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More than 17,000 ill returned travelers were evaluated within the GeoSentinel network, 30 specialized travel clinics around the globe. Some of the most common pathogens identified were those causing malaria, dengue, and rickettsial disease. The proportionate morbidity of various travel-related infectious diseases was calculated according to region of travel.
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Angiotensin-converting–enzyme (ACE) inhibitors provide renal protection in patients with mild-to-moderate renal insufficiency, slowing progression. However, the efficacy and safety of this class of medications in patients with advanced renal insufficiency are less clear. The results of this randomized, double-blind study indicate that benazepril, an ACE inhibitor, confers substantial renal benefits in patients without diabetes who have advanced renal insufficiency.
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The survival of patients receiving transplanted lungs is poorer than that of patients receiving transplants of many other organs. In this trial, inhaled cyclosporine, in addition to systemic immunosuppression, did not improve rejection rates but was associated with better overall survival and chronic rejection–free survival.
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Pacemaker channels in the sinoatrial node generate the sinus rhythm and regulate the heart rate. In an Italian family affected by sinus bradycardia, a mutation was identified in the α-subunit of the cardiac pacemaker channel. This mutation mimics the effect of mild vagal stimulation on heart rate.
A 36-year-old woman with a long history of catamenial migraines had had a headache almost every day for a year. The background headache was mild, but it became severe and incapacitating at least twice a week, interfering with work and sleep. She took six to eight tablets containing a combination of aspirin, acetaminophen, and caffeine per day, with minimal relief. She did not have fever, weight loss, diplopia, or tinnitus. Her headaches were not exacerbated by a Valsalva maneuver or positional change. Her physical examination was normal. How should she be evaluated and treated?
A 64-year-old man who had received a double-lung allograft because of emphysema six months previously was admitted to the hospital with cough, hemoptysis, and abdominal pain of three days' duration. He had a history of smoking, chronic obstructive pulmonary disease, and lung cancer. Since the transplantation, he had had an episode of rejection and had recently had thrombophlebitis of the leg. A chest radiograph revealed a new right upper-lobe infiltrate, and a cytomegalovirus antigenemia test was positive at 185 cells per two slides. A diagnostic procedure was performed.
The authors argue that extensive reform of the system of drug regulation in the United States is needed to improve drug safety. In order to develop a more comprehensive system that is not so narrowly focused on testing of drugs before marketing, the authors propose a new federal authority for drug regulation, to be made up of three independent centers: a Center for New Drug Approval, a Center for Post-marketing Studies, and a Center for Drug Information.
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