigrated from Peru is found to have induration of 16 mm on a tuberculin skin test. He received bacille Calmette–Guérin vaccine as an infant and is asymptomatic. Chest radiography shows fibronodular opacities in the upper lobe. In another case, a 27-year-old schoolteacher born in the United States has induration of 17 mm on a tuberculin skin test, no symptoms, and a normal chest radiograph. How should these patients' cases be managed?
Classic genetic tests indicate, either directly or indirectly, the presence of DNA variants associated with rare but highly penetrant disorders such as Huntington's disease or multiple endocrine neoplasia type 2. This article not only reviews these classic tests but also shows how novel genetic tests can reveal the presence of DNA variants that are more logically considered risk factors for a given condition.
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