Charité Clinical Journal Club (English) by Fred Luft - 06.03.2019

The N Engl J Med image of the week concerns an otherwise healthy 9-year-old girl presented to the primary care clinic with a sore throat and fever. Her temperature was 38.5°C. Physical examination revealed swollen and tender cervical lymph nodes, an inflamed uvula, enlarged tonsils, and “doughnut” lesions on both the hard and soft palates. What is the underlying cause? You are offered group A streptococcus, Epstein-Barr virus, adenovirus, measles virus, and Neisseria gonorrhea. Hypoxemia is the most common complication during tracheal intubation of critically ill adults and may increase the risk of cardiac arrest and death. Whether positive-pressure ventilation with a bag-mask device (bag-mask ventilation) during tracheal intubation of critically ill adults prevents hypoxemia without increasing the risk of aspiration remains controversial. In a multicenter, randomized trial conducted in seven intensive care units in the United States, investigators randomly assigned adults undergoing tracheal intubation to receive either ventilation with a bag-mask device or no ventilation between induction and laryngoscopy. The primary outcome was the lowest oxygen saturation observed during the interval between induction and 2 minutes after tracheal intubation. Bagging did no harm and may have helped. Systematic pelvic and paraaortic lymphadenectomy has been widely used in the surgical treatment of patients with advanced ovarian cancer, although supporting evidence from randomized clinical trials has been limited. Investigators intraoperatively randomly assigned patients with newly diagnosed advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage IIB through IV) who had undergone macroscopically complete resection and had normal lymph nodes both before and during surgery to either undergo or not undergo lymphadenectomy. All centers had to qualify with regard to surgical skills before participation in the trial. The primary end point was overall survival. Lymphnode dissection did not improve survival but instead seemed to cause harm. Central centrifugal cicatricial alopecia (CCCA) is the most common form of scarring alopecia among women of African ancestry. The disease is occasionally observed to affect women in families in a manner that suggests an autosomal dominant trait and usually manifests clinically after intense hair grooming. Investigators sought to determine whether there exists a genetic basis of CCCA and, if so, what it is. They used exome sequencing in a group of women with alopecia (discovery set), compared the results with those in a public repository, and applied other filtering criteria to identify candidate genes. They then performed direct sequencing to identify disease-associated DNA variations and RNA sequencing, protein modeling, immunofluorescence staining, immunoblotting, and an enzymatic assay to evaluate the consequences of potential etiologic mutations...