Cleveland Clinic journal of medicine
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The management of pulmonary arterial hypertension (PAH) should aim to provide vasodilation of the pulmonary arteries, treat right ventricular failure, improve functional capacity and quality of life, and improve survival, if possible. Data from right heart catheterization and an estimation of vasoresponsiveness together guide treatment for PAH. ⋯ Coumarin derivatives, epoprostenol, and, in selected patients, calcium channel blockers are the only drugs associated with improved survival, and only epoprostenol has been shown to improve survival in a prospective randomized trial. Knowledge of the supportive therapies, indications for surgical intervention, and emerging drug therapies should provide the working armamentarium for clinicians treating this rare but devastating disease.
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With 64-ounce sodas and "supersized" fast food on nearly every street corner, America has become the land of the obese. Despite disheartening statistics regarding the success of weight-loss plans, patients are more likely to take steps to lose weight if encouraged to do so by their primary care physician.
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The recommendation for HIV antiretroviral therapy is changing from "treat early, treat hard" to "treat a little later, treat hard" as more toxicities of the drugs are recognized. Drug-resistant HIV is becoming a serious problem, even in treatment-naive patients. For HIV patients with organ failure, transplantation is increasingly an option.
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To achieve glycemic goals in type 2 diabetes, one must usually use combinations of oral agents or oral agents plus insulin. This paper discusses the metabolic derangements of type 2 diabetes, the different classes of antihyperglycemic drugs, and strategies for using these drugs rationally.