Featuring articles on presymptomatic SARS-CoV-2 in a nursing facility, olaparib for metastatic prostate cancer, PTEN defects from WWP1 activation, liraglutide for adolescents with obesity, and label testing for over-the-counter naloxone sales; a review article on acute-on-chronic liver failure; a case report of a man with Covid-19 and acute kidney injury; and Perspective articles on harnessing our humanity, on sharing health data and biospecimens with industry, on flattening the curve for incarcerated populations, and on blood ties.
Featuring articles on thrombectomy with or without alteplase for stroke, rivaroxaban in peripheral artery disease, a Covid-19 outbreak at a long-term care facility, Covid-19 in critically ill patients in Seattle, allocating scarce medical resources for Covid-19, and a memorable article; a review article on sexually transmitted infections; a case report of a woman with recurrent melanoma and pulmonary nodules; and Perspective articles on developing Covid-19 vaccines at pandemic speed, on the toughest triage, on leadership for the social climate, and on when they call us and we go.
A 50-year-old, previously healthy man presents to the ED with 2 days of worsening dyspnea. He had fever, cough, and fatigue during the week before presentation. He appears acutely ill. The body temperature is 39.5°C, heart rate 110 beats per minute, respiratory rate 24 breaths per minute, and blood pressure 130/60 mm Hg. The oxygen saturation is 87% while the patient is breathing ambient air. The white-cell count is 7300 per microliter with lymphopenia. Chest X-ray shows patchy bilateral opacities in the lung parenchyma. An RT–PCR assay detects the presence of SARS-CoV-2 RNA in a nasopharyngeal swab. How would you evaluate and manage this case? Full-text recordings of Clinical Practice articles can be found at NEJM.org.
Featuring articles on vericiguat in patients with heart failure, anti-PD-L1 and anti-VEGF in hepatocellular carcinoma, Lactin-V to prevent recurrence of bacterial vaginosis, rivaroxaban or enoxaparin in nonmajor orthopedic surgery, and dopaminergic precursor cells for Parkinson’s disease; a review article on transient ischemic attack; a case report of a man with hyponatremia and involuntary movements of the arm and face; and Perspective articles on facing Covid-19 in Italy, on the state of cannabis research legislation in 2020, on Medicare Part D and insulin affordability, and on the day a physician’s gut feeling led her astray.
A 73-year-old man with hypertension and chronic obstructive pulmonary disease calls to report that he has had a fever and a dry cough for the past 2 days. He notes that his shortness of breath has worsened. His medications include losartan and inhaled glucocorticoids. He lives alone. How should he be evaluated? If he has Covid-19, the disease caused by SARS-CoV-2, then how should he be treated? Full-text recordings of Clinical Practice articles can be found at NEJM.org.
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