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Cleveland Clinic Journal of Medicine

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Table of Contents

October 01, 2022; Volume 89,Issue 10

From the Editor

  • You have access
    Decongesting heart failure with diuretics: Easier to prescribe than to fully understand
    Brian F. Mandell, MD, PhD
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 545-546; DOI: https://doi.org/10.3949/ccjm.89b.10022

    Digging deep into the pathophysiology of diuretic resistance reveals complex interacting pathways. But none of these pathways can fully explain or be used to safely reverse diuretic resistance.

The Clinical Picture

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    Blue sclera: An overlooked finding of iron deficiency
    Yasuhiro Kano, MD
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 549-550; DOI: https://doi.org/10.3949/ccjm.89a.22045

    The pathogenesis is thought to involve thinning of collagen fibers of the sclera due to iron deficiency, allowing the bluish color of the underlying uvea to become visible.

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    Scaly plaques in a malnourished patient
    Sandra Oska, MD, Harleen Arora, MD and Allison Zarbo, MD
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 551-552; DOI: https://doi.org/10.3949/ccjm.89a.21112

    A markedly low serum zinc level and the characteristic location of the rash in a patient with long-standing alcohol use disorder and cirrhosis led to the correct diagnosis.

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    Mucormycosis presenting as dental pain
    Pankaj Garg, MS, MBBS, Aalam Sohal, MD and Sankalp Mittal, MDS
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 553-555; DOI: https://doi.org/10.3949/ccjm.89a.22001

    A root canal procedure failed to relieve the pain, and 1 week later the patient developed mobility of the left upper teeth.

1-Minute Consult

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    How do I interpret and use quantitative buprenorphine and norbuprenorphine urine levels?
    Richard C. Waters, MD, MSc and Matthew Perez, MD
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 557-560; DOI: https://doi.org/10.3949/ccjm.89a.21019

    Confirmatory testing of urine samples can be useful in outpatient settings where buprenorphine dosing is not directly observed. But retaining and engaging the patient in effective treatment should be the ultimate goals of testing.

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    How do we maximize diuresis in acute decompensated heart failure?
    Saeid Mirzai, DO, Christopher N. Kanaan, MD, Felix Berglund, MD, Maria Mountis, DO and Heba Wassif, MD, MPH
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 561-565; DOI: https://doi.org/10.3949/ccjm.89a.22016

    The initial goal is to maximize loop diuretic therapy using urine output or urinary sodium for guidance. Combination therapy can be used when patients respond poorly to escalating loop diuretic doses.

  • Atrial fibrillation: Rate control or rhythm control?
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    Atrial fibrillation: Rate control or rhythm control?
    Radhika Deshpande, MBBS, Yasser Al Khadra, MD, Raad Al-Tamimi, MBBS, Nour Albast, MBBS and Mohamed Labedi, MD
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 567-571; DOI: https://doi.org/10.3949/ccjm.89a.21093

    Rate control has been preferred as the primary approach, but the pendulum is swinging in favor of rhythm control.

Symptoms to Diagnosis

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    A 65-year-old man with melena and a blood disorder
    Monia E. Werlang, MD, Marilia L. Montenegro, MD and Bhaumik Brahmbhatt, MD, MBBS
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 573-578; DOI: https://doi.org/10.3949/ccjm.89a.20175

    The patient had chronic anemia related to primary myelofibrosis and was being treated with epoetin alfa and ruxolitinib, with blood transfusions every other week.

Guidelines to Practice

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    Diagnostic stewardship for urinary tract infection: A snapshot of the expert guidance
    Glenn T. Werneburg, MD, PhD and Daniel D. Rhoads, MD
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 581-587; DOI: https://doi.org/10.3949/ccjm.89a.22008

    New guidance on ordering, processing, and reporting urine cultures focuses on reducing unnecessary antibiotic use and the misdiagnosis of urinary tract infection.

Symptoms to Diagnosis

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    Confusion in a 22-year-old woman, and diagnostic uncertainty
    Brian Elliott, MD, Christopher Newey, DO, MS, Katelynn Alcorn, MPH and Luke McCoy, MD
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 589-595; DOI: https://doi.org/10.3949/ccjm.89a.20176

    The patient had been complaining of gradual-onset and progressive headache and neck and back pain for 3 weeks.

Correction

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    The role of GLP-1 receptor agonists in managing type 2 diabetes
    Cleveland Clinic Journal of Medicine October 2022, 89 (10) 597;

    The following article in the August 2022 issue contained an error: Nachawi N, Rao PP, Makin V. The role of GLP-1 receptor agonists in managing type 2 diabetes. Cleve Clin J Med 2022; 89(8): 457–464. doi:10.3949/ccjm.89a.21110

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In this issue

Cleveland Clinic Journal of Medicine: 89 (10)
Cleveland Clinic Journal of Medicine
Vol. 89, Issue 10
1 Oct 2022
  • Table of Contents
  • Table of Contents (PDF)
  • Index by author
  • Complete Issue (PDF)

Issue highlights

  • Blue sclera: An overlooked finding of iron deficiency
  • Diagnostic stewardship for urinary tract infection: A snapshot of the expert guidance
  • Atrial fibrillation: Rate control or rhythm control?
  • How do I interpret and use quantitative buprenorphine and norbuprenorphine urine levels?
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The beat goes on: Highlights from the new American and European A-fib guidelines
What diagnostic tests should be done after discovering clubbing in a patient without cardiopulmonary symptoms?
Tinea incognito
Prolonged venous filling time and dependent rubor in a patient with peripheral artery disease
Nociplastic pain: A practical guide to chronic pain management in the primary care setting
Sarcoidosis with diffuse purplish erythematous plaques on the hands
Cardiovascular disease in people living with HIV: Risk assessment and management
Heart to heart: Progress in cardiovascular disease prevention for people living with HIV
Don’t judge a book by its cover: Unusual presentations of pericardial disease
Hypoglycemia after bariatric surgery: Management updates
Risk-factor modification to prevent recurrent atrial fibrillation after catheter ablation
Common electrolyte imbalance, uncommon cause

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