The American journal of medicine
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A wide array of products in the category of complementary or alternative medicine for cardiovascular disease and prevention are readily available on online retail platforms. However, a critical assessment of these products, including their therapeutic claims, has not been previously performed. ⋯ Given the popularity of complementary and alternative medicine and their easy accessibility through online retailing, and the fact that prior studies suggest a minority of patients discuss use with their providers, further study is needed to evaluate the extent of and the potential for both undiagnosed drug-drug interactions and replacement of guideline-directed medical treatment for heart failure with unapproved products.
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Persistence of COVID-19 symptoms may follow severe acute respiratory syndrome coronavirus 2 infection. The incidence of long COVID increases with the severity of acute disease, but even mild disease can be associated with sequelae. ⋯ Elevated levels of complement are present in acute COVID-19 patients and may persist at lower levels in long COVID. Evidence supports complement activation, with endotheliopathy-associated disease as the molecular mechanism causing both acute and long COVID.
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Review Comparative Study
Comparability of control and comparison groups in studies assessing long COVID.
Awareness of long coronavirus disease (COVID) began primarily through media and social media sources, which eventually led to the development of various definitions based on methodologies of varying quality. We sought to characterize comparison groups in long COVID studies and evaluate comparability of the different groups. ⋯ Long COVID studies in high-impact journals primarily examine symptoms and risk factors of long COVID; often lack an adequate comparison group and often do not control for potential confounders. Our results suggest that standardized definitions for long COVID, which are often based on data from uncontrolled and potentially biased studies, should be reviewed to ensure that they are based on objective data.
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While there has been a decline in the use of digoxin in patients with heart failure and atrial fibrillation, acute and chronic digoxin toxicity remains a significant clinical problem. Digoxin's narrow therapeutic window and nonspecific signs and symptoms of toxicity create clinical challenges and uncertainty around the diagnostic criteria of toxicity and responsive treatment choices for the bedside clinician. ⋯ The results demonstrate agreement about the need to consider time of ingestion and nature of the exposure (ie, acute, acute-on-chronic, chronic) and the use of digoxin immune Fab for life-threatening exposure to decrease risk of death. While several areas of continued uncertainty were identified, this work offers formalized guidance that may help providers better manage this persistent clinical challenge.