Humans

To the Editor Nemes and colleagues (July 12 issue)1 examined the effects of bacille Calmette–Guérin (BCG) revaccination on reducing the rate of sustained QuantiFERON-TB Gold In-tube assay (QFT) conversion among adolescents in a high-risk setting. One aspect that received relatively little attention in the trial regards the immunologic mechanisms responsible for these effects, which were
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To the Editor: Fibrous dysplasia and the McCune–Albright syndrome constitute a rare mosaic disorder caused by somatic activating mutations of Gαs (the G-protein subunit αs). Characteristic manifestations, including café-au-lait skin lesions, fibrous dysplasia of bone, and hyperfunctioning endocrinopathies, occur with varying severity, depending on the embryonic stage at which the mutation occurred. Mutations early in
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A 56-year-old woman presented to the emergency department with shortness of breath that had progressively worsened over 8 months. She had no history of tobacco use. On presentation, the patient received 3 liters of supplemental oxygen to maintain an oxygen saturation of 93%. Findings from a lung examination were notable for bronchial breath sounds in
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To the Editor Post hoc analysis of Sanofi’s Dengvaxia (CYD-TDV) vaccine by Sridhar et al. (July 26 issue)1 provides evidence for an increased risk of severe dengue virus (DENV) disease among DENV-seronegative vaccinees. The authors address the possibility of antibody-dependent enhancement, but T-cell–mediated immunopathology represents another plausible explanation for this clinical outcome. Vaccine efficacy among
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To the Editor The results of the iNNOVATE trial reported by Dimopoulos et al. (June 21 issue)1 showed the improved efficacy of ibrutinib when added to rituximab monotherapy for Waldenström’s macroglobulinemia. This practice-changing, phase 3 trial involved patients with a rare form of lymphoma. Table 1. Table 1. Outcomes and Prices of Common Immunochemotherapeutic Regimens
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To the Editor Gaudino et al. (May 31 issue)1 report a lower risk of the composite of death, myocardial infarction, or repeat revascularization with radial-artery graft than with saphenous-vein graft revascularization during coronary-artery bypass grafting (CABG). We question the appropriateness of this composite: death and myocardial infarction are more serious than repeat revascularization. The authors
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Despite decades-long improvement, recent evidence suggests that rates of myocardial infarction, stroke, and other cardiovascular disease (CVD) events have plateaued and are increasing among certain groups, including adults aged 35 to 64 years.1,2 These events are common, costly, and largely preventable. Million Hearts, a national initiative co-led by the Centers for Disease Control and Prevention
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The US Preventive Services Task Force (USPSTF) has recently published recommendations on screening and counseling to reduce unhealthy alcohol use in adults and adolescents. What Is Unhealthy Alcohol Use? Unhealthy alcohol use means drinking more than the recommended amount of alcohol. This includes exceeding daily or weekly recommended limits as well as alcohol use disorder
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Most medical centers today acquire supplies, medications, and devices through group purchasing organizations (GPOs) rather than directly from a manufacturer. GPOs are intermediaries that catalog medical supplies so medical centers can purchase them from manufacturers. According to the American Hospital Association, 68% of hospitals used a GPO for their main purchasing needs in 2000, and
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In Reply In discussing the topic of injection drug use–associated infective endocarditis in our review,1 our intent was to highlight the lack of certainty with respect to the use of surgery and outcomes in these patients. Cardiac surgery in patients with injection drug use–associated infective endocarditis has been associated with higher mortality and reoperation in
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Patients with heart failure may develop secondary mitral regurgitation, in which a dysfunctional heart valve allows blood to leak back into the organ’s left atrium and the lungs, further worsening the condition. Some patients remain symptomatic despite receiving maximal heart failure therapies. Abbott An investigational transcatheter mitral-valve repair device from Abbott called the MitraClip may
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The percentage of US adults with Alzheimer disease and related dementias is projected to grow from 1.6% in 2014 to 3.3% in 2060, according to a study by the CDC in the journal Alzheimer & Dementia. Centers for Disease Control and Prevention The study authors estimated the future prevalence of Alzheimer and related conditions using
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Gadolinium-based contrast agents (GBCAs) revolutionized magnetic resonance imaging (MRI) examinations by depiction of pathology otherwise undetectable on unenhanced MRI or other imaging modalities. Since initial regulatory approval in 1988, it is estimated that more than 450 million GBCA doses have been administered worldwide. In the United States, it is estimated that approximately 8.8 million MRI
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Trial Design and Oversight We conducted a randomized, intention-to-treat, multicenter trial funded by the Cooperative Studies Program of the Department of Veterans Affairs. The rationale and design of the trial have been published previously.13 Cardiac surgery programs at Veterans Affairs medical centers with expertise in performing endoscopic vein-graft harvesting were eligible to participate. An executive
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Trial Design Details of the trial design have been published previously.9 We conducted a multicenter, randomized, double-blind, active-controlled trial of the in-hospital initiation of sacubitril–valsartan therapy, as compared with enalapril therapy, among patients who had been admitted for acute decompensated heart failure with reduced ejection fraction. The trial protocol (available with the full text of
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Trial Design and Oversight This randomized, double-blind, placebo-controlled, investigator-initiated trial was funded by the NHLBI. The trial protocol, available with the full text of this article at NEJM.org, was designed by the trial executive committee with input from NHLBI staff and an NHLBI-appointed protocol-review committee, the members of which subsequently served as the trial data
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1. Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: National Academies Press, 2011. Google Scholar 2. LeFevre ML. Screening for vitamin D deficiency in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2015;162:133–140. 3. Kantor ED, Rehm CD, Du M, White E, Giovannucci EL. Trends in dietary
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1. Bhatt DL, Eagle KA, Ohman EM, et al. Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis. JAMA 2010;304:1350–1357. 2. Nambi V, Bhatt DL. Primary prevention of atherosclerosis: time to take a selfie? J Am Coll Cardiol 2017;70:2992–2994. 3. Vaduganathan M, Venkataramani AS, Bhatt DL. Moving toward
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Abstract Background Antibiotic-resistant Neisseria gonorrhoeae has prompted the development of new therapies. Zoliflodacin is a new antibiotic that inhibits DNA biosynthesis. In this multicenter, phase 2 trial, zoliflodacin was evaluated for the treatment of uncomplicated gonorrhea. Methods We randomly assigned eligible men and women who had signs or symptoms of uncomplicated urogenital gonorrhea or untreated
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Audio Interview Interview with Dr. Melinda Ashton on easing the burden of administrative tasks in medicine and helping clinicians find more meaning in their work. (10:17) Download Many health care organizations are searching for ways to engage employees and protect against burnout, and involvement in meaningful work has been reported to serve both functions. According
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To the Editor: Despite the astonishing advances in hepatitis C virus (HCV) treatment, HCV remains a major source of chronic liver disease.1,2 Abul-Husn et al.3 recently reported an association between a loss-of-function variant (rs72613567:TA) in HSD17B13 and reduced risk of alcoholic and nonalcoholic nonviral chronic liver diseases. We conducted a test for association between the
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Summary Daratumumab, a human IgG1κ monoclonal antibody targeting CD38, is used to treat multiple myeloma. We describe successful treatment with daratumumab in a case of treatment-refractory pure red-cell aplasia after ABO-mismatched allogeneic stem-cell transplantation. The patient was a 72-year-old man with the myelodysplastic syndrome who received a transplant from an HLA-matched, unrelated donor with a
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To the Editor Figure 1. Figure 1. Trends in Hospitalizations, Cost of Each Hospitalization, and Death among Adult Patients with Sickle Cell Anemia, 2000 through 2014. Niihara et al. (July 19 issue)1 show the clinical benefits of oral therapy with pharmaceutical-grade l-glutamine (USAN, glutamine; Endari, Emmaus Medical). We analyzed the growing financial burden of sickle
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A 39-year-old man presented to the emergency department with a 4-week history of increasing abdominal pain and constipation. Physical examination of the abdomen and the results on abdominal imaging, including ultrasonography and computed tomography, were normal. Laboratory investigations revealed a hemoglobin level of 12.5 g per deciliter (normal range, 14.0 to 17.5). Findings on upper
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If your blood pressure is suspected to be high, it is important to know your blood pressure measurement pattern outside the doctor’s office. If you are taking medication to control your blood pressure, regular blood pressure monitoring could help your doctor decide how to adjust your medication, if necessary. There are 2 different ways to
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