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  • Original Article

    Unintended pregnancy is a major problem in the United States. Approximately 3 million pregnancies per year — 50% of all pregnancies — are unintended, and this rate is significantly higher than that in other developed countries. Unintended pregnancy in the United States results in 1.2 million…

    • May 24, 2012
    • Winner B., Peipert J.F., Zhao Q., et al.
    • N Engl J Med 2012; 366:1998-2007
    • CME

    This study involved women at high risk for unintended pregnancy who received free contraception. Long-acting reversible contraception was associated with a significantly lower risk of pregnancy than contraceptive pills, patch, or ring and was highly effective regardless of age.

  • Case Records of the Massachusetts General Hospital

    Presentation of Case. Dr. Steven Jay Isakoff (Hematology–Oncology): A 32-year-old woman was seen in the outpatient cancer center at this hospital because of infiltrating ductal carcinoma of the right breast. The patient had been well until 2 months before admission, when she became aware of a…

    • May 24, 2012
    • Baselga J., Smith B.L., Rafferty E.A., Bombonati A.
    • N Engl J Med 2012; 366:2018-2026
    • CME

    A 32-year-old woman noted a crease in her right breast. Imaging studies showed a suspicious mass, and a biopsy specimen revealed infiltrating ductal carcinoma, positive for HER2. Staging showed liver lesions consistent with metastases. Management decisions were made.

  • Correspondence

    To the Editor: Five percent of women who are raped become pregnant, which results in an estimated 32,000 pregnancies annually in the United States. In many circumstances, it is unclear whether the pregnancy resulted from the rape or from consensual intercourse. The only options available for…

    • May 3, 2012
    • N Engl J Med 2012; 366:1743-1745
    • Free Full Text

    By comparing markers of circulating fetal DNA with markers of maternal DNA and those of DNA obtained from both the biologic father and an unrelated man, investigators were able to identify the biologic father in 30 out of 30 tests.

  • Perspective

    Foster Friess, a conservative political donor, recently discounted the importance of insurance coverage for contraceptives, saying, "Back in my days, they used Bayer Aspirin for contraception. The gals put it between their knees, and it wasn't that costly." Though his comment stunned interviewer…

    • April 12, 2012
    • Charo R.A.
    • N Engl J Med 2012; 366:1361-1364
    • Free Full Text

    Opponents of the new federal policy regarding insurance coverage of contraception have reframed it as discrimination against religion. But the controversy is fundamentally about our multicultural society's cross-subsidization of the varied choices of its citizens.

  • Correspondence

    To the Editor: Leptin is considered to have an important role in reproductive functions, including menstrual-cycle regulation, pregnancy, and lactation. The absence of leptin action caused by functional mutations in the leptin gene (LEP) or the leptin receptor gene (LEPR) has been linked to…

    • March 15, 2012
    • N Engl J Med 2012; 366:1064-1065
    • Free Full Text

    This case report describes a spontaneously conceived pregnancy in a woman with a leptin receptor mutation, an observation that calls into question the belief that leptin is necessary for normal reproductive function.

  • Correspondence

    To the Editor: Sirolimus prevents rejection of renal allografts by blocking the mammalian target of rapamycin (mTOR), a signaling pathway known to regulate ovarian function. Sirolimus is being assessed as a treatment for autosomal dominant polycystic kidney disease (ADPKD). Observational data…

    • March 15, 2012
    • N Engl J Med 2012; 366:1062-1064
    • Free Full Text

    Low-dose oral sirolimus appears to increase the risk of menstrual-cycle disturbances and ovarian cysts. Monitoring patients for sirolimus-associated ovarian toxicity may be considered.

  • Clinical Practice

    Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 30-year-old…

    • March 15, 2012
    • Hooton T.M.
    • N Engl J Med 2012; 366:1028-1037
    • CME
    • Full Text Audio

    Nitrofurantoin, trimethoprim–sulfamethoxazole, fosfomycin, and pivmecillinam are considered first-line agents for cystitis. Fluoroquinolones should not be routine first-line choices for cystitis, although they are first-line empirical therapy for pyelonephritis.

  • Original Article

    Smoking in pregnancy is the leading preventable cause of morbidity and death among women and infants. Adverse pregnancy and birth outcomes associated with smoking include placental abruption, miscarriage, prematurity, low birth weight, congenital abnormalities, and neonatal or sudden infant death.…

    • March 1, 2012
    • Coleman T., Cooper S., Thornton J.G., et al.
    • N Engl J Med 2012; 366:808-818
    • CME

    In this placebo-controlled trial, the addition of a nicotine patch to behavioral support for smoking cessation did not significantly increase rates of prolonged abstinence lasting until delivery, nor did it affect rates of adverse pregnancy and birth outcomes. Compliance rates were low.

  • Editorial

    Cigarette smoking during pregnancy increases the risk of delivering a low-birth-weight or preterm infant, as well as the risks of pregnancy complications (premature rupture of membranes and placental abruption) and perinatal and infant death. Despite these risks, 10 to 12% of pregnant women in the…

    • March 1, 2012
    • Oncken C.
    • N Engl J Med 2012; 366:846-847

      Cigarette smoking during pregnancy increases the risk of delivering a low-birth-weight or preterm infant, as well as the risks of pregnancy complications (premature rupture of membranes and placental abruption) and perinatal and infant death.1 Despite ...

    • Original Article

      It is still unknown how puberty in humans, occurring during the early years of the second decade of life, is initiated. The hallmark of puberty is increased secretion of the gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which act in concert to stimulate the gonads…

      • February 16, 2012
      • Topaloglu A.K., Tello J.A., Kotan L.D., et al.
      • N Engl J Med 2012; 366:629-635

        Kisspeptin and neurokinin B stimulate gonadotropin-releasing hormone. The authors describe an inactivating mutation in the human kisspeptin gene KISS1 leading to failure of pubertal progression.

      • Original Article

        Active secretion of thyroid hormone in the fetus does not start until about 18 to 20 weeks' gestation. Studies in animals suggest that until fetal hormone secretion begins, the fetus is dependent on circulating free thyroxine (T4) in the mother for growth and development, including central nervous…

        • February 9, 2012
        • Lazarus J.H., Bestwick J.P., Channon S., et al.
        • N Engl J Med 2012; 366:493-501
        • CME

        In this randomized trial, antenatal screening (at a median gestational age of 12 weeks 3 days) and treatment for hypothyroidism did not result in improved cognitive function in children at 3 years of age.

      • Editorial

        Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring. In surveys, almost half the obstetricians in private practices in Maine and the majority of obstetricians in a…

        • February 9, 2012
        • Brent G.A.
        • N Engl J Med 2012; 366:562-563

          Maternal hypothyroidism in pregnancy has been associated with a range of adverse outcomes, most importantly miscarriage, preterm delivery, and reduced cognitive function in offspring.1 In surveys, almost half the obstetricians in private practices in ...

        • Perspective

          It is time to sound the alarm. During the past 3 years, the wily gonococcus has become less susceptible to our last line of antimicrobial defense, threatening our ability to cure gonorrhea and prevent severe sequelae. Gonorrhea is the second most commonly reported communicable disease in the United…

          • February 9, 2012
          • Bolan G.A., Sparling P.F., Wasserheit J.N.
          • N Engl J Med 2012; 366:485-487

            Gonorrhea, which disproportionately affects marginalized populations, is the second most commonly reported communicable disease in the United States. Over the past 3 years, the gonococcus has shown decreased susceptibility to our last line of antimicrobial defense.

          • Clinical Practice

            Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the authors' clinical recommendations. Stage. A 14-year-old…

            • February 2, 2012
            • Palmert M.R. and Dunkel L.
            • N Engl J Med 2012; 366:443-453
            • CME
            • Full Text Audio

            Puberty is considered delayed when it has not yet occurred at an age that is 2 to 2.5 SD later than average (traditionally, 14 years in boys and 13 years in girls). Constitutional delay of growth and puberty (CDGP) is the most common cause. Management of CDGP is discussed.

          • Editorial

            The 2011 report from the Agency for Healthcare Research and Quality on comparative management of uterine fibroids noted, "Despite the prevalence and possible complications of uterine fibroids, few published studies examining the effectiveness of treatment strategies exist." Few therapies are…

            • February 2, 2012
            • Stewart E.A.
            • N Engl J Med 2012; 366:471-473

              The 2011 report from the Agency for Healthcare Research and Quality on comparative management of uterine fibroids noted, “Despite the prevalence and possible complications of uterine fibroids, few published studies examining the effectiveness of treatment ...

            • Original Article

              Uterine leiomyomas, or fibroids, are the most common benign uterine tumors in women of reproductive age. In addition to anemia caused by heavy bleeding, fibroids can cause pelvic pain, pressure, dysmenorrhea, reduced quality of life, and infertility. Current management strategies consist mainly of…

              • February 2, 2012
              • Donnez J., Tomaszewski J., Vázquez F., et al.
              • N Engl J Med 2012; 366:421-432
              • CME

              In this trial comparing oral ulipristal acetate (5 mg or 10 mg daily) with once-monthly leuprolide acetate in women with symptomatic uterine fibroids before planned surgery, both doses of ulipristal acetate were noninferior to leuprolide acetate in controlling uterine bleeding.

            • Original Article

              Uterine leiomyomas, or fibroids, are benign, hormone-sensitive, smooth-muscle tumors that occur in 20 to 40% of women of reproductive age. The most common symptoms are menorrhagia and iron-deficiency anemia, which may lead to chronic fatigue that may not be adequately controlled with iron…

              • February 2, 2012
              • Donnez J., Tatarchuk T.F., Bouchard P., et al.
              • N Engl J Med 2012; 366:409-420

                In this trial involving women with symptomatic fibroids who were planning to undergo surgery, treatment with the selective progesterone-receptor modulator ulipristal acetate was effective in controlling excessive bleeding and reducing fibroid size at 13 weeks.

              • Perspective

                On December 7, 2011, Health and Human Services (HHS) Secretary Kathleen Sebelius instructed Food and Drug Administration (FDA) Commissioner Margaret Hamburg not to approve the application for over-the-counter sales of Plan B One-Step, a single-dose emergency contraceptive. Dr. Hamburg issued her…

                • January 12, 2012
                • Wood A.J.J., Drazen J.M., Greene M.F.
                • N Engl J Med 2012; 366:101-102
                • Free Full Text

                On December 7, Health and Human Services Secretary Kathleen Sebelius overruled an FDA decision to approve over-the-counter sales of Plan B One-Step. Although the drug can be used safely without medical supervision, it apparently poses unacceptable political risks.

              • Review Article

                Among both prospective parents and providers of medical care, genetic and social concerns peak during the perinatal period. Advances in genomics and assisted reproductive technology have created new opportunities to detect genetic disorders and susceptibilities at multiple times during perinatal…

                • January 5, 2012
                • Bodurtha J. and Strauss J.F.
                • N Engl J Med 2012; 366:64-73
                • Free Full Text
                • Interactive/Multimedia

                Advances in genomic technologies and methods of assisted reproduction have opened up new possibilities for testing and screening of prospective parents, their fertilized eggs, their fetuses, and their newborn babies.

              • Correspondence

                To the Editor: On July 19, the Institute of Medicine released a historic report outlining key preventive health services for women to be covered by insurers under the Affordable Care Act (ACA) without consumer cost sharing. Particularly notable was the report's inclusion of contraception, with the…

                • December 22, 2011
                • N Engl J Med 2011; 365:2438-2439
                • Free Full Text

                The IOM recommends including contraception among the preventive services for women to be covered without patient cost sharing. Reforms in medical education and primary care delivery are needed to ensure safe, effective, and appropriate contraceptive care.

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              Medical Meetings Pediatrics Conferences and Meetings

              2012 Certifying Examinations of the American Board of Pediatrics

              The general pediatrics examination will be held in various cities, Oct. 16-18. Registration for first-time applicants is ongoing through May 3. Registration for re-registrants is ongoing through May 24. The following subspecialty examinations will be held in various cities: "Hospice and Palliative Medicine" (Oct. 4); "Pediatric Transplant Hepatology" (Oct. 11); "Pediatric Cardiology" (Nov. 7); "Pediatric Pulmonology" (Nov. 8); "Medical Toxicology" (Nov. 12); and "Pediatric Critical Care Medicine" (Nov. 14). Registration for first-time applicants is ongoing through April 30. Registration for re-registrants is ongoing through June 15.

              Contact the American Board of Pediatrics, 111 Silver Cedar Court, Chapel Hill, NC 27514-1513; or call (919) 929-0461; or fax (919) 918-7114 or (919) 929-9255; or see http://www.abp.org .

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