Cleveland Clinic journal of medicine
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Review Case Reports
To scan or not to scan? DXA in postmenopausal women.
Fracture is a major cause of morbidity and death in postmenopausal women. Dual-energy x-ray absorptiometry (DXA) measures bone mineral density, which helps in estimating fracture risk and in identifying those who may benefit from treatment. Although screening guidelines differ somewhat for postmenopausal women under age 65, in general, DXA is indicated if the patient has a high risk for fracture.
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The cornerstone of preventive migraine treatment has long been drugs developed for other diseases such as epilepsy, depression, and hypertension. But a new set of drugs is available for preventing migraine attacks: erenumab, galcanezumab, fremanezumab, and eptinezumab. These monoclonal antibodies target calcitonin gene-related peptide (CGRP) or its receptors, each a key molecule in the pathophysiology of migraine.
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The 2018 and 2019 guidelines from the American College of Cardiology and American Heart Association reflect the complexity of individualized cholesterol management. The documents address more detailed risk assessment, newer nonstatin cholesterol-lowering drugs, special attention to patient subgroups, and consideration of the value of therapy, all with the aim of creating personalized treatment plans for each patient. Overall, the guidelines recommend shared decision-making to meet the individual needs of each patient.
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Gastroesophageal reflux disease (GERD) is mainly a clinical diagnosis based on typical symptoms of heartburn and acid regurgitation. Current guidelines indicate that patients with typical symptoms should first try a proton pump inhibitor (PPI). If reflux symptoms persist after 8 weeks on a PPI, endoscopy of the esophagus is recommended, with biopsies taken to rule out eosinophilic esophagitis. This review discusses the evidence for different medical, endoscopic, and surgical therapies and presents a management algorithm.