Managing obesity like any other chronic condition. Long-term therapy may reduce comorbidity as well

Patients often seek help from their primary care physician for weight loss, so familiarity with pharmacologic options and their risks is important. Anorexiants have been available for decades and are relatively safe. Orlistat and sibutramine are two of the newer medications that patients may have heard about in television, newspaper, and magazine advertising. In addition, patients often ask for advice regarding various herbal or nonprescription medications for weight loss. In this article, the authors help physicians prepare to address these questions.

Methylphenidate in the treatment of coma

While there is significant morbidity and mortality involving patients in semicomatose and comatose states, the care of such patients has traditionally been limited to supportive measures. We report two cases of patients treated with methylphenidate hydrochloride: the first, a patient in a semicomatose state resulting from traumatic brain injury, and the second, a patient in a comatose state secondary to a subdural hematoma that occurred after a fall. Treatment with methylphenidate may provide neurostimulations by augmenting the activity of injured neuronal tissue within the reticular activating system, and by amplifying the net effect of the reduced number of viable neurons. Methylphenidate is a low-cost, potentially efficacious intervention for reducing the duration of comas, for preventing life-threatening and costly complications of prolonged unconsciousness, and for promoting early ambulation and recovery. Further research using more rigorous research designs to ascertain the effectiveness of methylphenidate in the treatment of patients in semicomatose and comatose states is needed.