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Resistance to chloroquine is a major challenge in the treatment of falciparum malaria. In 1993, Malawi replaced chloroquine with sulfadoxine–pyrimethamine for malaria treatment. After the return of chloroquine-susceptible falciparum malaria to Malawi, investigators studied the reemergent clinical efficacy of chloroquine and found that it was approximately 99% effective.
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Induction therapy reduces the frequency of acute rejection and delayed graft function. In this study in patients at high risk for acute rejection or delayed graft function who received a cadaveric renal transplant induction therapy with rabbit antithymocyte globulin reduced the incidence and severity of acute rejection, but not the incidence of delayed graft function, as compared with a monoclonal interleukin-2 receptor antibody. Patient and graft survival were similar in the two groups.
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In this sham-controlled trial of neurostimulation of the internal globus pallidus for primary dystonia, neurostimulation improved movement, disability, and quality-of-life scores. Adverse events were common; 18% of patients had infections at the stimulator site, seroma, or lead breakage or dislodgment, and 12% had dysarthria.
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Spinal epidural abscesses are often initially misdiagnosed, particularly in neurologically intact patients. Epidural infections can cause injury to the spinal cord. The incidence of these infections has increased with increasing use of spinal instrumentation, vascular access, and injection drugs. This review explains the diagnostic and therapeutic challenges and how to avoid spinal cord infarction.
Abdominal paracentesis can establish the cause of ascites or rule out spontaneous bacterial peritonitis in patients with ascites. Large-volume paracentesis in hemodynamically stable patients with tense or refractory ascites can alleviate discomfort or respiratory compromise. This procedure video demonstrates how to perform paracentesis.
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A 72-year-old woman awoke from sleep with nausea that worsened during a 24-hour period. Evaluation disclosed pulmonary infiltrates, an elevated granulocyte count, hypoxemia, and hypotension; antibiotics were administered. Blood drawn later showed elevated levels of cardiac enzymes, and an electrocardiogram showed ST-segment elevation. Hypoxemia and hypotension worsened. A diagnostic procedure was performed.
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