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January 6, 2005 Vol. 352 No. 1
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Among a cohort of children born at 25 weeks or fewer of gestation in the United Kingdom and Ireland in 1995 and evaluated at a median age of six years and four months, cognitive and neurologic impairment was common. An earlier diagnosis of severe disability at 30 months of age was highly predictive of moderate-to-severe disability at early school age.
Statin therapy lowers not only low-density lipoprotein (LDL) cholesterol levels, but also levels of C-reactive protein (CRP), a marker of inflammation. This study examined the independent effects of decreasing LDL cholesterol and CRP levels on subsequent coronary risk in patients with acute coronary syndromes who were receiving pravastatin or atorvastatin. Lowering CRP levels reduced coronary risk irrespective of the extent of LDL cholesterol lowering. Patients with the lowest risk had the lowest levels of both LDL cholesterol and CRP after 30 days of statin therapy.
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Statins have pleiotropic effects, reducing not only low-density lipoprotein cholesterol levels, but also the levels of C-reactive protein (CRP), an inflammatory marker. This study found that the effects of statin therapy on the progression or regression of coronary atherosclerosis are related to both their lipid-lowering effect and their CRP-lowering effect. These results provide additional support for the concept that part of the beneficial effect of statins is due to the lowering of CRP.
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At a rural district hospital in Kenya, nearly 13 percent of infants were found to have bacteremia on admission, as were nearly 6 percent of all children who were 60 or more days of age. Of all the deaths in the hospital, 26 percent were among infants and children with community-acquired bacteremia.
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Metabolic complications such as dyslipidemia, insulin resistance, and altered fat distribution (loss of subcutaneous fat and relatively increased central fat) are common in adults infected with the human immunodeficiency virus who are receiving highly active antiretroviral therapy and may increase their risk of cardiovascular disease. This review discusses progress in understanding the pathogenetic mechanisms and treatment strategies for addressing cardiovascular risk in this population.
This report discusses the heated controversy over the proliferation of physician-owned specialty hospitals, such as cardiac and orthopedic hospitals. The owners of general hospitals argue that specialty hospitals provide services for the most profitable cases and thus have an unfair competitive advantage. Late in 2003, Congress declared an 18-month moratorium on the opening of new specialty hospitals, and it will soon decide whether the moratorium should be lifted or made permanent.
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