The New England Journal of Medicine

doi: 10.1056/NEJMc1900909pmid: 31067400

To the Editor: Schnadower et al. (Nov. 22 issue)1 report that preschool children with acute gastroenteritis who received a 5-day course of Lactobacillus rhamnosus GG did not have better outcomes than those who received placebo. The authors did not highlight a crucial limitation of the trial: stool samples were obtained from 78.4% of the participants, with 45.6% of these samples positive for viruses. A therapeutic benefit of probiotics has been documented mostly in acute gastroenteritis of a viral origin.2,3 Furthermore, probiotics are more effective when administered early in the course of diarrhea rather than later,2,3 whereas in most participants in . . .

Saun, Tomas J.; Truong, Jessica; Dev, Shelly P.; Wanzel, Kyle

doi: 10.1056/NEJMvcm1404883pmid: 31067374

This video demonstrates elliptical excision of the skin, a procedure that can be used in the diagnosis and management of skin and subcutaneous lesions, may be performed with minimal risk in most patients, and may avert the need for other, more invasive procedures.

doi: 10.1056/NEJMc1902837pmid: 31067395

To the Editor: In the Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction 58 (DECLARE–TIMI 58) trial, Wiviott et al. (Jan. 24 issue)1 found that dapagliflozin did not result in a lower incidence of the composite of major adverse cardiovascular events (MACE) — defined as cardiovascular death, myocardial infarction, or ischemic stroke — than placebo (hazard ratio, 0.93; 95% confidence interval [CI], 0.84 to 1.03). There was no between-group difference in the incidence of cardiovascular death (hazard ratio, 0.98; 95% CI, 0.82 to 1.17), and the incidence of death from any cause was not lower in the dapagliflozin group than . . .

Elens, Maxime; Verhelst, Robert

doi: 10.1056/NEJMicm1812453pmid: 31067376

A 66-year-old man presented with abdominal bloating. The physical examination was notable for a pulsatile abdominal mass (shown in a video). Imaging revealed a large infrarenal aortic aneurysm.

Podolsky, Scott H.; Herzberg, David; Greene, Jeremy A.

doi: 10.1056/NEJMp1902811pmid: 30969504

Though the Sackler family did not invent the practice of selling drugs to physicians, they were pioneers whose story illustrates the ways marketers developed, naturalized, and monetized the interface between the pharmaceutical industry and prescribing physicians.

Farrar, Jeremy J.

doi: 10.1056/NEJMp1902683pmid: 31067366

New patterns of viral emergence and spread are being driven by ecologic and sociologic changes, ranging from climate change to political instability and conflict. Our preparations for epidemics must keep pace with such changes.

Denno, Deborah W.

doi: 10.1056/NEJMp1814786pmid: 31067367

In Bucklew v. Precythe, the Supreme Court decided against a death-row inmate with a rare medical condition. The case reveals to an unprecedented degree the extent and complexity of the medical community’s role in executions.

Bergl, Paul A.

doi: 10.1056/NEJMp1900543pmid: 31067368

Increasingly, inpatient internal medicine teams focus exclusively on a patient’s immediate crisis, leaving the rest for ambulatory care. By adopting a “baseline” mind-set, we are creating physicians who prioritize throughput over critical appraisal skills and inquisitiveness.

doi: 10.1056/NEJMtwj190509pmid: N/A

Issue Highlights, May 09, 2019Thrombolysis up to 9 Hours after StrokeNipah Virus TransmissionKidney Disease in Agricultural CommunitiesVideo: Elliptical Excision of the SkinPreying on Prescribers

Ma, Henry; Campbell, Bruce C.V.; Parsons, Mark W.; Churilov, Leonid; Levi, Christopher R.; Hsu, Chung; Kleinig, Timothy J.; Wijeratne, Tissa; Curtze, Sami; Dewey, Helen M.; Miteff, Ferdinand; Tsai, Chon-Haw; Lee, Jiunn-Tay; Phan, Thanh G.; Mahant, Neil;