NEJM evidence最新文献

{"title":"A 53-Year-Old Woman with Ear Pain and Facial Weakness.","authors":"Yu Si, Jia Guo, Donghui Zheng, Yong Li, Suijun Chen, Zhigang Zhang","doi":"10.1056/EVIDmr2500144","DOIUrl":"10.1056/EVIDmr2500144","url":null,"abstract":"<p><p>AbstractMorning Report is a time-honored tradition in which 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 story of a 53-year-old woman who sought evaluation for pain in both ears, hearing loss, and facial weakness. 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 7","pages":"EVIDmr2500144"},"PeriodicalIF":11.6,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304121","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":"Outcomes of Pneumonia in ICUs in Low- and Middle-Income Countries - A Systematic Review.","authors":"Melissa Pitrowsky, Mariana Balbi Pacheco, Otavio Ranzani, Filipe Sousa Amado, Antonio Paulo Nassar Junior, Bruno Adler Maccagnan Pinheiro Besen, Giulliana Martines Moralez, Gloria Martins, Pedro Povoa, José Roberto Lapa E Silva, Jorge I F Salluh","doi":"10.1056/EVIDoa2500244","DOIUrl":"10.1056/EVIDoa2500244","url":null,"abstract":"<p><strong>Background: </strong>Community-acquired pneumonia (CAP) is a leading cause of intensive care unit (ICU) admission and death in low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis to estimate mortality among patients with CAP admitted to ICUs in LMICs.</p><p><strong>Methods: </strong>We searched multiple databases using terms related to CAP admitted to the ICU and LMIC. We included both observational studies and clinical trials. The primary outcome was all-cause ICU, 28-day or 30-day mortality. Demographics, comorbidities, clinical characteristics, mechanical ventilation, and length of ICU stay were described. We registered the study in PROSPERO (CRD42022363048).</p><p><strong>Results: </strong>A total of 52 studies from 18 countries met inclusion criteria, encompassing 48,707 patients. Most studies originated in upper-middle-income countries and no studies from low-income countries were identified. The most frequent comorbidities were hypertension, chronic obstructive pulmonary disease, and diabetes. Mechanical ventilation was reported in 36 studies, with median use in 59% (interquartile range, 41.4-77.4) of patients. Pooled mortality was 37% (95% confidence interval [CI], 31-42), rising to 61 (44-75) among patients requiring mechanical ventilation. In a meta-regression, age and mechanical ventilation were the strongest moderators of mortality, explaining 55.2% of heterogeneity in short-term mortality.</p><p><strong>Conclusions: </strong>Mortality among patients with CAP admitted to ICUs in middle-income countries remains high, especially in older and mechanically ventilated patients. The lack of data from low-income countries is notable.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDoa2500244"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038497","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":"A 7-Year-Old Girl with Limping and Leg Pain.","authors":"Emanuele Savasta, Alessandra Vincenza Fera, Samuele La Mendola, Carola Aschieri, Francesca Robasto, Francesco Licciardi, Francesco Del Monte, Franca Fagioli","doi":"10.1056/EVIDmr2500149","DOIUrl":"10.1056/EVIDmr2500149","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 previously healthy 7-year-old girl who presented with leg pain and a limp for 6 weeks without any preceding trauma. Using questions, physical examination, and testing, an illness script for the presentation emerges. As the clinical course progresses, the differential is refined, a diagnosis is achieved, and a management plan is developed.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDmr2500149"},"PeriodicalIF":11.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038428","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":"Andes Hantavirus Outbreak on a Cruise Ship, 2026.","authors":"","doi":"10.1056/EVIDpha2600170","DOIUrl":"10.1056/EVIDpha2600170","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600170"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147984606","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":"Severe Pneumonia in Low- and Middle-Income Countries - A Gap We Can Close.","authors":"Leticia Helms, Lisa M Bebell","doi":"10.1056/EVIDe2600111","DOIUrl":"https://doi.org/10.1056/EVIDe2600111","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDe2600111"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037774","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":"From Static to Dynamic - Refining MDS Risk through Clonal Evolution.","authors":"Guru Subramanian Guru Murthy, Sameem Abedin","doi":"10.1056/EVIDe2600129","DOIUrl":"https://doi.org/10.1056/EVIDe2600129","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDe2600129"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038491","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":"Beyond Equal Weighting - A Step Toward Incorporating Patient Preferences in Atrial Fibrillation Trials.","authors":"Sachin J Shah","doi":"10.1056/EVIDe2600092","DOIUrl":"https://doi.org/10.1056/EVIDe2600092","url":null,"abstract":"","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDe2600092"},"PeriodicalIF":0.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038471","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":"Detection of a Single Measles Infection Using Untargeted Ultra-Deep Metagenomic Sequencing of Wastewater in Cook County, Illinois.","authors":"Rachel S Poretsky, Vineet K Dhiman, Dylan L Hendricks, Chi-Yu Lin, Dolores Sanchez Gonzalez, Stephanie Greenwald, Sarah M Owens, Charles H Williams, Matthew T Leslie, Kelley Bemis, Mabel Frias, Jeff T Kaufman, David H O'Connor, Marc C Johnson","doi":"10.1056/EVIDpha2600079","DOIUrl":"10.1056/EVIDpha2600079","url":null,"abstract":"<p><p>AbstractMeasles is a contagious, vaccine-preventable viral disease that can be shed into wastewater by infected individuals. In September 2025, as part of an ongoing, nontargeted, ultra-deep metagenomic sequencing effort of wastewater in Cook County, Illinois, we detected measles reads from a facility serving more than 1 million people. Out of more than 900 million reads sequenced from wastewater collected on September 14, 2025, 43 matched measles virus genotype B3. Subsequent genomic analysis linked these reads to a confirmed measles infection that was present in the community on that day, demonstrating that untargeted metagenomics appeared to detect a single measles infection in a large municipal wastewater stream.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":" ","pages":"EVIDpha2600079"},"PeriodicalIF":11.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823823","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":"Prognostic Score for Myelodysplastic Syndromes Based on Molecular Evolution.","authors":"Ivan Civettini, Federica Malighetti, Matteo Villa, Valentina Crippa, Andrea Aroldi, Fabrizio Cavalca, Alex Graudenzi, Luca Lanino, Giulia Maggioni, Torsten Haferlach, Pierre Fenaux, Uwe Platzbecker, María Díez-Campelo, Lorenza Maria Borin, Monica Fumagalli, Arianna Zappaterra, Beatrice Manghisi, Najla H Al Ali, David A Sallman, Eric Padron, Zhuoer Xie, Onyee Chan, Amer M Zeidan, Luca Mologni, Rocco Piazza, Rami S Komrokji, Matteo Giovanni Della Porta, Carlo Gambacorti-Passerini, Daniele Ramazzotti","doi":"10.1056/EVIDoa2500124","DOIUrl":"10.1056/EVIDoa2500124","url":null,"abstract":"<p><strong>Background: </strong>Myelodysplastic syndromes are clonal hematopoietic stem cell disorders characterized by multistep molecular evolution and a variable risk of leukemic transformation. Given this prognostic heterogeneity, accurate risk stratification is essential for clinical decision-making. We developed ProgEvo, a proprietary framework that infers molecular evolutionary trajectories and integrates them with clinical data to improve prognostic accuracy.</p><p><strong>Methods: </strong>ProgEvo was trained on 2519 patients in cBioPortal (https://www.cbioportal.org) and validated using two external cohorts: Genomed4All (2043 patients) and a Moffitt Cancer Center (MCC) cohort (2157 patients). Directional evolutionary routes were inferred and selected for prognostic modeling if they were consistently associated with leukemia-free survival. A multivariable feature selection strategy was applied to integrate evolution-consistent variables into the existing IPSS-M model.</p><p><strong>Results: </strong>ProgEvo identified 1765 gene co-occurrences aggregated into 45 directional evolutionary routes. Of these, 18 were validated in the Genomed4All cohort. Five evolution-informed variables, two directional routes (Additional Sex Combs-Like 1 [<i>ASXL1</i>]→KRAS Proto-Oncogene [<i>KRAS</i>] and Serine and Arginine-Rich Splicing Factor 2 [<i>SRSF2</i>]→NRAS Proto-Oncogene [<i>NRAS</i>]), one co-occurrence (<i>NRAS/</i>RUNX Family Transcription Factor 1 [<i>RUNX1</i>]), and two early mutations (<i>ATRX</i> [ATRX Chromatin Remodeler] and Janus Kinase 2 [<i>JAK2</i>]) were integrated into IPSS-M to generate IPSS-M-Evo. The model with \"-Evo\" improved discrimination for both leukemia-free survival and overall survival, with over 40% of patients restratified in the Genomed4All data. The performance of the model was further confirmed in the MCC cohort.</p><p><strong>Conclusions: </strong>ProgEvo enabled inference of a molecular evolution model and integration of evolution-informed covariates into clinical prognostic frameworks, supporting the development of the IPSS-M-Evo model. A free web-based tool allows clinicians to calculate the IPSS-M-Evo score and match individual mutational profiles to cohort-derived evolutionary trajectories (https://evoclin.unimib.it/tools/evolution-graphs.html and https://evoclin.unimib.it/tools/ipssmevo.html). (Funded by the European Union and others.).</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDoa2500124"},"PeriodicalIF":11.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148038553","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":"The Landscape of Genetically Driven Immune Disorders.","authors":"Xiao P Peng, Jo L Wilson, Dusan Bogunovic","doi":"10.1056/EVIDra2400377","DOIUrl":"10.1056/EVIDra2400377","url":null,"abstract":"<p><p>AbstractThe increasingly widespread use of genetic diagnostic testing has shed light on genetic architectures, landscapes, and paradigms corresponding to the clinical and immune features of genetically driven immune disorders, but this wealth of information has also contributed additional layers of complexity for patient diagnosis and care. This review discusses concepts related to genetically driven immune disorders as they apply to current diagnostic and management strategies to help clinicians navigate these complexities.</p>","PeriodicalId":74256,"journal":{"name":"NEJM evidence","volume":"5 6","pages":"EVIDra2400377"},"PeriodicalIF":11.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148037791","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}