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Complete Issue (PDF) VOLUME 88 • NUMBER 8 • AUGUST 2021 • www.ccjm.org Autoimmune brain disease: Antiobesity drug therapy: Think before testing An individualized approach Vertebral body enhancement The obesity paradox, heart failure, and cardiorespiratory fi tness Subungual mucous cysts Antibody-mediated Eruptive seborrheic keratosis autoimmune encephalitis Alcohol use disorder in the elderly PICC insertion in patients with chronic kidney disease: Key considerations 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 Mary T. Cusick, MS, Executive Editor (610) 529-0322 • [email protected] David A. 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PRINTED IN U.S.A. CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 88 • NUMBER 8 AUGUST 2021 417 AUGUST 2021 TABLE OF CONTENTS FROM THE EDITOR ................................................................................................................ Autoimmune brain disease: Think before testing 420 Immune serologic tests are not specifi c for any defi ned clinical diagnosis and thus should not be used to drive therapeutic decisions. Brian F. Mandell, MD, PhD THE CLINICAL PICTURE .......................................................................................................... Pseudopathologic vertebral body enhancement 424 Contrast-enhanced computed tomography revealed sclerotic enhancement of the T1 vertebral body and the vertebral bodies from C2 to T2. Yi Pan, MD; Peixin Tan, MD; Songxi Xie, MD; Jiewen Chen, MMed; Yi-Long Wu, MD THE CLINICAL PICTURE .......................................................................................................... Shedding light on subungual digital mucous cysts 426 Transillumination is a quick and easy way to diagnose digital mucous cysts and rule out other subungual masses. Taylor Bullock, BS; Daniel Michalik, MD; Rashmi Unwala, MD; John Anthony, MD THE CLINICAL PICTURE .......................................................................................................... Eruptive seborrheic keratosis: A perilous clue 428 An abrupt increase in seborrheic keratoses in patients with an underlying malignancy is called the Leser-Trélat sign. Akanksha Kaushik, MD; Soufila KT, MD; Manju Daroach, MD; Divya Aggarwal, MD; Pulkit Rastogi, MD, DM; Muthu Sendhil Kumaran, MD, DNB 1-MINUTE CONSULT .............................................................................................................. Can I place a peripherally inserted central catheter 431 in my patient with chronic kidney disease? Future need for permanent dialysis access is an important consideration. Nora Hilda Hernandez Garcilazo, MD; Mohamed Hassanein, MD; Tushar J. Vachharajani, MD; Evamaria Anvari, MD CONTINUED ON PAGE 419 Upcoming Features ■ Teriparatide: Labeling changes, long-term dosing ■ Stress testing and noninvasive coronary imaging ■ Ketogenic diets for type 1 diabetes 418 CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 88 • NUMBER 8 AUGUST 2021 AUGUST 2021 CONTINUED FROM PAGE 418 1-MINUTE CONSULT .............................................................................................................. How do you effectively evaluate the elderly 434 for alcohol use disorder? A brief review of clues to an underrecognized and underdiagnosed problem with physical as well as emotional and social consequences. Moronkeji Fagbemi, MD, FASAM CURRENT DRUG THERAPY ...................................................................................................... Antiobesity drug therapy: An individualized 440 and comprehensive approach As part of a comprehensive plan, these drugs can provide lasting obesity control and additional health benefi ts, including decreased cardiovascular risk. Yael Mauer, MD, MPH; Marcie Parker, PharmD, BCACP; Sangeeta R. Kashyap, MD REVIEW ............................................................................................................................... The obesity paradox in heart failure: 449 What is the role of cardiorespiratory fi tness? What should these patients be advised about weight management and about cardiorespiratory fi tness, a major factor infl uencing the paradox? Asad Khan, MD; Erik H. Van Iterson, PhD; Luke J. Laffin, MD REVIEW ..............................................................................................................................CME MOC. Antibody-mediated autoimmune encephalitis: 459 A practical approach Symptoms may include subacute, progressive neuropsychiatric symptoms with associated cognitive dysfunction, movement disorders, and autoimmune seizures. Justin R. Abbatemarco, MD; Chen Yan, MD; Amy Kunchok, MBBS; Alexander Rae-Grant, MD, FAAN, FRCPC DEPARTMENTS ..................................................................................................................... CME Calendar 422 CME/MOC Instructions 472 Visit WWW.CCJM.ORG Test your knowledge of clinical topics CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 88 • NUMBER 8 AUGUST 2021 419 FROM THE EDITOR Autoimmune brain disease: Think before testing As a rheumatologist, I have the opportunity to see many patients in con- sultation for the evaluation of complex and often diffi cult-to-defi ne symp- toms. The buzzword referral diagnosis is frequently “autoimmune.” In 2021, autoim- mune is seemingly the evil humor or miasma of centuries past revisited, with the added distinction that there are laboratory tests that can be ordered that, if positive, seem to provide superfi cial evidence for the validity of this diagnosis. The problem is that many immune serologic tests are not specifi
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