Lancet
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The overnight urinary albumin excretion rate (AER) of 87 patients with insulin-dependent diabetes mellitus was measured in 1966-67, 14 years later information was obtained on 63 of the original cohort; those alive were restudied, and for those who had died relevant clinical information and case of death were recorded. The development of clinical diabetic nephropathy ('Albustix'positive proteinuria) was related to the 1966-67 AER values. Clinical proteinuria developed in only 2 of 55 patients with AER below 30 microgram/min but in 7 of 8 with AER between 30 and 140 microgram/min. ⋯ Mean duration of diabetes was longer, but not significantly so, in those with AER above 30 microgram/min. Thus, elevated levels of microalbuminuria strongly predict the development of clinical diabetic nephropathy. These levels of AER are potentially reversible, and their detection and treatment may prevent diabetic renal disease.
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Comparative Study
Collaborative study of very-low-birthweight infants: Techniques of perinatal care and mortality.
The neonatal units in two large maternity hospitals collaborated in a study of 440 liveborn infants weighting 500-1500 g born in 1977 and 1978: 377 (85.7%) were born in hospital. The overall survival rate was 70.5%, with a range of 67.5% to 71.5% for the inborn and outborn categories of infants in each hospital. In hospital A the survival rate of infants weighing greater than or equal to 1100 g was higher than that in hospital b, whereas the survival rate of infants weighing less than 800 g was higher in hospital B. Obstetric risk factors and obstetric management differed little between the hospitals, but there were several important differences in paediatric management; in particular, hospital B (with a better survival rate of infants weighing under 800 g) used ventilatory support and parenteral feeding much more frequently.
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Randomized Controlled Trial Comparative Study Clinical Trial
Analgesic efficacy of parenteral metkephamid acetate in treatment of postoperative pain.
The analgesic efficacy and side-effects of a single parenteral dose of metkephamid acetate 70 mg were compared with those of pethidine (meperidine) hydrochloride 100 mg and placebo in a double-blind, randomised, controlled clinical trial. 30 out of 32 postoperative patients completed the study--10 in the metkephamid group, 11 in the pethidine group, and 9 in the placebo group. The time-effect curves of summated pain measures and analyses of derived measures all indicated that the analgesic activity of metkephamid 70 mg was significantly greater than that of placebo and not less than that of pethidine 100 mg. The metkephamid group had a greater incidence of side-effects than the other two treatment groups. Some side-effects, such as sensations of heaviness of the extremities and nasal congestion, were peculiar to metkephamid but not distressing.