A woman had a large, deep ulcer at an injection site on her thigh, with a dusky violaceous border extending 2 to 5 cm from the wound edge, fever to 39.8 °C, and elevated white blood cell count and procalcitonin level; histologic examination of excised tissue showed a dense pan-dermal neutrophilic infiltrate, and multiple blood and tissue cultures were negative. What is the diagnosis and what would you do next?
SARS-CoV-2 infection during pregnancy is associated with increased risk for maternal morbidity and adverse birth outcomes. COVID-19 vaccines are effective for preventing severe disease, including in pregnant populations. Although more than 100 countries recommend COVID-19 vaccination during pregnancy, COVID-19 vaccination in pregnant people has lagged behind that for age-matched, nonpregnant adults. As of February 2022, the US Vaccine Safety Datalink estimated that 68% of pregnant individuals have completed the primary COVID-19 vaccine series. Persistent wide disparities in COVID-19 vaccination during pregnancy by race or ethnicity are likely to exacerbate longstanding disparities in maternal morbidity and mortality.
This Viewpoint discusses actions that health care leaders and policy makers can take to better assess the likely constitutionality of reducing “COVID misinformation” through government prohibitions or sanctions.
Administering smaller doses of COVID-19 vaccines could be economically viable and could save more lives than either full-dose vaccination or no vaccination in low- and middle-income countries (LMICs)—even with the emergence of new, more highly transmissible variants, according to a cost-effectiveness modeling study.
Monitoring SARS-CoV-2 infections in animals is critical to prevent formation of animal reservoirs and to reduce risks of transmission to humans, according to a joint statement by the World Health Organization (WHO) and animal health partners. SARS-CoV-2 infection has been detected in wild, free-ranging, or captive animals including big cats, minks, ferrets, North American white-tailed deer, and great apes, in addition to domestic animals.
More than 3 times as many people may have died around the world due to direct and indirect effects of the COVID-19 pandemic than officially reported, according to an estimate of excess mortality by the Institute for Health Metrics and Evaluation at the University of Washington.
In Reply Ms Skaritanov and colleagues take issue with our limited summary of cardiovascular risk factors, specifically hypertension and the use of CHCs, in our recent Review article. The objective of the Review was to provide clinicians with an evidence-based foundation to effectively and safely prescribe contraception. We discussed a variety of key medical conditions but did not intend to provide an exhaustive review of contraception and cardiovascular risk factors. We are pleased to see Skaritanov and colleagues reference the MEC, a clinical guideline that we highlighted in the Review and that is freely available to clinicians to aid with prescribing contraception to individuals with medical conditions such as hypertension.
In Reply We agree with Dr Brenner and colleagues that the safe performance of emergency tracheal intubation involves both technical aspects (eg, glottic visualization) and nontechnical aspects (eg, protocols, teamwork). Multicenter randomized clinical trials should rigorously examine the drugs (eg, choice of induction agent), devices (eg, video laryngoscopes), techniques (eg, use of positive pressure ventilation for preoxygenation), and processes (eg, operator training and teamwork) used in emergency tracheal intubation to improve care and outcomes for critically ill adults.
To the Editor The recently published NOR-DRUM B trial demonstrated that proactive therapeutic drug monitoring (TDM) during maintenance therapy with infliximab was more effective in sustaining disease control in immune-mediated inflammatory diseases than treatment without TDM. We believe these results must be interpreted with caution.
To the Editor The BOUGIE trial showed that rates of successful first-attempt intubations with use of a bougie vs endotracheal tube with stylet were comparable during tracheal intubation for critically ill adults. However, we believe that the difference between the suitability of various laryngoscopes used with a bougie or a stylet could have affected the study results.
To the Editor A recent randomized trial comparing success rates in tracheal intubation with bougie vs endotracheal tube with stylet found no difference in outcomes. This negative result raises several questions about which other measures might be helpful when intubating critically ill patients.
This study uses state data sets from the 2017 and 2019 Youth Risk Behavior Survey to assess health risk factors and health outcomes by gender identity among a large, population-based sample of gender minority adolescents.
Philips Respironics must do a better job of notifying all users, suppliers, distributors, retailers, and prescribers about the months-old recall of some of its products, which includes ventilators, continuous positive airway pressure machines, and bilevel positive airway pressure machines, according to a recent FDA mandate.
With the increasing emphasis on diversity and equity in health care and in the context of increasing numbers of individuals with dementia, there is growing interest in knowing how pervasive and equally distributed dementia is among older individuals in racial and ethnic populations in the US and other countries. The article by Kornblith and colleagues in this issue of JAMA makes an important contribution to that knowledge base, especially by the breadth of its sample of 1.8 million veterans from the national Veterans Health Administration in all regions of the US. This report is in contrast to others that have compared rates of dementia in ethnic and racial populations that have been primarily confined to local or regional health care systems or census areas. The fact that the veterans were all cared for in the same national health care system reduces the number of variables that could affect the comparisons.
In this narrative medicine essay, an internal medicine resident who grew close to a patient with COVID-19 and to his teenaged daughters pinned her hopes on his recovery and followed his progress and setbacks even after she rotated to a new assignment.
When I have a learning in me I go to science a place soundproofed by the heavy breathing of strangers who stay strange behind a-tonal language in the concrete halls winding between fact and personhood I search for open doors when I have an embryo in me and thus a learning science says it knows from urine and blood and the brain’s profound anatomical changes science says neurogenesis for adaptive purposes or becoming less voluminous in the head
Among adults with peripheral artery disease and intermittent claudication, this randomized clinical trial compares walking capacity at 3 months between patients who received a home-based, walking exercise behavior change intervention led by a physical therapist vs usual care.
This study using US National Center for Health Statistics data for more than 1.5 million individuals with gestational diabetes aged 15 to 44 years with singleton nonanomalous live births assesses whether the frequency of adverse pregnancy outcomes among those in the US with gestational diabetes changed over time, and whether the risk of these outcomes differed by maternal race and ethnicity.
In Reply We agree with Drs Rigatelli and Zuin that the PFO-Associated Stroke Causal Likelihood (PASCAL) Classification System used in our study does not include every attribute of potential relevance to the causal relatedness of a discovered PFO to an index stroke, such as Eustachian valve prominence or tunnel length. We would add to their list of PASCAL-omitted variables with a putative association with paradoxical embolism: Valsalva at stroke onset, recent history of prolonged immobility, history of sleep apnea, and presence of venous thrombophilia, to mention only a few.
In Reply Even though we were deeply interested in evaluating the cause of the increased risk of pancreatic cancer in young women, the outcome analyses for our study did not inform the mechanisms of carcinogenesis or allow us to draw conclusions about risk factors and patient management. We also did not aim to evaluate global trends, underlying histopathological characteristics, survival, the role of genetics, or socioenvironmental status.
In Reply We agree with Drs Bousquet and Coulet that worthwhile artificial intelligence wayfinding systems should avoid alert fatigue, support and not preempt clinician judgment, and operate variably in the foreground or background, depending on the clinical context.
To the Editor We have several concerns about the methods and results of the recent Research Letter that found an increased incidence of pancreatic cancer among younger women. In this study, women younger than 55 years accounted for only 4.6% of the enrolled population and women younger than 35 years represented only 0.3%. These small numbers of patients made it more likely that there would be an uneven incidence of pancreatic cancer in men and women.
To the Editor A recent Research Letter highlighted concerning trends in the incidence of pancreatic cancer in individuals younger than 55 years, with a significantly greater increase in the average annual percentage change in women compared with men. The difference was most pronounced in individuals aged 15 to 34 years, with the average annual percentage change of 7.68% in women and 4.20% in men. These directional trends are profoundly worrisome.
To the Editor A recent Viewpoint proposed to support diagnosis with next-generation artificial intelligence that not only predicts diagnosis but also accompanies physicians on their journey. The wayfinding metaphor poses interesting research questions about the best way to represent the map from an ergonomic point of view, but it also calls into question the volume of interventions of the system and its level of autonomy. A high volume of alerts accompanied clinical decision support systems for prescription and laboratory ordering. The strategy of alerting physicians initially seemed relevant and necessary to help reduce prescription errors. However, the frequent alerts led to a fatigue phenomenon, and physicians eventually ended up not taking them into account. Likewise, one can imagine observing a fatigue alert linked to the wayfinding provided by next-generation artificial intelligence. Therefore, it is vital to set the recommendation and intervention level of the system.
This study assesses trends in drug overdose deaths among US adolescents aged 14 to 18 years from January 2010 to June 2021, by substance type and race and ethnicity, using data from the Centers for Disease Control and Prevention WONDER database.