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Seroprevalence studies suggest that one third of the world's population has been infected with hepatitis E virus (HEV). Infection, especially during pregnancy, is associated with substantial rates of death and complications. No vaccine or specific therapy has been available for the treatment of HEV infection. In this double-blind, placebo-controlled trial involving 2000 subjects in Nepal, the administration of three doses of a novel recombinant HEV vaccine had 95.5% efficacy.
This report describes the serologic and clinical findings in 29 patients in whom thrombocytopenia developed during treatment with vancomycin. Vancomycin-dependent antiplatelet antibodies were detected in these patients. The platelet counts returned to normal within days after discontinuation of the antibiotic.
Epidemiologic data suggest a possible link between periodontal disease and cardiovascular disorders. In this study, patients with severe periodontitis who were treated with intensive periodontal therapy, as compared with standard community-based therapy, had improvement in flow-mediated dilatation, a measure of vascular endothelial function. The findings suggest that severe periodontal inflammation may promote vascular endothelial dysfunction.
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This study assessed the effectiveness of the Health Disparities Collaboratives, which were designed to improve care for patients with chronic disease at community health centers, where many patients in minority groups and uninsured patients receive treatment. The collaboratives improved care for diabetes and asthma but not for hypertension. There were significant improvements in many of the processes of care, such as the monitoring of glycated hemoglobin levels, but not in any of the clinical outcomes measured, such as the control of glycated hemoglobin levels.
A 73-year-old man with coronary artery disease, hypertension, and renal insufficiency presents with recurrent, symptomatic atrial fibrillation despite a well-controlled ventricular rate. Amiodarone is recommended for rhythm control. Amiodarone is among the most effective antiarrhythmic agents, but its use is associated with potentially serious toxic effects — is it right for this patient?
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