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The first case of 2009 pandemic influenza A (H1N1) infection in China was identified on May 10, 2009. An initial policy of quarantine was instituted, and the early cases were systematically monitored. In these early 426 cases, the incubation period (2 days), spectrum of illness (67.4% with fever), and duration of viral shedding by PCR (6 days) were determined.
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Using a novel gene chip, investigators identified single-nucleotide polymorphisms (SNPs) from three chromosomal regions, including the LPA locus, that were associated with the risk of coronary disease. Two SNPs in LPA were strongly associated with both the level of Lp(a) lipoprotein and the risk of coronary disease. After adjustment for the Lp(a) lipoprotein level, the association with the risk of coronary disease was abolished. These findings support a causal role of an increased Lp(a) lipoprotein level in the risk of coronary disease.
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Early-repolarization patterns on electrocardiography are generally considered to be benign. However, this study with 30 years of follow-up in a Finnish population indicates that early-repolarization patterns in the inferior and lateral leads are associated with an increased risk of death from cardiac causes and from arrhythmia.
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In a retrospective analysis from a randomized trial, stored serum samples from patients with stable coronary artery disease were analyzed with the use of a new, highly sensitive assay for cardiac troponin T. At levels well below the limit of detection of the conventional assay, troponin T concentrations correlated significantly with the subsequent risk of cardiovascular death and heart failure but not with the risk of myocardial infarction.
A 56-year-old obese man with long-standing gastroesophageal reflux who recently received a diagnosis of Barrett's esophagus presents for a follow-up visit. He has been taking omeprazole at a dose of 20 mg twice daily and currently has no symptoms of reflux. He has no dysphagia or weight loss. Endoscopic and histopathological examinations show a 4-cm segment of Barrett's esophagus without dysplasia. How should Barrett's esophagus be managed?
Endometrial biopsy is an office-based method for evaluating the tissue lining of the uterus. The many indications for endometrial biopsy include abnormal uterine bleeding, postmenopausal bleeding, amenorrhea for a year or longer, evaluation of infertility, evaluation of uterine response to hormone therapy, and follow-up for a Papanicolaou smear that has shown atypical glandular cells. The video demonstrates the technique of endometrial biopsy.
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A 29-year-old man was transferred to this hospital because of fever and respiratory distress. Nine days earlier, fever, a nonproductive cough, and myalgias developed. On admission to this hospital, he was hypoxemic. Computed tomography of the chest revealed diffuse infiltrates. Respiratory failure, renal failure, and hypotension developed. On the sixth hospital day, a diagnostic test result was received.
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Health care reform seems to be a two-act play. We are moving toward the conclusion of the first act, universal coverage. The second act will consist of controlling the cost of health care, or “bending the cost curve.”
A recent article by Atul Gawande ...






