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The use of systemic corticosteroids in the treatment of the acute respiratory distress syndrome (ARDS) is controversial. In this study, 180 patients were treated with methylprednisolone sodium succinate or placebo within 7 to 28 days after the onset of ARDS. There was no significant difference in mortality at 60 or 180 days; thus, treatment of ARDS with systemic corticosteroids is not recommended.
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Persons with prehypertension (formerly, “borderline hypertension”) were randomly assigned in a blinded fashion to receive two years of candesartan or placebo, followed by two years of placebo for all. Over four years, therapy with candesartan reduced the risk of the development of hypertension by 15.6 percent (P<0.007). Further research is needed to evaluate the clinical usefulness and ultimate safety of antihypertensive treatment for prehypertension.
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In this randomized, controlled trial in children who presented to an emergency department with vomiting and dehydration due to gastroenteritis, a single dose of oral ondansetron reduced vomiting, facilitated oral rehydration, and decreased the use of intravenous rehydration. The rate of hospitalization was low (4 percent) and was not significantly reduced by treatment with ondansetron.
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The Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial compared clopidogrel plus aspirin with aspirin alone for reducing the rate of myocardial infarction, stroke, or death from cardiovascular causes in patients with stable cardiovascular disease or multiple cardiovascular risk factors. There was no difference between the treatment groups in this outcome.
A 30-year-old man notes diffuse, intense itching. He reports that his girlfriend has the same itchiness. Examination of the skin reveals interdigital lesions, with small papules, vesicles, and excoriations on the hands and indurated nodules on the genitalia, all of which are suggestive of classic scabies. How should this case be managed?
A 37-year-old physician was seen in the pulmonary clinic because of night sweats, hemoptysis, and a mass-like infiltrate visible in the lower lobe of the right lung on computed tomography (CT). He was otherwise in good health; a recent tuberculin skin test was negative, and the results of a physical examination and routine laboratory tests were normal. Antibiotics were prescribed, and the infiltrate resolved, but night sweats continued. CT repeated three months later disclosed new lesions in the same lobe. A diagnostic procedure was performed.
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