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.

Syndromes of Thrombotic Microangiopathy

Posted by Sara Fazio • August 15th, 2014

A new review article covers the diverse pathophysiological pathways that can lead to microangiopathic hemolytic anemia and a procoagulant state with or without damage to the kidneys and other organs. An interactive graphic shows the nine primary syndromes of thrombotic microangiopathy (TMA), and narrated animations describe the causes, clinical features, initial management, and underlying mechanisms… Read More…

37-Year-Old Man with Ulcerative Colitis and Bloody Diarrhea

Posted by Sara Fazio • August 15th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 37-year-old man with ulcerative colitis was admitted to the hospital because of abdominal cramping, diarrhea, hematochezia, fever to a peak temperature of 38.8°C, and drenching night sweats. Several weeks earlier, he had performed home fecal transplantation. Bloody diarrhea is characteristic of infections caused by… Read More…

A Gut Instinct

Posted by Sara Fazio • August 8th, 2014

In the latest Clinical Problem-Solving article, a 30-year-old female physician presented to the emergency department in mid-August, with a 4-day history of anorexia, nausea, vomiting, and diarrhea. She had no fever or respiratory symptoms but had mild abdominal discomfort. Tuberculosis is a well-recognized occupational hazard for those involved in health care. In a systematic review… Read More…

Kidney Transplantation in Children

Posted by Sara Fazio • August 8th, 2014

A new review discusses unique aspects of kidney transplantation in children that necessitate specialized approaches and have resulted in clinical advances leading to higher success rates in young children than in any other age group. The most common primary causes of kidney failure are congenital or inherited disorders such as renal dysplasia, obstructive uropathies, or… Read More…

Brain Abscess

Posted by Sara Fazio • August 1st, 2014

Despite advances in diagnostic techniques and treatment, brain abscess remains a challenging clinical problem with substantial case fatality rates. Delays in diagnosis and treatment can result in a poor outcome. A new review summarizes current approaches to effective treatment. Despite advances in imaging techniques, laboratory diagnostics, surgical interventions, and antimicrobial treatment, brain abscess remains a… Read More…

Scorpion Envenomation

Posted by Sara Fazio • August 1st, 2014

Each year more than a million cases of scorpion envenomation occur worldwide, causing substantial morbidity and, among children, a risk of death. A new brief review discusses the effects and treatment of scorpion envenomation. Every year, more than 1 million cases of scorpion envenomation are reported worldwide. Although the resultant mortality is lower than that… Read More…

Care of the Asplenic Patient

Posted by Sara Fazio • July 25th, 2014

Asplenic patients are at risk for rapidly progressive septicemia and death. Such patients should be vaccinated against pneumococci, H. influenzae type b, meningococci, and influenza virus, and if fever develops, they should receive empirical antimicrobial therapy immediately.  This is the topic of the latest Clinical Practice review. Mortality among patients with postsplenectomy sepsis can be… Read More…

Fevers, Rash, Pancytopenia, and Abnormal Liver Function

Posted by Sara Fazio • July 25th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 41-year-old man was admitted to the hospital in midsummer because of fever, rash, pancytopenia, and abnormal results of liver-function tests. Two days before the onset of fever, he had returned from a 3-week trip to Europe. Diagnostic tests were performed. The combination of fever,… Read More…

40-Year-Old Woman with Postpartum Dyspnea and Hypoxemia

Posted by Sara Fazio • July 18th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 40-year-old woman was admitted to this hospital 10 days post partum because of dyspnea and hypoxemia associated with leg edema and blood-tinged sputum. Diagnostic procedures were performed. Causes of dyspnea and hypoxemia in the peripartum period are predominantly of pulmonary or cardiovascular origin, the… Read More…

Single-Pill Regimens for HIV-1 Infection

Posted by Sara Fazio • July 18th, 2014

In the latest Clinical Therapeutics review, a 52-year-old man with a history of HIV-1 infection and poor medication adherence presents for evaluation. A single-pill regimen is considered. For some patients with HIV-1 infection, combination regimens consisting of one pill to be taken daily can improve adherence. With the advent and refinement of combination ART [antiretroviral… Read More…