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.

Control of Hypertension in Pregnancy

Posted by Carla Rothaus • January 30th, 2015

In a trial comparing less-tight control of hypertension (target diastolic blood pressure, 100 mm Hg) with tight control (85 mm Hg) among pregnant women, rates of pregnancy loss, high-level neonatal care, and serious maternal complications were similar between groups. Blood-pressure targets for women with nonsevere hypertension during pregnancy are much debated. Relevant randomized, controlled trials have been… Read More…

Allergic Rhinitis

Posted by Carla Rothaus • January 30th, 2015

Allergic rhinitis is common and is often associated with asthma. Treatment includes intranasal glucocorticoids, oral and nasal antihistamines, leukotriene-receptor antagonists, and, when pharmacotherapy is not effective or produces unacceptable side effects, allergen immunotherapy. Read the latest Clinical Practice review on this topic. The frequency of sensitization to inhalant allergens is increasing and is now more than 40%… Read More…

Abdominal Pain, Dyspnea, and Diplopia

Posted by Carla Rothaus • January 27th, 2015

Peripheral causes of acute generalized weakness include motor neuronopathies, acute acquired polyneuropathies, myopathies, and presynaptic and postsynaptic neuromuscular-transmission disorders. Clinical Pearls – Is botulism a presynaptic or postsynaptic neuromuscular-transmission disorder? Botulism is a toxin-mediated disease that results in the presynaptic blockade of acetylcholine transmission across the neuromuscular junction.  – What is adult intestinal toxemia? Adult intestinal… Read More…

PD-1 Blockade with Nivolumab

Posted by Carla Rothaus • January 23rd, 2015

Preclinical studies suggest that Reed-Sternberg cells exploit the programmed death 1 (PD-1) pathway to evade immune detection. An ongoing phase 1 study tests the hypothesis that nivolumab, a PD-1-blocking antibody, can inhibit tumor immune evasion in patients with relapsed or refractory Hodgkin’s lymphoma. Clinical Pearls – How do tumors exploit the PD-1 [programmed death 1] pathway?… Read More…

Multiple-System Atrophy

Posted by Carla Rothaus • January 16th, 2015

Multiple-system atrophy is a neurodegenerative disease characterized by progressive autonomic failure, parkinsonism, and cerebellar and pyramidal tract symptoms. Glial cytoplasmic inclusions of α-synuclein are a defining histologic feature. There is no curative treatment. A new review on this topic comes from Innsbruck Medical University’s Alessandra Fanciulli, M.D., and Gregor K. Wenning, M.D., Ph.D. Multiple-system atrophy… Read More…

Abdominal Pain, Syncope, and Hypotension

Posted by Carla Rothaus • January 16th, 2015

In the latest Case Record of the Massachusetts General Hospital, a 25-year-old man was admitted to the hospital because of abdominal pain, syncope, and hypotension that occurred while he was lifting heavy boxes. An abdominal ultrasound examination revealed a hypoechoic lesion in the liver. A diagnostic test was performed. Rupture or leak of hydatid-cyst fluid… Read More…

Complicated Grief

Posted by Carla Rothaus • January 9th, 2015

Complicated grief is intense grief after the death of a loved one that lasts longer than expected according to social norms and causes functional impairment. Psychotherapy directed at the loss and at restoring activities and effective functioning is recommended. The condition of complicated grief, which is also called prolonged grief disorder, affects about 2 to… Read More…

Dengue Vaccine

Posted by Carla Rothaus • January 9th, 2015

Dengue is a mosquito-borne viral illness that causes hundreds of millions of infections each year. No specific therapy exists. In a randomized, controlled trial involving Latin American children, a tetravalent dengue vaccine showed significant protective efficacy. Several dengue vaccine candidates are in development. As part of the clinical development of a recombinant, live, attenuated, tetravalent… Read More…

Diagnosing One Letter at a Time

Posted by Carla Rothaus • January 2nd, 2015

A 45-year-old woman presented with lower-extremity weakness. She first noted weakness in her ankles and feet 5 months previously. The weakness progressed to involve her knees and hips, and she had been unable to walk without support for the prior 2 months. Electrodiagnostic studies cannot always classify a neuropathy definitively into an axonal or demyelinating… Read More…

Disorders of Plasma Sodium

Posted by Carla Rothaus • January 2nd, 2015

The latest review in the Disorders of Fluids and Electrolytes series considers the causes and consequences of an abnormal plasma sodium concentration and offers a framework for correcting it. Human cells dwell in salt water. Their well-being depends on the ability of the body to regulate the salinity of extracellular fluids. By controlling water intake… Read More…