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National data on deaths among on-duty firefighters between 1994 and 2004 were assessed in relation to estimates of the proportions of time spent by firefighters in various duties. The rate of death from coronary heart disease during active fire suppression was approximately 10 to 100 times as high as the expected rate. This study suggests that firefighting is associated with an unusually high risk of death from cardiac causes.
A region on chromosome 17 has been associated with a range of epidemiologically associated autoimmune and autoinflammatory diseases, including vitiligo. Using two sets of genetic markers and two groups of patients, the authors have implicated variants of NALP1 in susceptibility to autoimmune disease.
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Enterovirus 71 is a common cause of hand, foot, and mouth disease and encephalitis in Asia and elsewhere. Among 142 children who had enterovirus 71 infection with central nervous system involvement, assessment at 2.9 years after infection revealed poor neurodevelopment and cognitive outcomes for children who had severe central nervous system involvement with cardiopulmonary failure. In most children who had central nervous system involvement alone, neurodevelopment was normal.
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Pulsed-dye–laser therapy is effective for port-wine stains, but the benefits may not be durable. This follow-up study of patients who had received an average of five laser treatments demonstrated redarkening of port-wine stains 10 years after treatment. Patients should be informed about the possibility of redarkening before beginning treatment.
A 58-year-old, previously healthy mail carrier reports cramping pain in his right calf when he walks. The discomfort has progressively worsened over the past 6 months and is interfering with his ability to perform his job; he can now walk no farther than half a block without rest. He has a normal right femoral pulse and a diminished right popliteal pulse; right ankle and foot pulses are absent. How should this patient be evaluated and treated? Should he undergo revascularization?
A 27-year-old woman had the sudden onset of pain in the feet, more in the left foot than in the right, associated with edema of the lower legs and a rash over the feet and toes. Pain and paresthesia persisted and worsened; a neurologic examination revealed normal motor strength and reflexes but decreased sensation to pinprick in the toes. A diagnostic procedure was performed.
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