In conclusion, in symptomatic patients with suspected CAD who required noninvasive testing, an initial strategy of CTA had not been associated with better clinical outcomes than practical testing over a median follow-up of 2 years.. Pamela S. Douglas, M.D., Udo Hoffmann, M.D., M.P.H., Manesh R. Patel, M.D., Daniel B. Mark, M.D., M.P.H., Hussein R. Al-Khalidi, Ph.D., Brendan Cavanaugh, M.D., Jason Cole, M.D., Rowena J. Dolor, M.D., Christopher B. Fordyce, M.D., Megan Huang, Ph.D., Muhammad Akram Khan, M.D., Andrzej S. Kosinski, Ph.D., Mitchell W.Stress behind deadly outbreaks The candidate conjugate meningococcal A vaccine protects against contamination by group A Neisseria meningitidis , the strain mainly responsible for deadly outbreaks in 25 ‘meningitis belt’ countries. Some 430 million people, living in the region stretching east to west over the continent from Senegal to Ethiopia are at threat of this bacterial disease. Even with antibiotic treatment, at least 10 percent of patients die and up to 20 percent have severe permanent health problems because of the condition. A phase I medical trial in adults aged 18 to 35 years was successfully completed in India.