The Medical clinics of North America
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Effective management of patients who have cerebrovascular disease depends on accurate diagnosis. Many conditions cause clinical findings that closely mimic cerebrovascular disorders and are often ruled out through brain imaging or laboratory findings. Diagnosis of cerebrovascular disorders is based on the presence of risk factors for vascular disease, the tempo of onset, the presence of concurrent conditions, and the clinical course of development of neurologic symptoms and signs. This article shares a process by which clinicians can combine a patient's history, neurologic examination, and brain and vascular imaging to localize a lesion and diagnose cerebrovascular disease.
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Osteoarthritis (OA) is the most prevalent form of arthritis in the elderly. A large body of evidence, including familial aggregation and classic twin studies, indicates that primary OA has a strong hereditary component that is likely polygenic in nature. ⋯ In recent years several linkage analyses and candidate gene studies have been performed and unveiled some of the specific genes involved in disease risk, such as FRZB and GDF5. This article discusses the impact that future genome-wide association scans can have on our understanding of the pathogenesis of OA and on identifying individuals at high risk for developing severe OA.
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Med. Clin. North Am. · Jan 2009
Obesity and osteoarthritis: disease genesis and nonpharmacologic weight management.
The mechanisms by which obesity affects osteoarthritis (OA) are of great concern to osteoarthritis researchers and clinicians who manage this disease. Inflammation and joint loads are pathways commonly believed to cause or to exacerbate the disease process. This article reviews the physiologic and mechanical consequences of obesity in older adults who have knee OA, the effects of long-term exercise and weight-loss interventions, the most effective nonpharmacologic treatments for obesity, and the usefulness and feasibility of translating these results to clinical practice.
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Med. Clin. North Am. · Nov 2008
Regional infectious disease surveillance networks and their potential to facilitate the implementation of the international health regulations.
The International Health Regulations (IHR) 2005 present a challenge and opportunity for global surveillance and control of infectious diseases. This article examines the opportunity for regional networks to address this challenge. ⋯ The public-private partnerships in the networks have led to an upgrade in infectious disease surveillance systems in capacity building, purchasing technology equipment, sharing of information, and development of preparedness plans in combating avian influenza. These regional networks have become an appropriate infrastructure for the implementation of the IHR 2005.