Cleveland Clinic journal of medicine
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Although it is well established that adding early revascularization to optimal medical therapy reduces mortality and recurrent myocardial infarction in acute coronary syndrome, there is less convincing evidence to guide intervention in stable ischemic heart disease. This review summarizes the International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial, which investigated whether there is benefit from initial catheterization and possible revascularization in addition to optimal medical therapy in patients with at least moderate ischemia on stress testing.
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There's nothing more frustrating than not getting credit for work performed. Physicians often leave large amounts of compensation on the table, because even though services were provided, insurance payers do not recognize the work due to suboptimal documentation. This problem is especially apparent in preventive medicine and wellness visits with adult and geriatric patients, and results in physician services being undervalued. This article outlines specific documentation requirements for receiving full credit for the work already provided by most primary care physicians.
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Glucocorticoids cause significant bone loss, predominantly affecting trabecular bone, with consequent fragility fractures. The risk of fractures is related to the dose and duration of glucocorticoid use, but an increased risk may be observed even at low doses and even in the first month of treatment. Steps to prevent or treat osteoporosis should be considered in all patients who take the equivalent of prednisone at a dose of 2.5 mg or more per day for 3 or more months.
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Treatment of resistant hypertension is a challenge, especially in patients who have chronic kidney disease. The choice of medications may be limited in this group, making the possibility of device-based therapies attractive. We explore 4 devices and procedures available to treat this vexing issue.
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To date, there are no effective antiviral medications for COVID-19. Drug repurposing, a strategy that uses existing drugs, offers potential prevention and treatment options for COVID-19. ⋯ We also describe the pathobiology and immunologic characteristics of COVID-19 and highlight the rationale of combination drug treatment to rescue the pulmonary and cardiovascular conditions resulting from COVID-19. A preliminary analysis reveals a high potential for the synergistic effects of melatonin and toremifene to reduce viral infection and replication, and the aberrant host inflammatory responses, offering strong biologic plausibility as an effective therapy for COVID-19.