{"title":"Shortness of breath in a 52-year-old man with HIV and severe mitral regurgitation.","authors":"Felix Wangmang, Achilles Aiken, Kuang-Yuh Chyu","doi":"10.3949/ccjm.92a.24060","DOIUrl":"https://doi.org/10.3949/ccjm.92a.24060","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 1","pages":"23-30"},"PeriodicalIF":3.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sleep is like Rodney Dangerfield.","authors":"Brian F Mandell","doi":"10.3949/ccjm.92b.01025","DOIUrl":"https://doi.org/10.3949/ccjm.92b.01025","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 1","pages":"9-10"},"PeriodicalIF":3.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Roberto León-Barriera, Margaret M Chaplin, Jasleen Kaur, Vania Modesto-Lowe
Insomnia is a common and challenging complaint in older adults (> 65 years) because of age-related alterations in sleep physiology. Cognitive behavioral therapy for insomnia is the gold standard for treatment of insomnia in young as well as older patients. Both clinicians and patients often prefer the simplicity of medication, but risks associated with some hypnotics increase with age. Pharmacologic options for older adults include low-dose doxepin, melatonin, ramelteon, and the dual orexin receptor antagonists. A well-informed clinician can help patients navigate the risks and benefits of both pharmacologic and behavioral options.
{"title":"Insomnia in older adults: A review of treatment options.","authors":"Roberto León-Barriera, Margaret M Chaplin, Jasleen Kaur, Vania Modesto-Lowe","doi":"10.3949/ccjm.92a.24073","DOIUrl":"10.3949/ccjm.92a.24073","url":null,"abstract":"<p><p>Insomnia is a common and challenging complaint in older adults (> 65 years) because of age-related alterations in sleep physiology. Cognitive behavioral therapy for insomnia is the gold standard for treatment of insomnia in young as well as older patients. Both clinicians and patients often prefer the simplicity of medication, but risks associated with some hypnotics increase with age. Pharmacologic options for older adults include low-dose doxepin, melatonin, ramelteon, and the dual orexin receptor antagonists. A well-informed clinician can help patients navigate the risks and benefits of both pharmacologic and behavioral options.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 1","pages":"43-50"},"PeriodicalIF":3.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
More and more patients with atrial fibrillation are undergoing catheter ablation as a rhythm-control strategy, but the recurrence rate after the procedure is high. A wide array of risk factors contribute to the pathogenesis of atrial fibrillation, including hypertension, diabetes mellitus, dyslipidemia, obesity, obstructive sleep apnea, metabolic dysfunction-associated steatotic liver disease (MASLD), smoking, alcohol consumption, and physical inactivity. This review summarizes the emerging evidence for periablation risk-factor modification to optimize postablation outcomes.
{"title":"Risk-factor modification to prevent recurrent atrial fibrillation after catheter ablation.","authors":"Jack Hartnett, Nour Chouman, Eoin Donnellan","doi":"10.3949/ccjm.92a.24011","DOIUrl":"10.3949/ccjm.92a.24011","url":null,"abstract":"<p><p>More and more patients with atrial fibrillation are undergoing catheter ablation as a rhythm-control strategy, but the recurrence rate after the procedure is high. A wide array of risk factors contribute to the pathogenesis of atrial fibrillation, including hypertension, diabetes mellitus, dyslipidemia, obesity, obstructive sleep apnea, metabolic dysfunction-associated steatotic liver disease (MASLD), smoking, alcohol consumption, and physical inactivity. This review summarizes the emerging evidence for periablation risk-factor modification to optimize postablation outcomes.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 1","pages":"53-61"},"PeriodicalIF":3.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diabetic ketoacidosis (DKA) was historically considered a condition typical of type 1 diabetes. However, patients with type 2 diabetes may present with DKA, usually with higher blood glucose levels and milder ketoacidosis. With the increased use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, the variant euglycemic DKA has been described. SGLT-2 inhibitors cause a low level of ambient ketones; any additional ketone formation predisposes to ketoacidosis, while the agent's glycosuric effect limits hyperglycemia. The principles of DKA management are fluid administration, electrolyte control, and glucose control with insulin. In euglycemic DKA, the immediate use of a glucose-containing intravenous fluid induces endogenous insulin secretion and stops ketogenesis. Due to the half-life of SGLT-2 inhibitors, the duration of euglycemic DKA may be more prolonged.
{"title":"Classic diabetic ketoacidosis and the euglycemic variant: Something old, something new.","authors":"Adi E Mehta, Robert Zimmerman","doi":"10.3949/ccjm.92a.24075","DOIUrl":"10.3949/ccjm.92a.24075","url":null,"abstract":"<p><p>Diabetic ketoacidosis (DKA) was historically considered a condition typical of type 1 diabetes. However, patients with type 2 diabetes may present with DKA, usually with higher blood glucose levels and milder ketoacidosis. With the increased use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors, the variant euglycemic DKA has been described. SGLT-2 inhibitors cause a low level of ambient ketones; any additional ketone formation predisposes to ketoacidosis, while the agent's glycosuric effect limits hyperglycemia. The principles of DKA management are fluid administration, electrolyte control, and glucose control with insulin. In euglycemic DKA, the immediate use of a glucose-containing intravenous fluid induces endogenous insulin secretion and stops ketogenesis. Due to the half-life of SGLT-2 inhibitors, the duration of euglycemic DKA may be more prolonged.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 1","pages":"33-39"},"PeriodicalIF":3.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amanda Pomerantz, Anna P Shapiro-Krew, Andrew Coulter
{"title":"How can I better recognize and manage delirium in my hospitalized patients?","authors":"Amanda Pomerantz, Anna P Shapiro-Krew, Andrew Coulter","doi":"10.3949/ccjm.92a.24048","DOIUrl":"https://doi.org/10.3949/ccjm.92a.24048","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 1","pages":"17-20"},"PeriodicalIF":3.4,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142920771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Akhil Anand, Jared Ontko, Jyothika Yermal, Kush Sehgal, Ashley Cantu-Weinstein
{"title":"Matter of the heart: Prioritizing harm reduction in managing infective endocarditis associated with injection drug use.","authors":"Akhil Anand, Jared Ontko, Jyothika Yermal, Kush Sehgal, Ashley Cantu-Weinstein","doi":"10.3949/ccjm.91a.24020","DOIUrl":"https://doi.org/10.3949/ccjm.91a.24020","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"91 12","pages":"731-734"},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The diagnostic dilemma of myocardial infarction without obstructive coronary artery disease: Advanced imaging to the rescue!","authors":"Fawzi Zghyer, Khaled M Ziada","doi":"10.3949/ccjm.91a.24106","DOIUrl":"https://doi.org/10.3949/ccjm.91a.24106","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"91 12","pages":"755-761"},"PeriodicalIF":3.4,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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