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In a randomized trial, 5518 patients with type 2 diabetes mellitus who were at high risk for cardiovascular events were all treated with simvastatin and assigned to receive either fenofibrate or placebo. At a mean follow-up of 4.7 years, the rates of the primary outcome (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) did not differ significantly between the two study groups.
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In a randomized trial, 4733 patients with type 2 diabetes mellitus who were at high risk for cardiovascular events received treatment aimed at a target systolic blood pressure of less than 120 mm Hg or less than 140 mm Hg. At a mean follow-up of 4.7 years, the rates of the primary end point (nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death) were not significantly different between the two trial groups.
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Aspirin and low-molecular-weight heparin are often prescribed to women with unexplained recurrent miscarriage, but their benefit is unclear. In this randomized trial involving women with a history of unexplained recurrent miscarriage, treatment with 80 mg of aspirin and open-label nadroparin (at a dose of 2850 IU) or aspirin alone did not improve live-birth rates or other pregnancy outcomes, as compared with placebo.
A 29-year-old man presents with intermittent epigastric discomfort, without weight loss or evidence of gastrointestinal bleeding. He reports no use of aspirin or nonsteroidal antiinflammatory drugs. A serologic test for Helicobacter pylori is positive, and he receives a 10-day course of omeprazole, amoxicillin, and clarithromycin. Six weeks later, he returns with the same symptoms. How should his case be further evaluated and managed?
Deaths from pancreatic ductal adenocarcinoma, also known as pancreatic cancer, rank fourth among cancer-related deaths in the United States, yet the causes of pancreatic cancer remain unknown. This review article summarizes recent progress in the understanding and management of pancreatic cancer.
An 18.5-month-old girl was seen in the pediatric gastroenterology clinic of this hospital because of watery diarrhea and poor weight gain. The child had been healthy until 12 months of age, when chronic watery diarrhea developed. Six months later, her weight had decreased to the fourth percentile for her age. Extensive studies of stool, ultrasonography of the abdomen, and upper and lower endoscopic examinations were normal. A sweat test was interpreted as borderline. A diagnostic test result was received.
A physician describes the daily work in his primary care practice and documents the high volume of tasks involved in patient care aside from face-to-face visits. In a typical day, each doctor saw 18 patients, made 24 telephone calls, sent 17 e-mail messages, and reviewed 31 laboratory and imaging reports and 14 consultation reports.
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