The American journal of medicine
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Type 2 diabetes mellitus and obesity are associated with increased cardiovascular risk. While lifestyle interventions such as medical nutrition therapy and appropriately prescribed physical activity remain cornerstones of disease prevention and treatment, most patients with type 2 diabetes will eventually require pharmacotherapy for glycemic control. ⋯ Type 2 diabetes treatment guidelines and algorithms have been developed, taking into account a combination of evidence-based information and expert opinions, with various groups offering diverse glucose goals and approaches to hyperglycemia management. Virtually all recognize that type 2 diabetes is a multifaceted disease, necessitating an integrated yet individualized approach to patient care.
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Acute respiratory distress syndrome resulting from novel influenza A virus (H1N1) infection remains uncommon. ⋯ Clinicians should be vigilant for the potential of H1N1 infection to progress to severe acute respiratory distress syndrome in a variety of patient demographics, including younger patients without baseline cardiopulmonary disease. A high degree of suspicion is critical, especially with the relative insensitivity of rapid testing, and should prompt empiric antiviral therapy.
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We reported earlier that there was no decline of acute myocardial infarction hospitalization from 1988 to 1997. We now extend these observations to document trends in acute myocardial infarction hospitalization rates and in-hospital case-fatality rates for 27 years from 1979 to 2005. ⋯ During the past quarter century, hospitalization for acute myocardial infarction increased until the mid-1990s, but has declined since then. At the same time, in-hospital case-fatality rates declined steadily. This decline has been associated with more aggressive therapeutic intervention.