Postgraduate medicine
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Even though significant progress has been made in understanding migraine headache pathophysiology and bringing new therapeutic options into practice, migraine remains underdiagnosed and undertreated in the United States. This paper couples recent research and expert opinion to provide practical guidance on the diagnosis of migraine for the primary care setting, where many patients first seek medical care for headache. Headache diagnosis in the primary care setting entails differentiating primary from secondary headache. ⋯ A brief but complete neurological history should be taken as well as performing physical and neurological examinations. When diagnosing the patient with headache, the clinician should be alert to the possible presence of chronic daily headache arising from medication overuse or uncontrolled migraine. Additionally, patient diaries and disability assessment tools can help identify a pattern of headaches and headache-related disability suggestive of migraine or medication-overuse headache.
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Postgraduate medicine · May 2005
ReviewCurbing the psoriasis cascade. Therapies to minimize flares and frustration.
Psoriasis, a T-cell-mediated disorder, affects 1% to 3% of the world's population. The characteristic lesions occur in many different forms, can cause significant discomfort and social distress, and in some instances, lead to dehydration and metabolic derangement. ⋯ However, topical and systemic drug therapies and phototherapy can help minimize the exacerbations and prolong remissions. In this article, Dr Shenenberger outlines treatment approaches and discusses research into the use of immunomodulatory agents.
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Postgraduate medicine · Mar 2005
ReviewIs it asthma or COPD? The answer determines proper therapy for chronic airflow obstruction.
Evaluation and diagnosis of obstructive lung disease call for careful history taking to distinguish asthma from chronic obstructive pulmonary disease (COPD). A history of atopy and intermittent, reactive symptoms points toward a diagnosis of asthma, whereas smoking and advanced age are more indicative of COPD. ⋯ Spirometry, usually performed in the primary care setting, is the key diagnostic tool that distinguishes patients with asthma from patients with COPD. In this article, the authors outline an approach to differential diagnosis of asthma and COPD that should result in better evaluation, therapy, and quality of life for these patients.
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Postgraduate medicine · Jan 2005
ReviewStroke prevention. MATCHing therapy to the patient with TIA.
The short-term risk of stroke after transient ischemic attack (TIA) is about 10% to 20% in the first 3 months, with much of the risk front-loaded in the first week. Unfortunately, little is known about the best therapies for hyperacute stroke prevention after TIA. A recent trial referred to by the acronym MATCH (for Management of Atherothrombosis With Clopidogrel in High-risk Patients With Recent Transient Ischemic Attack or Ischemic Stroke) provides hypothesis-generating data to suggest that double antiplatelet therapy in the short term may be appropriate. Here, the authors discuss treatment considerations, outlining the current knowledge and stressing the need for formal randomized trials to definitively establish the effectiveness of preventive therapies after minor stroke or TIA.