Cleveland Clinic journal of medicine
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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.
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Restless legs syndrome (RLS) is a common and clinically significant motor disorder increasingly recognized by physicians and the general public, yet still underdiagnosed, underreported, and undertreated. Effective therapies are available, but a high index of suspicion is required to make the diagnosis and start treatment quickly. We now have enough data to support the use of dopaminergic agents, benzodiazepines, antiepileptics, and opioids in these patients.
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Migraine aura without headache should be considered as a diagnosis in anyone who has recurrent episodes of transient symptoms, especially those that are visual or neurological or involve vertigo. Visual and neurological symptoms due to migraine are not unusual and most commonly occur in older persons with a history of migraine headaches. Migraine aura without headache should be diagnosed only when transient ischemic attack and seizure disorders have been excluded.