NEJM evidence最新文献

{"title":"A 9-Year-Old Girl with Persistent Fevers and Lethargy.","authors":"Aoun Zaib Khan, Farva Zaib Khan, Ahmed Sajid, Zainab Zaib Khan, Kaitlin J Murphy, Monty Mazer","doi":"10.1056/EVIDmr2400406","DOIUrl":"https://doi.org/10.1056/EVIDmr2400406","url":null,"abstract":"<p><p>AbstractMorning Report is a time-honored tradition where physicians-in-training present cases to their colleagues and clinical experts to collaboratively examine an interesting patient presentation. The Morning Report section seeks to carry on this tradition by presenting a patient's chief concern and story, inviting the reader to develop a differential diagnosis and discover the diagnosis alongside the authors of the case. This report examines the case of a 9-year-old girl who presented to the emergency department with prolonged fevers and malaise. Using questions, physical examination, and testing, an illness script for the presentation emerges. As the clinical course progresses, the differential is refined until a diagnosis is made.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDmr2400406"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multistate Infant Botulism Outbreak Associated with Powdered Infant Formula.","authors":"Connie H Chung, Jason R Barash, Jacquelin L Castonguay, Claire Penzel-McNamara, Katie Lee, Jennifer S Read, Kerry A Padgett, Nir Dover, Aaron J Judson, Liz Lamere, Ethel V Taylor, Jennifer R Cope, Amanda Conrad, Rochelle Medford, Myra Brooks, Laura Whitlock, Janet Dykes, Carolina Lúquez, Julia M Bracken, Steven M Grube, Jessica M Khouri","doi":"10.1056/EVIDpha2600020","DOIUrl":"10.1056/EVIDpha2600020","url":null,"abstract":"<p><p>AbstractThis report details the identification of an outbreak of infant botulism linked to powdered infant formula in the United States. In October 2025, the Infant Botulism Treatment and Prevention Program, California Department of Public Health (IBTPP-CDPH) noted common powdered infant formula exposure among three neonates with suspected infant botulism. Subsequent laboratory analyses at CDPH identified <i>Clostridium botulinum</i> type A from an open container of ByHeart powdered infant formula associated with one infant with infant botulism. As of December 10, 2025, 51 suspected or confirmed infant botulism cases with exposure to ByHeart powdered infant formula had been identified across 19 states. All ByHeart powdered infant formula has been recalled nationwide.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600020"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"West Nile Virus-Neutralizing Plasma for West Nile Virus Disease.","authors":"Gili Regev-Yochay, Noam Barda, Yonatan Shusterman, Erez Magiel, Ithamar Ganmore, Nadav Baharav, Ana Belkin, Ili Margalit, Victoria Indenbaum, Yaniv Lustig, Yael Weiss-Ottolenghi, Gili Joseph, Enosh Tomer, Nicola Maggio, Michal Canetti, Hagith Yonath, Eyal Leshem, Itzchak Levy, Yovel Peretz, Sharon Amit, Liron Miller, Mudi Misgav, Natalie Landa, Eilat Shinar, Marina Brod, Anat Wieder-Finesod, Dror Harats, Dafna Yahav","doi":"10.1056/EVIDoa2500169","DOIUrl":"https://doi.org/10.1056/EVIDoa2500169","url":null,"abstract":"<p><strong>Background: </strong>In 2024, Israel faced a major West Nile virus (WNV) disease outbreak. We aimed to evaluate the efficacy and safety of WNV-neutralizing plasma for hospitalized patients with WNV disease.</p><p><strong>Methods: </strong>We conducted a randomized, double-blind, placebo-controlled trial. Patients hospitalized with laboratory-confirmed symptomatic WNV disease, 60 years of age or older, or 18 to 59 years of age and immunocompromised, were eligible. Participants were randomly assigned (2:1) to donor-derived WNV-neutralizing plasma or placebo. The primary outcome was a composite of all-cause mortality and any functional deterioration at 30 days, defined as a decrease of more than 5 points from baseline on the Barthel Index (range 0-100; higher scores indicate greater independence) for activities of daily living (i.e., failure to return to pre-illness functional status). Key secondary outcomes included mortality, functional capacity (Barthel Index), and cognitive score (Modified Mini-Mental State Examination; range 0-30; higher scores indicate higher cognitive ability) at 30 and 90 days.</p><p><strong>Results: </strong>Of the 34 participants enrolled, 22 were randomly assigned to the intervention group and 12 to placebo. Median age was 74 (interquartile range, 64-82), 50% were women, and 91% had neuroinvasive disease at enrollment. At 30 days, 11/22 (50%) and 6/12 (50%) patients in the treatment and placebo group, respectively, died or had functional deterioration (risk ratio [RR], 0.96; 95% confidence interval [CI], 0.51-1.79). Two patients (2/22) died in the intervention group, compared with 4 (4/12) in the placebo group (RR, 0.33, 95% CI, 0.09-1.15). The intervention was associated with higher functional capacity (Barthel Index 85 in the intervention group vs. 78 in the placebo group; RR, 1.15; 95% CI, 1.05-1.27), and higher cognitive scores (Mini-Mental score 25 vs. 22; RR, 1.24; 95% CI, 1.04-1.47) at 30 days. One (4.5%) allergic reaction was observed in the intervention group.</p><p><strong>Conclusions: </strong>In this small, randomized trial of predominantly severe neuroinvasive WNV, treatment with WNV-neutralizing plasma did not reduce the composite outcome of death or functional deterioration at 30 days compared to placebo. It was associated with improved cognitive and functional outcomes. Potential differences in mortality warrant further evaluation. (ClinicalTrials.gov number, NCT06590207.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDoa2500169"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Deferred Consent in Randomized Clinical Trials.","authors":"Jessie Van Leeve, Michael Colacci","doi":"10.1056/EVIDctw2400266","DOIUrl":"https://doi.org/10.1056/EVIDctw2400266","url":null,"abstract":"<p><p>AbstractGood clinical practice standards mandate that informed consent be obtained before enrollment for all trials that present more than minimal risk to participants. Deferred consent, the process of enrolling patients in a clinical trial before consent is obtained, is sometimes employed in emergency care settings when patients are unable to consent at the time of trial enrollment, are critically ill, and a delay in enrollment would preclude them from potentially benefiting from the trial treatment. This article reviews the risks and benefits associated with the use of deferred consent in randomized controlled trials and the ethical acceptability of its use within specific clinical trial contexts.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDctw2400266"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To Preserve or Not to Preserve the Infrapatellar Fat Pad in Knee Arthroplasty Surgery.","authors":"L Stefan Lohmander, Gunnar Flivik","doi":"10.1056/EVIDe2600019","DOIUrl":"https://doi.org/10.1056/EVIDe2600019","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 4","pages":"EVIDe2600019"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibodies Elicited by the 2025-2026 Influenza Vaccine.","authors":"Jiaojiao Liu, Shuk Hang Li, Naiqing Ye, Tachianna Griffiths, Elizabeth M Drapeau, Reilly K Atkinson, Ronald G Collman, Scott E Hensley","doi":"10.1056/EVIDpha2600007","DOIUrl":"10.1056/EVIDpha2600007","url":null,"abstract":"<p><p>AbstractA new H3N2 variant (named subclade K) possesses several key hemagglutinin substitutions and is circulating widely during the 2025-2026 influenza season. We sought to determine whether the 2025-2026 seasonal influenza vaccine elicits antibodies in humans that recognize this variant. We found that H3N2 subclade K viruses are antigenically advanced; however, the 2025-2026 seasonal influenza vaccine elicited antibodies in many individuals that efficiently recognized these viruses. Thus, the current seasonal influenza vaccine likely will be partially effective at preventing illness associated with H3N2 subclade K virus infections.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600007"},"PeriodicalIF":0.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147349917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility Trial of Prolonged versus Single-Dose Challenge in Penicillin Allergy.","authors":"Morgan Rose, Sara Vogrin, Elise A Mitri, Joseph De Luca, Daniel Lapirow, Gemma K Reynolds, Rebecca Hall, Kerryn McInnes, Fiona James, Irvin Ng, Richard Sullivan, Michael Lane, Amy Legg, Ana Copaescu, Michelle S Goh, Kyra Y L Chua, Natasha E Holmes, Jason A Trubiano","doi":"10.1056/EVIDoa2500038","DOIUrl":"https://doi.org/10.1056/EVIDoa2500038","url":null,"abstract":"<p><strong>Background: </strong>We aimed to evaluate the feasibility of conducting a multicenter, double-blind, placebo-controlled trial of prolonged (i.e., multidose) compared with single-dose amoxicillin challenge in patients with a history of delayed penicillin allergy and to assess the frequency of immune-mediated adverse events.</p><p><strong>Methods: </strong>We conducted a parallel, double-blind, placebo-controlled multicenter randomized feasibility trial at four Australian hospitals. Adults who had a history of penicillin allergy of delayed-onset (2 or more hours after exposure) or unknown timing and had tolerated a single-dose oral challenge to amoxicillin were eligible to enroll. Participants were randomly assigned 1:1 using a permuted block design to either a 5-day amoxicillin challenge (intervention) or a placebo (control). The primary outcome measures were adherence to the intervention (N, % taking at least 80% of capsules), need for unblinding (N, %), and recruitment feasibility (N, % of eligible patients enrolled). The secondary outcome measures included positive oral challenges, defined as immune-mediated adverse events up to and including day 7.</p><p><strong>Results: </strong>We screened 302 adults and randomly assigned 120 participants to intervention (n=60) or control (n=60). The mean (standard deviation) age was 49.4 years (17.6). Allergy histories included 42% (50/120) delayed reactions and 58% (70/120) of unknown timing. Adherence to the intervention was 83% (100/120; 95% confidence interval, 75 to 90) (88% intervention and 78% control). No patients were unblinded and recruitment feasibility was 71% (120/169). The number of positive oral challenges was 7 of 60 (12%) in the intervention group and 3 of 60 (5%) in the control group (risk difference, 6.7 percentage points; 95% confidence interval, -3.2 to 16.5). One serious adverse event (1/60, 1.7%, severe cutaneous adverse reaction) was observed in the control group.</p><p><strong>Conclusions: </strong>Conducting a double-blind, placebo-controlled randomized trial of single-dose versus multidose oral amoxicillin challenge was feasible. A fully powered efficacy trial is needed to assess between-group differences in immune-mediated adverse events. (Funded by Austin Health and others; trial registration: ANZCTR - ACTRN12623001242617, registered on November 30, 2023.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 3","pages":"EVIDoa2500038"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Treatment Options in Colorectal Cancer - Expanding the Evidence.","authors":"Alena Annbalou Hasenburg, Axel Grothey","doi":"10.1056/EVIDe2600003","DOIUrl":"https://doi.org/10.1056/EVIDe2600003","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 3","pages":"EVIDe2600003"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of PROSPECTOR - A Randomized Trial Evaluating Oral Challenge Duration in Penicillin Allergy Evaluation.","authors":"Santiago Alvarez-Arango, Kimberly G Blumenthal","doi":"10.1056/EVIDe2500223","DOIUrl":"10.1056/EVIDe2500223","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 3","pages":"EVIDe2500223"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seasonal Influenza Activity, Vaccination Rates, and Pediatric Influenza Mortality, Massachusetts 2024-2025.","authors":"Catherine M Brown, Carley Perez Kauffman, Victoria Carroll, Spencer C Cunningham, Rosa Ergas, Joyce Cohen, Mia Haddad, Erika Buzby, Juliana Jacoboski, Stephanie Ash, Elizabeth Russo, Peter Breen, Joshua Norville, Seana Cofsky, Andrew Tibbs, Eric Fahim, Joshua Hall, Sandra Masson, Ramesh Jadi, Sanjib Bhattacharyya, Angela Fowler, Nicolas Epie, Lawrence C Madoff, Robert H Goldstein","doi":"10.1056/EVIDpha2500136","DOIUrl":"10.1056/EVIDpha2500136","url":null,"abstract":"<p><p>AbstractTo inform public health actions during the current influenza season, the authors describe activity, vaccination, and pediatric mortality during the 2024-2025 influenza season in Massachusetts using public health surveillance data. Influenza activity was elevated, as measured by influenza-like illness, emergency department visits, and hospitalizations. Vaccination coverage was low in pediatric patients but remained high in people 65 years of age and older. There were 10 reported pediatric deaths; 7 of those occurred among children with preexisting conditions; 8 of 10 had not received that year's influenza vaccination.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2500136"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145992410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}