2010 Jan 21 - NEJM Clinical Practice: Systolic Heart Failure

John J.V. McMurray, M.D. NEJM Volume 362:228-238 January 21, 2010 Number 3
A 74-year-old man with a history of hypertension and myocardial infarction that occurred 5 years previously presents with breathlessness on exertion. His current medications include a statin and aspirin. On examination, his pulse is 76 beats per minute and regular, and his blood pressure is 121/74 mm Hg. There is jugular venous distention, lateral displacement of the apex beat, and edema in . . .

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2010 Jan 21 - NEJM Editorial: Clostridium difficile — Beyond Antibiotics

Lorraine Kyne, M.D., M.P.H. NEJM Volume 362:264-265 January 21, 2010 Number 3
In this decade, the prevention and control of Clostridium difficile infection in health care settings has become a global public health challenge. Infection rates have increased dramatically, and several large outbreaks associated with toxinotype III BI/NAP1/027 strains have been described.1

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2010 Jan 21 - Treatment with Monoclonal Antibodies against Clostridium difficile Toxins

Israel Lowy, M.D., Ph.D., Deborah C. Molrine, M.D., M.P.H., Brett A. Leav, M.D., Barbra M. Blair, M.D., Roger Baxter, M.D., Dale N. Gerding, M.D., Geoffrey Nichol, M.B., Ch.B., William D. Thomas, Jr., Ph.D., Mark Leney, Ph.D., Susan Sloan, Ph.D., Catherine A. Hay, Ph.D., and Donna M. Ambrosino, M.D. NEJM Volume 362:197-205 January 21, 2010 Number 3

Figure. Pseudomembranous colitis
Background New therapies are needed to manage the increasing incidence, severity, and high rate of recurrence of Clostridium difficile infection.

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2010 Jan 14 - Images in Clinical Medicine: Postoperative Tracheal Stenosis

NEJM. Volume 362:e5 January 14, 2010 Number 2
A 45-year-old woman presented for an assessment of breathlessness. She had been receiving inhaled bronchodilators and corticosteroids for years without improvement. Her medical history was notable for prolonged endotracheal intubation 8 years earlier. Examination revealed a biphasic wheeze. Pulmonary-function testing showed ....

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2010 Jan 7 - NEJM Correspondence: Intravenous Zanamivir for Oseltamivir-Resistant 2009 H1N1 Influenza

NEJM Volume 362:88-89 January 7, 2010 Number 1
To the Editor: A 10-year-old girl with acute lymphoblastic leukemia was transferred to our hospital on August 31. The patient required mechanical ventilation for worsening lobar pneumonia, despite the administration of broad-spectrum antibiotics (for details, see the Supplementary Appendix, available with the full text of this letter at NEJM.org). Two weeks earlier, she had completed 5 days of oseltamivir for an upper respiratory tract infection caused by influenza A virus (with positive results on rapid antigen testing). On August 27, she had presented with lobar pneumonia (with negative results on rapid antigen testing).

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2010 Jan 7 - Preventing Surgical-Site Infections in Nasal Carriers of Staphylococcus aureus

Lonneke G.M. Bode, M.D., Jan A.J.W. Kluytmans, M.D., Ph.D., Heiman F.L. Wertheim, M.D., Ph.D., Diana Bogaers, I.C.P., Christina M.J.E. Vandenbroucke-Grauls, M.D., Ph.D., Robert Roosendaal, Ph.D., Annet Troelstra, M.D., Ph.D., Adrienne T.A. Box, B.A.Sc., Andreas Voss, M.D., Ph.D., Ingeborg van der Tweel, Ph.D., Alex van Belkum, Ph.D., Henri A. Verbrugh, M.D., Ph.D., and Margreet C. Vos, M.D., Ph.D. NEJM Volume 362:9-17 January 7, 2010 Number 1
Background Nasal carriers of Staphylococcus aureus are at increased risk for health care–associated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.

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2009 Dec 31 - NEJM Medical Therapeutics: Activated Protein C for Sepsis

NEJM Volume 361:2646-2652 December 31, 2009 Number 27
A 55-year-old man is brought to the emergency department with abdominal pain, fever (temperature, 102.9°F), and dyspnea. His medical history includes an appendectomy 8 years earlier. Abdominal radiography shows free air as well as signs of small-bowel ileus. An . . . [Full Text of this Article]

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2009 Dec 24 - NEJM Correspondence: Sensitive Cardiac Troponin Assays

Volume 361:2575-2577 December 24, 2009 Number 26
To the Editor: Keller et al.1 and Reichlin et al.2 (Aug. 27 issue) unequivocally report the superiority of new sensitive troponin assays over standard assays in the diagnosis of acute myocardial infarction.

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2009 Dec 24 - NEJM Images in Clinical Medicine: Coughing and Masks

NEJM Volume 361:e62 December 24, 2009 Number 26
Coughing can transmit infectious agents, such as influenza virus, and it has been assumed that wearing a mask limits transmission of these agents.

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2009 Dec 24 - NEJM Correspondence: Holiday Spikes in Pneumococcal Disease among Older Adults

NEJM Volume 361:2584-2585 December 24, 2009 Number 26
To the Editor: Rates of invasive pneumococcal disease in the United States increase dramatically, or "spike," during winter holidays.1 We analyzed population-based surveillance data to determine whether spikes may be caused by increased transmission from children to older adults.

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2009 Dec 23 - NEJM Correspondence: Intravenous Zanamivir for Oseltamivir-Resistant 2009 H1N1 Influenza

Published at www.nejm.org December 23, 2009 (10.1056/NEJMc0910893)
To the Editor: A 10-year-old girl with acute lymphoblastic leukemia was transferred to our hospital on August 31. The patient required mechanical ventilation for worsening lobar pneumonia, despite the administration of broad-spectrum antibiotics (for details, see the Supplementary Appendix, available with the full text of this letter at NEJM.org). Two weeks earlier, she had completed 5 days of oseltamivir for an upper respiratory tract infection caused by influenza A virus (with positive results on rapid antigen testing). On August 27, she had presented with lobar pneumonia (with negative results on rapid antigen testing).

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2009 Dec 24 - Case 40-2009 — A 29-Year-Old Man with Fever and Respiratory Failure

Timothy M. Uyeki, M.D., M.P.H., M.P.P., Amita Sharma, M.D., and John A. Branda, M.D. NEJM Volume 361:2558-2569 December 24, 2009 Number 26
Presentation of Case:
Dr. Wilson Tak-Yu Kwong (Medicine): A 29-year-old man was admitted in July 2009 to the critical care unit of this hospital because of fever and respiratory failure.
The patient had been well until 9 days earlier, when a nonproductive cough and myalgias in his legs developed.

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2009 Dec 23 - Pediatric Hospitalizations Associated with 2009 Pandemic Influenza A (H1N1) in Argentina

Romina Libster, M.D., Jimena Bugna, M.D., Silvina Coviello, M.S., et al. Published at www.nejm.org December 23, 2009 (10.1056/NEJMoa0907673)
Background While the Northern Hemisphere experiences the effects of the 2009 pandemic influenza A (H1N1) virus, data from the recent influenza season in the Southern Hemisphere can provide important information on the burden of disease in children.

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2009 Dec 23 - Severe 2009 H1N1 Influenza in Pregnant and Postpartum Women in California

Janice K. Louie, M.D., M.P.H., Meileen Acosta, M.P.H., Denise J. Jamieson, M.D., M.P.H., Margaret A. Honein, Ph.D., M.P.H., for the California Pandemic (H1N1) Working Group. Published at www.nejm.org December 23, 2009 (10.1056/NEJMoa0910444)
Background Like previous epidemic and pandemic diseases, 2009 pandemic influenza A (H1N1) may pose an increased risk of severe illness in pregnant women.

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2009 Dec 9 - NEJM Correspondence: A Community Cluster of Oseltamivir-Resistant Cases of 2009 H1N1 Influenza

Published at www.nejm.org December 9, 2009 (10.1056/NEJMc0910448)
To the Editor: Oseltamivir-resistant infection with the 2009 pandemic influenza A (H1N1) virus has so far been described only rarely and is conferred by the H275Y substitution in the neuraminidase enzyme.1

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2009 Dec 9 - Clinical Features of the Initial Cases of 2009 Pandemic Influenza A (H1N1) Virus Infection in China

Bin Cao, M.D., Xing-Wang Li, M.D., Yu Mao, M.D., Jian Wang, M.D., Hong-Zhou Lu, M.D., Yu-Sheng Chen, M.D., Zong-An Liang, M.D., Lirong Liang, M.D., Su-Juan Zhang, M.D., Bin Zhang, M.D., Li Gu, M.D., Lian-He Lu, M.D., Da-Yan Wang, Ph.D., Chen Wang, M.D., for the National Influenza A Pandemic (H1N1) 2009 Clinical Investigation Group of China. Published at www.nejm.org December 9, 2009 (10.1056/NEJMoa0906612)

Background The first case of 2009 pandemic influenza A (H1N1) virus infection in China was documented on May 10. Subsequently, persons with suspected cases of infection and contacts of those with suspected infection were tested. Persons in whom infection was confirmed were hospitalized and quarantined, and some of them were closely observed for the purpose of investigating the nature and duration of the disease.

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2009 Nov 25 - The Emotional Epidemiology of H1N1 Influenza Vaccination

Danielle Ofri, M.D., Ph.D.Published at www.nejm.org November 25, 2009
Last spring, when 2009 H1N1 influenza first came to our attention, my patients were in a panic. Our clinic was flooded with calls and walk-in patients, all with the same question: "When will there be a vaccine?"

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2009 Nov 25 - NEJM Perspective: Australia's Winter with the 2009 Pandemic Influenza A (H1N1) Virus

James F. Bishop, M.D., Mary P. Murnane, B.A., and Rhonda Owen, B.Sc. Published at www.nejm.org November 25, 2009
When the World Health Organization declared a "public health emergency of international concern" on April 25, 2009, after the emergence in Mexico of pandemic influenza A (H1N1) virus, Australia activated its well-rehearsed plan for response to pandemic influenza.1

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2009 Nov 12 - NEJM Correspondence: Neurologic Prognosis after Cardiac Arrest

NEJM. Volume 361:1999-2000 November 12, 2009 Number 20
To the Editor: We are concerned that Young (Aug. 6 issue)1 did not emphasize the considerable help provided by the clinical history in predicting the prognosis for a patient after cardiac arrest. Elements of the clinical history — such as the location of the arrest (home or outdoors), the presence or absence of witnesses, and the chronology (delays in delivery of cardiopulmonary resuscitation and the first therapeutic shock) — are generally easy to collect and are strongly associated with outcomes.2,3 Therefore, such information may assist clinicians in making the difficult decision to withdraw life support. In these situations, it seems . . .

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2009 Nov 12 - NEJM Editorial: Preparing for 2009 H1N1 Influenza

Richard P. Wenzel, M.D., and Michael B. Edmond, M.D., M.P.H. NEJM Volume 361:1991-1993 November 12, 2009 Number 20
In 1743, when disease was presumed to be astral in origin, European newspapers reported on a contagious influence (influenza in Italian) that was being visited on the citizens of Rome. Two hundred years later, Wilson Smith and colleagues would isolate an influenza A virus, one of the members of the orthomyxovirus family.1 The key reservoirs of all influenza A viruses are migrating waterfowl, and intermittently, other hosts, such as pigs and people, are infected.

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