Cleveland Clinic journal of medicine
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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.
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The initial evidence supporting the prone position in non-ventilated awake patients with COVID-19 infection was anecdotal and theoretical. However, several early studies support the potential role of this practice to improve oxygenation, improve clinical outcomes, and reduce the need for intensive care admission. Although there is not a set amount of time that has been proven to be optimal for awake proning, we recommend sessions of 2 to 3 hours for at least a total 4 to 5 hours a day as tolerated based on the existing data and our anecdotal experience. Despite the low-risk and low-cost nature of proning awake patients, there are still logistical concerns that may prevent adequate proning, the most significant of which is patient comfort and compliance.
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Information about the clinical presentation and course of COVID-19 is evolving rapidly. On presentation, cough and fever predominate, but extrapulmonary symptoms are also common; in some patients, loss of sense of smell may be an early but favorable sign. ⋯ Risk factors for severe disease and death include comorbid conditions such as hypertension, cardiovascular disease, diabetes mellitus, and chronic obstructive pulmonary disease. Other implicated factors include older age, obesity, end-stage renal disease, and a higher neutrophil-lymphocyte ratio.