Cleveland Clinic Journal of Medicine

Viral respiratory diseases affect millions of individuals worldwide each year. Annual vaccinations are recommended by the World Health Organization for some of them, such as influenza and more recently for the coronavirus disease of 2019 (COVID-19) and respiratory syncytial virus, with the goal of reducing disease severity and limiting transmission. In the context of infection and vaccination, it is of primary importance to evaluate the immune response to pathogens to shed light on the mechanisms of protection...

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In 2023 and 2024, 3 vaccines were approved by the US Food and Drug Administration (FDA) against respiratory syncytial virus (RSV) in adults. In addition, the first long-acting RSV monoclonal antibody for infants and young children was approved. This review provides clinicians with practical guidance to navigate this new era of RSV prevention.

The new vaccines against respiratory syncytial virus (RSV) reduce the risk of RSV illness, which is common in older people and carries the risk of hospitalization with its attendant risks such as delirium and physical decline leading to loss of function and independence. Individualized discussions regarding vaccination should weigh the risks of vaccination, which are minor, against the preventive benefits. Discussions incorporating these elements may lead to greater vaccine uptake, especially by those at high risk...

Vaccination is a cornerstone of public health, but vaccine hesitancy poses significant challenges as highlighted during the COVID-19 pandemic. Addressing the challenge requires healthcare professionals to effectively counter misinformation. They have a pivotal role in fostering trust and promoting evidence-based vaccine recommendations, with tailored communication strategies and community engagement initiatives. Legislation, policy interventions, research, innovation, and technology are needed to enhance vaccine uptake and ensure equitable access...

Testing for respiratory viruses has changed greatly over the past decade, owing to advances in technology, drug development, vaccine research, and a growing recognition of the importance of improving patient access. Here, we focus on the most common respiratory viruses and review preanalytic variables (eg, collection and storage) that affect test results, testing methods including nucleic acid amplification testing (NAAT), and controversies, challenges, and trends in diagnostic testing relevant to clinicians...

Respiratory syncytial virus (RSV) is a threat to infants globally causing bronchiolitis and pneumonia. Despite decades of research, RSV outbreaks occur with only modest advancements in prevention or treatment. Vaccine development faced challenges because past attempts caused enhanced disease and treatment options demonstrated limited efficacy. Recent advancements, including maternal vaccines focusing on the prefusion form of the F glycoprotein are now showing significant benefits in preventing severe RSV-related illness in infants...

Respiratory syncytial virus (RSV) is a significant cause of morbidity and mortality in infants, older adults, and patients with weakened immune systems. Disease severity differs by underlying immunologic pathologies, with worse outcomes associated with progression from upper to lower respiratory disease. In this review we address the impact of RSV in immunocompromised populations, and discuss the limited available treatments and the potential impact of newer RSV prevention strategies on immunocompromised adults and children...

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Primary adrenal insufficiency is rare but serious; it puts patients at risk of acute decompensation and adrenal crisis due to insufficient cortisol and aldosterone production. Further, its diagnosis is often delayed, or it is mistaken for secondary adrenal insufficiency, which can have life-threatening consequences. Early recognition and appropriate treatment can greatly improve patient outcomes and quality of life.

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Mesenteric ischemia occurs because of inadequate intestinal blood flow. Its severity depends on the vessels involved and whether collateral blood vessels are available to prevent malperfusion. Mesenteric ischemia is an uncommon cause of abdominal pain, but it is associated with high mortality and often poses a diagnostic challenge to clinicians because its symptoms are nonspecific. Early recognition and treatment are imperative to improve patient outcomes.

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Digoxin, the oldest known cardiovascular drug, is still used today to treat heart failure and atrial fibrillation. Because it has a narrow therapeutic index and multiple interactions, it frequently causes toxicity with a wide range of symptoms and cardiac arrhythmias. More importantly, elevated serum digoxin levels have been linked to a higher risk of death in patients with heart failure or atrial fibrillation, even without signs or symptoms of toxicity. This article reviews the current state of digoxin use, its pharmacologic principles, and the mechanisms, clinical presentation, and management of toxicity...

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Helicobacter pylori is a significant public health concern given its high prevalence, growing rates of antibiotic resistance, and carcinogenic effect, all of which create management challenges for internists, gastroenterologists, and other specialty physicians. With almost half of the world's human population harboring H pylori , carcinogenic sequelae are a concern to many practitioners. Recent guidelines recommend testing high-risk populations for H pylori using noninvasive or invasive methods. H pylori eradication regimens are tailored based on the presence of effective empiric therapy (local cure rates ≥ 90% for a given regimen) or antimicrobial susceptibility testing...

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