The American journal of medicine
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Heart disease was an uncommon cause of death in the US at the beginning of the 20th century. By mid-century it had become the commonest cause. After peaking in the mid-1960s, the number of heart disease deaths began a marked decline that has persisted to the present. ⋯ These decreases are very likely explained by a decrease in coronary atherosclerosis due to primary prevention, and a decrease in the progression of nonobstructive coronary atherosclerosis to obstructive coronary heart disease due to efforts of primary and secondary prevention. In addition, more effective treatment of patients hospitalized with acute myocardial infarction has led to a substantial decrease in deaths due to acute myocardial infarction. It is very likely that the 20th century was the only century in which heart disease was the most common cause of death in America.
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African Americans have a substantially higher prevalence of risk factors for gout than Caucasians. The aim of the present study was to compare the risk for incident gout among African Americans and Caucasians. ⋯ After accounting for the higher prevalence of risk factors, African American ethnicity is associated with a significantly lower risk for gout and hyperuricemia compared with Caucasian ethnicity.
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New guidelines for the treatment of Clostridium difficile-associated diarrhea were published by the Infectious Disease Society of America (IDSA) in 2010, however, there has been no literature evaluating the effectiveness of these guidelines. The purpose of this study was to examine the clinical outcomes of Clostridium difficile infection including death, C difficile infection recurrence, toxic megacolon, and surgery between patients who received guideline-concordant therapy vs guideline-discordant therapy. ⋯ There was a significant reduction in C difficile infection recurrence and mortality when prescribers followed the IDSA/Society for Healthcare Epidemiology of America guidelines for treatment of C difficile infection.
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Acute aortic dissection associated with cocaine use is rare and has been reported predominantly as single cases or in small patient cohorts. ⋯ Cocaine use is implicated in 1.8% of patients with acute aortic dissection. The typical patient is relatively young and has the additional risk factors of hypertension and tobacco use. In-hospital mortality for those with cocaine-related type A dissection is lower than for those with non cocaine-related dissection, likely due to the younger age at presentation.
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The clinical epidemiology of venous thromboembolism has changed recently because of advances in identification, prophylaxis, and treatment. We sought to describe secular trends in the occurrence of venous thromboembolism among residents of the Worcester, Massachusetts, metropolitan statistical area. ⋯ Despite advances in identification, prophylaxis, and treatment between 1985 and 2009, the annual event rate of venous thromboembolism has increased and remains high. Although these increases partially may be due to increased sensitivity of diagnostic methods, especially for pulmonary embolism, they also may imply that current prevention and treatment strategies are less than optimal.