Posts in the ‘Physicians-In-Training’ Category

The posts below are excerpted from the NEJM Resident e-Bulletin, a free weekly email of teaching topics. Including the content here in Now@NEJM enables you to have a conversation or ask questions about clinical points that interest you. To receive the email version, register as a student or resident on NEJM.org.

Immunogenicity of a Meningococcal B Vaccine

Posted by • July 21st, 2016

In December 2013, a multicomponent meningococcal serogroup B (4CMenB) vaccine was used before licensure on the basis of special consideration by the Food and Drug Administration to respond to an outbreak of Neisseria meningitides B at a U.S. university. Data suggested that vaccination would control the university outbreak because it isolates expressed antigens that were… Read More…

Extending Aromatase-Inhibitor Therapy

Posted by • July 21st, 2016

The risk of recurrence of hormone-receptor–positive early breast cancer continues indefinitely. The MA.17R trial, conducted by Goss et al., examined the effects of treatment with an aromatase inhibitor for 10 years rather than 5 years after any duration of prior treatment with tamoxifen, in postmenopausal women with hormone-receptor–positive early breast cancer. An additional 5 years of… Read More…

Initiation Strategies for Renal-Replacement Therapy

Posted by • July 14th, 2016

Renal-replacement therapy is the cornerstone of the management of severe acute kidney injury. Gaudry et al. compared a strategy of early initiation of renal-replacement therapy with a strategy of delayed initiation in patients in the intensive care unit who had acute kidney injury of Kidney Disease: Improving Global Outcomes (KDIGO) classification stage 3. This multicenter randomized… Read More…

A Man in an Unresponsive State

Posted by • July 14th, 2016

Clinical care for patients with acute liver failure should focus on preventing and treating associated complications, identifying the cause so that targeted therapy (if available) can be initiated, and determining the patient’s transplant eligibility. A 32-year-old man was admitted to this hospital after being found in an unresponsive state in his jail cell. He had jaundice and… Read More…

A Bruising Loss

Posted by • July 7th, 2016

Whereas inherited clotting-factor deficiencies are typically clinically evident from birth, the sudden appearance of a bleeding diathesis in a previously healthy adult is suggestive of an acquired factor inhibitor. Although inhibitors to most of the major clotting factors have been described, factor VIII inhibitors are the most common; however, factor VIII inhibitors are still rare,… Read More…

Polycystic Ovary Syndrome

Posted by • July 7th, 2016

The polycystic ovary syndrome is a disorder characterized by hyperandrogenism, ovulatory dysfunction, and polycystic ovaries. The polycystic ovary syndrome increases the risk of infertility, endometrial cancer, abnormal glucose metabolism, and dyslipidemia. Strategies such as lifestyle modification, hair removal, and combined oral contraceptive therapy and other pharmacotherapies are reviewed. A new Clinical Practice summarizes. Figure 1. Basic Pathophysiology of Hyperandrogenemia… Read More…

Axial Spondyloarthritis

Posted by • July 1st, 2016

The classic clinical description of ankylosing spondylitis was made in the late 1800s and was refined by the addition of radiographic descriptions during the 1930s. Pathological investigation revealed the importance of enthesitis (inflammation at sites of ligamentous attachment to bone) and synovitis. The identification in 1973 of a very strong association with human leukocyte antigen… Read More…

A Man with Cloudy Vision

Posted by • July 1st, 2016

Syphilis can cause uveitis and retinitis. The uveitis can be anterior, posterior, or both (panuveitis) and can occur with or without a hypopyon (usually without). A 50-year-old man with psoriatic arthritis and HIV infection presented with cloudy vision, decreased hearing, and gait instability. Two months earlier, the patient had begun taking antiretroviral medications. A diagnostic test result was… Read More…

A Man with a Pruritic Rash

Posted by • June 24th, 2016

Although human T-lymphotropic virus type 1 (HTLV-1) is a retrovirus, it seems to induce a precancerous state that can lead to adult T-cell leukemia–lymphoma (a subtype of cutaneous T-cell lymphoma), instead of being directly carcinogenic. HTLV-1 is associated with a long latency period, and most affected patients are exposed to the virus early in life…. Read More…

Body-Mass Index in Adolescents

Posted by • June 24th, 2016

Overweight and obesity in adolescents have increased substantially in recent decades and affect a third of the adolescent population in some developed countries. Twig et al. assessed the risk of fatal cardiovascular events in adulthood according to the body-mass index range during adolescence, using a national database of 2.3 million Israeli adolescents in whom height… Read More…