#NEJM

Dr. Katrina Armstrong, Chair of Medicine and Physician-in-Chief of MGH, shared her clinical reasoning in constructing a differential diagnosis for today's CPC at Medicine Case Conference. It was phenomenal teaching on how a master diagnostician thinks about a patient presentation! The case:⁣ ⁣ "A 47-Year-Old Woman with Recurrent Melanoma and New Bilateral Pulmonary Nodules"⁣ ⁣ The woman had 3 episodes of melanoma metastatic to the axillary, for which she received immunotherapy. After returning from vacation in South America, surveillance imaging revealed new pulmonary abnormalities. A diagnostic test was performed.⁣ ⁣ Congratulations on your fantastic CPC, Dr. Armstrong! Thank you also to the amazing lineup of expert discussants who presented in the CPC.⁣ ⁣ Follow @nejmcpc for updates! Look for this CPC, to be published soon in the weekly NEJM Case Records of the MGH! Link to NEJM in our bio. Primary discussant: Katrina Armstrong⁣ Discussants: Jo-Anne Shepard, Michael Mansour, Jonathan Stefely, Justine Cohen, Erik Folch⁣ Editor: Eric Rosenberg⁣ Assoc Ed: David Dudzinski ⁣ Ed Fellow: @kathymaytran⁣ Prod Ed: Emily McDonald, Tara Corpuz


7💬Normal

Asciminib, a novel ABL tyrosine kinase inhibitor that targets the myristoyl site of the molecule rather than the ATP-binding domain, showed mainly low-grade toxic effects in a minority of patients and considerable antileukemic activity in the majority of those who had resistance to or unacceptable side effects from standard TKIs.⁠ ⁠ Read more in the full Original Article on #NEJM


7💬Normal

Oggi è S.Lucia, la santa protettrice della vista, iniziamo quindi con un caso pubblicato anni fa sul @nejm e che ci viene ricordato dagli amici di @__cripto__ (che vi invitiamo a seguire). Ciò che vedete è la comparsa di "cataratta stellata" in entrambi gli occhi di un elettricista 42enne come conseguenza di una scossa da 14000V presa alla spalla sinistra. Oltre al danno del cristallino, degenerazione di nervo ottico e retina han fatto che sì che anche dopo la chirurgia ed i seguenti follow-up, la riabilitazione ottica non fosse completa. #themedicalalphabet #cripto #stellatecataract #ophtalmology #ophtalmicsurgery #lensreplacement #whenablindmancries #nejm #eyedisease #santalucia


3💬Normal

・・・ Imagem da semana do jornal médico New England Journal of Medicine. Este é um exame de tomografia, que faz imagens do corpo humano como se fizesse fatias, que olhamos de baixo para cima. Na imagem a pessoa está deitada com os pés na sua direção e a cabeça atrás da sua tela. A imagem é uma fatia na altura do mamilo. Na parte de baixo vemos uma vértebra, mais branca. A imagem circular no meio do exame é o coração, ao redor vemos os musculos e costelas e em cinza os pulmões. A seta preta aponta para um câncer de pulmão. Durante o exame também se observam duas imagens que não fazem parte do corpo humano: o pequeno triângulo é um isqueiro e a seta branca é um maço de cigarros. Ambos no bolso da camisa. . Reposted from @drfelipeades . . #cancer #oncologia #medicina #tomografia #combateaotabagismo #combateaocigarro #tabagismo #fumo #cigarro #cancerdepulmao #radiologia #nejm


0💬Normal

n idiopathic achalasia patients a less invasive procedure proved equal to a surgical approach in controlling symptoms at 2 years but resulted in more cases of gastroesophageal reflux, according to an international randomized trial. Thomas Rösch, MD, of University Hospital Hamburg-Eppendorf in Germany, and colleagues compared the efficacy of peroral endoscopic myotomy (POEM) with laparoscopic Heller's myotomy (LHM) plus Dor's fundoplication and found POEM to be non-inferior in the study's primary endpoint. At 2-year follow-up, clinical success – defined as an Eckardt symptom score of 3 or less with no additional treatments – was observed in 83.0% of POEM patients and 81.7% of LHM patients (95% confidence interval –8.7-11.4, P=0.007 for non-inferiority). "Our results could assist in shared decision making in selecting the appropriate individual therapy for patients with primary achalasia," wrote the European-North American research team in the study online in the New England Journal of Medicine. #doctor #physician #medstudent #medicalstudent #futuredoctor #medtwitter #medicine #healthcare #medical #medicalnews #medpagetoday #healthnews #nurse #instahealth #medicalstudy #medicalresearch #instagood #NEJM


0💬Normal

Yo 😜 What’s the word family 🤩 #ItsChicagoNigga #ThaBoonieWay #femalemc #femalerapper #chicagomusic #NEJM


5💬Normal

A 57-year-old woman presented with a 1-year history of an itchy facial rash, which was unresponsive to a 3-month course of prednisone and hydroxychloroquine. Redness had spread from her face to her scalp and neck. She reported a productive cough and progressive dyspnea for the preceding 2 weeks.⁠⠀ ⁠⠀ Read the full article by Cristina Thomas, M.D., Ruth Ann Vleugels, M.D., M.P.H., David J. Kwiatkowski, M.D., Ph.D., Bruce Levy, M.D., and Joseph Loscalzo, M.D., Ph.D. on #NEJM at the link in our bio.⁠


34💬Normal

Over here making dreams come true ⭐️ #NEJM #ItsChicagoNigga #BoonieThaGod #CEODuck #ChaseMadison


0💬Normal

#Repost @nejm with @get_repost ・・・ A randomized trial compared peroral endoscopic myotomy with laparoscopic Heller’s myotomy plus Dor’s fundoplication in patients with symptomatic idiopathic achalasia. POEM was noninferior to LHM in controlling symptoms of achalasia at 2 years. Symptoms of gastroesophageal reflux were more common in the POEM group. ⁠⠀ ⁠⠀ Read the full article on #NEJM at the link in our bio.⁠


0💬Normal

A randomized trial compared peroral endoscopic myotomy with laparoscopic Heller’s myotomy plus Dor’s fundoplication in patients with symptomatic idiopathic achalasia. POEM was noninferior to LHM in controlling symptoms of achalasia at 2 years. Symptoms of gastroesophageal reflux were more common in the POEM group. ⁠⠀ ⁠⠀ Read the full article on #NEJM at the link in our bio.⁠


32💬Normal

Residency is what you make it out to be. I make it a habit daily to go to work with a positive attitude, to have fun, and to learn but most important to be there for my patients. How do I do it? By taking my work seriously, letting go of ego and not being afraid to be corrected if it means my pt gets optimal care. Also, it means having the courage to speak up when your pts aren’t getting the guideline directed care they deserve. Follow your heart but also medicine guidelines haha #nejm #medicine #latinodoc #medschool #premedmotivation #residencylife


0💬Normal

@nejm A 24-year-old man presented with pain, swelling, and decreased vision in his right eye after it had been struck by a tennis ball. Examination showed a retinal hemorrhage.⁠ ⁠ Read the full article by Jitender Jinagal, M.S., F.I.C.O., F.A.I.C.O., and Poonam Dhiman, M.Optom. on #NEJM at the link in our bio.⁠⠀


0💬Normal

Posted @withrepost@nejm A 24-year-old man presented with pain, swelling, and decreased vision in his right eye after it had been struck by a tennis ball. Examination showed a retinal hemorrhage.⁠ ⁠ Read the full article by Jitender Jinagal, M.S., F.I.C.O., F.A.I.C.O., and Poonam Dhiman, M.Optom. on #NEJM at the link in our bio.⁠⠀


0💬Normal

A 24-year-old man presented with pain, swelling, and decreased vision in his right eye after it had been struck by a tennis ball. Examination showed a retinal hemorrhage.⁠ ⁠ Read the full article by Jitender Jinagal, M.S., F.I.C.O., F.A.I.C.O., and Poonam Dhiman, M.Optom. on #NEJM at the link in our bio.⁠⠀


105💬Normal

Congratulations to Dr. Andrea Ciaranello, perinatal infectious diseases expert, for her CPC today at Medicine Case Conference!⁣ ⁣ "A 33-Year-Old Pregnant Woman with Fever, Abdominal Pain, and Headache"⁣ ⁣ A woman presented at 10 weeks gestation with fever and abdominal pain similar to her prior exacerbations of ulcerative colitis and headache and neck pain similar to her prior migraines. T100.8, WBC 8.9, ESR 16, CRP 6.5.⁣ ⁣ A diagnostic test was performed.⁣ ⁣ Thanks again to Dr. Ciaranello, as well as Drs. Craig Audin and Melis Anahtar for your wonderful teaching!⁣ ⁣ Read this CPC soon in the NEJM Case Records of the MGH: Link in bio! ⁣Primary discussant: Andrea Ciaranello Radiology: Craig Audin Microbiology: Melis Anahtar Editor: Eric Rosenberg Ed Fellow: Kathy May Tran Prod Ed: Tara Corpuz, Emily McDonald


1💬Normal

COMPLETE Trial! Check out our highlights of this possible game changer article. COMPLETE demonstrated that full revascularization had better outcomes than culprit-only. Notice how these results cannot be applied to the patient of our latest clinical case, since he was in cardiogenic shock, and COMPLETE did not included these kind of patients. DOI: 10.1056/NEJMoa1907775 . . . . . . . . . #cardiology #cardio #complete #cathlab #doctor #medicaldoctor #md #heartdoctor #article #medschool #medicine #medstudent #nejm #stemi #follow #followback #followtrain #mty #spgg #mexico #heartteam


1💬Normal

Tıp dünyasının en prestijli dergisi olan Nejm, geçtiğimiz günlerde yayınladığı bir çalışma ile, danışanlarımın bana sıkça sorduğu Aspirin konusunu çok güzel cevaplamış.. Çalışmanın ismi ASPREE. Cevapladığı konu da 65 yaş üzerinde, fakat bu zamana kadar herhangi bir kalp damar hastalığı geçirmemiş olan, yani sağlıklı görünen kişilerde, düşük doz Aspirin (100mg) almanın, tüm sebeplere bağlı ölümlerde bir azalma sağlayıp sağlayamadığı.. Yani, kalp damar hastalığı geçirmemiş bir yaşlı birey, Aspirin kullanmaya başlar ve devam ederse, bunun yaşam süresine etkisi ne olur? Bu çalışma için 20.000 kişi, iki gruba bölünerek Aspirin veya Plasebo verilen kişiler 5 yıl boyunca takip edilmiş. Sonuç çok ilginç; Aspirin alan 10.000 kişilik grupta, Plasebo (yalancı ilaç) alan kişilere göre tüm sebeplere bağlı ölümlerde artış olmuş. Çünkü Aspirin alan gruptaki özellikle kanser ile ilişkili ölümlerde belirgin yükselme görülmüş. Çalışmaya katılan kişilerin %74’ü yüksek tansiyon hastası, %11’i şeker hastası ve aynı zamanda büyük bir kısmı fazla kilolu veya obez. Aslında zaten riskli bir grupla çalışılmış. Sonuç olarak; daha önce kalp damar hastalığı geçirmemiş olanlarda, koruma açısından Aspirin almanın hiçbir faydası yok; hatta zarar olabileceğine dair güçlü veriler mevcut. Yani, hastalıklardan korunmak amacıyla Aspirin alma gibi bir planınız varsa, bir kez daha düşünün ve doktorunuza danışın. #nejm #aspree #aspirin #health #ilaç #tansiyon #fonksiyoneltıp #ortomolekülertıp #holistichealth


1💬Normal

CURE trial (2001): Clopidogrel is beneficial in addition to aspirin in acute coronary syndrome without ST-elevation, at the expense of increased major bleeding. 12,562 patients with ACS without ST-segment elevation who presented within 24 hours of onset of symptoms were randomised to receive clopidogrel (300mg immediately, 75mg OD) (6259 patients) or placebo (6303 patients) in addition to aspirin for 3-12 months. The primary outcome (cardiovascular death, non-fatal myocardial infarction, stroke) occurred in 9.3% of clopidogrel group and 11.4% of placebo group (RR 0.80; 95%. CI 0.72-0.90; p<0.001). The secondary outcome (primary outcome, refractory ischemia) occurred in 16.5% of clopidogrel and 18.8% of placebo group (RR 0.86; p<0.001). Clopidogrel was associated with significantly more major bleeding (3.7% vs 2.7%; RR 1.38; p=0.001) but not life-threatening bleeding or hemorrhagic strokes. Published article: https://www.nejm.org/doi/full/10.1056/NEJMoa010746


1💬Normal

Do Doctors Study❓❓❓ . All the time! Often it's in the moment - "I need to look this up" kind of stuff but it's also important to keep up to date and review! 💡 . Today I'm starting my day with some nice coffee and a cool case about essential thrombocythemia (increased platelets in the blood 💉) . . Every day I may try to do a quick flashcard, practice case, or even read through a few recent abstracts to understand what's new in medicine! . Gotta love that life long learning! 🥼🥼👍 . Questions about being a resident? Comment below! ⤵️⤵️⤵️


3💬Normal

The e-cigarettes do (a bit) better than #nicotine substitutes. Therefore #vaping could be suggested for smokers who have difficulties in quitting while their #skindisease needs #smoking cessation #skin #skindiseases #skindisease #tobacco #vape #vapping #ecigarette #nejm #dermatology #dermatologie #dermatologia #jdp2019 #journeesdermatologiquesdeparis #journeesdermatologiquesdeparis2019


0💬Normal

What is the effect of brown adipose tissue activity on insulin resistance? And what is the relevance of branched-chain amino acids? The results of a recent study that used mouse models provide some answers.⁠ ⁠ Read the full article by Zoltan Arany, M.D., Ph.D. on #NEJM at the link in our bio.⁠⠀


9💬Normal

Adson's sign ... It is the loss of the radial pulse in the arm by rotating head to the ipsilateral side with extended neck following deep inspiration. It is sometimes used as a sign of thoracic outlet syndrome (TOS). ...... #medicine #medical #medicallife #medlife #medicalstudent #doctors #internalmedicine #patientcare #medicalcare #medicines #medscape #medicinehat #physicaltherapy #physicist #physician #nursinglife #usmle #radiologist #doctorsofinstagram #osce #internalmedicine #familymedicine #medicalscience #instamedicine #pediatrician #docofinsta#nejm #pubmed #hashtag #instagram


1💬Normal

Early Surgery Best in Severe Asymptomatic Aortic Stenosis?⁠ ⁠ New randomized trial results show early aortic valve replacement (AVR) resulted in a lower risk for operative mortality or death from cardiovascular causes compared with conservative care in asymptomatic patients with severe aortic valve stenosis.⁠ ⁠ Secondary analysis also showed a reduced risk for all-cause mortality, the researchers report.⁠ ⁠ The results, from the RECOVERY trial, were presented here at #AHA19 last week and were published in #NEJM. ⁠ ⁠ Early surgical aortic valve replacement, as compared with conventional treatment, significantly reduced the risk of operative or cardiovascular mortality and death from any cause among asymptomatic patients with very severe aortic stenosis, the researchers noted.⁠ ⁠ The RECOVERY trial provides the evidence to support preemptive aortic valve replacement for asymptomatic severe aortic stenosis, they added.⁠ Follow @dayanats_blog to learn everyday! #doctor #physician #medstudent #medicalstudent #futuredoctor #medicine #healthcare #medical #obgyn #womenshealth #gyno #gynecologist #pregnancy #gyn #doula #gynecology #womeninmedicine #pregnant #embryo #twins #IVF


0💬Normal

Congratulations to MGH cardiologist Raj Malhotra for a riveting CPC at Medicine Case Conference:⁣ ⁣ "A 72-Year-Old Woman with Hematuria and Weakness"⁣ ⁣ Dark urine developed and the woman self-administered ciprofloxacin. Soon weakness developed. Exam revealed pallor, yellow skin, and murmur. Evaluation was notable for anemia. A diagnostic test was performed. ⁣ ⁣ Thank you, Dr. Malhotra for your excellent differential diagnosis, and thank you to all of our experts for your teaching! ⁣ ⁣ Read this Case Records of the MGH soon in the weekly NEJM - link in our bio.⁣ ⁣ Primary Discussant: Rajeev Malhotra⁣ Expert Discussants: Mayooran Namasivayam, Brian Ghoshhajra, Jonathan Passeri, James Stone⁣ Editor: Eric Rosenberg⁣ Associate Editor: David Dudzinski⁣ Prod Editors: Emily McDonald, Tara Corpuz


3💬Normal

OVER 80% OF LEG ULCERS ARE CAUSED BY VEIN PROBLEMS. An important part of getting them healed quickly is by applying medical compression (as well as fixing the vein problem). BUT... leg ulcers will not respond to compression if the artery circulation is poor. So, all patients should have their artery circulation checked by a Doppler Assessment (also called ABPI). Lucy Wicks, helped by Natalie Pike, demonstrates how this is done.


1💬Normal

The 41st Annual Primary Care Pediatrics Conference, which was presented by the Massachusetts General Hospital for Children and Harvard Medical School, hosted a NEJM CPC. ⁣ Pediatrician Yamini Virkud discusses her differential diagnosis for:⁣ ⁣ "A 29-Month-Old Boy with Seizure and Hypocalcemia."⁣ ⁣ Aa GTC seizure occurred. The boy had a history of febrile seizure and allergies. Lab evaluation showed calcium of 5. A diagnostic test was performed.⁣ ⁣ This patient's story coming soon to Case Records of the MGH in the weekly NEJM - link in our bio!⁣ ⁣ Discussant: Yamini Virkud⁣ Speakers: Deb Mitchell, Ruth Lim, William Rothwell, Neil Fernandes⁣ Editor: Eric Rosenberg⁣ Editorial Fellow: Kathy May Tran⁣ ProdEds: Emily McDonald, Tara Corpuz⁣ PhotoCred: Tara Corpuz


1💬Normal

Increasing population densities and subsequent range expansion, in conjunction with nondiscriminating biting habits and the capacity to transmit diverse pathogens, position the lone star tick as an important emerging health threat.⁠ ⁠ Read the full article by Goudarz Molaei, Ph.D., Eliza A.H. Little, Ph.D., Scott C. Williams, Ph.D., and Kirby C. Stafford, Ph.D. on #NEJM at the link in our bio.⁠⠀


7💬Normal

Cancer Center Grand Rounds this week was a CPC with a "known" diagnosis. Unlike the typical "unknown" diagnosis presentation, the discussants were aware of the diagnosis and involved in the patient's care.⁣ ⁣ "A 34-Year-Old Woman with Cholangiocarcinoma."⁣ ⁣ The woman presented with back pain and abdominal pain. Imaging was suspicious for malignancy and pathology showed intrahepatic cholangiocarcinoma and FGFR mutation. ⁣ ⁣ Dr. Lipika Goyal discussed the diagnostic and management decisions that were made. She received surgery, interventional radiology, chemotherapy,  targeted therapy, and immunotherapy. ⁣ ⁣ The landscape of cholangiocarcinoma is rapidly changing. Innovative research is and new therapies are on the horizon for this rare cancer. ⁣ ⁣ Read the Case Records of the MGH - the CPCs - in the weekly NEJM. Link in our bio!⁣ ⁣ Discussants: Lipika Goyal, Theodore Pierce, Vikram Deshpande⁣ Case: Christopher Chen⁣ Editor: Eric Rosenberg⁣ Associate Editor: Dennis Sgroi⁣ Editorial Fellow: Kathy May Tran⁣ Production Editors: Emily McDonald, Tara Corpuz


2💬Normal

Foot lesion, slowly growing. Common in African-Americans and Asian population. What type of melanoma is this? . . . . #nejm #skinpathology #pathologyformbbs #neoplasia . . . Acral Lentiginous Melanoma Carries poor prognosis


0💬Normal

#repost from @nejm Lay responders play a major role in the resuscitation of persons with out-ofhospital cardiac arrest. Crucial steps include recognition of cardiac arrest, a call for emergency assistance, cardiopulmonary resuscitation, and use of an automated external defibrillator.⁠ ⁠ Read the full article by William J. Brady, M.D., Amal Mattu, M.D., and Corey M. Slovis, M.D. on #NEJM at the link in our bio.⁠⠀⁠


0💬Normal

#Repost @nejm (@get_repost) ・・・ Lay responders play a major role in the resuscitation of persons with out-ofhospital cardiac arrest. Crucial steps include recognition of cardiac arrest, a call for emergency assistance, cardiopulmonary resuscitation, and use of an automated external defibrillator.⁠ ⁠ Read the full article by William J. Brady, M.D., Amal Mattu, M.D., and Corey M. Slovis, M.D. on #NEJM at the link in our bio.⁠⠀⁠


2💬Normal

Lay responders play a major role in the resuscitation of persons with out-ofhospital cardiac arrest. Crucial steps include recognition of cardiac arrest, a call for emergency assistance, cardiopulmonary resuscitation, and use of an automated external defibrillator.⁠ ⁠ Read the full article by William J. Brady, M.D., Amal Mattu, M.D., and Corey M. Slovis, M.D. on #NEJM at the link in our bio.⁠⠀⁠


14💬Normal

PSA- pretty alarming email I stumbled across this morning. We must be conscious of all the products we use on an everyday basis that may be causing a negative impact on our health. This is just one example of products that may be potentially linked to increased risk of cancer. The same goes for all the supplements we see out on the market. Just because it’s over the counter does not mean it’s safe. We must also hold all these companies responsible for being transparent with the risks associated with using their products. Talk to your primary care doctor before starting any new products, you may be surprised at what you hear. Wishing you all a wonderful week xoxo sistersinmed Source: https://bit.ly/2Patyug


3💬Normal

🔷Great article in the @nejm on #statusepilepticus . 🔷 Had a patient recently in Status. Multiple doses of Benzo’s didn’t seem to work. In this article: . . .🔷 1st choice ➡️ Benzo’s (usually Lorazepam, Midazolam) . . 🔷 2nd choice➡️ these meds led to seizure cessation and improved alertness by 60 minutes in approximately half the patients! . . 🔷 3rd choice ➡️ not great data. . ✅ My neurology consult requested Dilantin, Phenobarbital and STAT EEG. ✅ that combo of meds seem to work. . . 📌#emergencymedicine #nejm #emergencias #medicalstudent #paramedicstudent #nursingstudent #doctormom#pastudent#nursepractitioner#doctora#femalephysician#medstudent#premedpremedstudent#emergencias#emergentologia#urgencias#urgenciologo#erdoctor#womeninmedicine#doctor#md#whatyoudomatters#erdoc#erresident#medicalschool#latinadoctor#mimentor#erstories#doctorlife


0💬Normal

Should women with dense breast tissue have additional screening? An article published in TIME magazine reviewing a study published in the New England Journal of Medicine provides the strongest data yet to support adding MRI screening to mammograms for women with extremely dense breast tissue. Swipe to learn more or visit the link here/in bio for the full article: https://time.com/5740245/breast-cancer-mri-screening/?utm_source=facebook&utm_medium=social&utm_campaign=editorial&utm_term=health_cancer&linkId=77832712 #breastcancer #earlydetection #mammogram #timemagazine #nejm #densebreasttissue


11💬Normal

Puxando o gancho dos artigos de Nefro dos stories de hoje, o videozinho do IDEAL- ICU do NEJM que não mostrou diferença de mortalidade em 90 dias no uso de diálise precoce x tardia nos doentes com choque séptico e injúria renal aguda. ⏰ . . .👍🏽 Forças : Randomizado, análise por intenção de tratar, mínima perda de follow up. . .👎🏽 Fraquezas : não cego, interrupção precoce por futilidade . . .📚🤓 🎥vídeo na íntegra -> https://youtu.be/w9EFsiQ-UXI #nefrointensivismo #medicinaintensiva #criticalcare #nejm #medicinabaseadaemevidencias #studytosavelives #intensivista #terapiaintensiva


2💬Normal

The Lower Drug Costs Now Act of 2019 represents a major departure from the U.S. status quo. It has several key but politically divisive provisions targeting prices paid to drug manufacturers and would reduce Medicare spending and beneficiaries’ out-of-pocket costs.⁠⠀ ⁠⠀ Read the full article on #NEJM at the link in our bio.⁠⠀


0💬Normal

Dr. Sebastian Unizony shares his differential diagnosis for yesterday's CPC at Medicine Case Conference...⁣ ⁣ "A 48-Year-Old Man with Transient Vision Loss"⁣ ⁣ The vision loss occurred acutely and lasted several hours. On exam, normal pupils, IOP, and color vision. There was ptosis, palpable mass under the orbital rim, prominent temporal arteries. Transaminases were elevated.⁣ ⁣ A diagnostic test was performed.⁣ ⁣ ⁣Congratulations, Dr. Unizony! Thank you to you and the other CPC discussants.⁣ ⁣ Read the case, see his differential diagnosis, and learn the final diagnosis... coming soon in the weekly NEJM! Link in our bio.⁣ ⁣ DDx: Sebastian Unizony⁣ Rads: Hillary Kelly⁣ Mgmt: Elizabeth O'Donnell⁣ Path: Sam Sadigh⁣ Ed: Eric Rosenberg⁣ AE: Meridale Baggett⁣ ProdEd: Tara Corpuz, Emily O'Donnell⁣ EdFellow: Kathy May Tran


1💬Normal

#Repost @nejm • • • • • • A 20-month-old boy was admitted to the hospital because of severe anemia. On examination, tachycardia, tachypnea, hepatosplenomegaly, multiple café au lait skin macules, and inguinal freckling were noted. The hematocrit was 9.0%, and the white-cell count 33,000 per microliter. A diagnostic test result was received, and additional diagnostic tests were performed.⁠⠀ ⁠⠀ Read the full article on #NEJM at the link in our bio.⁠⠀


1💬Normal

A 20-month-old boy was admitted to the hospital because of severe anemia. On examination, tachycardia, tachypnea, hepatosplenomegaly, multiple café au lait skin macules, and inguinal freckling were noted. The hematocrit was 9.0%, and the white-cell count 33,000 per microliter. A diagnostic test result was received, and additional diagnostic tests were performed.⁠⠀ ⁠⠀ Read the full article on #NEJM at the link in our bio.⁠⠀


34💬Normal

😥 O @papodepediatras pediu interconsulta pra esse casinho tranquilo‼️‼️ ・・・ 🏥Você está tranquilo na sala de emergência, quando chega o SAMU🚑 com um menino🧒🏽 com 2 anos e meio que apresentou uma convulsão e foi realizado massagem cardíaca e respiração boca-a-boca (provavelmente). • 👩🏾‍⚕️Na entrada, paciente estava estável e apresentava abdome distendido. Optado por realizar radiografia de tórax e abdome (imagem do post). • ❓O que fazer? 1️⃣ Faz cara de desespero? 2️⃣ Chama o @papodecirurgiao e foge? 3️⃣ Reza brava? 4️⃣ Senta e chora? • Compartilhando esse caso e exame inacreditável para descontrair um pouco na segunda! • #segundou #nejm #radiografia #pediatria #provaderesidencia #internato #papodepediatras


96💬Normal

Amigos👨‍👩‍👦‍👦!! Uma FOTOGRAFIA 🎥inesquecível!! A CAUSA E A CONSEQUÊNCIA‼️ Isto é uma chapa de um exame chamado de tomografia de pulmão, realizado num paciente masculino na ilha de Malta! No meio, em branco , está o coração! Na seta preta, está o TUMOR de pulmão💣! Na seta branca, um maço de cigarros e, no pequeno triângulo, um isqueiro , os quais foram esquecidos pela pessoa no bolso da roupa, na hora de fazer o exame! 👀 TABAGISMO é a maior causa previnível de CÂNCER‼️ Tabagismo passivo é Tabagismo!😱 Esta fotografia foi publicada no jornal médico americano New England Jornal of Medicine, o mais importante do mundo nesta área! #cancer #cancerdepulmao #cncerdepulmão #tabagismo #smoking #lungcancer #smoking #nejm


4💬Normal

#repost @nejm • 🏥Você está tranquilo na sala de emergência, quando chega o SAMU🚑 com um menino🧒🏽 com 2 anos e meio que apresentou uma convulsão e foi realizado massagem cardíaca e respiração boca-a-boca (provavelmente). • 👩🏾‍⚕️Na entrada, paciente estava estável e apresentava abdome distendido. Optado por realizar radiografia de tórax e abdome (imagem do post). • ❓O que fazer? 1️⃣ Faz cara de desespero? 2️⃣ Chama o @papodecirurgiao e foge? 3️⃣ Reza brava? 4️⃣ Senta e chora? • Compartilhando esse caso e exame inacreditável para descontrair um pouco na segunda! • #segundou #nejm #radiografia #pediatria #provaderesidencia #internato #papodepediatras


51💬Normal

A 62-year-old woman who had recently been treated for pelvic inflammatory disease presented with abdominal pain. On laparoscopy, adhesions between the anterosuperior hepatic surface and the abdominal wall were seen, a finding consistent with the Fitz-Hugh–Curtis syndrome.⁠⠀ ⁠⠀ Read the full article on #NEJM at the link in our bio.⁠⠀


115💬Normal

#repost from @nejm Thinking of “culture” as a process in which tensions between social values are resolved, rather than as a fixed state, may help U.S. health care leaders envision an approach to transforming organizational culture to support the improvement of economic value.⁠ ⁠ Read the full #Perspective by Michael Nurok, M.B., Ch.B., Ph.D., and Thomas H. Lee, M.D.⁠ on #NEJM - link in bio.⁠


0💬Normal

Thinking of “culture” as a process in which tensions between social values are resolved, rather than as a fixed state, may help U.S. health care leaders envision an approach to transforming organizational culture to support the improvement of economic value.⁠ ⁠ Read the full #Perspective by Michael Nurok, M.B., Ch.B., Ph.D., and Thomas H. Lee, M.D.⁠ on #NEJM - link in bio.⁠


7💬Normal

“If you’re in an accident, you don’t want a doctor on the scene,” said the wilderness first aid instructor. “You want a nurse or an EMT. Doctors are useless outside a hospital.” At the scene of an accident 20 years later, a doctor discovers the instructor was right.⁠ ⁠ Read the full article on #NEJM at the link in our bio.


75💬Normal

Essential thrombocythemia is associated with increased risks of bleeding and thrombosis. Estimation of the risk of thrombosis is based on history of thrombosis, presence of the JAK2 V617F mutation, age, and cardiovascular risk. Treatment commonly involves low-dose aspirin; therapy is used in patients with high thrombotic risk.⁠ ⁠ Read the full article on #NEJM at the link in our bio.


3💬Normal

This week's Case Records of the MGH in the NEJM:⁣ ⁣ "Case 37-2019: A 20-Month-Old Boy with Severe Anemia⁣" ⁣ The boy was brought to another hospital because he was tired and pale. Hb was 2.2, Hct 9, and WBC 33. He was transferred to the MGHfC pediatric intensive care unit for severe anemia. ⁣ ⁣ A diagnostic test was performed.⁣ ⁣ The full case was shared as an unknown diagnosis to primary discussant and MGHfC pediatric intensivist Dr. Brian Cummings. He shares his differential diagnosis and recommended management. ⁣ ⁣ Drs. Randheer Shailam, Ana Rosales, Mary Huang, and Valentina Nardi reveal the answer and what actually happened to the patient...⁣ ⁣ Read all about this CPC in this week's NEJM - link in our bio.⁣ ⁣ @nejm @massgeneral @mghfcpeds


1💬Normal

Refresher THEMIS Ticagrelor in Patients with Stable Coronary Disease and Diabetes N Engl J Med 2019; 381:1309-1320 CONCLUSIONS In patients with stable coronary artery disease and diabetes without a history of myocardial infarction or stroke, those who received ticagrelor plus aspirin had a lower incidence of ischemic cardiovascular events but a higher incidence of major bleeding than those who received placebo plus aspirin. #DailyCardiology #Refresher #MI #stroke #ticagrelor #aspirin #cardiology #cardiologyresident #cardiologyfellow #cardiologyeducation #medicaleducation #CardioEd #MedEd #FOAMed #Medicare #CardioTwitter #InstaCardio #NEJM @nejm


4💬Normal

SYNTAX. Vamos falar desse estudo Clássico na Cardiologia? Publicado em 2009 na NEJM, esse estudo randomizado e multicêntrico, teve como objetivo avaliar a não inferioridade da intervenção coronariana percutânea (ICP) com stent farmacológico em relação à cirurgia de revascularização miocárdica em pacientes que tivessem lesão de tronco de coronária esquerda OU doença aterosclerótica triarterial sem tratamento prévio. Foram excluídos pacientes com infarto agudo do miocárdio ou necessidade de cirurgia cardíaca concomitante. O estudo avaliou como desfecho primário IAM, AVE isquêmico, morte por todas as causas e necessidade de nova revascularização em 12 meses (MACCE). O paciente era antes avaliado por um cardiologista intervencionista e um cirurgião cardíaco que determinavam se sua anatomia era passível de abordagem por uma ou outra técnica. Ao final do estudo, observou-se incidência de 19,4% de MACCE no grupo da ICP x 12,8% no grupo da cirurgia (NNT 19) às custas de maior necessidade de nova revascularização no primeiro grupo, sem diferenças quanto à morte por todas as causas e IAM. Após esse estudo ainda foi publicado o Syntax Score, que avalia a complexidade anatômica da circulação coronária, que pode ser baixa (<22), intermediária (23-32) ou alta (>33). Análise de subgrupo mostrou que nos pacientes com Syntax Score de complexidade baixa e intermediária, não havia diferença quanto a MACCE entre a estratégia cirúrgica e ICP. De fato, análises de subgrupos não devem ser interpretadas como verdades, mas têm a finalidade de gerar hipóteses. Assim foi gerada a pergunta que motivou a realização do estudo EXCEL, que teve seu seguimento de 5 anos publicado há uma semana na mesma revista, e que oportunamente comentaremos por aqui. Quanto à incidência de AVC, esta foi maior no grupo cirúrgico (NNT de 60 ICP para evitar um AVC), mesmo com os grupos sendo semelhantes quanto à porcentagem de estenose carotídea significativa. Por mais que o estudo favoreça a opção pelo tratamento cirúrgico, é importante lembrar que sempre devemos considerar a taxa de complicações cirúrgicas de cada serviço e autonomia do paciente. #syntaxtrial #syntaxscore #cabg #pci #cardiology #nejm


3💬Normal

Imagem da semana do jornal médico New England Journal of Medicine. Este é um exame de tomografia, que faz imagens do corpo humano como se fizesse fatias, que olhamos de baixo para cima. Na imagem a pessoa está deitada com os pés na sua direção e a cabeça atrás da sua tela. A imagem é uma fatia na altura do mamilo. Na parte de baixo vemos uma vértebra, mais branca. A imagem circular no meio do exame é o coração, ao redor vemos os musculos e costelas e em cinza os pulmões. A seta preta aponta para um câncer de pulmão. Durante o exame também se observam duas imagens que não fazem parte do corpo humano: o pequeno triângulo é um isqueiro e a seta branca é um maço de cigarros. Ambos no bolso da camisa. #cancer #oncologia #medicina #tomografia #combateaotabagismo #combateaocigarro #tabagismo #fumo #cigarro #cancerdepulmao #radiologia #nejm By Dr Felipe Ades. #VivendoComCncerDiárioDeBordo😎


0💬Normal

Imagem da semana do jornal médico New England Journal of Medicine. Este é um exame de tomografia, que faz imagens do corpo humano como se fizesse fatias, que olhamos de baixo para cima. Na imagem a pessoa está deitada com os pés na sua direção e a cabeça atrás da sua tela. A imagem é uma fatia na altura do mamilo. Na parte de baixo vemos uma vértebra, mais branca. A imagem circular no meio do exame é o coração, ao redor vemos os musculos e costelas e em cinza os pulmões. A seta preta aponta para um câncer de pulmão. Durante o exame também se observam duas imagens que não fazem parte do corpo humano: o pequeno triângulo é um isqueiro e a seta branca é um maço de cigarros. Ambos no bolso da camisa. #cancer #oncologia #medicina #tomografia #combateaotabagismo #combateaocigarro #tabagismo #fumo #cigarro #cancerdepulmao #radiologia #nejm


40💬Normal

Refresher PARAGON-HF: Angiotensin–Neprilysin Inhibition in Heart Failure with Preserved Ejection Fraction N Engl J Med 2019; 381:1609-1620 RESULTS Patients in the sacubitril–valsartan group had a higher incidence of hypotension and angioedema and a lower incidence of hyperkalemia. CONCLUSIONS Sacubitril–valsartan did not result in a significantly lower rate of total hospitalizations for heart failure and death from cardiovascular causes among patients with heart failure and an ejection fraction of 45% or higher. #DailyCardiology #Refresher #heartfailure #sacubitrilvalsartan #cardiology #cardiologyresident #cardiologyfellow #cardiologyeducation #medicaleducation #CardioEd #MedEd #FOAMed #Medicare #CardioTwitter #InstaCardio #NEJM @nejm


0💬Normal

Videos in Clinical Medicine: This video presents a practical method for conducting focused cardiac ultrasonography, a qualitative or semiquantitative means of assessing cardiac size, structure, and function at the bedside. The video shows how to perform visual assessment of left ventricular systolic function.⁠ ⁠ Watch the video with research by Gabriel Prada, M.D., Ashley V. Fritz, D.O., Mariana Restrepo-Holguín, M.D., Pramod K. Guru, M.B., B.S., and José L. Díaz-Gómez, M.D. on #NEJM at the link in our bio.⁠


11💬Normal

Can you see all the fall colors in this photo? ⁣ ⁣ If you look closely, you’re hunting for a little bit of orange in a sea of green - jade water included. ⁣ ⁣ The photo reflects what’s happening when we look at mammograms of women who have extremely dense breast tissue. The NEJM just published this article today on the use of MRI as supplemental screening (see link below). ⁣ ⁣ The study was conducted with over 40,000 women with extremely dense breast tissue who were assigned to screening mammography alone or mammography with MRI supplementation. The addition of MRI was associated with a higher cancer-detection rate of 16.5 per 1000 screenings (compared to 2.5 per 1000 for mammography alone) but resulted in a false positive rate of 8.0%. Adding MRI resulted in earlier detection and fewer interval cancer diagnoses than mammography alone, although the impact on survival could not be determined. ⁣ ⁣ Does this mean MRI is right for everyone as a screening tool? Definitely not! But those with extremely dense breast tissue can benefit. So ladies, talk to your doctors, and my fellow doctors, talk to your patients. We can make an educated and empowered decision together. ⁣ ⁣ Copy the link or search “NEJM MRI” to read more:⁣ https://www.nejm.org/doi/full/10.1056/NEJMoa1903986?query=TOC⁣ ⁣ #nejm #screeningsaveslives #breastcancerscreening #mammogram #mammogramssavelives #breastcancerawareness #breastcancer #gofightwin #cancersucks #oncologist #surgeon #evidencebasedmedicine #evidencebased #evidencebasedhealth #womenempoweringwomen #education #supportwomen #somedocs #doctors #IGers #wednesdaywisdom #wednesday


22💬Normal

Images in Clinical Medicine: A 22-year-old man presented with palpitations and chest discomfort. Echocardiography revealed an enlarged, thickened mitral-valve leaflet with systolic prolapse of multiple segments (shown in a video), and a diagnosis of myxomatous mitral-valve prolapse was made.⁠⠀ ⁠⠀ Read the full article by Faraz A. Farooqui, M.D., and Siddharthan Deepti, M.D., D.M. on #NEJM at the link in our bio.⁠⠀


26💬Normal

“Most medical journals don’t have the resources or the luxury of having full-time editorial staff,” said John Jarcho, deputy editor of the New England Journal of Medicine, during an event hosted by the Knight Science Journalism program on November 21.⁣ ⁣ But NEJM is not most medical journals. ⁣ ⁣ Started in 1812, it is the oldest continuously published medical journal in existence. ⁣ ⁣ For scientists across the globe, it has become one of the most coveted venues for publishing groundbreaking medical research.⁣ ⁣ Part of what sets NEJM apart, Jarcho explained, is its thorough editorial and peer review process. ⁣ The journal employs editors from six major areas of medicine who review papers corresponding to their backgrounds. ⁣ ⁣ Jarcho handles cardiovascular medicine, his specialty at Harvard Medical School and at Brigham and Women’s Hospital in Boston. ⁣ ⁣ There, he said, his clinical interests in cardiomyopathy, congestive heart failure, and heart transplantation are informed by the cardiology research manuscripts he fields as deputy editor for NEJM.⁣ ⁣ Hit the link in our bio or head to https://bit.ly/35D3COH to read a full recap of the seminar, written by MIT Graduate Science Writing student Ashley Belanger.⁣ ⁣ 📷: Ashley Belanger⁣ ⁣ #ksjatmit #knightsciencejournalism #sciencejournalism #nejm #seminarrecap


0💬Normal

Posted @withrepost@medscape Early Surgery Best in Severe Asymptomatic Aortic Stenosis?⁠ ⁠ New randomized trial results show early aortic valve replacement (AVR) resulted in a lower risk for operative mortality or death from cardiovascular causes compared with conservative care in asymptomatic patients with severe aortic valve stenosis.⁠ ⁠ Secondary analysis also showed a reduced risk for all-cause mortality, the researchers report.⁠ ⁠ The results, from the RECOVERY trial, were presented here at #AHA19 last week and were published in #NEJM. An analysis is available for free on Medscape by tapping on the link in bio. ⁠ ⁠ Early surgical aortic valve replacement, as compared with conventional treatment, significantly reduced the risk of operative or cardiovascular mortality and death from any cause among asymptomatic patients with very severe aortic stenosis, the researchers noted.⁠ ⁠ The RECOVERY trial provides the evidence to support preemptive aortic valve replacement for asymptomatic severe aortic stenosis, they added.⁠ ⁠ More on Medscape.


0💬Normal

TWILIGHT trial Ticagrelor with or without Aspirin in High-Risk Patients after PCI N Engl J Med 2019; 381:2032-2042 CONCLUSIONS Among high-risk patients who underwent PCI and completed 3 months of dual antiplatelet therapy, ticagrelor monotherapy was associated with a lower incidence of clinically relevant bleeding than ticagrelor plus aspirin, with no higher risk of death, myocardial infarction, or stroke. #DailyCardiology #Refresher #cardiology #cardiologyresident #cardiologyfellow #cardiologyeducation #medicaleducation #CardioEd #MedEd #FOAMed #Medicare #CardioTwitter #InstaCardio #NEJM @NEJM


0💬Normal

Just spent two intensive days deep into ground breaking scientific research that has been going on for some time now working with @drcarolineleaf . I want to thank @drcarolineleaf and her family for welcoming me into her home, their hospitality and being apart of this amazing project! #research #mind #brain #NEJM #JAMA #ameriasenergydoctor #MD #science #journals #littletonconciergemedicine #Texas #medicine #groundbreaking


12💬Normal

| APPLE WATCH UND VORHOFFLIMMERN | #2 Mit der Apple Watch versucht Apple seit Jahren das Diagnostizieren vom Vorhofflimmern zu erleichtern, doch wie effektiv ist das Vorhaben denn nun wirklich? Die Apple Watch kann sowohl irreguläre Pulse als auch eine einzelne EKG-Ableitung messen, und da das oftmals asymptomatische Vorhofflimmern die häufigste Herzrhythmusstörung ist (und damit 2% der Bevölkerung betrifft), ist das Interesse an einer Früherkennung sehr groß. . Wir haben zuvor schon von der Apple Watch gesprochen, nun gibt es aber endlich eine Large-Scale Studie mit über 400.000 Probanden über 8 Monaten, die uns hoffentlich endlich eine zufriedenstellende Antwort darauf gibt, ob die Apple Watch als neues Früherkennungstool verwendbar ist. Dabei war es wichtig, dass alle Probanden ein voriges Vorhoffflimmern negierten. Sobald ein irregulärer Puls auf der Apple Watch gemessen wurde, wurde dem Proband sowohl ein digitaler Arztbesuch zugesprochen als auch ein EKG-Patch zugeschickt, welches er für die nächsten 7 Tage tragen musste. Am Ende der Studie wurde dann der positive prädikative Wert der Apple Watch gemessen, d.h., wie oft die Apple Watch ein Vorhofflimmern korrekt diagnostizierte auf Grundlage der EKG Auswertung. . Von 419.297 Probanden, 2161 wurden mit einem irregulären Puls gemessen, wovon nur 450 Probanden eine auswertbare EKG-Patch Analyse aufwiesen. Der positive prädikative Wert bei solchen war 0.84 (84%) [Zeitgleiche Apple Watch-Benachrichtigung und positiver EKG-Messung] und 0.71 (71%) [Positive EKG-Messung nach voriger Benachrichtigung]. . Dementsprechend kann man abschließend sagen, dass 84% der Probanden, die ein EKG-Patch zugeschickt bekommen und zurückgegeben haben, mit Vorhofflimmern diagnostiziert wurden. Das klingt daher als sehr vielversprechend für die Sekundärprävention eines Afibs, und soll, laut des Authors, den Weg zu neuen Forschungsmöglichkeiten ebnen. Ebenso sollen die Daten verwendet werden, um die Präzision des Gerätes zu verbessern.


7💬Normal

Early Surgery Best in Severe Asymptomatic Aortic Stenosis?⁠ ⁠ New randomized trial results show early aortic valve replacement (AVR) resulted in a lower risk for operative mortality or death from cardiovascular causes compared with conservative care in asymptomatic patients with severe aortic valve stenosis.⁠ ⁠ Secondary analysis also showed a reduced risk for all-cause mortality, the researchers report.⁠ ⁠ The results, from the RECOVERY trial, were presented here at #AHA19 last week and were published in #NEJM. An analysis is available for free on Medscape by tapping on the link in bio. ⁠ ⁠ Early surgical aortic valve replacement, as compared with conventional treatment, significantly reduced the risk of operative or cardiovascular mortality and death from any cause among asymptomatic patients with very severe aortic stenosis, the researchers noted.⁠ ⁠ The RECOVERY trial provides the evidence to support preemptive aortic valve replacement for asymptomatic severe aortic stenosis, they added.⁠ ⁠ More on Medscape.


1💬Normal

Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrial fibrillation during typical use is unknown. . Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatch-based irregular pulse notification algorithm identified possible atrial fibrillation, a telemedicine visit was initiated and an electrocardiography (ECG) patch was mailed to the participant, to be worn for up to 7 days. Surveys were administered 90 days after notification of the irregular pulse and at the end of the study. The main objectives were to estimate the proportion of notified participants with atrial fibrillation shown on an ECG patch and the positive predictive value of irregular pulse intervals with a targeted confidence interval width of 0.10. . We recruited 419,297 participants over 8 months. Over a median of 117 days of monitoring, 2161 participants (0.52%) received notifications of irregular pulse. Among the 450 participants who returned ECG patches containing data that could be analyzed — which had been applied, on average, 13 days after notification — atrial fibrillation was present in 34% (97.5% confidence interval [CI], 29 to 39) overall and in 35% (97.5% CI, 27 to 43) of participants 65 years of age or older. Among participants who were notified of an irregular pulse, the positive predictive value was 0.84 for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular pulse notification and 0.71 for observing atrial fibrillation on the ECG simultaneously with a subsequent irregular tachogram. Of 1376 notified participants who returned a 90-day survey, 57% contacted health care providers outside the study. There were no reports of serious app-related adverse events. . The probability of receiving an irregular pulse notification was low. Among participants who received notification of an irregular pulse, 34% had atrial fibrillation on subsequent ECG patch readings and 84% of notifications were concordant atrial fibrillation.(Funded by Apple; Apple Heart Study) #nejm #afib


0💬Normal

@dr.ivanoncologo #NEJM: El tx. de primera línea con #nivolumab#ipilimumab en pacientes con #cncerdepulmón de células no pequeñas en estadio IV o recurrente, tuvo una mayor supervivencia global📈 que la quimioterapia independientemente del nivel de expresión de PD-L1 https://t.co/yMmNymo56H


0💬Normal

Finally got around to reading this one. ⭐️First oral GLP-1RA!⭐️ #nejm #diabetes #diabetes2


0💬Normal

La monoterapia con ticagrelor en pacientes sometidos a PCI con alto riesgo de sangrado luego de los primeros 3 meses con terapia dual, presenta menor incidencia de sangrado mayor sin aumentar la incidencia de stroke, infarto de miocardio ni mortalidad. ----------------------------- Monotherapy with ticagrelor in patients with high risk of bleeding after 3 months with dual therapy, has lower incidence of major bleeding without increasing the incidence of stroke, myocardial infarction or mortality. November 21, 2019 N Engl J Med 2019; 381:2032-2042 DOI: 10.1056/NEJMoa1908419 #nejm #cardiolearning #cardio #americancollegeofcardiology #esc


0💬Normal

Clinical Implications of Basic Research: Focusing on two of the mutant worms with normal morphologic features, Wang et al. mapped the genetic lesions that were responsible for opioid hypersensitivity. The first mutation altered egl-19, which encodes an L-type calcium channel that is known to potentiate analgesic effects of opioids in the clinic, thus showing the validity of the genetic screen.⁠ ⁠ Read the full article by Brigitte L. Kieffer, Ph.D. on #NEJM at the link in our bio.


8💬Normal

#repost from @nejm Case Records of the Massachusetts General Hospital: A 34-year-old man was admitted to the hospital because of dyspnea. An antibody differentiation assay confirmed a diagnosis of human immunodeficiency virus type 1 infection, and chest imaging was notable for diffuse ground-glass opacities. After treatment for Pneumocystis jirovecii pneumonia was initiated, acute abdominal pain developed. A diagnostic procedure was performed.⁠ ⁠ Read the full article by Michael Saag, M.D., Dexter P. Mendoza, M.D., Marc S. Sherman, M.D., Ph.D., Gregory M. Cote, M.D., Ph.D., and Angela R. Shih, M.D. on #NEJM at the link in our bio.⁠ ⁠


0💬Normal

Next Page