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.

Sentinel node biopsy or nodal observation

Posted by Daniela Lamas • February 12th, 2014

By the time your patient visited the dermatologist, the dark spot on her back had grown to the size of a dime. She calls you, her long-term doctor, panicked by the biopsy results: melanoma. As you talk her through the diagnosis and what to expect, certain things are clear. Her surgeons will cut out the… Read More…

Intussusception Risk after Rotavirus Vaccination

Posted by Joann Schulte • February 5th, 2014

Rotavirus vaccines have emerged as important vaccines in preventing severe childhood diarrhea and, in low-income countries, deaths.  As a class of vaccines, they have accelerated the development of surveillance systems to monitor vaccine safety. Two trials recently published in NEJM evaluated the risk of intussception in young infants in the context of the overall health… Read More…

Origins of Obesity in Early Childhood

Posted by Joann Schulte • January 29th, 2014

Adults who stuff their mouths with the wrong foods and don’t move their muscles often gain weight and may develop health problems such as obesity and diabetes as a consequence. Now there’s new evidence about how this scenario applies to children. In kindergarten, more than one in four U.S. children is overweight or obese, according… Read More…

Tuberculosis Control in the Gold Mines of South Africa

Posted by John Staples • January 22nd, 2014

It’s a clinical trialist’s dream: A prevalent disease, an effective intervention, and an implementation strategy that’s practical in a community setting. How could the result be anything but dramatically positive? In this week’s NEJM, the Thibela TB study investigators report on a cluster-randomized trial with a setting precisely this promising – and discuss their unexpected… Read More…

Shedding Convention: New Treatment for Genital Herpes

Posted by Rena Xu • January 15th, 2014

Let’s talk about herpes.  To start, if you get genital herpes, you will have it for a lifetime; currently there is no cure.  Anti-viral therapy — valacyclovir or famciclovir, both nucleoside DNA polymerase inhibitors — can reduce the frequency and severity of clinical recurrences and have been the standard of care for years.  These drugs… Read More…

Upper Airway Stimulation: To Help Obstructive Sleep Apnea Patients with Difficulty Complying

Posted by Rachel Wolfson • January 8th, 2014

  Despite the numerous medications and therapeutics that have accumulated in the physician’s armamentarium, developing treatments is only half the battle with treating patients. While many drugs or devices work well in theory, in practice, there remains the major hurdle of patient compliance. Interventions may be too frequent or uncomfortable, or they are simply forgotten… Read More…

The Case Against Renal Stenting for Treatment of Hypertension and Chronic Kidney Disease

Posted by Joshua Allen-Dicker • January 2nd, 2014

Wouldn’t it be great if medicine could borrow from the science behind percutaneous coronary arterial stenting (used over 600,000 times per year in the United States for coronary ischemia) in order to treat a chronic and widespread disease such as hypertension?  The CORAL trial (Cardiovascular Outcomes in Renal Atherosclerotic Lesions), published in this week’s NEJM,… Read More…

Bardoxolone Methyl in Type 2 Diabetes and Stage 4 Chronic Kidney Disease

Posted by Daniela Lamas • December 26th, 2013

Intuitively, controlling diabetic kidney disease should be easy – manage hyperglycemia, manage blood pressure. And the more control, the better, right? Unfortunately, it hasn’t been so simple. With effective treatment of hyperglycemia and control of blood pressure, the incidence of end-stage renal disease (ESRD) due to diabetes has reached a plateau in the past 10… Read More…

Calreticulin (CALR): A new player in the mutational landscape of myeloproliferative disorders

Posted by Mounica Vallurupalli • December 18th, 2013

Advances in molecular biology and sequencing technology have expanded our understanding of myeloproliferative disorders while aiding in the identification of the molecular defects that underlie these diseases. The first among these discoveries was the identification of the oncogenic fusion protein Bcr-abl in CML. Subsequent work lead to the discovery of a small molecule inhibitor, imatinib… Read More…

The Cold Truth: Rethinking Temperature Management after Cardiac Arrest

Posted by Rena Xu • December 4th, 2013

Over a decade ago, two pivotal trials altered the standard of care for unconscious patients after cardiac arrest.  Many of these patients suffer severe neurologic injury and death; researchers sought a treatment that could reduce global brain ischemia and prevent neurologic damage even when initiated after cardiopulmonary resuscitation and the restoration of circulation. The trial… Read More…