Cleveland Clinic journal of medicine
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Cutaneous manifestations, a well-known effect of viral infections, are beginning to be reported in patients with COVID-19 disease. These manifestations most often are morbilliform rash, urticaria, vesicular eruptions, acral lesions, and livedoid eruptions. ⋯ With COVID-19, although we are at a relatively early point in the pandemic, cutaneous manifestations in infected patients are beginning to emerge from around the world. In this article, we describe some of the current cutaneous abnormalities observed in patients with COVID-19.
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Point-of-care ultrasound has an important role in the management of patients with COVID-19 infection. Because the utility of each application varies by setting, individual institutions should consider how they can best use ultrasound within their specific environments. In general, procedural guidance and focused echocardiography are high yield. ⋯ Lower extremity point-of-care ultrasound for deep vein thrombosis may help guide decision making regarding anticoagulation or undifferentiated shock. It is of the utmost priority that ultrasound not spread infection, so point-of-care ultrasound must be used only when clinically indicated. Institutions should have protocols for machine disinfection.
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At present, there are no firm guidelines for the treatment of COVID-19-related emotional distress. The current approach is based on our knowledge of how to manage anxiety in medically ill patients, taking into consideration all associated medical comorbidities, drug-drug interactions, and the patient's specific needs and preexisting mental illness. Interventions should be implemented at the bedside to augment the patient's own resiliency in coping with these stressful events. A targeted combination of psychopharmacology (targeting acute anxiety and panic symptoms) and psychotherapy (relaxation techniques, breathing exercises, and encouragement) is recommended.
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Concerns have been raised about the potential for renin-angiotensin system (RAS) inhibitors to upregulate expression of angiotensin-converting enzyme 2 (ACE2) and thus increase susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entry. Currently, there is no evidence that even if RAS inhibitors increase expression and activity of ACE2, that they would increase the risk of SARS-CoV-2 infection by facilitating greater viral entry or worsen outcomes in patients with COVID-19. At this time, there is no clinical evidence to suggest that treatment with RAS inhibitors should be discontinued in stable patients with COVID-19. In hospitalized patients with severe COVID-19, decisions about these medications should be based on clinical condition, including hemodynamic status and renal function.
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Hydroxychloroquine (HCQ) is in short supply as a result of the coronavirus disease 2019 (COVID-19) pandemic, presenting a challenge to rheumatologists to ensure their patients with systemic lupus erythematosus (SLE) continue to take this essential drug. HCQ is the only SLE treatment shown to increase survival and any change in the HCQ regimen is potentially dangerous. Changes in the HCQ regimen should be made jointly with the patient after a discussion of the available evidence and expert opinion and the patient's preferences. Providers need to make thoughtful, informed decisions in this time of medication shortage.