AFP Clinical Answers

COVID-19, Scoliosis, Muscle Weakness, Preterm Birth, Fecal Incontinence


Am Fam Physician. 2021 Jan 15;103(2):78.

Does dexamethasone reduce mortality in patients with COVID-19 who are oxygen dependent?

Dexamethasone, in a dosage of 6 mg per day for 10 days, reduces mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) who require supplemental oxygen (number needed to treat [NNT] = 29) and mechanical ventilation (NNT = 9), but it is not necessary in hospitalized patients or outpatients who do not require supplemental oxygen.

How should a patient with concerns for scoliosis be evaluated?

The forward bend test is performed to look for thoracic or lumbar prominence suggesting curvature of the spine, which, if present, can be measured with a scoliometer. For a scoliometer measurement of 5 degrees or more, radiologic evaluation for Cobb angle measurement is recommended, particularly in patients who are overweight or obese.

What diagnostic workup should be performed in patients with muscle weakness?

A medication and toxin review should be completed in patients with muscle weakness. History and physical examination findings should guide laboratory testing, imaging, electromyography, and muscle biopsy. Electromyography should be performed in patients with muscle weakness if the diagnosis is unclear after a history, physical examination, and targeted laboratory evaluation. Muscle biopsy should be considered to clarify the diagnosis in patients who have objective muscle weakness with elevated creatine kinase levels or abnormal findings on electromyography or muscle magnetic resonance imaging.

Are omega-3 fatty acids safe and effective for reducing the risk of preterm birth?

Omega-3 fatty acids, taken as supplements or consumed as part of the diet, reduce the risk of preterm birth before 37 weeks' gestation (NNT = 68) and early preterm birth before 34 weeks' gestation (NNT = 55). However, they also increase the risk of prolonged gestation (more



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