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In This Issue of Archives of Internal Medicine |

In This Issue of Archives of Internal Medicine FREE

Arch Intern Med. 2004;164(5):478. doi:10.1001/archinte.164.5.478.
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CAUSES AND FACTORS ASSOCIATED WITH EARLY FAILURE IN HOSPITALIZED PATIENTS WITH COMMUNITY-ACQUIRED PNEUMONIA

Early failure is a matter of great concern in the treatment of community-acquired pneumonia. However, there are few current data analyzing this problem. This study offers a comprehensive evaluation of the causes and risk factors associated with early failure in a recent, prospective series of 1383 hospitalized adults with community-acquired pneumonia.

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ASSOCIATION BETWEEN PULMONARY FIBROSIS AND CORONARY ARTERY DISEASE

Pulmonary fibrosis and atherosclerosis exhibit histopathological similarities, and fibrotic lung disorders have the potential to influence the vasculature outside the lungs. To investigate whether fibrotic lung disorders might predispose to coronary artery disease (CAD), Kizer et al examined the prevalence of angiographic CAD in 630 patients with advanced lung disease referred for lung transplantation evaluation. Patients with fibrotic lung diseases were more likely to have CAD compared with patients with nonfibrotic lung disorders (adjusted odds ratio, 2.18; 95% confidence interval, 1.17-4.06). The association became stronger when multivessel CAD was examined (adjusted odds ratio, 4.16; 95% confidence interval, 1.46-11.9). Moreover, it was maintained for subgroups having nongranulomatous pulmonary fibrosis and idiopathic pulmonary fibrosis. These findings support the existence of a relationship between fibrotic lung disorders and CAD, but this association will require further study.

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EVALUATION OF CARDIOVASCULAR EVENT RATES WITH HORMONE THERAPY IN HEALTHY, EARLY POSTMENOPAUSAL WOMEN: RESULTS FROM 2 LARGE CLINICAL TRIALS

Recent randomized trials of older postmenopausal women receiving hormone therapy have suggested early harm, with an increased rate of early coronary events. This evaluation of 4 recent large trials of younger, symptomatic women suggest that this increased risk does not pertain to women close to the onset of menopause.

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EVALUATION OF THE ASSOCIATION BETWEEN HEREDITARY THROMBOPHILIAS AND RECURRENT PREGNANCY LOSS

Recurrent pregnancy loss (RPL) is a significant clinical problem affecting 5% of women. Recently, thrombophilias have been implicated as a possible cause. A meta-analysis was conducted to evaluate the association of factor V Leiden (FVL) and prothrombin gene (G20210A) mutations in RPL. The combined adjusted odds ratios for the association between RPL and FVL and between RPL and G20210A were 2.0 (95% confidence interval, 1.5-2.7; P<.001) and 2.0 (95% confidence interval, 1.0-4.0; P = .03), respectively. Similar results were produced by the logistic regression and both fixed- and random-effects meta-analysis models. Carriers of FVL or prothrombin gene mutations have double the risk of experiencing 2 or more miscarriages compared with women without thrombophilias. The authors recommend screening women with RPL for these mutations.

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WHICH PATIENTS WITH KNEE PROBLEMS ARE LIKELY TO BENEFIT FROM NONARTHROPLASTY SURGERY?: DEVELOPMENT OF A CLINICAL PREDICTION RULE

Solomon et al examined factors associated with the clinical presentation of patients whom orthopedic surgeons judge likely to benefit from nonarthroplasty knee surgery. In multivariable logistic regression models, the following patient characteristics were associated with surgeons' judgment that the patient would likely benefit from knee surgery: a history of sports-related trauma, low (vs high) functional status; limited knee flexion or extension; medial or lateral knee joint line tenderness; a click or pain noted with the McMurray test; and a positive Lachmann or anterior drawer test result (C statistic from model, 0.83). These items were combined into a clinical prediction score, and low-, medium-, and high-risk categories were identified. Independent evaluation by surgeons indicated that only 8% of patients in the low-risk category and 84% of patients in the high-risk category were judged likely to benefit from surgery (P for trend <.001). Hence, using a small group of easily accessible patient characteristics, the authors developed a clinical prediction score that clearly differentiated those who were and were not viewed as likely to benefit from nonarthroplasty knee surgery by experienced orthopedic knee surgeons.

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