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Am Fam Physician. 2020;102(3):142

Which chronic diseases are associated with hospitalization or death from COVID-19?

A report from the Centers for Disease Control and Prevention (CDC) summarized coronavirus disease 2019 (COVID-19) cases reported to the CDC from January 22 through May 30, 2020. There were 1,761,503 cases reported and 103,700 deaths. The seven-day average number of cases peaked during this time period in the United States on April 12 (31,994 cases), and daily deaths peaked on April 21 (2,856). The CDC had sufficient information on 287,320 individuals with severe acute respiratory syndrome coronavirus 2 to report outcomes of patients with and without chronic diseases. Cardiovascular disease was present in 32% of patients, diabetes mellitus in 30%, and chronic lung disease in 18%. Of all COVID-19 cases reported to the CDC during this period, 184,673 patients (10.5%) were hospitalized, 29,837 (2%) were admitted to an intensive care unit, and 71,116 (4%) died. The hospitalization rate was six times higher among patients with a chronic disease (45.4% vs. 7.6%), and the death rate was 12 times higher (19.5% vs. 1.6%).

What evidence-based treatments should be used for acne?

Topical retinoids should be used as monotherapy for mild comedonal acne and in combination with other topical or oral agents for moderate to severe inflammatory acne. Systemic antibiotics should be used for treatment of moderate to severe inflammatory acne. Oral isotretinoin should be used for treatment of severe nodular acne or refractory acne in adults and adolescents. Combined oral contraceptives should be considered for menarchal patients unresponsive or intolerant to past therapies, for temporal association of acne outbreaks with menses, or for females with signs and symptoms of hyperandrogenism (e.g., acne, hirsutism, oligomenorrhea). Topical retinoids should be used for maintenance therapy once treatment goals are achieved and oral agents are discontinued.

Are progestogens a safe and effective treatment option for patients with threatened miscarriage?

According to a Cochrane review, progestogens reduce the risk of miscarriage when compared with placebo in patients with threatened miscarriage (number needed to treat = 10). The use of progestogens poses no significant maternal or fetal risks.

How should pilonidal disease be treated?

According to the American Society of Colon and Rectal Surgeons, pilonidal disease without abscess is best managed by frequent shaving or hair removal; adding local application of phenol can resolve disease and prevent recurrence. Fibrin glue application can be used alone or with surgical excision to treat chronic pilonidal disease without abscess and to reduce recurrence. Abscesses should be treated with incision and drainage or surgical excision.

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