Cleveland Clinic journal of medicine
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Hydroxychloroquine (HCQ) has multiple potential antiviral mechanisms of action that differ according to the pathogen studied (eg, Chikungunya, Dengue virus, human immunodeficiency virus, poliovirus, Zika virus). Data on HCQ for treatment of COVID-19 are rapidly evolving. ⋯ There are also no clinical trial data supporting prophylactic HCQ therapy in COVID-19. Use of HCQ in patients with COVID-19 is being investigated for prophylaxis, postexposure prophylaxis, and treatment.
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Asthma is highly prevalent and sometimes deadly, especially in certain groups. The 2019 Global Initiative for Asthma (GINA) guidelines recommend that all asthma patients be treated with inhaled corticosteroids taken daily or as needed; this improves symptoms and outcomes, even in those with mild disease. Further, asthma management requires a stepwise approach, escalating and de-escalating treatment based on symptom control.
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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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Aneurysm of the thoracic aorta is less common than in the abdominal aorta, but it is clinically important because of the risk of rupture and death. Cases are often found incidentally. Indications for surgical or endovascular repair are based on aneurysm location and risk factors for rupture such as aneurysm size, rate of growth, and associated conditions, while medical management is also important. Surveillance with various imaging tests is critical before and after intervention to guide treatment.