Search

The article from the New England Journal of Medicine discusses a case of a 37-year-old man with fever, myalgia, jaundice, and respiratory failure. The patient's symptoms developed rapidly, leading to hospitalization and a series of diagnostic tests. Ultimately, the patient was diagnosed with icteric leptospirosis, a rare but serious bacterial infection transmitted through contaminated water or soil. Treatment with doxycycline was successful, and the patient recovered after a 14-day course of antibiotics. The article highlights the challenges in diagnosing and managing leptospirosis, especially in areas where the disease is not common. [Extracted from the article]

This article presents a case study of a 40-year-old man who presented with symptoms of fevers, sore throat, fatigue, weakness, and joint pains. After ruling out common respiratory viruses and streptococcus infection, further examination revealed musculoskeletal findings and elevated inflammatory markers, suggesting a possible rheumatologic cause. The patient was diagnosed with adult-onset Still's disease, a rare inflammatory condition characterized by fevers, rash, and joint pain. Treatment options discussed include nonsteroidal anti-inflammatory drugs, biologic agents, disease-modifying antirheumatic drugs, and interleukin inhibitors. The article emphasizes the need for effective immunomodulatory therapy and further research in this area. [Extracted from the article]

This article presents a case study of a 45-year-old woman with kidney lesions and lytic bone disease. The patient underwent various imaging tests and reported symptoms such as fatigue and pain in the left shoulder and arm. Further evaluation and testing revealed polyclonal hypergammaglobulinemia with an elevated IgG level. The article explores potential causes for the patient's symptoms, ruling out certain diseases and suggesting a histiocytic disorder as the most likely diagnosis. Treatment options for systemic Rosai-Dorfman-Destombes disease are also discussed, with the patient in the case having a complete clinical response to cobimetinib. [Extracted from the article]

Neuroleptic Malignant Syndrome (NMS) is a rare and potentially fatal complication that can occur after exposure to dopamine-blocking drugs, especially antipsychotic medications. Symptoms of NMS include fever, severe muscle rigidity, and dysautonomia. The exact cause of NMS is not known, but it is believed to be related to the blockade of dopamine receptors in the central nervous system. NMS can be difficult to diagnose, as it can mimic other disorders such as serotonin syndrome, malignant hyperthermia, and anti-NMDA receptor encephalitis. Treatment for NMS is empirical and typically involves muscle relaxants and close monitoring in an intensive care unit. While the risk of recurrence is low, some risk remains. [Extracted from the article]

This article presents a case of a 47-year-old man who was admitted to the hospital with confusion and kidney failure. The patient had experienced fatigue and muscle pain prior to admission, and his symptoms worsened over time. Upon examination, the patient exhibited confusion, difficulty finding words, and garbled speech. Laboratory tests revealed abnormalities in blood and urine, and imaging studies showed consolidation in the right lower lobe of the lung. The article discusses the possible causes of the patient's symptoms, including nontraumatic, nonexertional rhabdomyolysis. It also explores the diagnosis and treatment of Legionella pneumonia, which was ultimately confirmed in this case. The patient's history of living in a converted factory and using dietary supplements, as well as the presence of lung consolidation, suggested a possible diagnosis of legionella infection. The article provides information on the transmission and diagnostic methods of legionella infection, as well as the treatment and prevention strategies. It also highlights the challenges in diagnosing the infection in this particular case due to the patient's altered mental state and poor sample quality. The patient's myopathy may have contributed to the severity of the infection. [Extracted from the article]

This article from the New England Journal of Medicine presents a case study of a 75-year-old woman with multiple medical conditions. The article explores the underlying cause of her symptoms and provides insights into her diagnosis and treatment. The patient's history and laboratory test results suggest the possibility of various conditions, including autoimmune disease, infectious disease, and cancer. The text discusses the importance of understanding the cause of the patient's hypocomplementemia and presents management options for her specific conditions, including AA amyloidosis and lupus nephritis. The challenge lies in finding effective and safe treatment options for her overlapping conditions of rheumatoid arthritis and systemic lupus erythematosus. [Extracted from the article]

The article focuses on a 59-year-old woman with a longstanding breast lesion and recent neurological symptoms, who was referred to a multidisciplinary breast oncology clinic. Topics include the diagnosis of acute infarction, positive SARS-CoV-2 screening, and imaging findings of a large breast mass with potential metastases and evidence of ischemic stroke.

The article present a case study of a 30-year-old woman who experienced postpartum anxiety and intrusive thoughts following the birth of her first child. Topics discussed include the clinical presentation of postpartum psychiatric disorders; the differential diagnosis; and the management strategies, particularly focusing on postpartum obsessive-compulsive disorder and coexisting major depressive disorder.

This article from the New England Journal of Medicine presents a case study of a 30-year-old woman who developed postpartum fever, abdominal pain, and skin ulcers. The patient's symptoms worsened over time, leading to further diagnostic tests. The article discusses the diagnosis of Sweet's syndrome, a rare condition characterized by skin lesions and inflammation. Treatment options for Sweet's syndrome include systemic glucocorticoids, and the prognosis is generally favorable. The text also highlights the importance of timely identification and management of Sweet's syndrome during pregnancy to prevent complications. The patient in the case study was successfully treated with intravenous methylprednisolone and oral nifedipine. [Extracted from the article]

The article presents a case study of a 73-year-old man presented with recurrent fever and liver lesions. It is reported that initially, he developed fever, cough, and fatigue, which were treated empirically as pneumonia. It is further reported that subsequent imaging revealed scattered solid pulmonary nodules, hepatic hemangiomas, and subcentimeter hepatic hypodensities.

The article presents a case study of the 46-year-old man with arthritis, rash, and systemic symptoms. It describes his initial symptoms of lightheadedness, which prompted an emergency department visit, followed by joint swelling and rash development over a period of weeks. It discusses the differential diagnosis process, considering autoimmune conditions like systemic lupus erythematosus (SLE), sarcoidosis, and infectious causes such as parvovirus B19.

The article focuses on Chiari malformation type 1 (CM1), discussing both congenital and acquired forms of the condition. It details the anatomical characteristics where the cerebellar tonsils descend below the foramen magnum, leading to potential obstruction of cerebrospinal fluid (CSF) flow and compression of the brainstem and upper spinal cord. It emphasizes the clinical manifestations such as headaches, neurological symptoms, and the diagnostic criteria involving MRI imaging.

The article presents a case study of a 51-year-old woman who presented to the emergency department with a sudden, severe headache. Topics include her medical history, examination findings, and diagnostic imaging results. The patient's history, examination, and imaging were consistent with a subarachnoid hemorrhage.

This article discusses the implementation of a newborn screening program for metachromatic leukodystrophy (MLD), a lysosomal storage disorder. The study conducted screening, diagnostic testing, and treatment decisions for newborn infants in Germany. The three-tiered screening algorithm involved analyzing sulfatide levels, measuring arylsulfatase A (ARSA) activity, and conducting genetic sequencing. The study found that early detection through newborn screening and presymptomatic treatment can improve clinical outcomes for children with MLD. The article emphasizes the feasibility and efficacy of implementing a high-throughput screening program for MLD. [Extracted from the article]

The article discusses the features of HIV infection in the context of long-acting cabotegravir preexposure prophylaxis (PrEP). The results of clinical trials showed that cabotegravir was superior to daily oral tenofovir disoproxil fumarate-emtricitabine in preventing sexual transmission of HIV. The article highlights that HIV infection in the context of cabotegravir PrEP may present differently from classic acute HIV infection, with a low or undetectable viral load and diminished antibody production. The use of RNA testing is recommended to detect HIV infection earlier and to identify instances of drug resistance. False positive HIV RNA tests may occur, leading to challenges in confirming HIV infection. Further research is needed to improve HIV screening assays and algorithms for individuals receiving cabotegravir PrEP. [Extracted from the article]

The article discusses a study on the reactivation of the SOX17 program as an immune-evasion mechanism in the early development of colorectal cancer. The study found that colorectal cancer cells reactivate a fetal program, usually switched off in adults, which allows them to evade the immune system. The reexpression of the SOX17 protein was identified as a crucial factor in mediating immune evasion. The study suggests that targeting SOX17 may be a strategy for preventing and intercepting colorectal cancer. [Extracted from the article]

The article discusses the ethical challenges associated with pragmatic and cluster randomized controlled trials (RCTs). Pragmatic RCTs aim to provide evidence for real-world clinical decision making and often include diverse patient populations. Cluster RCTs allocate entire communities or hospitals to study interventions, which can present logistical and ethical complications. The article explores issues related to obtaining informed consent, protecting vulnerable participants, and balancing the benefits and risks of these trial designs. The authors emphasize the importance of collaboration among various stakeholders and the need for ethical guidance specific to these study designs. [Extracted from the article]

The article focuses on autoimmune polyendocrine syndrome type 1 (APS-1), highlighting the lack of established immunotherapies. Oikonomou et al. report on the efficacy of a JAK1 and JAK2 inhibitor in both a mouse model and patients with APS-1, suggesting potential for JAK inhibitors as first-line treatments for this life-threatening condition characterized by diverse disease manifestations.

The article presents a case study of a 73-year-old woman transferred to the hospital due to a worsening rash, following rectal pain and abnormal laboratory findings. It discusses her initial evaluation, treatment, and subsequent development of an erosive rash, highlighting the diagnostic and management challenges in such cases.

The article explores cerebral cavernous malformations (CCMs), compact clusters of spongelike vascular spaces in the brain or spinal cord, focusing on their pathogenesis, including genetic factors, and clinical manifestations such as seizures and neurological deficits. Topics include the prevalence of CCMs, their genetic and molecular underpinnings, and the implications for clinical management and follow-up care,highlighting the importance of MRI for detection and surveillance.

The article presents a case study of a 67-year-old woman presenting with alternating sixth cranial nerve palsy, alongside headache and retro-orbital pain. Topics include the patient's medical history, including photosensitive rashes possibly related to medication, and the diagnostic process involving laboratory tests and imaging studies to identify potential causes of her symptoms.

The article focuses on the emergence of direct-to-consumer platforms for new antiobesity medications, highlighting both concerns and potential opportunities associated with this approach. Topics discussed include the rise in demand for antiobesity medications like semaglutide, the challenges of traditional healthcare systems in meeting this demand, and the potential risks and benefits of direct-to-consumer prescribing models for such medications.

The article focuses on a case involving a 67-year-old woman with alternating sixth cranial nerve palsy, discussing her clinical presentation, diagnostic evaluation, and differential diagnosis. Topics include her medical history, initial symptoms, diagnostic tests, and considerations for autoimmune and inflammatory conditions such as Sjögren's syndrome, neurosarcoidosis, and IgG4-related disease.

The article focuses on endemic mycoses, particularly histoplasmosis and coccidioidomycosis, caused by dimorphic fungi with distinct structures in the environment and varying impact on immunocompetent individuals, necessitating an understanding of their distribution, clinical manifestations, and pathogenesis for rational management strategies.

A case study of a 43-year-old woman presenting with dysuria and lower abdominal pressure, with a history of recurrent urinary tract infections (UTIs) over the past 2 years. Each episode was diagnosed as a UTI and treated with antibiotics. Given the recurrence, considerations include whether the diagnosis, pathogen or treatment approach is incorrect.

The article focuses on a 43-year-old woman admitted to the Prince of Wales Hospital in Hong Kong with abdominal pain, diarrhea, and additional symptoms, leading to a medical evaluation that revealed a history of polycystic ovarian syndrome and a connection to traditional Chinese medicine containing unknown ingredients. Topics include the patient's presenting symptoms, the history of traditional Chinese medicine use.

The article focuses on a 68-year-old woman admitted due to worsening confusion and abnormal movements, with a history of intermittent slurred speech and dizziness. Imaging revealed an acute ischemic infarct, and the patient, on apixaban for deep venous thromboses, underwent increased atorvastatin dosage while maintaining anticoagulant treatment.

The article focuses on the broad spectrum of cannabis-related terms, encompassing the plant, its chemicals, synthetic counterparts, and various products. It explores the legal complexities surrounding cannabis in the U.S. and delves into the diagnosis, treatment, and toxic effects associated with cannabis use as defined in the DSM-5-TR.

The article focuses on liver transplantation as a curative strategy for Mahvash disease, an ultra-rare disorder caused by biallelic inactivating variants in the glucagon receptor gene (GCGR). Topics include the diagnosis of Mahvash disease through the identification of novel biallelic frameshift variants in GCGR, the manifestation of portal hypertension and recurrent encephalopathy in the absence of cirrhosis.

The article presents a case study of a 62-year-old woman who experienced recurring hemorrhagic pericardial effusion. She initially sought medical attention with chest pain, and despite treatment, her condition worsened. Eventually, a diagnosis of pericardial effusion was made, and she underwent pericardiocentesis to drain bloody fluid from the pericardium. Further imaging revealed no serious complications.

The article presents a case study of a 33-year-old man with ulcerative colitis who developed severe gastrointestinal symptoms, including perforation, due to disseminated histoplasmosis. Topics discussed include the clinical presentation and diagnostic challenges of histoplasmosis in a patient receiving immunosuppressive therapy, the potential complications of disseminated histoplasmosis, and the importance of alternative causes of colitis in patients with underlying inflammatory bowel disease.

The article presents a case study of a 50-year-old woman who presented with confusion, and it details her medical history, including the development of dysphagia, weight loss, and edema. It highlights the diagnostic process and the need for a comprehensive evaluation to determine the underlying cause of her symptoms.

The article presents a case study of a 34-year-old woman with a history of liver transplantation who developed abdominal distention and acute kidney injury. It is reported that complications following transplantation, including clostridioides difficile infection, led to her hospitalization. It further highlights the complexities in managing post-transplant patients and the need for comprehensive diagnostic evaluation.

The article focuses on the corporate practice of medicine (CPOM) doctrine and its historical development, raising questions about its effectiveness in the current healthcare landscape. Topics include the rapid corporatization of healthcare, the need to strengthen the CPOM doctrine to protect the medical profession and public interest, and the benefits and challenges of corporate ownership of physician practices in today's healthcare environment.

The article focuses on a 55-year-old man who developed respiratory symptoms and hypoxemia 17 days after receiving a stem-cell transplant, discussing the differential diagnosis of pulmonary complications in an immunocompromised patient at this stage of engraftment after transplantation, considering both infectious and noninfectious causes.

The article discusses the use of beta-blockers in secondary prevention after a myocardial infarction, highlighting recent trials such as ABYSS and REDUCE-AMI. The trials suggest that stopping beta-blocker treatment may not be beneficial in terms of reducing the risk of death, nonfatal myocardial infarction, stroke, or rehospitalization for cardiovascular reasons. The results indicate that the use of beta-blockers in patients with a preserved left ventricular ejection fraction may need further evaluation before definitive guideline updates. [Extracted from the article]

The article discusses the effectiveness of preexposure prophylaxis (PrEP) in preventing HIV infection, particularly among cisgender women. The study, called PURPOSE 1, conducted in South Africa and Uganda, compared the efficacy of different PrEP regimens. The results showed that lenacapavir, a twice-yearly subcutaneous injection, was highly effective in preventing HIV infection when adherence was high. The article highlights the need for improved access to and affordability of PrEP for women at high risk of HIV infection. [Extracted from the article]

The article discusses the need for effective antiviral agents to treat respiratory syncytial virus (RSV) infection, particularly in infants and older children who are ineligible for or do not benefit from current interventions. The study evaluates the efficacy of ziresovir, an orally bioavailable fusion inhibitor, in infants hospitalized with RSV infection. The results show promising clinical improvement with ziresovir compared to placebo, although further studies are needed to determine its impact on other clinical outcomes. Early treatment and the potential benefits for individuals with severe immunosuppression are also highlighted. [Extracted from the article]

The article discusses the use of magnetic resonance imaging (MRI) in reducing overdiagnosis of prostate cancer in men with elevated prostate-specific antigen (PSA) levels. Initially, there was hesitation in using active surveillance for low-grade disease due to concerns about missing high-grade disease. However, recent studies have shown that MRI can help detect high-grade disease with targeted biopsies, reducing the need for systematic biopsies. The article presents the findings of the Swedish GOTEBORG-2 trial, which showed a lower risk of detecting low-grade disease and a lower proportion of men with higher-grade disease in the MRI-targeted biopsy group compared to the systematic biopsy group. However, the MRI-targeted biopsy approach also led to a delay in diagnosing higher-grade disease in some men. The article concludes that performing MRI in everyone with an elevated PSA level is resource-intensive, but the experimental approach used in the trial minimized the number and extent of biopsies. Overall, the use of MRI in the context of PSA-based screening is evolving, and further research is needed to determine the most effective and cost-efficient strategies. [Extracted from the article]

The article discusses the challenges and burdens associated with long-term oxygen therapy for patients with severe hypoxemia and chronic obstructive pulmonary disease (COPD). The article highlights concerns such as the high cost of therapy, the limitations of current oxygen delivery systems, and the social isolation and depression experienced by patients. The article presents the results of a recent trial that compared 24-hour oxygen therapy to 15-hour therapy and found no significant difference in outcomes. The authors suggest that efforts should be made to address these barriers and provide patients with more portable and accessible oxygen delivery systems. [Extracted from the article]

An editorial is presented on the treatment of subclinical atrial fibrillation in periodical. Topics discussed include the efficacy of oral anticoagulant therapy in preventing strokes or systemic embolism, a comparative analysis of apixaban versus aspirin for event reduction, and the delicate balance between increased bleeding risks and the prevention of severe strokes in patients with subclinical atrial fibrillation.

The article focuses on the balance between procoagulants and anticoagulants in hemostasis and discusses the use of concizumab, a drug that blocks an anticoagulant protein, to restore hemostasis in people with hemophilia with inhibitors. It also touches on the treatment of hemophilia A and B, including prophylactic therapy and extended half-life clotting-factor concentrates, as well as non-factor-replacement therapies such as emicizumab.

The article focuses on the management of primary immune thrombocytopenia (ITP) in pregnancy, discussing topics such as risk assessment, treatment options, and diagnosis. Topics discussed include the prevalence of ITP in pregnant women, the challenges of managing ITP during pregnancy, and the differential diagnosis of thrombocytopenia in pregnancy.

The article presents a case study of a 43-year-old man with a pulmonary nodule, who was evaluated in a multidisciplinary Pulmonary Nodule Clinic after being seen at a primary care clinic for routine imaging studies. Topics discussed include the patient's medical history, travel history, and physical evaluation.

The article presents a case study of 58-year-old woman who initially presented with pleuritic chest pain and subsequently developed fatigue, weakness, and dyspnea. She was diagnosed with myopericarditis and later exhibited neurological symptoms consistent with neuromyelitis optica spectrum disorder. Her clinical history, antibody testing, and bone marrow findings suggested RAS-associated autoimmune leukoproliferative disorder.

The article presents a case of a 59-year-old woman who experienced hypotension and electrocardiographic changes during the induction of anesthesia for a transsphenoidal hypophysectomy. The authors explore possible causes of the intraoperative hypotension and discuss patient-related risk factors, medication use and physiological changes that may have contributed to the observed symptoms.

The article discusses treatments for intermediate-risk pulmonary embolism. Topics covered include the case of a 33-year-old woman with a saddle pulmonary embolism with clots, parenchymal infiltrates, and cardiac interventricular septum fattening, and the treatment options and recommendations of thrombolysis in addition to heparin therapy and of parenteral herapin therapy only. Also noted are the scope and processes of the two options.

The article presents a case study of a 61-year-old man with eyelid swelling and puffiness that interfered with his ability to read and drive. Examinations showed a chronic orbital inflammatory process linked to thyroid eye disease, evidence of plasma-cell neoplasm with and increased number of mature plasma cells, and the final diagnosis of systemic immunoglobulin light-chain (AL) amyloidosis. The patient underwent induction chemotherapy and is receiving daratumumab maintenance therapy.

The article presents the case study of 32-year-old woman wth 6-month history of worsening abdominal pain. Topics include chills, sweats, and weight loss suggesting a systemic infectious, inflammatory, or neoplastic disease; and no known exposures to inhaled particulates such as silica or metal dusts including beryllium.

The article discusses on a case of a 52-year-old man with a metastatic solitary fibrous tumor who experienced recurrent episodes of hypoglycemia. It also include the patient's medical history, diagnostic findings, treatment approaches and clinical course, including disease progression and management of complications.