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In a large cohort study, patients who took azithromycin had significantly increased risks of cardiovascular death and death from any cause during a 5-day course of therapy, as compared with persons who received no antibiotic treatment or who took reference antibiotics.
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A 48-year-old woman was admitted to the hospital because of diplopia, headaches, and papilledema. Imaging revealed cysts in the fourth ventricle and spinal canal. A diagnostic procedure was performed.
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Pseudomonas aeruginosa is an important pathogen in patients with cystic fibrosis. In this report, data suggest that estrogen may play a role in the modulation of virulence factors in P. aeruginosa and thus affect clinical exacerbations in women with cystic fibrosis.
and J.-U. Wong
A 19-year-old woman with type 1 diabetes mellitus and suspected cystic fibrosis presented with a 1-day history of acute abdominal pain. Plain radiography revealed a typical mechanical obstruction.
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An 89-year-old man was brought to the emergency department for evaluation of changes in his cognition and personality. He exhibited poor memory for recent events and difficulty expressing himself.
Direct the investigation of the case, test your diagnostic and therapeutic skills, and compare your performance with that of others.
Nearly 100 years had passed since fungi were recognized as a cause of skin disease, and twenty-five years since the publication of “Les Teignes,” Sabourad’s classic work on the subject. The author outlines the accomplishments of those twenty-five years in the morphology, etiology, biology, and therapy of certain fungus diseases of the skin.
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Reviewing: Clin Infect Dis 2012 May 1
Active TB was diagnosed in 1% of contacts within 4 years after exposure; chemoprophylaxis of those with latent infection significantly reduced the risk for active disease.
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Reviewing: Am J Med 2012 May
In a prospective, multicenter trial, daily body cleansing with 2% chlorhexidine was associated with a significant reduction in central venous catheter bloodstream infections.
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Original Article
Effect of Estrogen on Pseudomonas Mucoidy and Exacerbations in Cystic Fibrosis
Pseudomonas aeruginosa is a gram-negative opportunistic pathogen associated with cystic fibrosis, a multisystem genetic disease characterized by defects in the cystic fibrosis transmembrane conductance regulator (CFTR) protein, which results in recurrent infective exacerbations. Median overall…
Editorial
Septic Shock — Evaluating Another Failed Treatment
Sepsis, severe sepsis, and septic shock are progressively severe stages of the host's systemic inflammatory response to infection. The latter stages carry increasing rates of end-organ failure and death. The spectrum of the sepsis syndrome remains a leading cause of death in the United States, and…
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Original Article
Drotrecogin Alfa (Activated) in Adults with Septic Shock
Recombinant human activated protein C, or drotrecogin alfa (activated) (DrotAA), was approved for the treatment of severe sepsis in 2001 on the basis of the Prospective Recombinant Human Activated Protein C Worldwide Evaluation in Severe Sepsis (PROWESS) study, a phase 3 international, randomized,…
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Case Records of the Massachusetts General Hospital
Case 15-2012 — A 48-Year-Old Woman with Diplopia, Headaches, and Papilledema
Presentation of Case. Dr. Rocío Hurtado (Infectious Diseases): A 48-year-old woman was admitted to the hospital because of diplopia, headaches, and papilledema. The patient had been well until 2 weeks before admission, when diplopia developed, which improved when she covered either eye. One week…
Original Article
Azithromycin and the Risk of Cardiovascular Death
Azithromycin, a broad-spectrum macrolide antibiotic, has been reported to be relatively free of cardiotoxic effects. However, the closely related drugs erythromycin and clarithromycin can increase the risk of serious ventricular arrhythmias– and are associated with an increased risk of sudden…
Perspective
Measles in the 21st Century
Barely 20 years ago, such a high proportion of childhood deaths globally was attributable to measles that the going estimate of more than 1 million measles-related deaths per year was almost certainly an underestimate. Pediatric wards in the developing world were filled with patients with measles…
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Case Records of the Massachusetts General Hospital
Case 14-2012 — A 43-Year-Old Woman with Fever and a Generalized Rash
Presentation of Case. Dr. Sarah Gee (Dermatology): A 43-year-old woman was admitted to the hospital because of fever and a generalized rash. The patient had a history of atopic dermatitis and had been in her usual health until approximately 1 week before admission, when a painful, pruritic rash…
- CME
Perspective
HIV–HBV Coinfection — A Global Challenge
Human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) exact a high toll worldwide. Both can lead to chronic disease, cancer, and death, and neither can be eradicated with the use of current therapies. Antiviral drug resistance often develops after patients have received treatment…
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Original Article
Albendazole Therapy and Enteric Parasites in United States–Bound Refugees
Approximately 25% of the world's population is infected with intestinal helminths. These neglected tropical infections disproportionately affect the world's least privileged and most vulnerable populations and are among the most common medical conditions in refugees.– Among resettled refugees,…
Review Article
Current Concepts: Dengue
Dengue is a self-limited, systemic viral infection transmitted between humans by mosquitoes. The rapidly expanding global footprint of dengue is a public health challenge with an economic burden that is currently unmet by licensed vaccines, specific therapeutic agents, or efficient vector-control…
- CME
Case Records of the Massachusetts General Hospital
Case 11-2012 — A 60-Year-Old Man with Weakness, Rash, and Renal Failure
Presentation of Case. Dr. Pritha Sen (Medicine): A 60-year-old man with a history of schizophrenia was admitted to this hospital in late spring because of weakness, rash, and renal failure. The patient was in his usual state of health until several days before admission, when fatigue and myalgias…
- CME
Perspective
Removing Legal Barriers to High-Quality Care for HIV-Infected Patients
When AIDS emerged in the 1980s, fear and misunderstanding about the disease prevailed. Patients with AIDS faced a grim prognosis, with no effective treatments. They confronted discrimination in the workplace and throughout society and had little legal recourse for combating it. Simply getting…
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Editorial
The Road to an Effective HIV Vaccine
During the 30 years since the discovery of HIV as the cause of AIDS, efforts to develop a vaccine have faced immense challenges. First, naturally acquired immunity to protect against infection that results in disease, found with virtually all other known infectious agents, may not exist for HIV.…
Original Article
Pyronaridine–Artesunate versus Mefloquine plus Artesunate for Malaria
Artemisinin-based combination therapy is critical for the effective treatment and control of Plasmodium falciparum malaria.– However, reports from the Cambodian–Thai border indicate the emergence of artemisinin tolerance or resistance in P. falciparum.– Pyronaridine–artesunate is a fixed…
- CME
Review Article
200th Anniversary Article: What We Don't See
Sixty-eight years after the inaugural issue of The New England Journal of Medicine and Surgery, Sir William Osler introduced the term "pediatrics." Although "diseases peculiar to children" had figured in Benjamin Rush's lectures at the University of Pennsylvania since 1789, most physicians in the…
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Original Article
Immune-Correlates Analysis of an HIV-1 Vaccine Efficacy Trial
In clinical trials that show the efficacy of a vaccine, the identification of immune responses that are predictive of trial outcomes generates hypotheses about which of those responses are responsible for protection.– The RV144 phase 3 trial in Thailand (ClinicalTrials.gov number, NCT00223080)…
Perspective
HIV and Aging — Preparing for the Challenges Ahead
By 2015, half the U.S. population living with human immunodeficiency virus (HIV) infection will be older than 50 years of age. As antiretroviral therapy (ART) coverage continues to expand worldwide, this aging of the HIV epidemic will be mirrored in developing countries. In sub-Saharan Africa, ART…
Clinical Problem-Solving
Skin Deep
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 56-year-old woman with symptoms…
- CME
