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The efficacy of calcium with vitamin D supplementation in preventing hip and other fractures in healthy postmenopausal women remains equivocal. In this Women's Health Initiative trial, 36,282 such women received calcium with vitamin D or placebo, with an average follow-up of seven years. Calcium with vitamin D supplementation moderately but significantly improved hip bone density, did not significantly reduce hip fracture, and increased the risk of kidney stones.
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Supplemental calcium and vitamin D have been associated with a reduced risk of colorectal cancer in epidemiologic and polyp-prevention studies, but evidence from randomized trials was lacking. Although the long latency involved in colorectal cancer may be relevant, this Women's Health Initiative trial involving 36,282 postmenopausal women showed that daily calcium plus vitamin D supplementation for an average of seven years had no effect on the incidence of colorectal cancer.
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Patients with severe asthma are distinct from patients with milder forms of the disease. Peripheral-blood monocytes from patients with severe asthma were shown to have enhanced expression of markers associated with tumor necrosis factor α (TNF-α). In a pilot, placebo-controlled, crossover study, the TNF-α receptor–binding agent etanercept improved airway responsiveness and asthma-related quality of life. TNF-α may have a role in refractory asthma.
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In this large study using Medicare data, hospitalization of patients was associated with increased mortality in their wives and husbands, and the adverse effect was independent of the effect of spousal death. The effect varied among illnesses; for example, a man's hospitalization for colon cancer did not increase his wife's risk of death, but his hospitalization for dementia had a substantial effect.
Given its rarity, drug-related hepatotoxicity may not be seen during the initial clinical trials of a new medication. After approval, when many more patients are exposed, toxic effects that are very infrequent may emerge. This review explains the difficulties in identifying the cause of hepatotoxic effects in such situations and provides clinical guidance with regard to the detection, evaluation, and possible prevention of drug-related hepatotoxicity.
An 11-year-old girl noticed a sudden loss of vision in her right eye. An examination disclosed leukokoria; she was sent to the emergency department. A test for visual acuity revealed only light perception in the right eye. Further examination and an ultrasonographic study disclosed a detached retina.
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