The American journal of medicine
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Multiple sclerosis (MS) is an autoimmune demyelinating and neurodegenerative disease of the central nervous system, and the leading cause of nontraumatic neurological disability in young adults. Effective management requires a multifaceted approach to control acute attacks, manage progressive worsening, and remediate bothersome or disabling symptoms associated with this illness. ⋯ The emergence of higher-efficacy drugs requiring less frequent administration have made these preferred options in terms of tolerability and adherence. Many experts now recommend use of these as first-line treatment for many patients with early disease, before permanent disability is evident.
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Randomized Controlled Trial
A Randomized Controlled Trial of the Lowest Effective Dose of Acetazolamide for Acute Mountain Sickness Prevention.
Acetazolamide is the most common medication used for acute mountain sickness prevention, with speculation that a reduced dose may be as efficacious as standard dosing with fewer side effects. ⋯ Acetazolamide 62.5 mg twice daily failed to demonstrate equal effectiveness to 125 mg twice daily for prevention of acute mountain sickness. With increased risk and no demonstrable symptomatic or physiologic benefits, acetazolamide 62.5 mg twice daily should not be recommended for acute mountain sickness prevention.
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Proven cases of vector-transmitted acute autochthonous Chagas disease in the United States are rare (<10 cases). Possible or probable cases of unknown duration determined by serology are uncommon as well (<100). In Latin America it is widely accepted that after feeding, the kissing bug defecates and Trypanosoma cruzi in the feces is rubbed into the bite punctum. ⋯ The average infected individual in Latin America suffers more than 1000 bites, but more importantly, there are often thousands of kissing bugs in a household dropping feces on the inhabitants and living quarters. Today in Brazil the most common form of acute Chagas is secondary to oral ingestion of the parasite in food and drink. We present our experience with many hundreds of individuals bitten by kissing bugs and the possibility of oral ingestion occurring in the United States.