Posts in the ‘Insights’ Category

Insights are brief stories about NEJM content, written by contributors appointed by NEJM editorial staff. While the posts often include quotes from editors, and are approved by editors, these blog posts about NEJM content are not published in NEJM, and should not be considered NEJM editorials or commentary. They are intended to provide insight into the clinical significance of interesting content found on NEJM.org, and where it may lead us in practice and research. Questions are included at the end to stimulate thinking and discussion.

Take the Fluids and Electrolytes Challenge

Posted by Karen Buckley • September 30th, 2014

A 22-year-old woman has received 6 liters of isotonic saline and is awaiting transfer to the operating room for stabilization of injuries suffered in a car accident. The lab values include blood pH 7.28, PaCO2 39 mm Hg, sodium 135 mmol per liter, potassium 3.8 mmol per liter, chloride 115 mmol per liter, and bicarbonate 18 mmol… Read More…

Anti–Interleukin-5 Monoclonal Antibody to Treat Severe Eosinophilic Asthma

Posted by Daniela Lamas • September 24th, 2014

Most asthma patients who come to your pulmonary office get better. With a regimen of inhaled therapies and possibly a short course of oral corticosteroids, the wheeze and cough and shortness of breath remit. But the patient you are seeing in clinic today is still struggling. She’s tried every inhaler at its maximum dose and… Read More…

Portrait of a Stone: CT versus Ultrasonography for Acute Nephrolithiasis

Posted by Rena Xu • September 17th, 2014

This summer, I started my residency in urology. My job for the first month was to see patients in the emergency department with urologic problems. Nephrolithiasis was one of the most frequently encountered diagnoses, and I soon learned the “drill” for working up kidney stones– check a white blood cell count, send off a urinalysis… Read More…

Influenza Vaccination in Pregnancy

Posted by Rupa Kanapathipillai • September 3rd, 2014

As the days get shorter and cooler, you have an increasing sense of dread that Winter Is Coming – and with it comes flu season.   Once you stop daydreaming of the halcyon days of summer, you notice that in your waiting room are two pregnant patients, one HIV positive, one HIV negative. You take a… Read More…

PARADIGM-HF Prompts a New Line of Thinking about Heart Failure

Posted by Chana Sacks • August 30th, 2014

Your patient – a 65-year-old man with an ischemic cardiomyopathy – presents to clinic one week after discharge from another hospitalization for a heart-failure exacerbation. He is doing much better. He remains at his discharge weight and reports good adherence to a low-salt diet and to the extensive medication regimen that you have prescribed: he… Read More…

Long-Term Colorectal Cancer Mortality after Adenoma Removal

Posted by Daniela Lamas • August 27th, 2014

Your patient had thought it would be a relief to get the colonoscopy over with. “Not for another ten years,” she had vowed as she chugged that dreaded colonoscopy prep. But then there was a polyp – low-risk, she was told – but with it, recommendations to return for another colonoscopy in as few as… Read More…

Learning to Modify the Chronic Neurologic Burden of Sickle Cell Anemia

Posted by Joshua Allen-Dicker • August 20th, 2014

The patient sitting in front of you is a smiling, well-adjusted 6-year old boy.  He has a supportive family, eats a healthy diet, and is physically active.  What if, despite all of this, you knew that he had more than a 30 percent chance of developing a condition that would hamper his educational attainment?  Every… Read More…

A Salty Subject: Sodium Consumption and Cardiovascular Health

Posted by Rena Xu • August 13th, 2014

Salt has long been a staple of life.  Once upon a time, it was a form of currency; roads were built to transport it; cities arose to produce and trade it.  And, of course, people ate it.  Today, we continue to consume it the whole world over. It’s hard to believe something so integral to… Read More…

Novel Ways to Detect Creutzfeld-Jacob Disease?

Posted by Daniela Lamas • August 6th, 2014

Anyone who has eaten a burger has had a sneaking fear, however irrational: Could I have been exposed to mad cow? And how could I possibly find out before symptoms of the disease take hold? As it is, the way to confirm the diagnosis of the fatal disease is by direct examination of brain tissue,… Read More…

The Future of Malaria: Rising Rates of Resistance and a Potential New Hope

Posted by Joshua Allen-Dicker • July 30th, 2014

What do Emperor Charles V, Thomas Jefferson, and King Tut all have in common?  Each historical figure is thought to have suffered from malaria at some point during his life. Plasmodium, malaria’s causative organism, is known as much for its effects on great civilizations and their leaders as for its present world-wide disease burden.  Yearly,… Read More…