Important questions exist regarding the ability to treat extensively drug-resistant tuberculosis. In this study involving 48 patients in Peru who had extensively drug-resistant tuberculosis but were not infected with the human immunodeficiency virus, treatment with a structured, comprehensive, community-based approach and aggressive antituberculosis medications (an average of five or six medications per patient) achieved a cure in 29 patients (60%).

Small numbers of monoclonal B cells with the phenotype of chronic lymphocytic leukemia (CLL) were detected by means of high-sensitivity flow cytometry in about 5% of adults with a normal blood count and about 14% of subjects with lymphocytosis. In the latter group, frank CLL ultimately developed in 15%. The principal features of these monoclonal B cells and the B cells of CLL were similar.

This study involving patients in whom hemodialysis was being initiated shows that increased levels of fibroblast growth factor 23 (FGF-23), a hormone that enhances the renal excretion of phosphate, appear to be independently associated with mortality. Whether FGF-23 is a potential biomarker that could guide strategies to reduce phosphorus levels in patients with chronic kidney disease remains to be established.

Syncytial giant-cell hepatitis is a rare, severe form of hepatitis. Human herpesvirus 6A (HHV-6A) from a liver donor was found to be the cause of disease in the organ recipient.

A family is planning a safari that includes 3 days in Cape Town, 3 days in Kruger National Park, South Africa, and 3 days in Victoria Falls, Zambia. The 31-year-old husband takes no medications, but recently he discontinued fluoxetine for depression. His 29-year-old wife is healthy and 15 weeks pregnant. Their 7-year-old child is in good health. How should the risk and prevention of malaria be managed in this family?

Treatment of B-cell non-Hodgkin's lymphoma has become more successful, largely owing to the availability of therapeutic monoclonal antibodies, which may avoid the toxic effects of chemotherapy, improve the outcomes when combined with chemotherapy, and provide options for patients with refractory disease. This article reviews the current uses of monoclonal antibodies in B-cell non-Hodgkin's lymphoma.

A 64-year-old Filipino man presented to a Baltimore hospital with a 4-month history of worsening midback pain, progressive leg weakness, and intermittent bladder and bowel incontinence. He had no fever or pulmonary symptoms.

In the context of the concerns of many experts about a looming shortage of physicians, the author discusses policy proposals to increase federal support for graduate medical education and to expand the supply of primary care physicians.