To the Editor: Ferryman et al. (Aug. 31 issue)1 acknowledge that the entire health care system suffers from the absence of data on race and ethnicity, particularly for underserved populations. Artificial intelligence (AI) applications that are trained on such health care data sets are inherently biased and likely to accentuate widening health inequities for underrepresented racial and ethnic groups

To the Editor: To bring focus to discrepancies in asthma-related incidence, morbidity, and mortality falling along socioeconomic lines, the inequity in the availability of guideline-concordant care should be noted in the Clinical Practice article by Mosnaim (Sept. 14 issue).1 The inhaled glucocorticoid–formoterol combination, as recommended in the Global Initiative for Asthma (GINA) 2023 track 1 guidelines

To the Editor: The definition of iron deficiency that has been widely adopted in the care of patients with heart failure and in the HEART-FID trial by Mentz et al. (Sept. 14 issue)1 blurs the difference between absolute and functional iron deficiency, a distinction that is evident in the bone marrow of patients with heart failure.2 Functional iron deficiency is characterized by a transferrin saturation

In early 2020, multisystemic inflammatory syndrome in children (MIS-C) was recognized as an emerging life-threatening disease occurring 2 to 6 weeks after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with symptoms resembling those of Kawasaki’s disease or toxic shock syndrome.1 Unlike typical Kawasaki’s disease, MIS-C has been frequently associated with gastrointestinal

“Wearables” is a term used for forms of technology that are worn on the body, such as smartwatches or adhesive patches containing sensors, and that perform a useful function for the wearer or a caregiver. Common examples include devices that track physical activity and sleep or provide physiological data about the wearer, such as heart rate and rhythm or blood glucose levels. Increasingly, wearables

The persistent scarcity of available donor hearts demands concerted efforts to expand the pool of donors and maximize their use for heart transplantation. Central to this goal is appropriate care for brain-dead donors as performed by organ-procurement organizations (OPOs) and guided by consensus protocols.1,2 Although decades old and incompletely aligned, these protocols generally recommend the use

A 29-year-old man with sickle cell disease, which had been complicated by vaso-occlusive events and osteonecrosis leading to hip arthroplasty, was admitted because of hip pain. A diagnosis was made.

Monitors to measure glucose levels have been paired with software controlling insulin delivery. The authors examine the state of the art in digital technology to manage diabetes (types 1 and 2).

Background Hemodynamic instability and myocardial dysfunction are major factors preventing the transplantation of hearts from organ donors after brain death. Intravenous levothyroxine is widely used in donor care, on the basis of observational data suggesting that more organs may be transplanted from donors who receive hormonal supplementation. Methods Download a PDF of the Research Summary. In this

This Double Take video from the New England Journal of Medicine presents the case of a toddler with a limp. Based on a Clinical Problem-Solving article published in the Journal, the video explores the differential diagnosis for a child refusing to bear weight on his right leg and follows its evolution as new clinical findings arise from the diagnostic evaluation. For further reading, the following

When Mr. C. is diagnosed with head and neck cancer, he discovers that undergoing cancer care while engaged in the methadone-clinic system is far more complicated than it should be.

A new pathway proposed by the Centers for Medicare and Medicaid Services aims to expedite access to breakthrough devices while preserving Medicare’s independent role in evidence generation.

There has been broad variation among states in policy approaches to unwinding of continuous Medicaid coverage. But there is still time for policymakers and others to minimize the risk of coverage loss.

To the Editor: The findings of the Randomized Trial to Prevent Vascular Events in HIV (REPRIEVE), reported by Grinspoon et al. (Aug. 24 issue),1 put statins at the forefront on reducing the excess risk of atherosclerotic cardiovascular disease among persons with human immunodeficiency virus (HIV) infection. We recently developed a model of atherosclerotic cardiovascular disease in persons with HIV

Exome sequencing of cell-free DNA from noninvasively obtained samples from 36 pregnant women and their partners found diagnostic variants in 11 of the fetuses, with 100% concordance with results from invasively obtained samples.

The authors describe a noninvasive prenatal screening approach involving a survey of sequence variation across the entire fetal exome using cell-free DNA obtained from a maternal blood draw.

The treatment by liver transplantation of a patient with Mahvash disease, which is characterized by pancreatic neuroendocrine tumors, extends understanding of the biochemical processes undergirding its signs and symptoms.

A 19-year-old man was evaluated because of kidney cysts. Three years earlier, he had received a diagnosis of diabetes when abdominal pain and increased urinary frequency had developed. A diagnosis was made.

Lung ultrasonography facilitates quick diagnosis at the bedside and is especially useful in emergency conditions. This video describes practical considerations for patients with the most common causes of dyspnea.

Screening for osteoporosis is recommended in postmenopausal women on the basis of age and risk factors. Treatment approaches are determined by T score and the presence or risk of fracture.

Mahvash disease is an exceedingly rare genetic disorder of glucagon signaling characterized by hyperglucagonemia, hyperaminoacidemia, and pancreatic α-cell hyperplasia. Although there is no known definitive treatment, octreotide has been used to decrease systemic glucagon levels. We describe a woman who presented to our medical center after three episodes of small-volume hematemesis. She was found

Many international medical graduates face higher barriers to licensing than graduates of U.S. or Canadian medical schools. A new Tennessee law aims to reduce these barriers.

Deeply affected by the increasingly visible oppression of Iranian women, an Iranian-born U.S. physician turns to her professional community for support and solidarity.

To the Editor: We have been interested in the use of hemodiafiltration for more than 40 years, and we reported on the results of an early longitudinal study on hemodiafiltration.1 The results of the Dialysis Outcomes and Practice Patterns Study2 suggested that high convection volumes (>17 liters per session) provided a survival benefit; however, a later study did not support those findings.3 In a randomized

To the Editor: In their article on the FIRE trial, Biscaglia et al. (Sept. 7 issue)1 state that the use of physiology-guided complete revascularization resulted in a lower risk of death from cardiovascular or other causes than percutaneous coronary intervention (PCI) alone in older patients (age, ≥75 years) with myocardial infarction and multivessel disease. This reduction in overall mortality was

Accurate classification of patients with hypotonic polyuria is essential because management differs for the three main causes1: arginine vasopressin (AVP) deficiency (formerly called central diabetes insipidus), AVP resistance (also known as nephrogenic diabetes insipidus),2 and primary polydipsia, in which excess fluid intake suppresses AVP secretion. Primary polydipsia is the most common cause of

An amyloid hypothesis1 for Alzheimer’s disease posits that amyloid-beta (Aβ) peptides cleaved from Aβ precursor protein trigger a neurodegenerative cascade, causing cognitive and functional impairment. The peptides have various lengths, ranging from monomers to self-assembled soluble oligomers, insoluble fibrils, and extracellular deposits, or plaques. Any of these species could be toxic. The antiamyloid

This editorial describes the science behind a phase 3 trial of selpercatinib to treat patients with RET fusion–positive non–small-cell lung cancer.

A 38-year-old woman was evaluated because of dyspnea, chest discomfort, and waxing and waning pulmonary nodules. A diagnosis was made.

Liver transplantation, first performed in humans 60 years ago, is now the standard of care for patients with life-threatening liver disease. This article focuses on current developments in liver transplantation.

Background Distinguishing between arginine vasopressin (AVP) deficiency and primary polydipsia is challenging. Hypertonic saline–stimulated copeptin has been used to diagnose AVP deficiency with high accuracy but requires close sodium monitoring. Arginine-stimulated copeptin has shown similar diagnostic accuracy but with a simpler test protocol. However, data are lacking from a head-to-head comparison

Background Monoclonal antibodies that target amyloid-beta (Aβ) have the potential to slow cognitive and functional decline in persons with early Alzheimer’s disease. Gantenerumab is a subcutaneously administered, fully human, anti-Aβ IgG1 monoclonal antibody with highest affinity for aggregated Aβ that has been tested for the treatment of Alzheimer’s disease. Methods Download a PDF of the Research

In this Double Take video from the New England Journal of Medicine, Drs. Franklin Cosey-Gay, Sonya Mathies Dinizulu, Selwyn O. Rogers, Jr., and Bradley Stolbach (University of Chicago) meet with members of REACT (Recovery Empowerment after Community Trauma) to discuss continuous traumatic stress from community violence in terms of its effects on health, its root causes, and how medical providers can

Background Primary biliary cholangitis is a rare, chronic cholestatic liver disease characterized by the destruction of interlobular bile ducts, leading to cholestasis and liver fibrosis. Whether elafibranor, an oral, dual peroxisome proliferator-activated receptor (PPAR) α and δ agonist, may have benefit as a treatment for primary biliary cholangitis is unknown. Methods In this multinational, phase

Continuous heart rhythm monitoring with cardiac implantable devices has shown that atrial tachyarrhythmias, termed high-rate episodes (AHREs), occur in approximately one third of device carriers.1,2 AHRE definitions vary across studies, but cutoffs of an intracardiac atrial frequency of at least 180 bpm with a duration of 5 minutes or more is common.1 The terms subclinical atrial fibrillation and AHREs

Certain implantable cardioverter–defibrillators that are subject to a recall continue to be implanted. Patients and clinicians are confronted with an important decision about how to proceed.

Is it ethically acceptable to obtain tissue from healthy volunteers to enable comparisons with tissue from patients? The answer may depend on the accessibility of the tissue in question.

Background A strategy of administering a transfusion only when the hemoglobin level falls below 7 or 8 g per deciliter has been widely adopted. However, patients with acute myocardial infarction may benefit from a higher hemoglobin level. Methods In this phase 3, interventional trial, we randomly assigned patients with myocardial infarction and a hemoglobin level of less than 10 g per deciliter to

Background Semaglutide, a glucagon-like peptide-1 receptor agonist, has been shown to reduce the risk of adverse cardiovascular events in patients with diabetes. Whether semaglutide can reduce cardiovascular risk associated with overweight and obesity in the absence of diabetes is unknown. Methods In a multicenter, double-blind, randomized, placebo-controlled, event-driven superiority trial, we enrolled

To the Editor: Inder et al. (Aug. 3 issue)1 offer a comprehensive review of the neurologic consequences of preterm birth. Despite the declining incidence of severe cerebral palsy, the prevalence of cognitive impairment and social–emotional difficulties among preterm survivors persists. An apparent omission in the review is the contribution of hearing loss to learning impairment. Deafness can affect

To the Editor: In their article on screening for Epstein–Barr virus DNA or antibodies in the diagnosis of nasopharyngeal carcinoma, Li and colleagues (Aug. 31 issue)1 describe a promising biomarker. Notwithstanding, I note that the number needed to screen to detect one case of nasopharyngeal carcinoma is approximately 540. Here, we estimate the number needed to screen to prevent one death, with several

In this follow-up report of a trial of CMV hyperimmune globulin in pregnant women with primary CMV infection, hyperimmune globulin did not improve hearing or developmental outcomes in children at the age of 2 years.

In response to the new U.S. Supreme Court ban on race-conscious admissions, medical schools have an opportunity to refocus on affirmative action’s original vision.

Nursing homes house a population most at risk for prolonged colonization with multidrug resistant organisms (MDROs) owing to the residents’ older age, repeat health care and antibiotic exposures, and ongoing contact with other persons with colonization.1 Although nursing homes pose a perfect opportunity for the cultivation and continued transmission of MDROs, decolonization efforts in this setting

In 2013, as sequencing tests that evaluated the genome or its coding regions (the exome) became available to aid in the diagnosis of suspected genetic disorders, the American College of Medical Genetics and Genomics (ACMG) issued a guideline1 that included a set of medically important genes to be evaluated and reported independently of the indication for the test. Originally referred to as the ACMG

Immune checkpoint blockade has become standard treatment for many types of cancer. Such therapy is indicated most often in patients with advanced or metastatic disease but has been increasingly used as adjuvant therapy in those with early-stage disease. Adverse events include immune-related organ inflammation resembling autoimmune diseases. We describe a case of severe immune-related gastroenterocolitis

Background Local injections of botulinum toxin type A have been used to treat essential head tremor but have not been extensively studied in randomized trials. Methods Download a PDF of the Research Summary. In a multicenter, double-blind, randomized trial, we assigned, in a 1:1 ratio, adult patients with essential or isolated head tremor to receive botulinum toxin type A or placebo. Botulinum toxin

Background In 2021, the American College of Medical Genetics and Genomics (ACMG) recommended reporting actionable genotypes in 73 genes associated with diseases for which preventive or therapeutic measures are available. Evaluations of the association of actionable genotypes in these genes with life span are currently lacking. Methods We assessed the prevalence of coding and splice variants in genes

Mounting clinical evidence could lead to the approval of new psychedelic medicines. The FDA’s draft guidance on psychedelics research includes several recommendations that may be contentious.

Background An unmet need exists for focal segmental glomerulosclerosis (FSGS) treatment. In an 8-week, phase 2 trial, sparsentan, a dual endothelin–angiotensin receptor antagonist, reduced proteinuria in patients with FSGS. The efficacy and safety of longer-term treatment with sparsentan for FSGS are unknown. Methods In this phase 3 trial, we enrolled patients with FSGS (without known secondary causes)

Focal segmental glomerulosclerosis (FSGS), a diagnosis based on glomerular histology,1 carries an ominous prognosis, although its downward slide to end-stage kidney disease is variable. FSGS is a syndrome, and, ultimately, identifying the pathogenesis in each patient might enable the effective individualization of treatment. FSGS is categorized as primary (presumed to be related to permeability factors)

Background A proliferation-inducing ligand (APRIL) is implicated in the pathogenesis of IgA nephropathy. Sibeprenlimab is a humanized IgG2 monoclonal antibody that binds to and neutralizes APRIL. Methods In this phase 2, multicenter, double-blind, randomized, placebo-controlled, parallel-group trial, we randomly assigned adults with biopsy-confirmed IgA nephropathy who were at high risk for disease

To the Editor: Warkentin et al. (Aug. 10 issue)1 recently reported two cases of vaccine-induced immune thrombotic thrombocytopenia (VITT)–like anti–platelet factor 4 (PF4) disorder associated with adenovirus infection. We now report the case of a 40-year-old woman with a 10-day history of fever and respiratory symptoms who was admitted to our department for severe intracranial bleeding and multiple