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Asthma is accompanied by inflammation of the airway. In this study, immunohistochemical analysis of the lymphocytes identified in asthmatic airways was consistent with a finding of natural killer T cells expressing an invariant T-cell receptor that produced type 2 helper (Th2) cytokines. These findings call into question the previous designation of these airway lymphocytes as Th2 T cells.
In this randomized, controlled trial of elderly patients with major depression who had had a response to initial treatment with paroxetine and psychotherapy, two years of maintenance paroxetine prevented recurrent depression, but maintenance psychotherapy did not. Major depression recurred in 35 percent of patients receiving paroxetine plus psychotherapy, 37 percent of those receiving paroxetine plus clinical-management sessions, 68 percent of those receiving placebo plus psychotherapy, and 58 percent of those receiving placebo plus clinical-management sessions.
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In this randomized trial in women under 36 years of age who were undergoing a first or second trial of in vitro fertilization, transfer of a single blastocyst-stage (day 5) embryo resulted in higher rates of pregnancy and delivery than transfer of a single cleavage-stage (day 3) embryo. Multiple gestation was rare.
Previous research has found differences in health care access and quality among sociodemographic groups. In this study of patients who had made at least one visit to a health care provider during the previous two years, quality-of-care scores were suboptimal overall but were not lower for women than for men or for black or Hispanic patients than for whites. Poorer patients had a slightly lower quality of care: recommended care was received by 53 percent of those with annual family incomes below $15,000 and 57 percent of those with incomes above $50,000.
The prevalence of delirium increases sharply with age, and about 20 percent of older patients have delirium at the time of hospital admission for any reason. This review summarizes the clinical manifestations of and risk factors for delirium and the evaluation of patients with this condition. It includes an update on the current understanding of the pathogenesis of delirium and provides guidance regarding practical measures to prevent this common complication.
A 71-year-old woman with Crohn's disease, who had been receiving treatment with mercaptopurine and infliximab, had fatigue, blurred vision, headache and mood changes, and an inguinal mass. She had a sudden onset of left-sided weakness; brain imaging disclosed a mass, and she was transferred to this hospital. Shortly after admission, she had a seizure and became unresponsive.
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