Cleveland Clinic journal of medicine
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Obesity is epidemic and dangerous. Weight loss is difficult but worth the effort. Although new weight-loss drugs are available, there are no magic bullets: to lose weight and keep it off, people must eat less and exercise more. ⋯ Because obesity is a chronic disease, drug treatment should be continued indefinitely. The physician and patient must understand the intention to treat long-term. The weight loss plan devised should improve upon previous plans: for example, implementing a regular, convenient exercise program that had not been included in the past, or offering pharmacotherapy.
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In most patients with spinal cord compression due to epidural metastasis, the initial symptom is progressive back pain with an axial or radicular distribution, but early symptoms are often nonspecific. Since the key prognostic factor is the neurologic status at the time of presentation, and since early complaints are often nonspecific, a high index of suspicion is needed to diagnose this complication early.
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In a recent major study, patients with acute respiratory distress syndrome or acute lung injury were randomly assigned to have their respirators set to deliver tidal volumes of either 6 mL/kg or a more-traditional 12 mL/kg. Mortality in the low-tidal-volume group was 31.0%, compared with 39.8% in the traditional-tidal-volume group, a 22% difference (P = .007).