The first consensus recommendations on the topic aim to address variation in diagnosis at the international, national, and local levels.

Sponsoring Organization: World Brain Death Project, assisted by international professional societies including the World Federation of Intensive and Critical Care, World Federation of Pediatric Intensive and Critical Care Societies, World Federation of Neurology, World Federation of Neurosurgery, and the World Federation of Critical Care Nurses.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CNS-GLB-1691

A strong relationship was seen in both women and men, irrespective of the presence of PFO.

Previous studies have evaluated some of the complex relationships among cryptogenic stroke, migraine, and patent foramen ovale (PFO) and suggested the following: Migraine is associated with ischemic stroke, migraine with aura is associated with the presence of PFO, and the association between mi-graine and cryptogenic ischemic stroke is stronger among patients with PFO than without. 

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CNS-GLB-1694

A machine-learning algorithm robustly differentiates two neuroanatomical patterns in patients diagnosed with schizophrenia, but associated clinical features were few. 
The psychiatric disorders grouped as schizophrenia are known for their clinical heterogeneity and highly diverse patterns in brain abnormalities on neuroimaging. 

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CNS-GLB-1605

A large study of older veterans finds a nearly twofold increase in risk for dementia following diagnosis of late-onset seizures without known cause. 
Do late-adult-onset seizures have an association with risk for dementia or just reflect an independent cause without concern for a degenerative disease?

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CNS-GLB-1604

Hypertensive disorders of pregnancy and low birth weight carry the greatest risk. 
Investigators have previously found an association between adverse pregnancy outcomes and future cardiovascular risk. 

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CVP-GLB-0376

Systemic Racism, Healthcare Disparities, and the Social Determinants of Health. 
The national conversation about systemic racism on a broad societal level has direct corollaries in healthcare. The coronavirus pandemic has exacerbated what were known to be large disparities across society in health and healthcare. 
 

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-IMU-GLB-0064

An algorithm developed with artificial intelligence was applied to electrocardiograms of patients presenting with dyspnea to the emergency department. 
New articles about artificial intelligence–related decision-support tools are being published at a rapid pace. 

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CVP-GLB-0370

In patients with type 2 diabetes, less-processed whole-grain products are associated with lower postprandial glucose levels.
Dietary recommendations for patients with diabetes include consumption of whole-grain foods. However, whole-grain foods differ in the extent to which they are processed: For example, wheat, brown rice, and oats can be finely milled or less processed.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-IMU-GLB-0057

CT angiography might be useful to personalize decision-making about preventive therapies in low- or intermediaterisk patients.
Coronary computed tomography angiography (CCTA) can assess the degree and progression of coronary atherosclerosis and higher-risk plaque features, such as remodeling of the blood vessel wall, low attenuation lesions, and spotty calcification.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CVP-GLB-0372

Iron deficiency is a common, delayed consequence of malabsorptive weight-loss surgery, especially in younger women.
Bariatric surgery can reduce the impact of obesity-associated comorbidities, but it increases the risk for iron deficiency (ID) and iron deficiency anemia (IDA).

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-IMU-GLB-0058

A meta-analysis indicates that almost two thirds of women have another psychotic episode, predominantly outside the postpartum period.
Postpartum psychosis denotes a severe mood disorder episode having psychotic, manic, or mixed affective symptoms and occurring within the first few weeks after childbirth.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CNS-CHL-0022

During 2 years of follow-up, most cases resolved, but one quarter developed into chronic inflammatory disease.
The differential diagnosis of recent-onset monoarthritis is broad and includes early presentation of what eventually is identifiable as chronic inflammatory rheumatic disease (CIRD),

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-PPF-CHL-0016

In the laboratory, median nerve stimulation reduced tic frequency and intensity and premonitory sensorimotor urges to tic.
Tourette syndrome (TS) is a neuropsychiatric disorder marked by involuntary tics, often associated with premonitory urges. Current treatments, including medications and psychological interventions, are often inadequate.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CNS-CHL-0021

In a prospective 4-year study, more of those with elevated cytokine levels had evidence of disease activity.

Although multiple sclerosis (MS) is often considered a disease of the white matter, appreciation is growing that pathology also directly affects the cortex.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM

Código de aprobación: PP-CNS-CHL-0019

Letter from the Editor

This collection (a seminal study from Denmark and several summaries of related studies along the medical-psychiatric interface) reminds us that the mind and body are continually interacting and affecting one another.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-CNS-CHL-0018

Low-to-moderate physical activity might be protective.

Patients and some clinicians still are concerned that physical activity, particularly vigorous physical activity, might be associated with excess risk for knee osteoarthritis (OA), despite considerable evidence to the contrary.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-PPF-CHL-0008

Many diagnoses are missed using serum aldosterone and renin levels alone.

Guideline-recommended screening for primary aldosteronism in patients with resistant hypertension usually is accomplished by measuring serum aldosterone-renin ratio (ARR); however, screening rates are very low, and ARR might have low sensitivity for disease detection (J Clin Endocrinol Metab 2016; 101:1889).

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-IMU-CHL-0006

Acute coronary syndrome is infrequent, presents most often as non-STEMI, but is associated with high early mortality.

Although as many as 50% of patients who undergo transcatheter aortic-valve replacement (TAVR) have known coronary artery disease, the incidence of acute coronary syndrome (ACS) after TAVR is unknown.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-CVP-CHL-0005

Self-ratings of higher stress coping ability correlated with lower tau burden on brain scans in older adults.

The relationship between psychological stress and neurodegenerative syndromes has been established clinically.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-CNS-CHL-0009

Remote sessions might become a convenient alternative to traveling for face-to-face care.

Telehealth programs are both cost-effective and more convenient alternatives to in-person interventions in people with dementia, especially as the dementia progresses.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-CNS-CHL-0007

Greater BP variability in early adulthood correlated with worse echocardiographic features at middle age. Visit-to-visit blood pressure variability (BPV) has been associated with adverse cardiovascular outcomes, independent of BP level. To understand if BPV in early adulthood is associated with later subclinical alterations in cardiac structure and function, researchers used data from a U.S.-based community cohort study (CARDIA) in which participants aged 18 to 30 at enrollment underwent eight BP evaluations over 25 years of follow-up and an echocardiogram at year 25.

NEJM Journal Watch

Long-term elevated blood pressure was responsible for greater cognitive decline in black Americans than in white Americans.

Black people, on average, experience earlier onset of elevated blood pressure (BP) and poorer control of BP throughout life than do white people. To establish whether blood pressure is associated with the observed earlier onset of cognitive impairment and faster decline in cognition in black patients, investigators performed a pooled cohort study of almost 20,000 patients (median age at study entry, 55; 20% black [self-reported]).

NEJM Journal Watch summary,

A study using a Mendelian randomization design finds causal associations between elevated total cholesterol and LDL levels and AS.

To date, aortic stenosis (AS) has no recommended prevention strategies, and statins have failed to slow disease progression in randomized trials. However, questions remain about whether dyslipidemia is associated with the condition.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-UMC-CHL-0034

Using MRI to score cerebral small-vessel disease may help predict dementia.

Cerebrovascular disease increases the risk for dementia. To determine whether an MRI score for cerebral small vessel disease (SVD) can assist in the prediction of dementia, investigators examined MRI scans from participants in three longitudinal cohorts. Participants’ SVD ranged from mild and asymptomatic to severe and symptomatic.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-UMC-CHL-0032

Letter from the Editor
In the past decade, there has been a powerful shift toward the use of transcatheter aortic valve replacement (TAVR) for patients with severe symptomatic aortic stenosis.

The 2018 European Society of Cardiology/ European Society of Hypertension Guidelines for the management of arterial hypertension raised the need for evidence to support the use of single-pill combination (SPC) therapy in preference to free-dosed therapy for hypertension. This systematic rapid evidence assessment sought to determine if initiating SPC therapy improves adherence, blood pressure (BP) control and/or cardiovascular outcomes vs. initiation of free-dose combination therapy.

Código de aprobación: PP-UMC-CHL-0008

Researchers in China find heightened short-term risks for cardiovascular hospitalizations.
Studies are accumulating about the relationship between air quality and cardiovascular risk. Because air quality in many areas of the world is deficient, we need to quantify the health effects at levels exceeding those that have been designated as safe, particularly with respect to short-term exposure.

A long-term study suggests so.
Researchers sought to uncover a potential relationship between physical activity and prodromal features of Parkinson disease (PD) — features that precede the clinical diagnosis — using the Nurses’ Health Study and the Health Professionals Follow-Up Study. Participants were followed from 1986 through 2012, with assessments at baseline and longitudinally at many consecutive 24-month periods thereafter.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-MCM-CHL-0190

In 2010, itwas estimated that more than 200million peopleworldwide were living with peripheral arterial disease. Chronic limbthreatening ischemia (CLTI) represents the end stage of peripheral arterial disease, which, left untreated, incurs a risk of major amputation, approaching 25%at 1 year.

© 2020 American Medical Association. All rights reserved. This journal and the individual contributions contained in it are protected under copyright by AMA, and the following terms and conditions apply to their use. JAMA® is a registered trademark of AMA, used under license.

Catheter-based edge-to-edge repair may provide benefit, according to results from a preliminary single-arm trial.
Tricuspid regurgitation (TR), a common form of valvular heart disease, frequently results from right ventricular dilatation and leaflet tethering, leading to malcoaptation of the leaflets. TR has been associated with poor long-term survival and with impaired response to correction of left-sided cardiac pathology.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-MCM-CHL-0187

Optical sensors on wearable devices can detect irregular pulses. The ability of a smartwatch application (app) to identify atrial fibrillation during typical use is unknown.
Participants without atrial fibrillation (as reported by the participants themselves) used a smartphone (Apple iPhone) app to consent to monitoring. If a smartwatchbased irregular pulse notification algorithm identified possible atrial fibrillation,

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-MCM-CHL-0181

Multiple stress disorders, but most strongly post-traumatic stress disorder, increase the risk for serious infections.
The poor physical health of individuals with post-traumatic stress disorder (PTSD) is presumed to occur through the stress-related compromise of multiple physiological systems producing an excess of somatic complaints and bona fide medical illnesses.

NEJM Journal Watch summary, reutilizado con permiso del Grupo NEJM.

Código de aprobación: PP-ZOL-CHL-0030

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Perspectivas futuras para el tratamiento de los trastornos de ansiedad

La ansiedad por el estado de salud o hipocondría, es una experiencia que surge cuando se cree que las sensaciones o los cambios corporales son indicativos de una enfermedad grave. Aunque la hipocondría se clasifica en el DSM - IV como un trastorno somatomorfo, se han sugerido varias alternativas para su clasificación. Estas incluyen, por ejemplo, la reclasificación como un trastorno de ansiedad, como parte de los trastornos del espectro obsesivo compulsivo, o como un nuevo trastorno somatomorfo complejo.

El rol de la terapia cognitivo conductual en la depresión

Aunque se tiende a pensar en la depresión como un trastorno tratable, las tasas de remisión no son tan impresionantes. Se estima que sólo 1 de cada 3 pacientes remitirá después de un esquema breve de tratamiento, que dura varios meses; y sólo 2 de cada 3 remitirá después de un tratamiento prolongado, que dura hasta un año. Por lo que se han realizado múltiples estudios en los que se evidencia la importancia de la terapia cognitivo conductual (TCC) asociada a la terapia farmacológica en pacientes con depresión.