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.

Narcolepsy

Posted by Carla Rothaus • January 4th, 2016

Narcolepsy affects approximately 1 in 2000 people but is often not correctly diagnosed. This review article summarizes recent discoveries regarding the neurobiologic features of this condition and describes a practical clinical approach to effective treatment. Narcolepsy, one of the most common causes of chronic sleepiness, affects about 1 in 2000 people. Despite the frequency of narcolepsy,… Read More…

Sofosbuvir and Velpatasvir for HCV

Posted by Carla Rothaus • January 4th, 2016

In a phase 3 study involving patients with HCV genotype 1, 2, 4, 5, or 6 infection, including those with compensated cirrhosis, treatment with 12 weeks of sofosbuvir and velpatasvir resulted in a sustained virologic response in 99% of patients. Of the 170 million patients who are chronically infected with hepatitis C virus (HCV) worldwide, approximately… Read More…

Comfort Care

Posted by Carla Rothaus • December 26th, 2015

The symptoms that cause suffering in hospitalized patients who are near death can be addressed by a variety of palliative interventions that improve the patient’s remaining life and ease the stress on both the patient and family members. A new review article summarizes.  Palliative care services can reduce the distress caused by symptoms and improve the… Read More…

Selexipag for Pulmonary Hypertension

Posted by Carla Rothaus • December 26th, 2015

Among over 1100 patients with pulmonary arterial hypertension who received selexipag, an oral selective IP prostacyclin-receptor agonist, or placebo, the risk of the composite end point of death or complication was lower with selexipag than with placebo at 1.3 years of follow-up. A new Original Article summarizes. Pulmonary arterial hypertension is a severe disease with a… Read More…

Ibrutinib as Initial Therapy for CLL

Posted by Carla Rothaus • December 18th, 2015

The Bruton’s tyrosine kinase inhibitor ibrutinib was compared with the alkylating agent chlorambucil in patients with chronic lymphocytic leukemia. In a new Original Article, ibrutinib was associated with a higher response rate, longer duration of response, and longer overall survival. Chronic lymphocytic leukemia (CLL) is the most common leukemia among adults in Western countries; it affects… Read More…

Andexanet Alfa

Posted by Carla Rothaus • December 18th, 2015

The new oral anticoagulants have many advantages over warfarin, but one disadvantage is the inability to rapidly reverse their anticoagulant effects. Andexanet, a small-molecule factor Xa fragment, rapidly lowered levels of rivaroxaban and apixaban in older healthy volunteers. A new Original Article summarizes.  The direct factor Xa inhibitors apixaban, rivaroxaban, and edoxaban are used in… Read More…

A Man with Weight Loss

Posted by Carla Rothaus • December 11th, 2015

In a new Case Record of the Massachusetts General Hospital, a 21-year-old man was admitted to this hospital because of fatigue, weight loss, tender gynecomastia, hyperthyroidism, and lesions in the lungs and liver on radiographic imaging. Diagnostic procedures were performed. Luteinizing hormone and human chorionic gonadotropin (hCG) are highly homologous and share the same receptor (the… Read More…

Thyroid Nodules

Posted by Carla Rothaus • December 11th, 2015

Ultrasonography of the thyroid and ultrasonographically guided fine-needle aspiration can help determine whether a nodule is probably benign or malignant. In the absence of growth or suspicious clinical or radiologic findings, nodules with a benign finding on FNA can be monitored. A new Clinical Practice article summarizes. Palpable thyroid nodules occur in approximately 4 to 7%… Read More…

Back to Nature

Posted by Carla Rothaus • December 4th, 2015

In a new Clinical Problem-Solving article, a 28-year-old man presented with severe bifrontal headache, nausea, anorexia, sweats, and temperatures as high as 40.3°C. He reported no confusion, photophobia, visual changes, neck stiffness, sensory loss, sore throat, cough, dyspnea, diarrhea, or abdominal pain. Tularemia is a zoonotic infection caused by Francisella tularensis, a fastidious, gram-negative coccobacillus. The… Read More…

Chest Compressions during CPR

Posted by Carla Rothaus • December 4th, 2015

In a new Original Article, over 23,000 patients with out-of-hospital cardiac arrest were assigned to standard CPR with a chest compression-to-ventilation ratio of 30:2 or to continuous chest compressions. There was no significant between-group difference in survival to hospital discharge. Standard cardiopulmonary resuscitation (CPR) consists of manual chest compressions to maintain blood flow and positive-pressure breathing to… Read More…