Obesity

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

A 45-year-old man sought medical advice after suffering for 6 months with recurrent pain and a purulent discharge at the sacrococcygeal region. Two weeks before this consultation, an abscess on the patient's right buttock had been drained by another physician. The patient had type 1 diabetes mellitus for 5 years; his medical history was otherwise unremarkable.

Obesity is a well-known risk factor for many diseases. Now it looks like asthma can be added to the list. A meta-analysis that was conducted by Beuther and Sutherland indicated that being overweight is associated with a 50% increase in the incidence of asthma. The risk applies to both men and women.

Frightened but lucid man who appears stated age. Vital signs are normal. No mass palpable in abdomen, though there is a faint suggestion of upper-abdominal distension. No supraclavicular lymphadenopathy, umbilical nodules, or upper-abdominal vascular bruit.

BETHESDA, Md. -- Heart disease risk factors in early adulthood presage atherosclerosis in middle age, suggesting that early intervention may be beneficial, researchers found.

BOSTON -- The gender gap in multiple sclerosis has doubled over the past six decades, reaching about four women with the disease for every affected man, investigators reported here.

ALAMEDA, Calif. -- In patients with chronic hepatitis C, a seven-gene test may outdo usual clinical risk factors in predicting the likelihood of advance to cirrhosis.

COLORADO SPRINGS, Colo. -- For prospective gastric bypass patients, surgeons may have a better tool to help gauge the risk of mortality from the procedure, researchers said here.

ANN ARBOR, Mich. -- Several genetic regions appear to contribute to the risk of developing type 2 diabetes, three research groups have found in a major collaborative effort.

BOSTON -- Patients 90 or older with acute coronary syndromes have decreased hospital mortality when recommended therapy guidelines are followed, researchers have reported.

BOSTON -- The risk of progression for advanced age-related macular degeneration may involve common variations in two genes, an effect amplified by risk factors such as smoking and obesity.

MIDDLESBROUGH, England -- Whole-grain oats can carry the lipid-lowering banner higher than other whole grains -- but not too high.

DURHAM, N.C. -- Strains, sprains, and pains are more common in obese employees than in normal-weight workers, costing U.S. companies billions of dollars, researchers here reported.

WINSTON-SALEM, N.C. -- Vitamin D deficiency in older patients has been associated with poor performance on simple physical tasks, according to investigators here.

SAN ANTONIO, Tex. -- Enoxaparin (Lovenox), a low-molecular-weight heparin, proved more effective than unfractionated heparin for preventing potentially fatal leg and lung clots after acute ischemic stroke, researchers reported.

CHICAGO -- Those habitual college keggers could be chugging toward heart disease later in life, investigators reported here.

OXFORD, England -- Use of hormone replacement therapy for at least five years added up to 1,300 additional ovarian cancers over 14 years in Britain and 1,000 extra deaths, researchers here reported.

SEUOL, Korea -- The average body mass index in a group of children with otitis media with effusion was about 35% higher than among those with no history of ear infection, found researchers here.

SEATTLE -- Increases in fasting plasma glucose in non-diabetic patients appear to be caused by decreased glucose clearance rather than an increase in hepatic glucose production.

For several months, a 52-year-old woman has had burning discomfort in the region of her lower sternum and frequent acid/sour sensations in her throat; the symptoms are usually associated with burping after meals and recumbency.

NEW YORK -- More than half the states have tied payment to performance for Medicaid services for some of their health care programs, according to a survey just published.

SEATTLE -- For long-term remission of refractory type 2 diabetes, a surgical procedure akin to gastric bypass has just entered clinical trials in Europe, investigators reported here today.

EXETER, England -- The first clear genetic link to obesity for the common man or woman may have been discovered by researchers here.

PRINCETON, N.J. -- The Robert Wood Johnson Foundation, the nation's largest health care philanthropy, announced it will commit at least million over the next five years to combat childhood obesity.

BETHESDA, Md. -- Women who began hormone replacement therapy within 10 years of starting menopause appear to be at a lower risk for coronary heart disease than women who start after a decade.

ROCKVILLE, Md. -- The FDA has approved the first type 2 diabetes treatment that includes a dipeptidyl peptidase-4 (DPP-4) inhibitor with metformin in a single tablet.

DENVER, April 2 -- The occurrence rate of asthma increases by 50% in adults who are overweight or obese, according to a small meta-analysis.

abstract: Low molecular weight heparins (LMWHs) have proved to be as safe and effective as unfractionated heparin for the treatment of venous thromboembolism. They have the advantage of not requiring frequent measurement of activated partial thromboplastin time and subsequent dosage adjustments. Patients who have deep venous thrombosis can be treated with once- or twice-daily subcutaneous doses. Hospital admission is necessary for patients with risk factors for major bleeding complications, for those with symptomatic pulmonary embolism, or when noncompliance is likely. Symptomatic proximal deep venous thrombosis and asymptomatic pulmonary embolism may be managed on an outpatient basis if there are no contraindications. Although heparin-induced thrombocytopenia occurs less frequently with LMWHs than with unfractionated heparin, the platelet count must still be monitored during therapy. (J Respir Dis. 2007;28(4):132-138)

abstract: Hemoptysis has many causes, including bronchiectasis, lung cancer, and bronchitis. The initial goals of the history and physical examination are to differentiate hemoptysis from epistaxis and hematemesis and then to establish its severity. A variety of signs and symptoms may suggest the underlying cause. For example, hematuria suggests vasculitis or an immunologically mediated disease, such as Wegener granulomatosis or systemic lupus erythematosus. The workup includes chest radiography and measurement of hemoglobin and hematocrit levels, platelet count, international normalized ratio, activated partial thromboplastin time, and creatinine level. Chest CT scanning often identifies sources of bleeding that are not apparent on radiographs and sometimes can be used in conjunction with bronchoscopy. Patients with massive hemoptysis should be hospitalized for rapid evaluation and intervention; treatment may include interventional bronchoscopy, angiography, or embolization. (J Respir Dis. 2007;28(4):139-148)

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