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In many cases, its driven by underlying metabolic, hormonal, or appetite-regulation factors that traditional approaches dont address

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[3] Beyond channel modulation, topiramate allosterically inhibits certain carbonic-anhydrase isoenzymes expressed in renal tubules and ocular ciliary epithelium

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Cavernous artery flow and end-diastolic velocity were normal: peak systolic velocity was 74 cm/seconds (bilaterally)