Cleveland Clinic journal of medicine
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Review
Multiple sclerosis: advances in understanding, diagnosing, and treating the underlying disease.
Recent advances in our understanding of the diagnosis, imaging, pathology, and clinical monitoring of multiple sclerosis (MS) have significantly increased our ability to successfully treat this often perplexing neurologic disorder. Magnetic resonance imaging (MRI) is now integral to the diagnostic process. Treatment of MS can be considered as three parallel pathways: treatment of relapses, symptom management, and long-term prevention of tissue injury.
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Ultrasonography can screen for abdominal aortic aneurysms (AAAs) safely, cheaply, and accurately. Once detected, an AAA can be monitored and repaired before it is likely to rupture. The US Preventive Services Task Force recently recommended a one-time screening for AAAs by ultrasonography for men age 65 to 75 years who have ever smoked. We should consider expanding the recommendations to include others at risk.
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Several lines of evidence support the use of corticosteroids as adjunctive therapy for sepsis. In human trials, high-dose, short-course corticosteroid therapy for sepsis has not shown benefit, but prolonged use of low doses has shown benefit in patients with vasopressor-dependent septic shock. The Corticosteroid Therapy of Septic Shock (CORTICUS) trial is addressing the remaining questions regarding the ideal target population for corticosteroid therapy, as well as the best definition of relative adrenal insufficiency in the critically ill.
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Assessing the effectiveness of bisphosphonate therapy is problematic. Bone mineral density and markers of bone turnover are often used, but the true measure is prevention of new fractures.
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If patients with hypercholesterolemia were started on higher doses of statins tailored to their lipid levels and risk, more of them would achieve their low-density lipoprotein cholesterol (LDL-C) goals, possibly leading to fewer cardiovascular events and deaths.