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July 15, 2004 Vol. 351 No. 3
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In a randomized, controlled trial in Thailand, pregnant women infected with the human immunodeficiency virus (HIV) type 1 received zidovudine treatment plus a single dose of either nevirapine or placebo. The rate of transmission of HIV to newborns was 2.8 percent in the nevirapine group and 6.3 percent in the placebo group. The rate was 1.9 percent in a group in which a single dose of nevirapine was also administered to the infants shortly after delivery.
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After participating in a placebo-controlled trial of antiviral regimens to reduce mother-to-child transmission of the human immunodeficiency virus (HIV) in Thailand, some of the women began taking a nevirapine-containing regimen. After six months, the rate of viral suppression was lower among the mothers who had received intrapartum nevirapine than among those who had not received it (49 percent vs. 68 percent, P=0.03).
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Despite knowledge that women with hypothyroidism should increase their usual levothyroxine dose during pregnancy, biochemical hypothyroidism still occurs. This study found that the levothyroxine requirement increased by a mean of 48 percent during the first half of pregnancy and that monitoring and dose adjustments were required until delivery.
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Arterial thrombosis is an important complication of systemic lupus erythematosus. These investigators found that the presence of variant alleles of mannose-binding lectin (MBL), a serum protein involved in innate immune defense, increases the risk of arterial thrombosis, especially myocardial infarction, in patients with lupus. The results suggest that the common allelic forms of mannose-binding lectin may have a role in protecting against arterial thrombotic events.
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A woman sought medical attention because of chest pain and shortness of breath. Physical examination and echocardiographic studies showed evidence of a pericardial effusion and cardiac tamponade. She was admitted to the hospital, and the effusion was drained, yielding fluid that was negative on culture and cytologic analysis. She had traveled to Kenya; a tuberculin skin test five months after the trip had been negative, but a test during hospitalization was positive.
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