Cleveland Clinic journal of medicine
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Polymyalgia rheumatica should be suspected in older patients with bilateral shoulder and hip stiffness that is worse in the morning and improves with use. An array of nonspecific musculoskeletal complaints, constitutional symptoms, and elevated serum inflammatory markers may be present, so other conditions should also be considered. Prolonged glucocorticoids with patient-tailored dosing and duration are the mainstay of treatment. Corticosteroid-sparing therapy with adjunctive methotrexate may benefit select patients.
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COVID-19 management practices devised for the medical intensive care unit are centered on 2 main goals: ensuring caregiver safety and providing the highest quality patient care through adherence to evidence-based best practices. Rapid, sweeping changes for successful management are based on creating an educational platform to introduce and then further cement these concepts through a unified approach to clinical care. Creating a culture change in a short period of time requires overcoming a host of challenges; however, the result is a more unified and focused approach.
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Acute cardiac injury, defined as an elevated high-sensitivity troponin I or troponin T upon admission or during hospitalization, is common in patients with COVID-19, occurring in 10% to 35% of patients depending on the assay used and the population studied. Even though the mechanisms of SARS-CoV-2 myocardial injury are not well defined, type 1 myocardial infarction and fulminant myocarditis are rare. Often, acute cardiac injury occurs in patients with elevated inflammatory markers, and both are associated with worse outcomes. However, the extent to which treatments should differ for patients with acute cardiac injury, heightened systemic inflammation, or both, is unknown.