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.

Letrozole or Clomiphene for Infertility in PCOS

Posted by Sara Fazio • July 11th, 2014

This double-blind, multicenter, randomized trial showed that letrozole, as compared with clomiphene, was associated with higher live-birth and ovulation rates among infertile women with the polycystic ovary syndrome. The PCOS, which is diagnosed on the basis of hyperandrogenism, oligo-ovulation with associated oligomenorrhea, and polycystic ovaries on ultrasonography, affects 5 to 10% of reproductive-age women and… Read More…

CNS Fungal Infections

Posted by Sara Fazio • July 11th, 2014

Molds are ubiquitous in soil, water, and decaying vegetation and can cause devastating infections that are difficult to treat. This review summarizes the epidemiologic profiles, clinical characteristics, and treatment of mold infections of the central nervous system. Molds are ubiquitous organisms found in soil, water, and decaying vegetation. All have septate, angular, branching hyphae in… Read More…

Acute Kidney Injury and Chronic Kidney Disease

Posted by Sara Fazio • July 4th, 2014

This new review article considers evidence that acute and chronic kidney diseases are not distinct entities but rather are closely interconnected.  The implications of this insight are discussed in terms of the approach to patients with kidney disease. During the past decade, separate conceptual models for chronic kidney disease and acute kidney injury were developed… Read More…

Giant-Cell Arteritis and Polymyalgia Rheumatica

Posted by Sara Fazio • July 4th, 2014

Both giant-cell arteritis and polymyalgia rheumatica are immune-mediated diseases that are treated with glucocorticoids, with higher doses used for giant-cell arteritis. In our latest Clinical Practice article, prompt initiation of high doses and a biopsy are recommended when ischemic optic neuropathy is suspected. Giant-cell arteritis is an inflammatory vasculopathy that typically occurs in medium and… Read More…

Dying with Dignity in the Intensive Care Unit

Posted by Sara Fazio • June 27th, 2014

It is common for patients to have an expected death in an ICU. The final review in the Critical Care series covers issues related to the end of life in the absence of discordance between the patient’s family and caregivers. The traditional goals of intensive care are to reduce the morbidity and mortality associated with… Read More…

Prophylaxis against Venous Thromboembolism in Ambulatory Cancer Patients

Posted by Sara Fazio • June 27th, 2014

Patients with cancer are at increased risk for thrombosis, and those with thrombi have poorer overall survival rates than those without. In a new review article, Dr. Jean Connors from Brigham and Women’s Hospital and Dana Farber Cancer Institute summarizes available data and provides guidance for determining which patients might benefit from thromboprophylaxis. The incidence… Read More…

Tofacitinib versus Methotrexate in Rheumatoid Arthritis

Posted by Sara Fazio • June 20th, 2014

In patients with rheumatoid arthritis, tofacitinib was associated with greater reductions in signs and symptoms than methotrexate. Herpes zoster infections and increases in creatinine and in LDL and HDL cholesterol levels were more common with tofacitinib. Rheumatoid arthritis is a chronic autoimmune disease characterized by inflammation and by joint destruction that leads to substantial disability…. Read More…

19-Year-Old Woman with Headache, Fever, Stiff Neck, and Mental-Status Changes

Posted by Sara Fazio • June 20th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 19-year-old woman was admitted to the pediatric ICU because of a headache, fever, photophobia, neck stiffness, and mental-status changes. She was drowsy and disoriented with respect to year. She had truncal ataxia and rotatory nystagmus, and her face and right arm were numb. In… Read More…

The Child or Adolescent with Elevated Blood Pressure

Posted by Sara Fazio • June 13th, 2014

Evaluation of children and adolescents with hypertension can detect evidence of the secondary systemic effects of hypertension (in particular, renal disease). Initial therapy is usually nonpharmacologic, but pharmacotherapy is used if other methods fail, hypertension is severe, or there are coexisting conditions such as diabetes mellitus.  NEJM Deputy Editor and Massachusetts General Hospital pediatrician Dr…. Read More…

Rash, Myalgia, and Weakness

Posted by Sara Fazio • June 13th, 2014

In the latest Case Record of the Massachusetts General Hospital, a 32-year-old man was admitted to this hospital because of a violaceous eruption that was followed by muscle pain and weakness, leading to respiratory failure. New papules with white centers developed. A diagnostic procedure was performed. Malignant atrophic papulosis can occur in association with autoimmune… Read More…