Impf_Info – Following Feed 204 Posts (gefiltert)

A video shows improvements in hearing in a child who received gene therapy for 𝘖𝘛𝘖𝘍-related deafness. Full video and accompanying article: https://www.nejm.org/doi/full/10.1056/NEJMoa2400521

The IARC Working Group summarizes guidance on 𝘏. 𝘱𝘺𝘭𝘰𝘳𝘪 screen-and-treat programs for gastric cancer prevention and concludes that prevention is the most effective strategy amid a rising global burden. Learn more: https://www.nejm.org/doi/full/10.1056/NEJMsb2515372

Faced with a young woman whose seizures, of untraceable cause, can’t be stopped by the medical team, a medical student viscerally learns the limits to what can be accomplished by pushing harder. Read the Perspective essay by Lena Becker, BS, BA: https://www.nejm.org/doi/full/10.1056/NEJMp2510698

Are we measuring team quality the right way in health care? Hannah Neprash, PhD, a health economist at the University of Minnesota (@UMNews) who has done some work studying teams, explains why it’s challenging to describe an ideal primary care team. How do you measure team quality in your practice? Reply with your tips. Learn more about primary care teams in the latest episode of the Not Otherwise Specified podcast hosted by NEJM National Correspondent Lisa Rosenbaum, MD: https://not-otherwise-specified-podcast.nejm.org/e/dream-team/ Listen to past episodes and subscribe to the podcast:  https://not-otherwise-specified-podcast.nejm.org/

A 66-year-old woman with a remote kidney transplant is found unresponsive with intermittent myoclonic jerks. How would you build the differential diagnosis & prioritize initial tests? 🩺️ Read the full case details in the Morning Report: https://eviden.cc/3MJOaLJ @hopkinsneurons

A 73-year-old woman presented in shock with a 1-day history of malaise, dyspnea, and confusion. Serum samples could not be processed owing to gross hemolysis. Dehemoglobinized red cells and bacilli were seen on a peripheral-blood smear. Read the full case details in the Images in Clinical Medicine article “Massive Intravascular Hemolysis from 𝘊𝘭𝘰𝘴𝘵𝘳𝘪𝘥𝘪𝘶𝘮 𝘱𝘦𝘳𝘧𝘳𝘪𝘯𝘨𝘦𝘯𝘴 Bacteremia,” from the Faculty of Medicine at the University of British Columbia and Royal Columbian Hospital (@fraserhealth): https://www.nejm.org/doi/full/10.1056/NEJMicm2514135

Correspondence: Postpartum Persistence of Ebola Virus in Breast Milk https://www.nejm.org/doi/full/10.1056/NEJMc2511894 #IDTwitter #GlobalHealth

Phase 3 CLL17 trial: Fixed-duration and continuous targeted therapies are both used to treat chronic lymphocytic leukemia. Research comparing these strategies is summarized in a new Quick Take video. https://www.nejm.org/do/10.1056/NEJMdo008402/full/

In a woman with chest pain, dyspnea, and syncope, point-of-care ultrasonography revealed a large pericardial effusion, and transesophageal echocardiography revealed mitral-valve abnormalities, shown in a video. Read the full case details: https://www.nejm.org/doi/full/10.1056/NEJMcpc2517857

Hierarchical noninferiority designs using the win ratio offer a way to emphasize the most clinically severe outcomes within a composite. 🔎 Learn more in a new Clinical Trials Workshop article: https://eviden.cc/4kSia4S @djc795

An 𝐚𝐝𝐞𝐧𝐨-𝐚𝐬𝐬𝐨𝐜𝐢𝐚𝐭𝐞𝐝 𝐯𝐢𝐫𝐮𝐬 is a naturally occurring, nonpathogenic virus that has been adapted for use as a vector for gene therapy, in which part of the original genome of the virus is replaced with a therapeutic gene sequence known as the transgene cassette. The outer protein shell, or capsid, of the adeno-associated virus (AAV) determines which tissues the vector will target. To learn more about this NEJM Illustrated Glossary term, read the editorial “Gene Therapy to Treat Profound Hearing Loss” by Paul Van de Heyning, MD, PhD, and Vincent Van Rompaey, MD, PhD: https://www.nejm.org/doi/full/10.1056/NEJMe2514326

A 52-year-old man presented to his primary care clinic with a 3-week history of fevers, drenching night sweats, fatigue, myalgias, and dyspnea on exertion. He reported poor appetite and a weight loss of 6.8 kg that had occurred during the previous 3 weeks. Two weeks before the onset of symptoms, he had traveled to Colorado for a family event. He had not gone hiking during his trip, and he reported not having had close contact with birds, wildlife, or exotic animals. He had no pets and had no history of international travel. Test your diagnostic and therapeutic skills in “A Feverish Pace,” a new Interactive Medical Case: https://www.nejm.org/doi/full/10.1056/NEJMimc2511942 #MedEd #MedTwitter

Perspective by Kevin Schulman, MD, and Arthur L. Kellermann, MD, MPH: Substandard Generic Drugs — Threats to Patient Safety and National Security https://www.nejm.org/doi/full/10.1056/NEJMp2518256 #HealthPolicy #PublicHealth

A 65-year-old woman with a recent history of acute necrotizing pancreatitis presented with a 5-day history of abdominal pain and fevers. Physical examination was notable for tenderness in the upper abdomen. Computed tomography of the abdomen is shown. What is the diagnosis? https://www.nejm.org/image-challenge?ci=20260319

A 57-year-old woman was evaluated because of 2 days of chest pain, dyspnea, lightheadedness, and syncopal episodes. A CT angiogram of the chest showed an aortic-root pseudoaneurysm, measuring 8 mm in diameter, arising from the noncoronary sinus of Valsalva. Full case details: https://www.nejm.org/doi/full/10.1056/NEJMcpc2517857

In this retrospective cohort study from Norway and Taiwan, paternal use of valproate within 90 days before conception was not associated with an increased risk of neurodevelopmental disorders in offspring after adjustment for confounding. Full results: https://eviden.cc/46jXlJw

Original Article: Fixed-Duration versus Continuous Treatment for Chronic Lymphocytic Leukemia (phase 3 CLL17 trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2515458 #Hematology

Original Article: Left Atrial Appendage Closure or Medical Therapy in Atrial Fibrillation (CLOSURE-AF trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? https://www.nejm.org/doi/full/10.1056/NEJMe2518067 #Cardiology

In an international, randomized trial involving patients with acute venous thromboembolism, the risk of clinically relevant bleeding was significantly lower with apixaban than with rivaroxaban during the 3-month treatment period. Full COBRRA trial results and Research Summary: https://www.nejm.org/doi/full/10.1056/NEJMoa2510703

To control EBOV outbreaks, defining potential sanctuary sites where the virus may persist and lead to transmission is important. In this report, persistence of EBOV RNA in breast milk was identified and characterized. Read the full report: https://www.nejm.org/doi/full/10.1056/NEJMc2511894

🧵 As patients live longer with cancer, traditional treatment models centered around hospitals and infusion centers increasingly burden patients, caregivers, and health care systems alike.

In a new blog post, @PaulSaxMD shares 20 facts about a surprisingly common group of infections: nontuberculous mycobacteria, or NTM. See the list: https://voices.nejm.org/doi/full/10.1056/VOICESpost2600004

A new interactive feature describes a 52-year-old man who presented to his primary care clinic with a 3-week history of fevers, drenching night sweats, fatigue, myalgias, and dyspnea on exertion. Test your diagnostic and therapeutic skills: https://www.nejm.org/doi/full/10.1056/NEJMimc2511942

The treatment goal for patients with polymyalgia rheumatica is the absence of clinical symptoms and systemic inflammation. Glucocorticoids are the first-line therapy. Abatement of symptoms and inflammatory signs is usually rapid (seen in figure). Learn more in a new review: https://www.nejm.org/doi/full/10.1056/NEJMcp2506817

The authors of a new Perspective write that the CMS Innovation Center is approaching the next negotiation cycle for the CGT Access Model. Several considerations will guide the selection of future candidate diseases and potential new model designs. Perspective by A. Sutton (@AbeSutton) et al.: https://www.nejm.org/doi/full/10.1056/NEJMp2513320

A 74-year-old man was admitted to the hospital with a 3-week history of intermittent fevers, muscle aches, and vomiting. Thin blood smears showed spirochetes. Read the full case details in the Images in Clinical Medicine article “Soft Tick Relapsing Fever,” from @ucdavis: https://www.nejm.org/doi/full/10.1056/NEJMicm2514982

The authors of a new Perspective write that some foreign pharmaceutical plants that export generic drugs to the United States have glaring quality problems that can lead to drug shortages. There is a better way to assure the safety of generic drugs. Read the Perspective by Kevin Schulman, MD, and Arthur L. Kellermann, MD, MPH: https://www.nejm.org/doi/full/10.1056/NEJMp2518256

Among patients with atrial fibrillation at high risk for stroke and bleeding, left atrial appendage closure was not noninferior to medical therapy in reducing the risk of stroke, embolism, major bleeding, or death at 3 years. Full CLOSURE-AF trial results: https://www.nejm.org/doi/full/10.1056/NEJMoa2513310 Editorial: Left Atrial Appendage Closure — Another Overused Method in Cardiology? https://www.nejm.org/doi/full/10.1056/NEJMe2518067

Original Article: Romiplostim versus Placebo for Chemotherapy-Induced Thrombocytopenia (phase 3 RECITE trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2511882 Editorial: Thrombopoietin-Receptor Agonists in Chemotherapy-Induced Thrombocytopenia https://www.nejm.org/doi/full/10.1056/NEJMe2517578 #Oncology #Gastroenterology

In a Perspective, Melissa Arguello Belli, MD, argues that U.S. clinicians, health systems, and policymakers should recognize immigration enforcement as a social determinant of health currently implicated in a public health crisis and act accordingly. Read the full Perspective: https://www.nejm.org/doi/full/10.1056/NEJMp2516715

Case Record of the Massachusetts General Hospital (@MassGeneralNews): A 57-year-old woman was evaluated at this hospital because of 2 days of chest pain, dyspnea, lightheadedness, and syncopal episodes. Six weeks before this evaluation, the patient was admitted to this hospital because of a temperature of 41.1°C, dyspnea and hypoxemia, tachycardia, altered mental status, and opioid injection. The results of blood and urine cultures and imaging of the chest, abdomen, pelvis, head, and neck were unrevealing. Transthoracic echocardiography revealed thickening of the mitral-valve leaflets and the noncoronary aortic-valve leaflet and no pericardial effusion. The patient received treatment for hypoxemic respiratory failure with mechanical ventilation, a brief course of empirical broad-spectrum antibiotic therapy, diuretic therapy, and albuterol and ipratropium bromide nebulizers. In addition, methadone therapy was started to alleviate the symptoms of opioid withdrawal. Her mental status and respiratory status improved, and she was discharged on hospital day 10 in stable condition. Read the full case details in “A 57-Year-Old Woman with Chest Pain, Dyspnea, and Syncope,” a Case Record of the Massachusetts General Hospital, by P.T. O’Gara et al., from @MassGenBrigham, @harvardmed, and Massachusetts General Hospital: https://www.nejm.org/doi/full/10.1056/NEJMcpc2517857

In the latest episode of AI Grand Rounds, Dr. Kyunghyun Cho (@kchonyc) discusses his wide-ranging career spanning fundamental AI research, co-founding Prescient Design (acquired by @genentech), and driving applications of AI in health care. Full episode: https://nejm.ai/ep40

A 12-year-old girl was admitted to the hospital with altered mental status and abdominal distention. The blood glucose level was 30 mg per deciliter. Symptoms abated with glucose administration. What is the most likely diagnosis in this case? 🗳️ Cast your vote before March 25: https://www.nejm.org/do/10.1056/NEJMdo008418/full/

Some of these rabies exposure stories from infectious diseases expert Paul Sax, MD, are pretty wild. Watch the full video for a rundown of the animal species most likely to have rabies ― any guesses?? https://clinician.nejm.org/dr-paul-sax-rabies-CLINccNA59902

Original Article: Prehospital Whole Blood in Traumatic Hemorrhage — a Randomized Controlled Trial (phase 3 SWiFT trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2516043 #ISICEM | @ISICEM

Original Article: High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure (SOHO trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2516087 Editorial: Rethinking High-Flow Oxygen in Acute Hypoxemic Respiratory Failure https://www.nejm.org/doi/full/10.1056/NEJMe2602037 #ISICEM | @ISICEM

Original Article: DB-OTO Gene Therapy for Inherited Deafness (CHORD study) https://www.nejm.org/doi/full/10.1056/NEJMoa2400521 Science behind the Study: Gene Therapy to Treat Profound Hearing Loss https://www.nejm.org/doi/full/10.1056/NEJMe2514326 #Genetics #Otolaryngology

Original Article: Bleeding Risk with Apixaban vs. Rivaroxaban in Acute Venous Thromboembolism (COBRRA trial) https://www.nejm.org/doi/full/10.1056/NEJMoa2510703 #Cardiology #CriticalCare

Images in Clinical Medicine: Vulvar Melanoma with Vaginal Extension https://www.nejm.org/doi/full/10.1056/NEJMicm2509511 #Oncology #OBGYN

Submit your answer to the latest Image Challenge: A 33-year-old pregnant woman with previously well-controlled atopic dermatitis presents at 34 weeks’ gestation with a 3-day history of fever and an itchy, painful rash. https://www.nejm.org/image-challenge?ci=20260312