Cleveland Clinic journal of medicine
-
Pregnant women are also affected by COVID-19, with infection rates similar to nonpregnant women. Labor and delivery by a women with COVID-19 presents unique challenges for ensuring the safety of the mother, fetus, and newborn as well as the safety of clinicians and other healthcare personnel. In this article, we present perinatal obstetric anesthetic management strategies derived from the best available evidence to provide guidance in caring for the obstetric patient with COVID-19.
-
Vaccine-induced thrombotic thrombocytopenia (VITT) has been reported after vaccination with the AztraZeneca ChAdOx1 nCoV-19 and the Johnson and Johnson Ad26. COV2. ⋯ This manuscript provides a brief overview of reported cases, clinical and laboratory features, and current understanding of the pathogenesis of VITT. The author also poses unananswered questions and identifies directions for future study.
-
Coronary revascularization has matured as a field since coronary artery bypass grafting (CABG) was first developed over 50 years ago, with diagnostic and treatment methods having advanced dramatically. CABG remains the standard of care for obstructive coronary artery disease, particularly for patients with multivessel disease or diabetes. It is now recognized that not all CABG is created equal-operative strategy, including conduit choice for bypass grafts and target coronary selection, affects survival. A multidisciplinary approach including surgeons with a special interest in CABG is recommended to optimize treatment selection and outcomes.
-
The percent of US children who are not vaccinated has been increasing, and so have the rates of communicable diseases. As the unvaccinated and undervaccinated population ages, practitioners are likely to see more adult patients who have never been vaccinated. This article reviews the recommendations for vaccinating previously unvaccinated patients and addresses potential barriers and concerns adult patients may have about vaccines.
-
The second-generation antipsychotic drug quetiapine (Seroquel) is increasingly being used off-label for treating insomnia in the general population, possibly to avoid standard medications with known addictive qualities and adverse side effects. However, evidence to support using it in this way is scant, and quetiapine is associated with weight gain and other metabolic effects. It must be used cautiously and with appropriate monitoring for adverse effects and abuse.