Continuing Medical Education

Patients with primary progressive MS who received the anti-CD20+ humanized antibody ocrelizumab were less likely to have clinical deterioration that was sustained for 12 weeks than those who received placebo. The drug was associated with decreased lesion activity on MRI.

An 18-year-old woman presented with acute liver failure. The total bilirubin was 19.7 mg per deciliter. Three days earlier, she had received a diagnosis of bronchitis and was treated with azithromycin. A diagnosis was made.

Obesity is prevalent in the U.S. population and contributes significantly to morbidity and mortality. Treatments include behavioral therapy, pharmacotherapy, and bariatric surgery. Some sequelae of obesity are reversed with weight loss. Maintaining weight loss is a challenge.

A 70-year-old woman presented with gradually progressive aphasic impairment of word finding, object naming, and word comprehension; other areas of cognition were mostly intact. A clinical diagnosis was made, and additional tests were performed.

In childhood and adolescent migraine, amitriptyline and topiramate were no better than placebo and not significantly different from each other in achieving a 50% or greater reduction in days with headache. The trial was stopped early for futility.

Screening for colorectal neoplasia should be initiated at 50 years of age, with tailored screening between 76 and 85 years of age. Most guidelines do not specifically recommend one screening strategy over others; this article reviews current screening strategies.

In this randomized trial involving 13,885 patients with symptomatic peripheral artery disease (PAD), ticagrelor was not shown to be superior to clopidogrel for the reduction of cardiovascular events. Major bleeding occurred at similar rates with ticagrelor and clopidogrel.

While driving home from a party, a 35-year-old previously healthy woman had a sudden onset of chills, myalgias, nausea, and abdominal cramping. That night fever, explosive nonbloody diarrhea, frequent vomiting, and abdominal and low back pain developed.

In a phase 1 trial, healthy volunteers were assigned to an RNAi therapeutic inhibitor of PCSK9 or placebo. Single doses of 300 mg or more reduced LDL cholesterol by up to 50%; multiple-dose regimens reduced LDL cholesterol by up to 59%. No serious adverse events were reported.

This randomized trial involving patients with osteoarthritis or rheumatoid arthritis who were at increased cardiovascular risk showed the noninferiority of celecoxib to naproxen or ibuprofen with respect to cardiovascular safety.

Myasthenia gravis is an autoimmune disease associated with several autoantibodies that attack the neuromuscular junction. Some cases are associated with thymoma. The hallmark of management is individualized immunosuppressive therapy.

Supplementation with fish oil–derived fatty acids during pregnancy reduced the incidence of cases of persistent wheeze or asthma in offspring.

This trial compared standard therapy (dual antiplatelet therapy plus a vitamin K antagonist) with two regimens containing rivaroxaban plus antiplatelet therapy. The rivaroxaban groups had reduced rates of bleeding and similar efficacy in preventing cardiovascular events.

In children 6 to 23 months of age with otitis media, 5 days of antibiotic therapy was associated with less-favorable outcomes than standard 10-day treatment. The shorter course did not result in a lower rate of adverse events or of emergence of antimicrobial resistance.

Infants born to mothers who take opioids may have symptoms of opioid withdrawal after birth. Early detection and holistic treatment that incorporates pharmacologic and nonpharmacologic interventions can help improve outcomes for affected infants.

This final report updates preliminary data on Zika virus infection among pregnant women in Rio de Janeiro. ZIKV infection during pregnancy was associated with fetal death, fetal growth restriction, and central nervous system abnormalities.

After 5 years of follow-up in this trial, the rates of the composite outcome of death, stroke, myocardial infarction, renal failure, or repeat revascularization were similar with off-pump and on-pump CABG. There was also no significant difference in cost or in quality of life.

In two 16-week, placebo-controlled trials enrolling adults with moderate-to-severe atopic dermatitis, dupilumab, a human monoclonal antibody against interleukin-4 receptor alpha, was effective in controlling the signs and symptoms of atopic dermatitis.

An 86-year-old woman was seen at this hospital because of fatigue, night sweats, leukocytosis, and splenomegaly. Review of the peripheral-blood smear revealed neutrophilia without dysplastic features, immature forms, or monocytosis. A diagnostic procedure was performed.

In a randomized trial, over 1900 patients with left main coronary artery disease were assigned to percutaneous coronary intervention or coronary-artery bypass grafting. At 3 years, PCI was noninferior to CABG with respect to the rate of death, stroke, or myocardial infarction.