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Typhoid remains an important cause of illness and death in the developing world. In this phase 4 trial in Kolkata, India, 37,673 subjects were vaccinated with either Vi typhoid vaccine or hepatitis A vaccine. The Vi vaccine was approximately 61% effective in preventing typhoid infection in vaccine recipients and was 44% effective in unvaccinated members of the same clusters as the Vi-vaccine recipients, suggesting that Vi vaccination has indirect benefits for those in close contact with vaccine recipients.
Atypical hemolytic–uremic syndrome, a complex of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure, is not associated with shigella toxin — unlike typical hemolytic–uremic syndrome — but is often associated with abnormal activation of complement by mutant components of the system. This study shows that in some patients with the atypical syndrome, there are disabling mutations of the THBD gene, which encodes thrombomodulin. As a result of these mutations, regulation of complement activation on cell surfaces is impaired, and cells are not protected from activated complement.
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After determining that vascular endothelial growth factor (VEGF) was expressed in vestibular schwannomas, the investigators administered bevacizumab, an anti-VEGF monoclonal antibody, to 10 consecutive patients who had neurofibromatosis 2 and vestibular schwannomas. Some patients had a reduction in tumor volume and improvement in hearing.
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In 2004, England introduced a pay-for-performance system to reward family physicians for achieving clinical-quality targets. This analysis of the quality of care for coronary heart disease, asthma, and diabetes from 1998 through 2007 shows that although there was an initial gain in quality after the system was introduced, quality improvement subsequently slowed.
A healthy 29-year-old woman who has been trying to conceive presents with vaginal spotting for the past 5 days and intermittent crampy abdominal pain in her left lower quadrant for the past 3 days. Her last menstrual period was 6 weeks and 2 days before presentation. She has had a spontaneous vaginal delivery and an anembryonic gestation treated by dilation and curettage. How should this patient be evaluated and treated?
A 13-year-old boy was admitted to the hospital because of headache, nausea, seizures, renal failure, and hypertension. Three weeks earlier, headaches, fatigue, and anorexia developed, with constipation and occasional nausea and vomiting. On the day of admission, nausea and vomiting became severe; episodes of numbness of the right leg and dizziness occurred, and he came to the emergency department, where he was found to be hypertensive with renal failure. A diagnostic procedure was performed.
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