Cleveland Clinic journal of medicine
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Breast cancer remains the most common female malignancy in the United States. Reducing this cancer burden involves identification of high-risk individuals and personalized risk management. ⋯ For select women at increased risk for breast cancer, preventive medication can greatly decrease risk and is vastly underutilized. Women's health clinicians are poised to evaluate risk, promote breast cancer risk reduction, and manage overall health.
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Benign paroxysmal positional vertigo (BPPV), caused by wayward crystals ("rocks") in the semicircular canals of the inner ear, is the most common cause of brief symptoms of vertigo secondary to head and body movements. Diagnosing and treating it are simple to do in the medical office. This article reviews the differential diagnosis for patients presenting with dizziness and vertigo, the pathophysiology of BPPV, how to diagnose it using maneuvers to elicit symptoms and nystagmus, how to interpret the nystagmus pattern to determine where the rocks are, and how to treat it using different maneuvers to reposition ("roll") the rocks back where they belong.
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Review
Primary and secondary prevention of atherosclerotic cardiovascular disease: A case-based approach.
Estimating the risk of atherosclerotic cardiovascular disease (ASCVD) is a daily challenge for clinicians and is crucial to tailoring preventive medical care and guiding shared decision-making. New imaging modalities and novel biomarkers allow for more accurate assessment of patient risk and minimize the risk of over- or undertreating patients. Major cardiovascular medicine societies have incorporated new diagnostic modalities in their guidelines to aid clinical decision-making for primary and secondary prevention of ASCVD. This review presents commonly encountered cases relevant to estimating and reducing ASCVD risk based on available guidelines and expert opinion.
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Cirrhosis has been regarded as a hypocoagulable state associated with an increased risk of bleeding. But patients with cirrhosis also have a high incidence of thrombotic complications, challenging this dogma. ⋯ Conventional coagulation tests such as the platelet count and prothrombin time do not assess the reduced anticoagulation factors in cirrhosis and overestimate the bleeding risk, and any intervention based on these test results can lead to thrombotic complications. This article reviews the changes in hemostasis associated with cirrhosis, newer tests for assessing coagulation, and preprocedural minimization of coagulopathy.
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Glucagon-like peptide-1 (GLP-1) receptor agonists improve glycemic control in patients with type 2 diabetes mellitus, have cardioprotective and renoprotective effects, and do not cause weight gain or significant hypoglycemia. In fact, they have been found to be effective for weight loss in patients with obesity with and without diabetes. They are now the preferred drugs to add to the regimen when oral metformin by itself is not enough to meet the patient's hemoglobin A1c goal.