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5-α reductase inhibitors and hip fracture in men; the effects of drug-reimbursement policy on outcomes; new guidelines for type 2 diabetes; beta-blocker-associated brady-cardia is linked to CVD events; FDA Updates.
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In patients with acute cardiogenic pulmonary edema, CPAP or NIV produces a more rapid improvement in respiratory distress and arterial blood gases than standard therapy.
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Uncomplicated type B aortic dissection (origin distal to left subclavian artery) is usually treated medically. However, early mortality is 10%-12%, and is due to complications.
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Intravenous thrombolysis is safe and effective for the treatment of ischemic stroke in the time window of 3-4.5 hours after the onset of symptoms.
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The incidence of legionellosis in the United States increased significantly in 2003-2005 compared to previous years. This was due mostly to an upsurge of cases in the northeastern and southern United States and a shift of disease from elderly to middle-aged adults. Legionellosis should be considered as a potential cause of pneumonia in a broad range of patients, rather than a small subset with specific risk factors.
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Many physicians have followed the historical practice of ordering blood cultures to be drawn as close as possible to the time of the peak of the febrile episode (fever spike). In the absence of prescient knowledge of this moment, physicians order blood cultures to be drawn at intervals ranging from 30 minutes to 2 hours. A paper by Jaimes et al suggested that many factors, other than fever, such as shaking chills, WBC counts, hypotension, and more were needed to better predict whether a patient was experiencing bacteremia.
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Among almost 6000 patients with COPD who were using other classes of respiratory therapies, the addition of tiotropium, compared with placebo, was associated with improvements in lung function, quality of life, and exacerbations during a 4-year period, but did not result in benefits in the rate of decline in FEV1.
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The FDA has extended the approval for the Human Papillomavirus Quadrivalent Recombinant Vaccine to include the prevention of vaginal and vulvar cancer. The vaccine, originally approved in 2006, is already approved for the prevention of cervical cancer and genital warts.
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Opinions on the consequences of marijuana use are wide-ranging: Some experts express grave concern that it may induce COPD, increase risk of lung cancer, promote the emergence of schizophrenia, and lead to "heavy drug" use; others essentially dismiss these (potential) adversities as inadequately established to permit accusations that marijuana has any commonplace serious adverse effects.
