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In this cohort study, children exposed in utero to valproate monotherapy had significantly lower IQ scores at 3 years of age than did children exposed in utero to monotherapy with other commonly used antiepileptic drugs. These findings support a recommendation that valproate should not be used as a first-choice drug in women of childbearing potential.
In a randomized trial, 1442 patients with a history of atrial fibrillation were assigned to receive either valsartan, an angiotensin II–receptor blocker, or placebo. Antiarrhythmic therapy was administered according to the treating physician's preference. At 1 year, there was no difference between the groups in the rate of either a first recurrence or multiple recurrences of atrial fibrillation.
Black patients with hemophilia are more likely to form antibodies against replacement factor VIII than are white patients. This article suggests a mechanism for this phenomenon, which is based on the distribution of variant factor VIII proteins in patients of diverse geographic origins. Replacement factor VIII contains variants that are not present in black patients, who therefore are likely to produce antibodies against them.
This national survey showed that less than 2% of U.S. hospitals have a comprehensive system of electronic health records across all clinical units. No more than 12% of U.S. hospitals have even a basic electronic-records system in at least one clinical unit. Computerized provider-order entry has been implemented in 16% of hospitals. The primary barriers to the adoption of electronic health records were reported to be the initial capital required and the high cost of maintenance.
A healthy 37-year-old woman presents at 10 weeks of pregnancy with vaginal bleeding. The level of serum human chorionic gonadotropin is 22,000 mIU per milliliter. Ultrasonography does not show an identifiable fetal heartbeat. The patient undergoes evacuation of the uterus; pathological examination indicates a complete molar pregnancy. How should this case be managed?
Genetic contributions to the cause of type 1 diabetes have been studied for more than 30 years, but only recently, with modern genetic tools, has the importance of seemingly minor contributors been appreciated. This article reviews recent advances in knowledge of the genetics of type 1 diabetes and shows how this information could find clinical applications of considerable consequence.
A 46-year-old man presented to this hospital with migraine headache, a 4-year history of neurologic events resulting in aphasia and hemiparesis, and a family history of two similarly affected brothers. Neuroimaging studies showed white-matter and deep gray-matter abnormalities. A diagnostic test was performed.
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