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Locally advanced rectal cancer usually receives a three-part treatment: chemotherapy followed by radiotherapy and then surgery. In a small-cohort study presented at this year’s ASCO conference researchers used a PD-1 inhibitor — dostarlimab — every three weeks for 6 months against the disease. All patients had mismatch repair deficient tumors. No o…
 
In this episode of Curbside Consults, we examine the latest guidelines from the Centers for Disease Control (CDC) on the treatment of sexually transmitted infections (STIs). We are joined by Dr. Kimberly Workowski, a Professor of Medicine in the Division of Infectious Diseases at Emory, and one of the guideline authors.…
 
Featuring articles on restricted intravenous fluid in septic shock, an oncolytic virus for pediatric pontine glioma, ibrutinib for untreated mantle-cell lymphoma, and on the potency of a KRAS silent variant; a review article on mantle-cell lymphoma; a case report of a man with vision changes; and Perspective articles on nineteen days in America, on…
 
Patients with metastatic breast cancer whose tumors express low levels of HER2 are generally classified and treated as having HER2-negative disease. However, Dr. Shanu Modi of the Memorial Sloan Kettering Cancer Center and a group of international collaborators explored the use of a monoclonal antibody–drug conjugate (trastuzumab–deruxtecan) in pat…
 
Featuring articles on PD-1 blockade in locally advanced rectal cancer, a vaccine against respiratory syncytial virus, a vitamin C infusion in adults with sepsis, and reducing administrative harm in medicine; a review article on Philadelphia chromosome–positive acute lymphoblastic leukemia; a case report of a woman with jaundice and chronic diarrhea…
 
Apnea testing is part of the protocol used to determine whether a patient is dead according to neurologic criteria. The question is, do clinicians need to obtain consent to proceed? In a fascinating 15-minute chat, two intensivists, Drs. Patricia Kritek and Robert Truog, discuss that question and another, larger one: what is death, anyway? Their ba…
 
Featuring articles on circulating tumor DNA and adjuvant therapy in colon cancer, the prevention of anal cancer, Chapare hemorrhagic fever in Bolivia, immune tolerance after sequential stem-cell and kidney transplantation, and potentiating the T cell; a review article on climate change, fossil-fuel pollution, and children’s health; a case report of…
 
In this episode of Curbside Consults, we discuss the intersection of climate change, health, and education with a group of residents and medical students who are leading initiatives to incorporate climate change into the curriculum at institutions across the country. We are joined by Dr. Jacob Fox, second year internal medicine resident at...…
 
As Editor-In-Chief of the New England Journal of Medicine, Dr. Eric Rubin is an authority on medical publishing, but he didn’t always know this was the job he wanted. In this special episode of Curbside Consults, we explore the highlights and challenges of being a physician editor at a medical journal, and the path to determining if it’s the right …
 
Featuring articles on chronic traumatic encephalopathy in military personnel, a PDE4 inhibitor for idiopathic pulmonary fibrosis, a monoclonal-antibody combination to prevent Covid-19, natural and hybrid immunity to SARS-CoV-2, and emerging technologies in health and medicine; a review article on the diagnosis and treatment of frostbite; a case rep…
 
Featuring articles on an albuterol–budesonide rescue inhaler in asthma, the efficacy of a plant-based SARS-CoV-2 vaccine, the efficacy and safety of a spike protein subunit vaccine, and neoantigen T-cell receptor gene therapy in pancreatic cancer; a review article on the uses of a GFR and albuminuria level in kidney disease; a Clinical Problem-Solv…
 
Featuring articles on neoadjuvant chemoimmunotherapy in resectable non–small-cell lung cancer, tranexamic acid for noncardiac surgery, activation of oncogene expression by demethylating agents, efficacy of the mRNA-1273 vaccine in older children, and structural racism in the academic residency clinic; a review article on the gliflozins in the manag…
 
In the early waves of the Covid-19 pandemic why did patients in unionized nursing homes, have a roughly 10% lower rate of mortality than those in non-unionized ones? A report in Health Affairs tries to sort out the possible reasons. Listen to our 13-minute interview, which raises the question: Should you send your patients to non-unionized faciliti…
 
In this episode of Curbside Consults, we examine the latest guidelines on the diagnosis and management of Barrett’s esophagus by the American College of Gastroenterology (ACG). We are joined by Dr. Nick Shaheen, a Professor of Medicine and Chief of Gastroenterology and Hepatology at UNC Chapel Hill, and one of the guideline authors.…
 
Featuring articles on childhood risk factors and adult cardiovascular events, results of two cases of pig-to-human kidney xenotransplantation, vaccine effectiveness against omicron in children and adolescents, the efficacy and safety of a BNT162b2 booster, catching up on REMs, and on NEJM Healer; a review article on brain tumors in children; a case…
 
Featuring articles on the treatment of mild chronic hypertension during pregnancy, lenacapavir for HIV-1 treatment, booster vaccination against omicron in Qatar, and on reframing the quality question; a review article on preeclampsia; a case report of a man with chylous ascites; and Perspective articles on health care reform under the Biden adminis…
 
The U.S. Preventive Services Task Force recently issued its sixth set of guidelines on using daily aspirin to prevent cardiovascular disease. The guidelines appeared in JAMA — whose editors asked our guest, Dr. Allan Brett, to write an editorial evaluation. This edition carries Brett’s advice on using the new guidelines in daily clinical practice. …
 
Saline or balanced crystalloids? The question of which resuscitation fluid to use in clinical practice seems to have been settled by recent research findings — or at least settled in favor of balanced crystalloids. But wait, our guests see slight differences that may affect your choice. Patricia Kritek practices critical care medicine at the Univer…
 
Featuring articles on baricitinib for alopecia areata, convalescent plasma for early SARS-CoV-2 infection, efficacy of a fourth mRNA vaccine dose in Israel, ivermectin for early Covid-19, a new image for cell sorting, and metric myopia; a review article on nonspecific low back pain; a Clinical Problem-Solving on looking back; and Perspective articl…
 
In this episode of Curbside Consults, we examine the latest guidelines on the diagnosis and management of pediatric osteomyelitis by the Infectious Diseases Society of America (IDSA) and Pediatric Infectious Diseases Society (PIDS). We are joined by Dr. Samir Shah, a Professor of Pediatrics at Cincinnati Children’s Hospital, Editor-in-Chief of...…
 
Featuring articles on CT or coronary angiography in stable chest pain, protection against omicron by a fourth vaccine dose, a vaccine for RSV in pregnancy, nasal high-flow therapy during neonatal intubation, and reassessing quality assessment; a review article on understanding vaccine safety; a case report of a man with myalgias, fever, and bradyca…
 
Spend 15 minutes with Dr. Natalia Shevchuk, whom we interviewed by candlelight last month. She is sheltering in the Odessa region now, having left the Donetsk area. This time, she relates how she lost a colleague in Russia’s attack on the Kramatorsk railway station and found another she’d feared lost in Mariupol. She told us that she’s impressed by…
 
Featuring articles on restricted calories and eating times in weight loss, asthma therapy in Black and Latinx adults, ivosidenib in IDH1-mutated acute myeloid leukemia, vaccine boost effects on protection against omicron, and fighting cardiac fibrosis with CAR T cells; a review article on early-onset colorectal cancer; a case report of a woman with…
 
Featuring articles on nirmatrelvir plus ritonavir for Covid-19, the treatment of acute Achilles’ tendon rupture, rilzabrutinib in immune thrombocytopenia, mitapivat for pyruvate kinase deficiency, and global health and the moral clarity of Paul Farmer; a review article on cancer-associated hypercalcemia; a case report of a woman with pancytopenia; …
 
During the American Academy of Neurology’s 2022 meeting in Seattle, Dr. Richard Lipton of Albert Einstein College of Medicine took questions from Dr. Teshamae Monteith (U. Miami) and Joe Elia. Lipton’s group sought to characterize the impact of patients’ monthly headache days on their quality of life, especially the role of depression, allodynia, a…
 
Featuring articles on endovascular therapy for large cerebral infarction, population immunity and Covid-19 severity with the omicron variant in South Africa, tebipenem for complicated urinary tract infection, an implanted stimulator in multiple-system atrophy, U.S. medical faculty diversity over four decades, and the origins of calcific aortic sten…
 
Dr. Natalia Shevchuk (pictured above) treats substance use disorders in Ukraine’s Donetsk region. Her face is candlelit because her town is under curfew, and people aren’t allowed to put on their room lights (if they have electricity) in the hours of darkness, lest Russian bombardments use the lights as guides. She talked with Dr. Ali Raja and Joe …
 
Gastroesophageal reflux, or GERD, was the focus of a revised set of guidelines issued in January in the American Journal of Gastroenterology. Given the frequency of that condition in primary care clinics, internist and NEJM Journal Watch editor-in-chief Allan Brett proposed a discussion about the practical application of these guidelines with David…
 
Some 85 years ago Guernica was bombed, and after that came Dresden, Coventry, Hiroshima, Bach Mai, and the rest. This episode of Clinical Conversations asks how it might be possible to help clinicians under bombardment in Ukraine. As you will hear, one hospital in Chernihiv keeps all but essential staff away from its buildings when […] The post Pod…
 
In this episode of Curbside Consults, we examine the latest guidelines on the evaluation and management of well-appearing febrile infants 8-60 days old by the American Academy of Pediatrics (AAP). We are joined by Dr. Benard Dreyer, a Professor of Pediatrics at NYU, the past president of the AAP, who is one of the guideline authors.…
 
You want more evidence that post-recovery vaccination against Covid-19 reinfection helps? Here is a careful study from the U.K. that followed some 35,000 health care workers — initially without symptoms — in over 100 institutions there. Starting in June 2020 the SIREN study tested these people regularly, with blood sampling every month and nasal sw…
 
Governments’ directives about how and when to vaccinate people who’ve recovered from Covid-19 vary widely. But, according to this episode’s guest, Dr. Ronen Arbel, they all say they don’t have enough evidence to set firm policy. So, Arbel and his colleagues set out to collect evidence from some 150,000 patients’ records in Israel who’d recovered [……
 
In this episode of Curbside Consults, we discuss the recently published guidelines on the management of venous thromboembolic disease by the American College of Chest Physicians. We are joined by one of the guideline authors, Dr. Lisa Moores, Associate Dean for Assessment and Professor of Medicine at the Uniformed Services University of...…
 
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