A previously healthy man presented with a 5-day history of fever, nausea, and vomiting and a 2-day history of an itchy rash. Examination showed an exanthem consisting of minute macules and subtly elevated papules. Read the full case details: https://nej.md/4tSKIiB
The authors of a new Perspective argue that trainees’ paths to safe, independent practice are variable. Artificial intelligence could help accelerate implementation of competency-based medical education to support individualized development. Read the Perspective by Sanjay V. Desai, MD (@sanjayvdesai), Sal Khan, MBA (@salkhanacademy), and Kimberly Lomis, MD (@KimLomisMD): https://nej.md/4cLixvZ
Group B streptococcal infection mostly affects newborns, infants, pregnant persons, and older adults. Perinatal prevention is successful but contributes to antibiotic exposure. Multivalent glycoconjugate vaccines are in development.
Learn more in the Review Article “Group B Streptococcal Disease” by Karen M. Puopolo, MD, PhD, from @PennMedicine and @ChildrensPhila: https://nej.md/4aJJ6Pv
Mpox continues to spread in many communities. Tecovirimat has activity against orthopoxviruses in vitro. In a phase 3 trial involving patients with acute mpox, tecovirimat showed no evidence of clinical activity. Full STOMP/A5418 trial results: https://nej.md/4rdlMA9
Xin Lu, PhD, describes the scientific foundations of a study of rezatapopt, which targets a variant form of p53, to treat patients with solid tumors.
Learn about the science behind the study in the editorial “Restoring Function to a Variant of p53 in Solid Tumors,” from @Ludwig_Cancer: https://nej.md/3N0pQW8
In a phase 1 study of the oral p53 reactivator rezatapopt in heavily pretreated patients with TP53 Y220C–mutated solid tumors, the most common adverse events were nausea and vomiting, and the overall response was 20%. Full PYNNACLE study results: https://nej.md/3OIQC5P
Science behind the Study: Restoring Function to a Variant of p53 in Solid Tumors https://nej.md/3N0pQW8
Sounding Board: One Pivotal Trial, the New Default Option for FDA Approval — Ending the Two-Trial Dogma https://nej.md/4tT2rqv
#HealthPolicy | @US_FDA
In low-risk patients with severe aortic stenosis, transcatheter and surgical aortic-valve replacement led to similar 7-year survival and valve durability outcomes, with no evidence of differences in composite end points. Full PARTNER 3 trial results and Research Summary: https://nej.md/4nieHfx
This diagram shows the suggested diagnostic approach to disorders associated with eosinophilia. To learn more, read the latest Case Record of the Massachusetts General Hospital (@MassGeneralNews): https://nej.md/463iKqj
𝐍𝐨𝐰 𝐚𝐯𝐚𝐢𝐥𝐚𝐛𝐥𝐞 𝐢𝐧 𝑵𝑬𝑱𝑴 𝑬𝒗𝒊𝒅𝒆𝒏𝒄𝒆!
A new Public Health Alerts report, published in partnership with @CIDRAP: Multistate Infant Botulism Outbreak Associated with Powdered Infant Formula https://eviden.cc/4qXflB5
#IDTwitter #Pediatrics
Language discordance in surgical care is a structural driver of inequity that affects patient safety, trust, and outcomes.
Emerging interpreter technologies, including #ArtificialIntelligence (AI) and remote video interpretation (RVI), are rapidly entering clinical settings. However, implementation decisions are often made without understanding how patients themselves perceive these modalities or whether they view them as replacements or complementary tools within their care.
To explore Spanish-speaking surgical patients’ perceptions of AI- and RVI-based interpreter technologies, and to understand how clinical context influences modality preferences, the author team conducted a descriptive concurrent mixed-methods study within a U.S. academic health system, enrolling 23 adult patients with Spanish language preference across the surgical continuum.
The patients did not choose a single preferred modality; instead, they expressed context-dependent needs. AI was viewed as advantageous for its speed, privacy, and literal translation in straightforward or time-sensitive scenarios. RVI was favored for emotionally complex conversations and cultural nuance.
Across narratives, patient agency emerged as a dominant theme. These findings support the development of a multifaceted language access infrastructure in which AI and remote human interpreters are deployed synergistically based on clinical sensitivity, urgency, and patient preference.
Read the In Depth article “Artificial Intelligence for Language Access in Surgical Care: Patient Preferences and an Implementation Framework” by M.A. Montoya Rubiano et al. in the March 2026 issue of @nejmcatalyst Innovations in Care Delivery: https://nej.md/46XDy2K
Explore the full issue: https://nej.md/40e5VG6
The risk of recurrent ischemic stroke can be reduced by managing modifiable risk factors and instituting a regimen of mechanism-specific secondary stroke prevention. Strategies for secondary prevention should be instituted as early as possible. Learn more: https://nej.md/3OFpJ2C
Perspective by Jessica S. Ross, MD: Heads or the Tail? https://nej.md/3MJWJ9r
#MedicalEthics #MedicalPractice
𝐁𝐢𝐝𝐢𝐫𝐞𝐜𝐭𝐢𝐨𝐧𝐚𝐥 𝐭𝐫𝐚𝐧𝐬𝐜𝐫𝐢𝐩𝐭𝐢𝐨𝐧 is a process in which both strands of DNA at a given locus are transcribed, producing RNA in opposite directions from the same region. Sense and antisense transcripts are thereby generated. Bidirectional transcription is a common feature of genomic regions with repeat expansions and can contribute to disease by generating toxic RNAs or proteins from both strands.
To learn more about this NEJM Illustrated Glossary term, read the editorial “A Trial of an Antibody–Oligonucleotide Conjugate” by Laura P.W. Ranum, PhD, from @UFMedicine, @UFMBI, @FixelInstitute, and @UFGenetics: https://nej.md/4aic8XJ
Explore more terms: https://nej.md/glossary
Johnson and colleagues report a phase 1–2 trial of del-desiran, an antibody–oligonucleotide conjugate designed to reduce DMPK mRNA, to treat myotonic dystrophy type 1. Full MARINA trial results and Research Summary: https://nej.md/4tBOFbu
Volume 5 Issue 3 of 𝘕𝘌𝘑𝘔 𝘌𝘷𝘪𝘥𝘦𝘯𝘤𝘦 is now available! Here is a preview of the latest content:
𝗣𝘂𝗯𝗹𝗶𝗰 𝗛𝗲𝗮𝗹𝘁𝗵 𝗔𝗹𝗲𝗿𝘁𝘀
Seasonal Influenza Activity, Vaccination Rates, and Pediatric Influenza Mortality, Massachusetts 2024–2025 https://eviden.cc/3Ng77px
Images in Clinical Medicine: Majocchi’s Granuloma https://nej.md/4qCbUiO
#DermTwitter #IDTwitter
Correspondence: Revival of Ethionamide by Alpibectir https://nej.md/46PP9Rn
#IDTwitter #GlobalHealth
After ischemic stroke, recurrence risk is reduced by identifying the stroke mechanism and targeting modifiable risk factors. Early diagnostic evaluation, prompt preventive therapy, and ongoing monitoring are central to care. Learn more: https://nej.md/3OFpJ2C
In a Perspective, Sonja A. Rasmussen, MD, and Daniel B. Jernigan, MD, MPH, write that both viral and host factors have contributed to the intensity of influenza activity during the 2025–2026 season. Some of these factors can be managed, whereas others are largely beyond human control. Learn more: https://nej.md/49VN4pc
The PARTNER 3 trial showed similar outcomes of transcatheter aortic-valve replacement and surgical aortic-valve replacement for severe, symptomatic aortic stenosis in low-risk patients at 5 years. Now, 7-year findings are summarized in a new Quick Take video. https://nej.md/4twDktn
In relapsed or refractory multiple myeloma, teclistamab plus daratumumab significantly prolonged progression-free survival as compared with DPd or DVd (83.4% vs. 29.7%) and led to higher response rates. Full phase 3 MajesTEC-3 trial results and Research Summary: https://nej.md/4431DUD
From an Original Article published March 1, 1956:
Early in the present century lesions of the peripheral nerves caused by arsenical intoxication were a frequent occurrence. In most cases the neuropathy could be attributed to contact with the many household articles such as dyes, wallpaper and insecticides that contained large quantities of arsenic. In recent years, exposure to arsenic has been greatly reduced, and arsenical intoxication is no longer considered a common cause of peripheral neuropathy. Dusts and sprays containing arsenic, however, continue to be extensively employed as pesticides on farms in North Carolina, and their accidental ingestion or inhalation has produced numerous cases of poisoning. Our experience with this condition suggests that arsenical intoxication may be a more frequent cause of neuropathy, particularly in rural areas, than is generally realized. The present paper analyzes 41 cases of acute and chronic arsenical poisoning with peripheral neuropathy seen in Duke University Hospital and Durham Veterans Administration Hospital during the past fifteen years. The clinical and laboratory diagnosis of this condition is emphasized. Special attention is also given to the effects of BAL therapy of the neuropathy since there is little information on the value of this commonly recommended agent.
Continue reading “Peripheral Neuropathy Caused by Arsenical Intoxication — A Study of 41 Cases with Observations on the Effects of Bal (2,3, Dimercapto-Propanol),” an article from 1956, in the NEJM Archive: https://nej.md/4rhDfIn
Images in Clinical Medicine: Peritoneal Coccidioidomycosis https://nej.md/4aykJ7y
#IDTwitter
A new Video in Clinical Medicine reviews the key aspects of patient-controlled analgesia device usage, including the indications and contraindications, routes of administration, and essential equipment required.
Watch the full video and read the accompanying article: https://nej.md/46POEXv
MARINA trial: Myotonic dystrophy type 1 currently has no approved therapies. Research on the safety of delpacibart etedesiran ― an antibody–oligonucleotide conjugate developed to treat the underlying cause of the disorder ― is summarized in a new Quick Take video. https://nej.md/4aLHnuh
Science behind the Study: A Trial of an Antibody–Oligonucleotide Conjugate https://nej.md/4aic8XJ
#Neurology #Genetics
A previously healthy 26-year-old man presented with a 5-day history of fever, nausea, and vomiting and a 2-day history of an itchy rash. The rash had started behind his ears and then spread to his face and entire body. The patient was a refugee from a Middle Eastern country and had had limited vaccinations. Well-demarcated erosions were also present on the buccal mucosa on both sides of the mouth. Submit your answer or see how others responded: https://nej.md/IC02192026
“... treatment with solriamfetol had a significant impact on sleep latency; while there was an increase in sleep latency in both groups, the solriamfetol group had an additional 9.4 minutes of sleep latency [vs. placebo], which was sustained.” https://eviden.cc/4ruRPft
Case Record of the Massachusetts General Hospital (@MassGeneralNews): A 91-year-old man was admitted to the hospital with weight loss, dyspnea, and eosinophilia. An anteroposterior chest radiograph obtained 2 months earlier showed bibasilar patchy opacities. A diagnosis was made. 👉 https://nej.md/463iKqj
An anteroposterior image obtained on portable chest radiography 2 months before the current admission (Panel A) shows new bibasilar patchy opacities (arrows), which are more prominent in the right lung than in the left lung, a finding that suggests pneumonia or aspiration (or both) in both lungs. A posteroanterior chest radiograph obtained on the day of admission (Panel B) shows a decrease in the size of the opacities in the right lower lobe and no change in the size of the opacities in the left lower lobe (white arrows), along with new small bilateral pleural effusions (black arrows).
Read the full case details in “A 91-Year-Old Man with Shortness of Breath, Weight Loss, and Eosinophilia,” a Case Record of the Massachusetts General Hospital, by P.K. Bendapudi et al., from Massachusetts General Hospital (@MassGeneralNews) and @harvardmed: https://nej.md/463iKqj
Reducing Tobacco Use Worldwide by Laura Llambi, MD, PhD (@laura_llambi), and Paola Morello, MD, MPH: Tobacco Cessation among Nondaily and Low-Intensity Smokers — Challenges and Opportunities in Latin America https://nej.md/4qMcevK
#GlobalHealth #HealthPolicy
Original Article: Transcatheter or Surgical Aortic-Valve Replacement in Low-Risk Patients at 7 Years (PARTNER 3 trial) https://nej.md/4nieHfx
#Surgery #Cardiology
Original Article: An Antibody–Oligonucleotide Conjugate for Myotonic Dystrophy Type 1 (MARINA trial) https://nej.md/4tBOFbu
Science behind the Study: A Trial of an Antibody–Oligonucleotide Conjugate https://nej.md/4aic8XJ
#Neurology #Genetics
In a follow-up to a study of pregnant individuals at high risk of hemolytic disease of the fetus & newborn, antenatal nipocalimab treatment resulted in low levels of detectable drug in fetal, neonatal & infant samples, w/ no unusual childhood illnesses. https://eviden.cc/46bss9Y
This Sounding Board announces a new @US_FDA policy that the default requirement for FDA approvals will be one robust pivotal trial plus confirmatory evidence, rather than two trials. Learn more: https://nej.md/4tT2rqv
Ischemic stroke, defined as a central nervous system injury caused by loss of blood flow, is most often due to arterial thromboembolism. Evaluation should include relevant blood tests and cardiovascular and cardiac investigations (seen in table). Learn more: https://nej.md/3OFpJ2C
A high-school wrestler presented with an itchy rash that had worsened despite topical antifungal and glucocorticoid treatment. A circular, scaly plaque with papules, nodules, and pustules was seen on his calf.
Read the full case details in the Images in Clinical Medicine article “Majocchi’s Granuloma,” from @nyulangone and @nyugrossman: https://nej.md/4qCbUiO
Sonja A. Rasmussen, MD, discusses the 2025–2026 influenza season, including factors contributing to the intensity of influenza activity. Listen to the full interview with NEJM Executive Managing Editor Stephen Morrissey (@srm128): https://nej.md/4rhH400
Original Article: Cabotegravir plus Rilpivirine for Persons with HIV and Adherence Challenges (phase 3 LATITUDE trial) https://nej.md/4qFyjMm
Editorial: From Efficacy to Access in Long-Acting HIV Therapy https://nej.md/4rRRyTT
#IDTwitter
Patients with relapsed or refractory multiple myeloma often face limited durable treatment options. Phase 3 MajesTEC-3 trial results are summarized in a new Quick Take video. https://nej.md/409MNsU