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February 17, 2005 Vol. 352 No. 7
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In this randomized trial involving nulliparous women at term, the rate of cesarean delivery was not higher among women who were given intrathecal analgesia early in labor than among those given systemic analgesia early in labor. Women who received intrathecal analgesia early also had better pain control and a shorter time to delivery.
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B-type natriuretic peptide is released by the ventricles in response to hemodynamic stress, and circulating levels have prognostic value in heart failure and unstable coronary disease. In this study, there was a significant independent association between circulating levels of N-terminal pro-BNP (an inactive fragment of the parent molecule) and overall mortality in stable coronary disease. The findings extend the prognostic value of this biomarker to a wider population of patients with cardiac disease.
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Patients being treated for gonorrhea or chlamydia were offered medication to give to their sexual partners or standard referral of partners. There was a lower rate of recurrent or persistent gonorrhea among the patients with expedited treatment of partners than among those with standard referral of partners (10 percent vs. 13 percent). This strategy had a smaller effect on recurrent chlamydial infection than on recurrent gonorrhea.
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In southern Vietnam, a four-year-old boy presented with severe diarrhea, followed by seizures, coma, and death. His nine-year-old sister had died from a similar syndrome two weeks earlier. In both children, the clinical diagnosis was acute encephalitis. Neither had respiratory symptoms at presentation.
This practical review for clinicians explains that memory dysfunction is now understood in terms of four systems: episodic memory, semantic memory, procedural memory, and working memory. Separate anatomical areas of the brain are responsible for each memory system. This overview of memory should help nonspecialists in the evaluation and diagnosis of patients with various types of memory dysfunction.
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A 53-year-old man had decreased energy and appetite after losing his job; he came to the emergency department for psychiatric evaluation. A diagnosis of major depressive disorder was made; on the medical-clearance evaluation, a pulmonary infiltrate and a high white-cell count were found. While awaiting admission, he became short of breath; pulmonary edema was observed.
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