Three patients who received visceral-organ transplants from one donor on the same day died of febrile illness 4 to 6 weeks after transplantation. When all available techniques had not indicated whether an infectious agent was the cause, the investigators turned to unbiased high-throughput gene sequencing. Analysis of deduced protein sequences led to identification of a new donor-derived arenavirus as the culprit.

Variants of the genes CYP2C9 and VKORC1 contribute to differences in the anticoagulant effect of warfarin among patients. The relative roles of these variants were studied in a cohort of 297 patients starting warfarin therapy. Although both genes influenced the response to warfarin over time, only the VKORC1 haplotype had a significant effect on the initial response.

In this case series of 23 adults in Latvia who were injection users of methcathinone (a drug manufactured by users from readily available pharmaceutical agents such as pseudoephedrine), patients had an extrapyramidal syndrome, elevated serum manganese levels, and MRI abnormalities in the basal ganglia. These findings suggest that methcathinone use can result in neurologic toxic effects from manganese contained in the methcathinone solution.

The autoimmune polyendocrine syndrome type 1 (APS-1) is a multiorgan autoimmune disorder caused by mutations in AIRE, the autoimmune-regulator gene. The authors identified reactivity to the NACHT leucine-rich-repeat protein 5 (NALP5) by immunoscreening a human parathyroid complementary DNA library, using serum samples from patients with APS-1 and hypoparathyroidism. The findings suggest that NALP5 is a tissue-specific autoantigen involved in hypoparathyroidism in patients with APS-1.

A 45-year-old woman reports leaking urine with coughing, laughing, or sneezing since the birth of her last baby. She has been unable to lose the 25 lb (11 kg) that she gained after that pregnancy. She voids every 3 hours and reports no urinary urgency or nocturia. Her incontinence keeps her from participating in her exercise class, and she leaks urine during sexual intercourse. Her body-mass index is 28, and a routine pelvic examination is normal. How should she be evaluated and treated?

Acute pulmonary embolism may occur rapidly and unpredictably and may be difficult to diagnose. Treatment can reduce mortality, and appropriate primary prophylaxis is usually effective. This review focuses on the pathogenesis, diagnosis, and treatment of acute pulmonary embolism of thrombotic origin.

An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting. She also reported increasing shortness of breath and fatigue, which had become worse over the past several weeks. She had a history of congestive heart failure, mitral regurgitation, hypertension, atrial fibrillation, hypothyroidism, peptic ulcer disease, and depression. She had no history of coronary artery disease or cardiac surgery.

Patients with chronic illness often receive care from multiple providers in multiple settings and require coordination of their complex care. This report assesses the quality of the coordination of care, describes barriers to coordinated care, and discusses some solutions to improve care coordination in the United States.