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.

Influenza Vaccination

Posted by • September 29th, 2016

The effects of influenza traditionally have been assessed by comparing hospitalizations and deaths during an influenza season with a baseline model. These calculations suggest that seasonal influenza epidemics in the United States are responsible for between 55,000 and 431,000 hospitalizations due to pneumonia and influenza each year and as many as 49,000 deaths. The highest… Read More…

Azithromycin Prophylaxis for Cesarean Delivery

Posted by • September 29th, 2016

Cesarean delivery is the most common major surgical procedure and is associated with a rate of surgical-site infection (including endometritis and wound infection) that is 5 to 10 times the rate for vaginal delivery. Tita et al. assessed whether the addition of azithromycin to standard antibiotic prophylaxis before skin incision would reduce the incidence of… Read More…

Primary Sclerosing Cholangitis

Posted by • September 22nd, 2016

Primary sclerosing cholangitis is an idiopathic, heterogeneous, cholestatic liver disease that is characterized by persistent, progressive biliary inflammation and fibrosis. There is no effective medical therapy for this condition. End-stage liver disease necessitating liver transplantation may ultimately develop in affected patients. This new Review Article summarizes the pathogenesis and management of this condition. Clinical Pearl • How… Read More…

Craniectomy for Traumatic Intracranial Hypertension

Posted by • September 22nd, 2016

Intracranial hypertension after traumatic brain injury (TBI) is associated with an increased risk of death in most case series. The monitoring of intracranial pressure and the administration of interventions to lower intracranial pressure are routinely used in patients with TBI, despite the lack of level 1 evidence. Hutchinson et al. conducted the Randomised Evaluation of… Read More…

A 31-Year-Old Woman with Infertility

Posted by • September 15th, 2016

Tuberculous endometrial granulomas take a while to become caseated; women of reproductive age, who regularly shed their endometrial lining, may do so before caseation has had the opportunity to develop. In older women, who have longer cycles or do not have cycles, caseating granulomas in the endometrium are more likely to develop. A 31-year-old Nepalese… Read More…

Herpes Zoster Subunit Vaccine in Adults 70 Years of Age or Older

Posted by • September 15th, 2016

An investigational herpes zoster subunit vaccine (HZ/su) is being evaluated for the prevention of herpes zoster and postherpetic neuralgia in adults 50 years of age or older. A previous trial (Zoster Efficacy Study in Adults 50 Years of Age or Older [ZOE-50]) showed that HZ/su had a vaccine efficacy against herpes zoster of 97.2%, which… Read More…

Acute Sinusitis in Adults

Posted by • September 8th, 2016

Acute bacterial sinusitis — involving purulent nasal discharge and nasal obstruction; facial pain, pressure, or fullness; or both — persists for 10 days or more with no improvement or worsens within 10 days after improvement. However, the natural history of acute sinusitis in adults is very favorable; approximately 85% of persons have a reduction or… Read More…

A Woman with Müllerian Carcinoma and Fever

Posted by • September 8th, 2016

The spleen plays an important role in the clearance of encapsulated bacteria and of erythrocytes parasitized by protozoa, such as malaria and babesia. A 71-year-old woman with müllerian carcinoma was admitted to the hospital because of fever, fatigue, and myalgias 3.5 weeks after extensive cytoreductive surgery. Anorexia, abdominal pain, and bloating had developed 1 day… Read More…

Origins of Chronic Obstructive Pulmonary Disease

Posted by • September 1st, 2016

The conventional thinking about chronic obstructive pulmonary disease (COPD) is that exposures in adult life, such as smoking, lead to a low FEV1:FVC ratio, the physiological hallmark of COPD (a frequent cause of illness and death). Although smoking is still considered a major culprit, it is now known that genetic, environmental, and developmental factors that… Read More…

Tip of the Tongue

Posted by • September 1st, 2016

A clue to the diagnosis of leptomeningeal carcinomatosis is the presence of neurologic findings that localize to multiple anatomical locations, since access to the subarachnoid space allows the tumor to have effects at multiple neurologic levels. A 65-year-old woman with a history of HIV infection, hypertension, and hyperlipidemia had a 1-week history of cough with… Read More…