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Complete Issue (PDF) VOLUME 87 • NUMBER 7 • JULY 2020 • www.ccjm.org Interpreting ISCHEMIA COVID-19 Short QT and sudden cardiac death Brief perspectives from the front line Steroids and osteoporosis • Cytokine storm: Devices that lower blood pressure Prospects for treatment Documentation and Medicare • Clinical presentation and course of COVID-19 Mönckeberg medial sclerosis • More at Curbside Consults A fi rm lesion on the thigh www.ccjm.org EDITORIAL STAFF ADVERTISING Brian F. Mandell, MD, PhD, Editor in Chief Sima Sherman, Director of Sales and Marketing Pelin Batur, MD, Deputy Editor SHERMAN MEDICAL MARKETING GROUP Craig Nielsen, MD, Deputy Editor 1628 John F. Kennedy Blvd., #2200, Philadelphia, PA 19103 Kristi Thomsen, Executive Editor (610) 529-0322 • [email protected] Ray Borazanian, Managing Editor David A. 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Only the AMA can update changes of address and other data. EDITORS EMERITI John D. Clough, MD Herbert P. Wiedemann, MD SUBSCRIPTIONS, EDITORIAL, BILLING, AND PRODUCTION James S. Taylor, MD 1950 Richmond Rd., TR404, Lyndhurst, OH 44124 • Phone (216) 444-2661 • Fax (216) 444-9385 • [email protected] • www.ccjm.org CLEVELAND CLINIC Tom Mihaljevic, MD Cleveland Clinic Journal of Medicine [ISSN 0891-1150 (print), ISSN President and Chief Executive Offi cer 1939-2869 (online)] is published monthly by Cleveland Clinic at 1950 Richmond Rd., TR404, Lyndhurst, OH 44124. CLEVELAND CLINIC EDUCATION INSTITUTE James K. Stoller, MD, MS, Chairman COPYRIGHT© 2020 THE CLEVELAND CLINIC FOUNDATION. Steven Kawczak, PhD, Senior Director, Professional ALL RIGHTS RESERVED. PRINTED IN U.S.A. Development and Knowledge Resources DISCLAIMER Statements and opinions expressed in the Cleveland Clinic Journal of Medicine are those of the authors and not necessarily of Cleveland Clinic or its Board of Trustees. CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 87 • NUMBER 7 JULY 2020 377 JULY 2020 TABLE OF CONTENTS FROM THE EDITOR ............................................................................ Cytokines and the still-baffl ing 381 clinical biology of COVID-19 The primary culprit is not certain. Is it all immune damage, or is the continued persistence of coronavirus playing a role? Online Brian F. Mandell, MD, PhD Features COVID-19 CURBSIDE CONSULT ........................................................... Clinical presentation and course of COVID-19 384 Access Information about the clinical presentation and course Cleveland Clinic Journal of Medicine of COVID-19 is rapidly evolving. content is readily available to all and Ryan Miller, DO; Kristin Englund, MD is free of charge at www.ccjm.org. Cytokine storm and the prospects 389 Services for immunotherapy with COVID-19 • Navigate quickly to articles in current and past issues via links and Despite gaping holes in our knowledge, treatment is evolving. pull-down menus at the top of the Leonard H. Calabrese, DO home page. Use the search function to fi nd a specifi c article, or use the THE CLINICAL PICTURE ...................................................................... pull-down content menu to browse Firm lesion on the lateral thigh 394 articles. A 41-year-old man presented with concern about a lesion • Continuing medical education he had fi rst noticed 6 years earlier. and maintenance of certifi cation activities are accessible from the Morteza Khodaee, MD, MPH; Eric Kim, MD, PhD CME/MOC pull-down menu on the Mönckeberg medial sclerosis 396 home page. Participation is free. A man with chronic kidney disease presents with pain • Follow links on the home page to and ulceration of the fi ngers. a calendar of upcoming CME events. Anthony Stack, DO; Sandra Sheffield, DO; Karan Seegobin, MBBS; • Click on the PDF symbol at the Satish Maharaj, MBBS top of any online article to read, download, or print the article in PDF 1-MINUTE CONSULT .......................................................................... format. Does a short QT interval increase the risk 398 Social Networking of cardiac death in healthy people? To post a CCJM article to Facebook No, but it may warrant further investigation to determine or Twitter, just click on the icon at if the patient is at risk. the top of any online article. Ahmed Subahi, MD; Ahmed S. Yassin, MD; Oluwole Adegbala, MD; Mohamed Shokr, MD; Luis Afonso, MD www.ccjm.org INTERPRETING KEY TRIALS ................................................................ The role of ISCHEMIA 401 in stable ischemic heart disease Decisions regarding treatment of stable ischemic heart disease must remain individualized. Nikolaos Spilias, MD; Benjamin Zorach, MD; Kara Denby, MD; Stephen Ellis, MD CONTINUED ON PAGE 380 378 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 87 • NUMBER 7 JULY 2020 JULY 2020 Upcoming CONTINUED FROM PAGE 378 Features COMMENTARY .................................................................................. Stable coronary artery disease: 410 ■ Troponin measurement Intervene or not? in acute coronary syndrome Stable coronary artery disease needs a patient-centered approach, and one size does not fi t all. Vinayak Nagaraja, MBBS, MS, MMed (Clin Epi), FRACP; ■ COVID-19 and coagulopathy A. Michael Lincoff, MD ■ Pneumonia REVIEW ...........................................................................................CME MOC in alcohol use disorder Glucocorticoid-induced osteoporosis: 417 Insights for the clinician Glucocorticoids cause signifi cant bone loss, predominantly ■ Rhinosinusitis: affecting trabecular bone, with consequent fragility fractures. The role of imaging Shakaib Hayat, MD; Marina N. Magrey, MD ■ HPV and cervical cancer REVIEW ...........................................................................................CME MOC Optimize your documentation 427 ■ to improve Medicare reimbursement Current asthma guidelines There’s nothing more frustrating than not getting credit for work performed. ■ Aneurysm surveillance: Ecler Ercole Jaqua, MD; Robert Chi, MD; Wessam Labib, MD, MPH; Thoracic, renal, splenic Marcos Uribe, MD; Juan Najarro, MD; Mary Hanna, MD ■ Weight-loss drugs: REVIEW ...........................................................................................CME MOC What are the barriers? Procedures and devices to treat 435 resistant hypertension in chronic kidney disease These treatments show potential. All but renal artery stenting are still experimental. Rama Dilip Gajulapalli, MD; Johnny Chahine, MD; Florian Rader, MD; Ashish Aneja, MD EDITORIAL ....................................................................................... Device-based therapies for resistant 444 hypertension in chronic kidney disease: The continuing quest for a cure Device-based therapies have shown promise, but many points still need clarifi cation. George Thomas, MD DEPARTMENTS ................................................................................
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