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.

Men Who Have Sex with Men

Posted by Carla Rothaus • August 28th, 2015

A new Clinical Practice article covers primary care for men who have sex with men. Care should include a detailed sexual history to assess the risk of infection with HIV, the use of preexposure prophylaxis for those at high risk, and appropriate vaccinations and regular testing for sexually transmitted infections. Men who have sex with men,… Read More…

Perioperative Bridging Anticoagulation

Posted by Carla Rothaus • August 28th, 2015

In this Original Article, a trial assigned patients with atrial fibrillation who required warfarin interruption for an elective procedure to either bridging anticoagulation or placebo. Forgoing bridging was noninferior to bridging for arterial thromboembolism and superior for major bleeding. A video summary is also available with the article on NEJM.org. For patients with atrial fibrillation who… Read More…

A 9-Month-Old Girl with Fevers

Posted by Carla Rothaus • August 21st, 2015

In a new Case Record of the Massachusetts General Hospital, a 9-month-old girl presented with a 2-month history of recurrent fevers. Examination revealed fever and tachycardia and was otherwise normal; chest and abdominal imaging studies showed no evidence of infection. Additional diagnostic tests were performed. Septic arthritis is a pediatric orthopedic emergency. Clinical Pearls • What is… Read More…

Unprovoked Venous Thromboembolism

Posted by Carla Rothaus • August 21st, 2015

In this Original Article, a trial showed that the addition of abdominopelvic CT to routine measures in patients with unprovoked venous thrombosis did not detect additional occult cancers. The incidence of cancer in first unprovoked venous thrombosis was 4%, not 10% as had been previously reported. Carrier et al. conducted a multicenter, open-label, randomized, controlled trial… Read More…

A Girl with a Chest-Wall Mass

Posted by Carla Rothaus • August 14th, 2015

In a new Case Record of the Massachusetts General Hospital, an 8-year-old girl with placement of a long-term tracheostomy tube presented with a chest-wall mass. Imaging studies revealed a soft-tissue mass, a pleural effusion, and pulmonary consolidation. A diagnostic procedure was performed. Bacterial tracheobronchitis and pneumonia are common in children who have undergone tracheostomy, with an… Read More…

Ischemic Limb Gangrene

Posted by Carla Rothaus • August 14th, 2015

A new review article covers ischemic limb gangrene. A variety of systemic illnesses can be associated with limb gangrene with preservation of arterial pulses. Many such disorders involve venous thrombosis caused by a procoagulant–anticoagulant imbalance often related to low levels of protein C. There are two distinct syndromes of microthrombosis-associated ischemic limb injury. Venous limb gangrene… Read More…

Chronic Cough

Posted by Carla Rothaus • August 7th, 2015

In a new Clinical Problem-Solving article, a 63-year-old nonsmoking man presented with a 2-year history of dry cough. Videos showing transthoracic echocardiograms obtained before and during the course of the patient’s treatment are available. Whipple’s disease may be difficult to recognize; its rarity and nonspecific clinical features (overlapping with those of many chronic inflammatory diseases) often… Read More…

Pregnancy Complicated by Venous Thrombosis

Posted by Carla Rothaus • August 7th, 2015

A new Clinical Practice article provides an overview of venous thrombosis in pregnancy. Low-molecular-weight heparins are generally preferred for the treatment of venous thromboembolism in pregnant women. Coumarins are contraindicated in pregnancy but can be used after delivery. Although the absolute incidence of venous thromboembolism in pregnancy is low (1 or 2 cases per 1000 pregnancies),… Read More…

Chagas’ Disease

Posted by Carla Rothaus • July 31st, 2015

The infection of millions of people with the protozoan parasite Trypanosoma cruzi is a public health concern. A new review article explains how treatments for Chagas’ disease remain marginally effective, and cardiac and gastrointestinal complications dominate the clinical picture. Chagas’ disease is caused by the protozoan parasite Trypanosoma cruzi, which is transmitted when the infected feces of… Read More…

Community-Acquired Pneumonia

Posted by Carla Rothaus • July 31st, 2015

The etiology of community-acquired pneumonia requiring hospitalization in adults is evolving, in light of vaccine deployment and new diagnostic tests. A new Original Article defines pathogens potentially causing pneumonia. In a majority of cases, no pathogen was identified. Community-acquired pneumonia is a leading infectious cause of hospitalization and death among U.S. adults. The last U.S. population-based… Read More…