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This epidemiologic study showed that the incidence of heart failure among young adults who were followed over the course of 20 years was much higher among blacks than among whites. Elevated blood pressure, obesity, chronic kidney disease, and systolic dysfunction noted in early adulthood were important antecedents. The findings underscore racial disparity in the development of heart failure and have implications for strategies aimed at the prevention of this disease.
Congenital cytomegalovirus (CMV) infection is a cause of significant neonatal morbidity. Preventing maternal infection during pregnancy is a potential strategy to minimize neonatal infection and disease. In this phase 2, randomized, double-blind, placebo-controlled trial, 464 women without CMV infection who were likely to become pregnant received either a CMV envelope glycoprotein B vaccine or placebo. Those who received the CMV vaccine had a 50% reduction in the incidence of CMV infection over 42 months.
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A 39-year-old female executive has a several-month history of fatigue, headache, and memory lapse. During a period of feeling worse than usual, she called a friend, who arrived at the residence to find the woman semicomatose and called 911. The patient was given supplemental oxygen and transported to the emergency department, where she is alert and has nonfocal findings on examination. Her carboxyhemoglobin level is 18%. How should she be treated? What is her expected outcome?
Moyamoya disease is a cerebrovascular condition predisposing affected patients to stroke in association with progressive stenosis of the intracranial internal carotid arteries and their proximal branches. Patients with characteristic moyamoya vasculopathy plus associated conditions are categorized as having moyamoya syndrome. This review describes the demographic characteristics, pathogenesis, evaluation, and treatment of moyamoya disease and syndrome.
An 81-year-old man was admitted to the hospital because of acute and massive rectal bleeding associated with hypotension. Two episodes of rectal bleeding had occurred in the previous 2 years, and evaluation had disclosed colonic diverticula and duodenal erosions. Bleeding continued and hypotension persisted despite the administration of fluid and red cells. A diagnostic procedure was performed.
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