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Herpes Zoster

The incidence of herpes zoster increases with age. Management includes antiviral therapy (recommended in persons with or at increased risk for …

Low-tidal-volume ventilation with positive end-expiratory pressure is the standard of care in acute respiratory distress syndrome. This week’s Insights post on the Now@NEJM blog looks at a new trial in which the use of protective ventilation during surgery, as compared with nonprotective ventilation, reduced postoperative complications. Click through for free access to the article. http://nej.md/16jTAPH

Primary Hyperoxaluria

The primary hyperoxalurias are a group of autosomal recessive disorders involving the overproduction of oxalate. The latest review article in our …

Answer to yesterday’s quiz: Which one of these symptoms is least likely to be a manifestation of an inflammatory myopathy: asymmetric muscle pain and swelling, difficulty swallowing, dyspnea, or symmetric and proximal-muscle weakness? The answer is A. Asymmetric muscle pain and swelling are not typical manifestations of the inflammatory myopathies. Rather, these myopathies are characterized by symmetric and proximal-muscle weakness, difficulty swallowing, and sometimes dyspnea (when the respiratory muscles become involved). Idiopathic inflammatory myopathies may be paraneoplastic syndromes, may be associated with distal neuromuscular weakness (e.g., inclusion-body myositis), or may be accompanied by a photosensitive rash (e.g., dermatomyositis). Myalgias can occur but are usually mild, except in viral myopathies. http://nej.md/1d7gfDo

Severe Sepsis and Septic Shock

<b>1.</b> Majno G. The ancient riddle of sigma eta psi iota sigma (sepsis). J Infect Dis 1991;163:937-945<p><b>2.</b> Funk DJ, Parrillo JE, Kumar A. Sepsis and septic …

Medicine

TNF Inhibitors for Inflammatory Bowel Disease

In the latest review article in our Clinical Therapeutics series, a 35-year-old man presents with an exacerbation of Crohn’s disease. Treatment with …

HCV-Related Cryoglobulinemic Vasculitis

Cryoglobulins are present in about a quarter of patients with hepatitis C; in some, cryoglobulinemia can become symptomatic or even life-threatening. …

Which one of the following statements about inherited or primary hyperoxaluria is true? A. Oxalate has a tendency to crystallize in the renal tubules. B. Oxalate is produced by the kidney. C. Oxalate is a highly soluble acid. D. The main defect of inherited hyperoxaluria is the inability to metabolize oxalate. http://nej.md/141HXN3

In the Thick of It

In our latest Clinical Problem-Solving article, a 52-year-old man presented to the emergency department with an acute onset of palpitations and chest …

Pain in the Thumb Related to Disease in the Lung

A 59-year-old man presented with a 6-week history of pain in the thumb. He also reported having a cough, weight loss, and a history of heavy smoking. …

Medical Journals

Answer to yesterday’s quiz: Cardiomyopathy develops in patients with Fabry’s disease because of the deposition of which one of these substances within the lysosomes of cardiomyocytes: cycstine, cytoskeletal proteins, fatty acids or glycosphingolipids? The answer is D, glycosphingolipids. Fabry’s disease is caused by a loss of function of lysosomal hydrolase α-galactosidase, which leads to the accumulation of glycosphingolipids within lysosomes. Deposition within cardiomyocytes over time can result in cardiac hypertrophy. http://nej.md/1007Lqe

Answer to yesterday’s quiz — Which condition is the most common symptom or sign associated with infective endocarditis? The correct answer is B) fever. Fever is common in infective endocarditis (80% of cases). Anemia is observed in about half of cases. In large contemporary case series, recognition of a new murmur or worsening of a known murmur has been reported in 48% and 20% of cases, respectively. http://nej.md/16PPldM

Which one of the following statements is true about the diagnostic assessment of hemolysis? A. A direct antiglobulin test is negative in approximately 25% of cases of autoimmune hemolytic anemia. B. An elevated haptoglobin level supports the diagnosis of hemolysis. C. Assessment for free hemoglobin in urine or plasma is a specific way to differentiate intravascular from extravascular hemolysis. D. Hemolysis is associated with a direct hyperbilirubinemia. http://nej.md/11qTAuM

Epidermolysis Bullosa Acquisita

A 50-year-old man presented with tense noninflammatory bullae and erosions on trauma-prone areas of skin (Panels A and B) and the mucosae (Panels C …

Medicine

Answer to yesterday’s quiz — Which of the following pulmonary infections is seen exclusively in immunocompromised hosts? The correct answer is A) Angioinvasive aspergillosis. Pneumocystis and angioinvasive aspergillosis are seen exclusively in immunocompromised hosts. http://nej.md/YGwtaA