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In this large community-based study, the incidence of acute myocardial infarction decreased significantly after the year 2000, with an especially marked decrease in ST-segment elevation myocardial infarction. A reduction in the case fatality rate was attributed both to the reduction in ST-segment elevation myocardial infarctions and a decrease in the rate of death from non–ST-segment elevation myocardial infarction.
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Control of the 2009 pandemic influenza A (H1N1) virus has been a difficult challenge. In this article, ring prophylaxis (geographically targeted containment by means of prophylaxis) with oseltamivir (75 mg per day for 10 days) was shown to substantially curtail four outbreaks involving 1175 personnel in the Singapore military. There were 75 cases before intervention and 7 after intervention. The overall reproductive number (the number of new cases attributable to the index case) was reduced from 1.91 before intervention to 0.11 after intervention.
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Pandemic 2009 influenza A (H1N1) virus has caused substantial disease around the world during the past year. In this study from Hong Kong, investigators show that the pandemic and seasonal influenza A viruses behave in a similar manner with respect to the pattern of illness, viral shedding, and secondary attack rates.
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This large case–control study used a European database to assess associations between first-trimester valproic acid monotherapy and 14 malformations reported previously to be linked to valproic acid use in early pregnancy. Valproic acid monotherapy was associated with significantly increased risks for 6 of the 14 malformations, including spina bifida, atrial septal defect, cleft palate, hypospadias, polydactyly, and craniosynostosis, as compared with no antiepileptic-drug use or use of other antiepileptic drugs.
A 72-year-old man seeks consultation at the urging of his wife for increasing difficulty with memory over the past 2 years. Clients at his brokerage firm have expressed concern about his occasional lapses in memory. His wife reports that he frequently repeats questions about social appointments and becomes angry when she points this out. The physical examination is normal, but the patient has difficulty remembering elements of a brief story and difficulty in adding a small amount of change. Alzheimer's disease is suspected. How should this patient be evaluated and treated?
Neuroblastoma, an embryonal cancer of the autonomic nervous system, is the most common cancer diagnosed during the first year of life. Although neuroblastoma accounts for disproportionately high morbidity and mortality among childhood cancers, it has one of the highest rates of spontaneous and complete regression. The author discusses recent advances in our understanding of neuroblastoma.
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A 29-year-old right-handed woman was seen in the neurology clinic of this hospital because of a 3-year history of involuntary flexion of the left hand and increasing difficulty moving the left foot. Examination revealed dystonic movements and posturing of the left arm, hand, and foot. Brain imaging was normal. During the next 2.5 years, symptoms gradually worsened, and difficulty swallowing and speaking developed. A diagnostic test was performed.
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