April 12th 2024
Your daily dose of the clinical news you may have missed.
The Expanding Role of Fluid Biomarkers in the Diagnosis and Management of Patients With Alzheimer Disease
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Expert Illustrations & Commentaries™: Targeting Immune Cells to Treat Multiple Sclerosis
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Improving Care for Patients with Motor Complications of Parkinson Disease: Role of Technology and Data
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Clinical Consultations™: Considerations for Customizing Care Plans for Patients with Parkinson Disease Psychosis
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Facing the Challenges of Implementing Palliative Care
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Evolving Perspectives in Alzheimer's Disease: Reaching an Earlier Diagnosis, Understanding Neuroinflammation, and Exploring Therapeutic Advances
September 15, 2024
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Mastering MS: Translating Evidence into Optimal Management Plans
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Advances In Treating Migraine in Your OB/GYN Practice: Navigating Treatment Paradigms to Improve Patient Care
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Recognizing Rett Syndrome Early to Improve Long-term Management Outcomes
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5th Annual International Congress on the Future of Neurology®
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Clinical Consultations™: Managing Depressive Episodes in Patients with Bipolar Disorder Type II
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Advances In™ Generalized Myasthenia Gravis: Improving Patient Outcomes Through Early Diagnosis and Management
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Medical Crossfire®: Understanding the Advances in Bipolar Disease Treatment—A Comprehensive Look at Treatment Selection Strategies
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Community Practice Connections™: Transforming Multiple Sclerosis Care – Clinical Updates on the Effects of BTK Inhibitors
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Burst CME: Optimizing Therapy in Parkinson’s Disease
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'REEL’ Time Patient Counseling: The Diagnostic and Treatment Journey for Patients With Bipolar Disorder Type II – From Primary to Specialty Care
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Burst Expert Illustrations & Commentary™ : Visualizing the Role of the Complement Proteins in Neurologic Disorders
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Addressing Healthcare Inequities: Bridging the Gap in Multiple Sclerosis – A Focus on Clinical and Healthcare Disparities in Black Patients
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Burst Expert Illustrations & Commentary™: Visualizing the Role of the Complement Pathway in Neurological Disorders
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Burst Expert Illustrations & Commentary™: Visualizing the Implications of Anti-Complement Therapies on Generalized Myasthenia Gravis
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Individualizing Treatment for Patients with Generalized Myasthenia Gravis
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Patient, Provider & Caregiver Connection™: Reducing the Burden of Parkinson Disease Psychosis with Personalized Management Plans
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Empowering Breast Cancer Patients with Non-Opioid Pain Management Innovations
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Clinical ShowCase™ in ALS: Addressing Diagnostic Delays, Evolving Therapies, and Multidisciplinary Care
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FDA Approves Drug for Breast Cancer Resistant to First-Line Treatments
October 17th 2007ROCKVILLE, Md. -- Bristol-Myers Squibb said its metastatic breast cancer drug ixabepilone (Ixempra) has received FDA approval for treatment of women with metastatic or locally advanced treatment-resistant breast cancer.
Woman With Short-Lasting, Strictly Unilateral Headaches
October 1st 2007A 47-year-old woman complains of severe headaches that involve only the right orbital, temporal, and occipital areas. She describes the pain as sharp and stabbing, and she rates its severity as 9 or 10 on a 10-point visual analog scale.
Annual Infusion of Zoledronic Acid (Reclast) Cuts Risk After Hip Repair
September 18th 2007HONOLULU -- An annual infusion of zoledronic acid (Reclast) following surgical repair of a fractured hip reduced the risk of a new fracture by 35% and mortality by 28% compared with placebo, researchers here said.
New Lymphadenopathy in a Woman With a History of Colon Cancer
September 1st 2007A 47-year-old woman who recently completed adjuvant chemotherapy for colon cancer has painless cervical lymphadenopathy of 1 to 2 cm. She has no fever, sore throat, cough, or unexplained weight loss, and she denies exposure to ill persons or animals.
Two Women With Severe Headaches: Different Symptoms, Similar Approaches
May 1st 2007The headaches vary in severity, but she usually has severeheadaches (8 on a 10-point visual analog scale[VAS]) once or twice a week; she describes the latter assevere throbbing or pounding pain on the top of thehead but also involving the occipital and frontalareas and occasionally one or the other temple.
Plantar Fasciitis: Office Management
February 1st 2007ABSTRACT: Heel pain that occurs with the first several steps in the morning and diminishes as walking continues is the classic symptom of plantar fasciitis. Assessment of risk factors, such as improper footwear, a change in physical activities, and a new running surface, is important. Radiographs are rarely useful. Plantar fasciitis is generally self-limited; symptoms typically take 6 to 18 months to resolve. Conservative measures may include relative rest, stretching, strengthening, shoe modifications, orthoses, night splints, NSAIDs, and ice therapy. A corticosteroid injection may be warranted in resistant cases. If extensive conservative treatment is unsuccessful, referral to an orthopedic surgeon may be indicated.
Avian Flu: Do You Need to Be Prepared?
January 1st 2007Avian influenza primarily affects wild birds and domesticated poultry. Humans acquire avian influenza viruses chiefly through direct contact of the mucous membranes with secretions or excreta from infected birds or contaminated poultry products. The upper respiratory tract and conjunctivae appear to be the main portals of entry. Influenza pandemics occur when new virus subtypes emerge and become readily transmissible among humans. On average, pandemics occur about 3 or 4 times per century. Avian influenza is not a pandemic influenza. It is not easily transmitted among humans, and it has not been found in the United States. Therefore, at present, the risk to persons in this country is considered low.
Woman With Headache, Diaphoresis, Abdominal Symptoms
January 1st 2007A 47-year-old woman complains ofepisodic headaches that began severalmonths earlier and are accompaniedby sweating, flushing, abdominal pain,and vomiting; these attacks have progressivelyworsened. She takes no medicationsand denies fever, chills, andnight sweats. The medical history isunrevealing.
Woman With Daily Headaches That Have Become Refractory to Triptans
January 1st 2007A 30-year-old woman complains that her headaches no longer respond to triptans; instead, they have increased in frequencyand severity. The pain interferes with her ability to work part-time and to take care of her 16-month-old daughter.
Preventing and Treating Influenza
January 1st 2007abstract: The keystone of influenza prevention is still vaccination. The 2 available types of influenza vaccine--the inactivated vaccine, which is administered intramuscularly, and the attenuated vaccine, which is delivered via nasal spray--have efficacy rates of 70% to 80%. Unfortunately, only about 65% of persons who should receive the influenza vaccine are, in fact, vaccinated. The neuraminidase inhibitors oseltamivir and zanamivir are 70% to 90% effective in preventing influenza. These antivirals also are effective in reducing the severity of influenza symptoms and the duration of illness when administered within 48 hours of the onset of clinical disease. Some patients have difficulty in self-administering zanamivir because the inhalation process is fairly complicated. Because of the resistance pattern observed in 2005, amantadine and rimantadine are not currently recommended for prophylaxis or therapy. (J Respir Dis. 2007;28(1):21-29)
Suspected Avascular Necrosis in a Runner
January 1st 2007A 34-year-old man has had bilateralknee pain for the past 16 months andbilateral hip pain for the past 8 months.The pain is exacerbated by running, byweight bearing, and recently even by sittingfor extended periods. Moving froma sitting to a standing position is especiallydifficult. A week earlier, he visitedan urgent care center and was given naproxen and a 7-day course of prednisone,but neither medication alleviatedthe pain; in fact, he now feels worse.
Young Man With a History of Vague Headaches Ascribed to Sinusitis
January 1st 2007A 37-year-old man found unresponsiveat home with erratic respiration andurinary incontinence was brought tothe emergency department (ED). Accordingto his family, the patient hadbeen complaining of headaches, vertigo,and mild neck pain for 2 months.During that time, a CT scan of thesinuses revealed chronic sinusitis; thepatient had completed a course ofprednisone, naproxen, and meclizinewithout symptomatic improvement.The day before he was brought to theED, he had presented to a differenthospital with the same complaints andwas given a prescription for antibioticsfor a presumed sinus infection. He haddiet-controlled hypercholesterolemiaand did not smoke.
NSAID Nephrotoxicity Revisited:Selective COX-2 Inhibitors
January 1st 2007For over 25 years, NSAIDs have been used to treat a variety of pain syndromesand inflammatory diseases. More than 50 million Americanstake these drugs. Unfortunately, control of pain and inflammation is notachieved without an associated cost-namely, GI complications and, to a lesserextent, nephrotoxicity.In an attempt to reduce drug-related toxicity, a new class of selectiveNSAIDs-the COX-2 inhibitors-was introduced in 1999. These selectiveNSAIDs are as effective as and pose less risk of gastric toxicity than nonselectiveNSAIDs.1,2The COX-2 inhibitors are thought to reduce end-organ injury, such as GIulceration, by sparing homeostatic or “constitutive” COX-1 enzyme function.1,2 Incontrast, therapeutic effects result from the inhibition of the “inducible” COX-2enzyme.1,2 Such drug effects target the production of proinflammatory prostaglandinsby COX-2 without interrupting normal cell function mediated by COX-1.2,3
Lifesaving Questions for Patients With Acute Headache
January 1st 2007In the first case study featured in the article by Drs Jagoda and Riggio, “WhatYou Forgot About the Neurologic Exam, Part 1: History, Mental Status,Cranial Nerves” (CONSULTANT, December 2004, page 1773), a 46-year-oldwoman with a history of migraine presented with a bilateral headache thatradiated to the occiput.
What Role for Short-Acting Opioids in the Control of Chronic Nonmalignant Pain?
January 1st 2007As a physician who specializes in pain management, I read with interest thearticle on chronic nonmalignant pain by Drs Atli and Loeser (CONSULTANT,November 2004, page 1693). Although the article was otherwise extremely informative,I was troubled by the authors’ failure to clarify the meaning of“breakthrough pain” in a nonmalignant setting and by their advocacy of theuse of short-acting opioids to treat such pain.
Extremely Elevated Liver Enzyme
January 1st 2007A 27-year-old woman is hospitalized after laboratory studies revealed extremelyelevated liver enzyme levels. The studies were ordered after the patient soughtmedical attention for severe headaches that began 3 weeks earlier and for thepast several days had been accompanied by malaise, nausea, and vomiting.