New England Journal of Medicine, Volume 380, Issue 26, Page 2497-2505, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2551-2562, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2529-2540, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2563-2563, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2494-2495, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2590-2590, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2492-2494, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2577-2578, June 2019.
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New England Journal of Medicine, Ahead of Print.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2564-2573, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2581-2582, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2588-2590, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2575-2576, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2587-2588, June 2019.
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New England Journal of Medicine, Volume 380, Issue 26, Page 2582-2587, June 2019.
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New England Journal of Medicine, Ahead of Print.
Wed Jun 26, 2019 12:00
Sedation is a component of the care of critically ill patients who are undergoing mechanical ventilation, but the appropriate choice of a primary sedative agent remains uncertain. Propofol and midazolam, which act mainly through pathways mediated by γ-aminobutyric acid, are widely used for this…
Thu Jun 27, 2019 03:00
Pain is "an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or [is] described in terms of such damage" when there is no physical derangement. The function of pain is to protect the body by making the organism aware of damaging events and to promote…
Thu Jun 20, 2019 03:00
Multiple sclerosis is a progressive demyelinating, inflammatory, and neurodegenerative autoimmune disease that results in the formation of lesions in the protective layer around nerves in the brain and spinal cord. Goals in the treatment of patients’ disabling symptoms include reducing the…
Thu Jun 20, 2019 03:00
Since the Centers for Disease Control and Prevention (CDC) released its Guideline for Prescribing Opioids for Chronic Pain in 2016, the medical and health policy communities have largely embraced its recommendations. A majority of state Medicaid agencies reported having implemented the guideline in…
Thu Jun 13, 2019 03:00
Huntington’s disease is a progressive neurodegenerative disorder inherited as an autosomal-dominant trait, with onset typically occurring in mid-adult life and characterized by movement disorder, cognitive decline, and behavioral symptoms. Huntington’s disease is caused by CAG trinucleotide repeat…
Thu Jun 13, 2019 03:00
Huntington’s disease is a severe autosomal-dominant neurodegenerative disorder that involves chorea, cognitive decline, and psychological problems such as depression, delusions, and impulsive behavior. Nowhere are the manifestations more striking than around Lake Maracaibo in northwestern…
Thu Jun 13, 2019 03:00
The existing paradigm for diagnosing infections relies on the physician formulating a differential diagnosis on the basis of a patient’s history, clinical presentation, and imaging findings, followed by serial laboratory testing. This traditional approach is particularly challenging for…
Thu Jun 13, 2019 03:00
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information by sharing relevant background and reasoning with the reader (regular type). The authors’ commentary follows. Stage. A 29-year-old woman…
Thu Jun 06, 2019 03:00
Michael and I met on the westbound Princeton Junction train station platform late one afternoon in October 2009. I had started using a scooter-type wheelchair in 1988 as my relapsing–remitting multiple sclerosis (MS) became secondary progressive, and this scooter had functioned well beyond its…
Thu May 30, 2019 03:00
A recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) on dietary sodium intake adds overwhelming weight to the already strong imperative to reduce the amount of sodium in the U.S. food supply. Some food companies had used the ongoing work on this report as a…
Wed May 29, 2019 03:00
To the Editor: The rapid accrual of knowledge in genomic medicine has prompted the reanalysis of existing data. We clinically reanalyzed data from two patient series that had undergone diagnostic proband-only exome sequencing. The exome sequences of the first series of 250 patients were obtained…
Thu Jun 20, 2019 03:00
In July 2018, the Journal published the results of TAILORx (Trial Assigning Individualized Options for Treatment). This randomized trial conducted by Sparano et al. showed the noninferiority of endocrine therapy to chemoendocrine therapy with respect to invasive disease–free survival among women…
Thu Jun 20, 2019 03:00
Eleven years ago, we suggested that physicians respond to a patient who asked whether to invest in a consumer genomewide genetic test by saying, "Not now — ask again in a few years." Now that more than a few years have passed, would we still give the same advice? In fact, we would. We have seen an…
Thu Jun 20, 2019 03:00
The premise of precision cancer medicine is elegantly simple. The basic concept involves the analysis — molecular and otherwise — of a tumor to identify key attributes that allow for the selection of therapeutic agents with a high likelihood of killing that particular tumor, while minimizing side…
Thu Jun 20, 2019 03:00
Clinicopathological features, including tumor size, histologic grade, and the presence of axillary lymph-node metastases, provide prognostic information about disease recurrence in women who have localized breast cancer after surgery, but these features have not been shown to be predictive of…
Thu Jun 20, 2019 03:00
Achondroplasia is the most common form of disproportionate short stature, with a prevalence of 1 in 25,000 live births. The condition is caused by an autosomal dominant mutation in the fibroblast growth factor receptor 3 gene (FGFR3) that constitutively activates the mitogen-activated protein…
Tue Jun 18, 2019 03:00
Almost all cancers arise in organs and tissues containing cells that have the ability, for the lifetime of the organism, to replicate in order to maintain and replace cells that are lost because of aging or damage. For example, the entire lining of the gut is replaced approximately every 7 days,…
Thu Jun 06, 2019 03:00
Stem cells and progenitor cells reside in various tissues of the body and are capable of generating daughter cells of different lineages. Mesenchymal stem cells (MSCs) are multipotent stromal cells that reside in tissues such as bone marrow, adipose tissue, liver, and skeletal muscle. MSCs are…
Thu Jun 06, 2019 03:00
Transcatheter aortic-valve replacement (TAVR) was approved in 2011 in the United States. As a condition of reimbursement, the Centers for Medicare and Medicaid Services (CMS) requires TAVR programs to perform a minimum of 20 TAVR procedures per year or 40 over a period of 2 years. Although other…
Thu Jun 27, 2019 03:00
Nearly a decade after its enactment, the Affordable Care Act (ACA) remains in limbo. The Trump administration’s recent decision to ask a federal appellate court to uphold a district court ruling that invalidated the entire ACA underscores the ongoing conflict over health care reform. Yet the…
Thu Jun 27, 2019 03:00
U.S. health care costs — and not merely prescription-drug prices — have risen to the top of the national agenda. More than two thirds (69%) of the U.S. public has said that reducing these costs should be a top priority for President Donald Trump and Congress in 2019, ranking it behind only…
Thu Jun 27, 2019 03:00
Shortly after midnight in the mountainous town of La Soledad, home to an indigenous community in the poorest state of Chiapas, Mexico, a mother woke Dr. R. to see her 18-month-old son. The patient was well known to the clinic staff as one of many local children with chronic malnutrition. On this…
Thu Jun 20, 2019 03:00
The introduction of penicillin transformed the practice of medicine and contributed to mortality from infections plummeting by about 80% in the United States, from 280 to 60 per 100,000 population. This transformation is now under threat, however, as rising rates of antibiotic resistance are…
Wed Jun 19, 2019 03:00
In recent years, policymakers have introduced unprecedented changes to Medicaid. As of April 2019, nine states have received approval by means of a federal waiver to implement work requirements in Medicaid, and six have applications pending. According to the Centers for Medicare and Medicaid…
Wed Jun 19, 2019 03:00
India is in the midst of a remarkably ambitious health insurance expansion. In September 2018, Prime Minister Narendra Modi announced a plan that will cover an additional 500 million Indians. The motivation? India grossly underspends on health care, and health outcomes in some regions are among the…
Thu Jun 13, 2019 03:00
The Hospital Readmissions Reduction Program (HRRP) was established by the Centers for Medicare and Medicaid Services (CMS) in 2010 with a goal of reducing preventable hospitalizations by imposing financial penalties on hospitals with higher-than-expected 30-day readmission rates. After the program…
Thu Jun 13, 2019 03:00
The Medicare Shared Savings Program (MSSP) has produced modest savings for Medicare and been popular among health care providers, with 561 participating accountable care organizations (ACOs) covering nearly a third of the fee-for-service Medicare population in 2018. Yet the pace of savings has not…
Thu Jun 06, 2019 03:00
In 2000, the United States achieved a historic public health goal: the elimination of measles, defined by the absence of sustained transmission of the virus for more than 12 months. This achievement resulted from a concerted effort by health care practitioners and families alike, working to protect…
Thu Jun 06, 2019 03:00
The observation that it’s difficult to make predictions, "especially about the future," has been made by baseball players (Yogi Berra) and physicists (Niels Bohr), but the economists at the Congressional Budget Office (CBO) don’t have a choice. The CBO was created in 1974 as a nonpartisan agency in…
Thu Jun 06, 2019 03:00
The United States has been experiencing an increasing number of measles outbreaks, and more measles cases were reported in the first 5 months of 2019 than in any full year since 1992, which was 8 years before endemic transmission was interrupted. Parents’ resistance to vaccination is leaving more…
Wed Jun 05, 2019 03:00
"Experience should teach us to be most on our guard to protect liberty when the government’s purposes are beneficent." — Justice Louis D. Brandeis Though a vaccine has been available for more than 50 years, measles has recently reemerged as a public health threat in the United States. Outbreaks…
Wed Jun 05, 2019 03:00
On June 4, 2019, the Ninth Circuit Court of Appeals will hear oral arguments in Juliana v. United States to determine whether the case will proceed to trial in district court in Oregon. Nearly 4 years ago, 21 children and adolescents between 8 and 19 years of age, including Kelsey Juliana from…
Thu May 30, 2019 03:00
Antimalarial drug resistance has arisen frequently in the past, causing familiar treatment regimens to fail, with sometimes devastating consequences. Resistance has eventually been managed when new treatments have been developed, but drug discovery is a painstaking process that takes decades of…
Thu May 30, 2019 03:00
The collateral and extended effects of preventive chemotherapy, many of which were unanticipated, have reduced disease burdens and saved lives on a scale that appears to have exceeded the intended impact on seven neglected tropical diseases (NTDs) — the three major soil-transmitted helminth…
Thu Jun 20, 2019 03:00
Presentation of Case. Dr. Erika J. Parisi (Medicine): A 38-year-old woman with a history of Crohn’s disease was admitted to this hospital because of abdominal pain and fever. The patient had been in her usual state of health until 3 years before the current admission, when nausea, vomiting,…
Thu Jun 20, 2019 03:00
Azithromycin, which was discovered by Croatian scientists in 1980, has broad antimicrobial activity. Its seeming broad-spectrum activity led its discoverers to name it Sumamed, invoking the summum bonum — the ultimate good. But is azithromycin the elixir of life, capable of reducing mortality? The…
Thu Jun 06, 2019 03:00
The MORDOR I trial (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) showed that twice-yearly azithromycin distributions reduced childhood mortality by 14% in communities in Niger, Malawi, and Tanzania (and unpublished data). The greatest observed benefit was seen in Niger,…
Thu Jun 06, 2019 03:00
To the Editor: Mass administration of azithromycin reduced childhood mortality in the trials MORDOR (Macrolides Oraux pour Réduire les Décès avec un Oeil sur la Résistance) I and MORDOR II (conducted by Keenan et al. published in this issue of the Journal). However, antibiotic resistance remains a…
Thu Jun 06, 2019 03:00
Routine surveillance for tickborne diseases in China led to the identification of a patient from the town of Alongshan who had a febrile illness with an unknown cause. An investigation was conducted to identify the pathogen that was causing this patient’s illness. Analyses revealed a previously…
Thu May 30, 2019 03:00
Heatstroke is the most hazardous condition in a spectrum of illnesses progressing from heat exhaustion to heatstroke, in which a shared finding is hyperthermia (i.e. the rise in core body temperature when heat accumulation overrides heat dissipation during exercise or exposure to environmental heat…
Thu Jun 20, 2019 03:00
My patient was a small, elderly woman lying in bed, looking gray. She was weak and not able to say much, but she confirmed "dolor del pecho" and gestured feebly toward her chest. Several days earlier, she had undergone knee-replacement surgery and had lost some blood. After the surgery, her…
Thu Jun 13, 2019 03:00
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. An 18-year-old…
Thu Jun 13, 2019 03:00
Presentation of Case. Dr. Alexander Melamed: A 24-year-old woman was seen in the emergency department of this hospital because of a pelvic mass. The patient had been well until 4 weeks before this presentation, when she began to notice an increased frequency of vaginal bleeding. At that time, an…
Thu Jun 13, 2019 03:00
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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,