Humans

A 67-year-old woman presented to the emergency department with a 6-week history of progressive exertional dyspnea. Her medical history was notable for lung transplantation that had been performed 8 years earlier. Immunosuppressive medications included mycophenolate mofetil and tacrolimus. Laboratory studies showed normocytic anemia, with a hemoglobin level of 6.9 g per deciliter (reference range, 11.9
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To the Editor: During the Zika virus (ZIKV) epidemic in Rio de Janeiro from September 2015 through June 2016, a prospective cohort study involving symptomatic pregnant women who had ZIKV infection confirmed by reverse-transcriptase–polymerase-chain-reaction assay was established.1 The study was approved by the institutional review boards at Fundação Oswaldo Cruz in Rio de Janeiro and
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This article has no abstract; the first 100 words appear below. To the Editor: Duncavage and colleagues (Sept. 13 issue)1 address the molecular predictors of disease progression and survival among patients with myelodysplastic syndrome (MDS) who underwent allogeneic hematopoietic stem-cell transplantation. With the use of enhanced exome sequencing, they found that detection of at least
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This article is available to subscribers. Subscribe now. Already have an account? Sign in PerspectiveHistory of MedicineFree Preview David M. Morens, M.D., and Jeffery K. Taubenberger, M.D., Ph.D. Funding and Disclosures Disclosure forms provided by the authors are available at NEJM.org. Author Affiliations From the Office of the Director (D.M.M.) and the Viral Pathogenesis and
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Abstract Background Radical prostatectomy reduces mortality among men with clinically detected localized prostate cancer, but evidence from randomized trials with long-term follow-up is sparse. Methods We randomly assigned 695 men with localized prostate cancer to watchful waiting or radical prostatectomy from October 1989 through February 1999 and collected follow-up data through 2017. Cumulative incidence and
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A 73-year-old man presented to the dermatology clinic with a persistent, generalized rash that had been present for 3 months and was associated with occasional itching. He had no history of any previous dermatoses or drug allergies; he was an active smoker, with a smoking history of 40 pack-years. Physical examination revealed a symmetric, generalized
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The molted wild feathers on my walls and in my pottery and on my shelves, these gifts, like words, will fade and fall. Each mark, each unique vane are coded letters holding genes that shape us all, and broken open spell our hidden names— the ones we each receive from time that turns upon itself
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The Editorial entitled “Medicare Bundled Payment Programs for Joint Replacement: Anatomy of a Successful Payment Reform,” published in the September 4, 2018, issue of JAMA,1 had an incorrect affiliation and included incorrect language. The affiliation should have read “University of Michigan School of Public Health.” In the first full paragraph in the second column of
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The World Medical Association developed the Declaration of Helsinki as a statement regarding ethical principles for medical research involving human research participants and directs physicians to promote and safeguard the health, well-being, and rights of patients. Included in this declaration is the requirement that each potential research participant be informed of possible conflicts of interest
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“Do you want to cut the cord?” the nurse asked. I watched my husband pick up the scissors, his hand trembling as he cautiously severed the lifeline that once connected our daughter, Anika, to me. The nurse wrapped her in a blanket that we had brought from home and placed her in my arms. I
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A bedside diagnostic approach is needed for mechanically ventilated patients in intensive care who develop new pulmonary infiltrates on chest x-ray and have a differential diagnosis of pneumonia. These patients are regularly given broad-spectrum antibiotics before bacteria culture results are ready, which contributes to overtreatment and antibiotic resistance. In addition, commonly used sampling methods like
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A recent report about a prominent academic investigator who failed to disclose millions of dollars in personal income from corporate relationships highlights the degree to which the system to manage, reduce, or eliminate financial conflicts of interest (COIs) in biomedical research remains inadequate.1 The story quoted the individual as stating that his disclosure lapses were
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Impaired renal activation of vitamin D may increase the risk of cardiovascular disease. The J-DAVID Investigators randomized 976 patients from 108 dialysis centers and found that oral alfacalcidol, a vitamin D receptor activator, did not reduce the incidence of cardiovascular events. In an Editorial, Hall and Scialla discuss the complexity of mineral metabolism in patients
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Jet engines are remarkable mechanical engineering feats and include more than 100 000 parts. A rudimentary understanding of mechanical engineering concepts helped physicians such as William Harvey, who described the heart as a pump with 1-way valves, make fundamental advances in medicine in the 17th century. Now, well into the 21st century, jet engines are monitored
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To the Editor Dr Berwick and Ms Gaines1 discussed potential harms of HIPAA, which has increased burdens for practitioners, staff, patients, and the US health care system. The law has been around for so long that practitioners and patients tend to forget that one of the main motivating factors for it, and for the Privacy
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The 340B program began as a means to lower the cost of outpatient medications for a small set of underresourced health care facilities that served primarily low-income patients, although sequential changes in the program over time have led to substantial growth. Hospitals, many of which are large and well financed, now dominate the facilities that
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Every few years, a story goes viral claiming that experts have finally ‘solved’ the Bermuda Triangle mystery. Maybe it’s strange hexagonal clouds acting as “air bombs”, rogue waves, or perhaps some freak whirlpools. But there’s one problem with all of these ‘solutions’ – the Bermuda Triangle doesn’t actually exist, and there is no ‘mystery’ to
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Between 2008 and 2017 in Australia, 266 people died from an animal of some sort. At first glance, you won’t find that surprising – after all, Australia is often thought of as a dangerous place. But what might surprise you is the type of animal causing most of these deaths. Is it one of the
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A cursory glance back through human history should be enough to convince anybody that our species is in love with hate. In the opinion of anthropologist R. Brian Ferguson, this doesn’t mean we have good reason to think large scale social conflict is in our genes. War isn’t in our nature, he argues. But that
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To the Editor Figure 1. Figure 1. The Prostaglandin Metabolic Pathway. PGH2 is an unstable intermediary produced by the cyclooxygenase enzymes. PGH2 is then converted into the five primary prostanoids (prostaglandin D2 [PGD2], prostaglandin E2 [PGE2], prostaglandin F2α [PGF2α], prostaglandin I2 [PGI2], and thromboxane A2 [TXA2]) by their respective synthases. In Figure 1 of the
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To the Editor The MARINER (Medically Ill Patient Assessment of Rivaroxaban versus Placebo in Reducing Post-Discharge Venous Thrombo-Embolism Risk) trial, which was conducted by Spyropoulos et al. (Sept. 20 issue),1 showed no benefit of rivaroxaban with regard to a composite outcome of symptomatic venous thromboembolism (VTE) or VTE-related death after hospitalization for medical illness. The
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Video A 58-year-old man presented to the otorhinolaryngology outpatient clinic with a 2-year history of progressive hoarseness and swelling on the left side of his neck. He had no associated dysphagia, regurgitation of food, or dyspnea. He worked as a farmer and had no history of tobacco use. On physical examination, he had nontender, compressible
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A 29-year-old man infected with the human immunodeficiency virus presented to the emergency department with a 2-day history of fever and pain in the right upper quadrant of the abdomen. His most recent CD4 cell count was 520 per microliter. Laboratory results showed an aspartate aminotransferase level of 208 IU per liter (reference range, 10
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Summary A loss-of-function variant in the gene encoding the prolactin receptor (PRLR) was reported previously in a woman with persistent postpartum galactorrhea; however, this paradoxical phenotype is not completely understood. Here we describe a 35-year-old woman who presented with idiopathic hyperprolactinemia that was associated with a complete lack of lactation after each of her two
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Trial Design and Oversight The AVERT trial was a randomized, placebo-controlled, double-blind clinical trial comparing apixaban (2.5 mg twice daily) with placebo. The members of the steering committee (see the Supplementary Appendix) had final responsibility for the trial design, clinical protocol, and trial oversight. The institutional review board at each of the 13 participating sites
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New treatments for hepatitis C are effective, simple, and increasingly accessible. Hepatitis C is a viral infection of the liver. About one-quarter of patients infected with hepatitis C recover from their infection, but the rest develop a long-term (chronic) infection. Chronic hepatitis C is one of many conditions that can damage the liver and cause
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In the Original Investigation titled “Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Nonobstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial,”1 published in the October 2, 2018, issue, the upper limits of 95% CIs were incorrectly reported as positive rather than negative numbers in Table 3. The between-group differences for
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Non–influenza-related respiratory virus infections cause an estimated 500 million colds per year in the United States. However, recent research suggests that disease-causing viruses enter individuals’ nasal passages much more frequently than they cause illness. In many cases, airway antiviral defense responses effectively clear local virus before it causes noticeable symptoms. Now, researchers have uncovered a
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It is important to distinguish vaccines designed to prevent cancer from those designed to treat cancer. The mode of action of the human papilloma virus (HPV) vaccine for the prevention of cervical and other HPV-associated malignancies is similar to that of vaccines for the prevention of infectious disease (ie, the induction of antibodies directed against
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For our second annual Articles of the Year, we did an accounting of all Original Investigations and Special Communications published in our journals between September 1, 2017, and August 31, 2018, and ranked them based on online views. We then interviewed the journal editors to find out why these articles proved so popular with physicians
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The first new antiviral treatment for acute, uncomplicated influenza in nearly 20 years received FDA approval in late October, just as a small uptick in outpatient visits for flu-like symptoms was reported. Genentech Baloxavir marboxil is an oral influenza cap–dependent endonuclease inhibitor that disables flu viruses by interfering with viral messenger RNA transcription. It is
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