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Which men should receive aspirin or statins for primary prevention of coronary artery disease?We performed a cost-utility analysis comparing treatment with aspirin, statins, and the combination of aspirin and statins among middle-aged men with no previous history of cardiovascular disease and with different underlying coronary artery disease (CAD) risk levels. Results showed that for men with a 10-year risk of CAD of 7.5% or higher, treatment with aspirin cost less and was more beneficial than no treatment. When the patient's 10-year risk of CAD before treatment was greater than 10%, adding a statin to aspirin treatment was cost effective.
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Improved retinopathy in a patient with type 1 diabetes: A review of the role for HMG-CoA reductase inhibitors in the treatment of diabetic retinopathyA 36-year-old Hispanic man was diagnosed with type 1 diabetes in 1987 and dyslipidemia in 2001.
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Contemporary stenting practices, optimal antiplatelet and antithrombotic therapy, and the continuum of care of patients with cardiovascular disease: A roundtable discussionThe first stent was invented in 1969 by Charles Theodore Dotter, experimenting on canine peripheral arteries.
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Will the Impact of COVID-19 on Clinical Trials Fast-Track Digital Health Technology?Digital technologies may have the best opportunity to change how trials are conducted for years to come.
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Video Capsule Endoscopy: Recent Advances in DiagnosisInvestigation of the small intestine or the esophagus with conventional diagnostic and imaging modalities can be challenging. Video capsule endoscopy is a relatively new and noninvasive technique that allows direct visualization of the small bowel or the esophagus and can obviate the need for or guide the use of more invasive procedures. The capsule contains a miniature camera that takes pictures of the lining of the small intestine or the esophagus. Unlike conventional diagnostic procedures, video capsule endoscopy can often successfully identify the source of the problem quickly and painlessly. It is also useful in assessing patients with a variety of other conditions affecting the small intestine or the esophagus, including Crohn's disease, celiac disease, tumors, reflux disease, esophagitis, and Barrett's esophagus.
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Analysis of regional left ventricular functionWe performed cineventriculography, unenhanced echocardiography, contrast-enhanced echocardiography, and magnetic resonance imaging to define the presence of regional left ventricular wall motion abnormalities. Interobserver agreement in the analysis of regional wall motion abnormality was highest for contrast-enhanced echocardiography, followed by cineventriculography and cardiac magnetic resonance imaging; it was lowest for unenhanced echocardiography. Contrast-enhanced echocardiography also showed the highest accuracy in the detection of panel-defined regional wall motion abnormalities.
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How Should I Evaluate This Patient's Injured Ankle?A 28 year-old commercial realtor comes to your office on Monday morning after spraining his right ankle in a basketball game with friends the preceding Saturday afternoon. He has a swollen right ankle with tenderness inferior and anterior to the lateral malleolus. He is limping but able to apply weight to the injured extremity.
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Alternative Medicines and Supplements for the Primary Prevention of Cardiovascular Disease and CancerThe use of various dietary supplements by patients will probably continue, so medical practitioners must be able to advise patients about potential harms and benefits.
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Low Dose Computed Tomography Scanning for Patients at risk for Lung CancerThe leading cause of cancer related deaths in both men and women is lung cancer. The 5-year survival rate of lung cancer is only 16%, as 75% of patients with lung cancer are presented with symptoms of advanced disease.
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Incidence of death and MI associated with stopping clopidogrel after ACSRates of death and myocardial infarction were assessed for a national sample of acute coronary syndrome patients after stopping clopidogrel. In the first 90 days after stopping treatment, patients experienced a nearly twofold increased risk of adverse events compared with subsequent follow-up intervals for patients treated medically without stents and for patients treated with coronary stents. This suggests a possible clopidogrel rebound effect, but additional studies are needed to support this hypothesis and to identify strategies to reduce early events after clopidogrel cessation.
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Hyperglycemia and platelet function in diabetic patients: Relevance to acute myocardial ischemia and infarctionDiabetic patients with acute coronary syndromes are at higher risk for mortality, even if they have ST-segment elevation myocardial infarction. Diabetic patients with unstable angina/non–Q-wave infarction have impaired platelet responsiveness to nitric oxide, a physiological anti-aggregating autocoid. The extent of this impairment depends on the degree of hyperglycemia. Rapid correction of hyperglycemia with infused insulin restores responsiveness to nitric oxide, thus ameliorating platelet dysfunction.
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Providing Obstetric Care for Women with a History of Sexual TraumaWe asked women with a history of sexual trauma about their pregnancy and childbirth experiences and used their experiences and insight to inform practice recommendations.
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Initial Results of the Ongoing MYSTIC Trial in Stage IV Lung CancerDavid R. Gandara, MD, professor of Medicine, University of California Davis Comprehensive Cancer Center, discusses the initial results of the ongoing MYSTIC trial, which is exploring the combination of durvalumab (Imfinzi) and tremelimumab versus chemotherapy in stage IV lung cancer.
