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In this double-blind trial, two oral doses of a live attenuated G1P[8] rotavirus vaccine were highly efficacious in protecting infants against severe diarrheal disease. During the active surveillance of 63,225 infants, the risk of intussusception was no greater after vaccination than it was with placebo (six cases vs. seven cases).
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In this randomized trial, the clinical efficacy of an oral, live pentavalent human–bovine reassortant vaccine was estimated to be 98.0 percent against severe gastroenteritis due to rotavirus. In the safety study, which included 68,038 infants, the rates of intussusception were similar in the vaccine and placebo groups (relative risk, 0.8; 95 percent confidence interval, 0.3 to 1.8).
This review summarizes recent changes in the treatment of adults with community-acquired bacterial meningitis. It explains the initial assessment and management, the use of adjunctive corticosteroids, and intensive care monitoring. The authors detail the approach to complications such as transtentorial herniation, hydrocephalus, and focal seizures.
Autoimmune hepatitis is a generally progressive, sometimes fluctuating chronic hepatitis of unknown cause that occurs in children and adults of all ages. It is important to distinguish autoimmune hepatitis from other forms of chronic hepatitis, because a high percentage of cases respond to antiinflammatory or immunosuppressive therapy, or both. Appropriate management can prolong survival, improve quality of life, and avoid liver transplantation. This review discusses the pathogenesis, diagnosis, and treatment of this important form of hepatitis.
A 63-year-old man presented to the emergency department with shortness of breath that had begun the evening before, after he had gone to bed, and worsened progressively during the night. He had had no fevers, chills, cough, hemoptysis, chest pain, or peripheral edema and had no history of congestive heart failure. Five months earlier, a pulmonary embolus had been diagnosed, for which he received warfarin maintenance therapy; the results of prothrombin-time testing, expressed as an international normalized ratio, were consistently above 2.0.
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