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Showing 1 to 20 of 89 NEJM Weekly CME Exams, Past 6 Months
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Original Article
Ocrelizumab versus Placebo in Primary Progressive Multiple Sclerosis
Primary progressive multiple sclerosis accounts for 10 to 15% of the overall population with multiple sclerosis. The course of this disease differs from those of relapsing–remitting and secondary progressive forms of multiple sclerosis in that progression consists mainly of gradual worsening of…
Case Records of the Massachusetts General Hospital
Case 2-2017 — An 18-Year-Old Woman with Acute Liver Failure
Presentation of Case. Dr. Carolyn A. Boscia (Medicine and Pediatrics): An 18-year-old woman was seen in the emergency department of this hospital 11 weeks after the birth of her first child because of acute liver failure. The patient had been well until 1 week before this presentation, when…
Review Article
Mechanisms, Pathophysiology, and Management of Obesity
Seven of the top 10 leading causes of death and disability in the United States today are chronic diseases (e.g. cancer and diabetes). Prevention and treatment of most of these conditions must address the close link with obesity. People who are overweight or obese account for more than two thirds…
Case Records of the Massachusetts General Hospital
Case 1-2017 — A 70-Year-Old Woman with Gradually Progressive Loss of Language
Presentation of Case. Dr. Bradford C. Dickerson: A 70-year-old woman was seen in the memory disorders clinic of this hospital because of progressive cognitive difficulties involving word finding. She was interviewed with the assistance of her daughter. The patient had reportedly been well until…
Original Article
Trial of Amitriptyline, Topiramate, and Placebo for Pediatric Migraine
More than 6 million children and adolescents in the United States have migraines. The majority continue to have headaches into adulthood, taking a toll on the U.S. economy of approximately $36 billion and resulting in substantial effects on quality of life. Pediatric clinical practice guidelines…
Clinical Practice
Screening for Colorectal Neoplasia
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 author’s clinical recommendations. Stage. A 79-year-old…
Original Article
Ticagrelor versus Clopidogrel in Symptomatic Peripheral Artery Disease
Peripheral artery disease is considered to be a clinical manifestation of systemic atherosclerosis affecting the vascular territories supplying the lower limbs. Most patients presenting with peripheral artery disease do not have a clinical history of cardiac or cerebral ischemic events, yet these…
Clinical Problem-Solving
After the Party’s Over
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, sharing his or her reasoning with the reader (regular type). The authors’ commentary follows. Stage. While driving home from an evening…
Original Article
A Highly Durable RNAi Therapeutic Inhibitor of PCSK9
An elevated level of low-density lipoprotein (LDL) cholesterol is a major risk factor for cardiovascular disease. Despite the use of statin therapy, alone or in combination with other lipid-lowering medications, many at-risk patients continue to have elevated levels of LDL cholesterol. Hence, there…
Original Article
Cardiovascular Safety of Celecoxib, Naproxen, or Ibuprofen for Arthritis
Nonsteroidal antiinflammatory drugs (NSAIDs) were introduced in the 1960s and became the most widely prescribed class of drugs in the world, with more than 100 million prescriptions issued annually in the United States alone. NSAIDs inhibit cyclooxygenase (COX), which reduces pain and inflammation…
Review Article
Myasthenia Gravis
Myasthenia gravis is an autoimmune disease in which antibodies bind to acetylcholine receptors or to functionally related molecules in the postsynaptic membrane at the neuromuscular junction. The antibodies induce weakness of skeletal muscles, which is the sole disease manifestation. The weakness…
Original Article
Fish Oil–Derived Fatty Acids in Pregnancy and Wheeze and Asthma in Offspring
The incidence of asthma and wheezing disorders has more than doubled in westernized countries in recent decades. These conditions often originate in early childhood and currently affect one in five young children. Concomitantly, the increased use of vegetable oils in cooking and of grain in the…
Original Article
Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI
Approximately 5 to 8% of patients who undergo percutaneous coronary intervention (PCI) have atrial fibrillation. Dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and aspirin is superior to oral anticoagulation with a vitamin K antagonist in reducing the risk of thrombosis in patients…
Original Article
Shortened Antimicrobial Treatment for Acute Otitis Media in Young Children
Next to the common cold, acute otitis media is the most frequently diagnosed illness in children in the United States and the most commonly cited indication for antimicrobial treatment. Concerns about the possible encouragement of antimicrobial resistance have led to recommendations by some…
Review Article
Neonatal Abstinence Syndrome
The neonatal abstinence syndrome was first described in the literature in the 1970s by Dr. Loretta Finnegan. Although this syndrome has been recognized for more than four decades, there have been substantial changes in the past 10 years, including a dramatic increase in prevalence and changes in…
Original Article
Zika Virus Infection in Pregnant Women in Rio de Janeiro
We have been conducting active surveillance for dengue infection in the general population of Rio de Janeiro since 2007. In 2012, we established a prospective cohort for dengue surveillance in mother–infant pairs within the Manguinhos Rio de Janeiro area. In 2015, we noted an increase in cases of a…
Original Article
Five-Year Outcomes after Off-Pump or On-Pump Coronary-Artery Bypass Grafting
Coronary-artery bypass grafting (CABG) reduces the risk of death in patients with extensive coronary artery disease. CABG is usually performed with the use of a cardiopulmonary bypass (on-pump CABG). With this approach, perioperative mortality is approximately 2%, with an additional 5 to 9% of…
Original Article
Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis
Atopic dermatitis is a chronic, relapsing inflammatory skin disease that is characterized by the up-regulation of type 2 immune responses (including those involving type 2 helper T cells), an impaired skin barrier, and increased Staphylococcus aureus colonization. In patients with…
Case Records of the Massachusetts General Hospital
Case 37-2016 — An 86-Year-Old Woman with Leukocytosis and Splenomegaly
Presentation of Case. Dr. Diane R. Pearl (Medicine): An 86-year-old woman was seen in the outpatient clinic of the cancer center at this hospital because of fatigue, night sweats, leukocytosis, and splenomegaly. The patient had a history of hypothyroidism and Lyme disease but was otherwise well…
Original Article
Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease
Left main coronary artery disease is associated with high morbidity and mortality owing to the large amount of myocardium at risk. European and U.S. guidelines recommend that most patients with left main coronary artery disease undergo coronary-artery bypass grafting (CABG). Randomized trials have…