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In patients with Staphylococcus aureus bacteremia or right-sided endocarditis, daptomycin was shown to be noninferior to standard antimicrobial therapy (vancomycin or an antistaphylococcal penicillin with low-dose gentamicin). Microbiologic evidence of treatment failure was more common in the daptomycin group, whereas treatment failure caused by an adverse event occurred more often in the standard-therapy group.
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The rapid emergence of methicillin-resistant S. aureus (MRSA) as a community pathogen threatens to change the practice of outpatient medicine. In this report, investigators from emergency departments in 11 cities throughout the United States show that S. aureus accounts for 76 percent of culturable skin and soft-tissue infections, of which 59 percent are MRSA.
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In this clinical trial, patients who had a rheumatic disease and were receiving glucocorticoids were given either daily alendronate and alfacalcidol placebo or daily alfacalcidol and alendronate placebo. Alendronate was more effective than alfacalcidol in the prevention of glucocorticoid-induced bone loss in the lumbar spine.
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In this prospective study, moderate-to-severe white-matter abnormalities on magnetic resonance imaging (MRI) at term equivalent among very preterm infants were significant predictors of neurodevelopmental impairments at a corrected age of two years. These abnormalities were predictive of severe motor delay and cerebral palsy even after adjustment for findings on cranial ultrasonography and other clinical factors.
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In this large survey of Americans 55 years of age or older, functional limitation was inversely associated with income across a broad range of income, with functional limitation most common among persons at the poverty line and least common among those at 700 percent or more of the poverty line.
Rheumatoid arthritis that was resistant to methotrexate and sulfasalazine developed in a 25-year-old woman who was evaluated for possible treatment with a tumor necrosis factor inhibitor. These agents are effective in some patients who have not had a response to other therapies. They increase the risk of infection, and their long-term efficacy and safety are not established.
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A 41-year-old woman had a three-year history of multiple painful subcutaneous nodules on the head, neck, and trunk. The pain was present at rest and increased on palpation of the nodules and with activity. The patient described intermittent fever and swelling of the arms and legs. Examination disclosed subcutaneous nodules on the neck and trunk that were tender on palpation. A diagnostic procedure was performed.
The cryopyrin gene, previously shown to be mutated in patients with periodic-fever syndrome, is critical in the innate immune response to some bacterial infections and to the inflammation that occurs after exposure to the crystalline material found in the joints of people with gout and pseudogout.
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