Obesity Medicine

Heart failure is prevalent in both primary care and cardiology practices. It develops in about 1 in 5 persons during their lifetime and in about 1 in 8 of those who have not sustained a myocardial infarction (MI). Heart failure is also the leading cause of hospitalization in the elderly.

Your Observations About the Man With the Tripod Sign

Lp(a) is a fascinating variant of low-density lipoprotein (LDL). It is basically an LDL molecule that has been modified by the covalent addition of apoprotein(a). Elevated levels of Lp(a) correlate with increased risk of acute coronary syndromes, cerebrovascular accident, peripheral arterial disease, and coronary mortality. This Q&A session answers some curiosities about Lipoprotein(a).

The diagnostic criteria for major depression are anhedonia, depressed mood, feelings of worthlessness or inappropriate guilt, inability to concentrate, fatigue, insomnia or hypersomnia, psychomotor agitation or retardation, significant weight loss or gain, and recurrent thoughts of death or suicide. Five or more of these symptoms must be present for at least 2 weeks, and one of them must be anhedonia or depressed mood. Conditions that can present with depression include dysthymia, bipolar disorder, cyclothymia, and adjustment disorder. Depression may also result from substance abuse or from the physiological conditions associated with a medical disorder, such as spinal or head injury, AIDS, or cancer.

A Photo Quiz to Hone Dermatologic Skills

Photo quiz

Clinical Images to Help You Hone Your Diagnoses

CHICAGO -- Painful neuropathy is more common with type 2 diabetes than with type 1, possibly, researchers suggest, because of a link with the metabolic syndrome.

CHICAGO -- Elevated glucose levels during pregnancy appear to increase risks to mother and baby even at levels below current criteria for gestational diabetes, researchers reported here.

CHICAGO -- Weight gain in type 1 diabetes is associated with coronary artery calcification, but, paradoxically, that may be a sign of better cardiovascular health, investigators here reported.

DENVER -- Type 2 diabetes is no longer the "adult-onset" disease it once was. More and more children with diabetes are type 2 these days, researchers found.

NEW HAVEN, Conn. -- Childhood obesity can be overcome by an intensive family-based program that includes supervised exercise and nutrition education, found researchers here. But dieting wasn't the answer.

CHICAGO -- When the spotlight here focused on rosiglitazone (Avandia) and its harshest critic, Steven E. Nissen, M.D., of the Cleveland Clinic, the cardiologist offered a mild apology to a room full of diabetologists for complicating their lives.

CHICAGO -- Fructose in sodas and other beverages -- but not glucose -- can set patients on the fast track to atherosclerosis, investigators here reported.

CALGARY, Alberta -- A plate and a cereal bowl marked for a portion size designed to limit calorie intake helped obese diabetic patients know when enough is enough, researchers reported.

CHICAGO -- The prevalence of diabetes of all types in the United States has risen by about 5% annually since 1990, keeping pace with the fattening of America, reported CDC investigators.

CAULFIELD, Australia -- The risk of cardiovascular mortality increases at the earliest sign of impaired glucose metabolism, researchers reported here.

INDIANAPOLIS -- Each person metabolizes food differently, so the diet that works for one person won't work for another.

KROZINGEN, Germany -- Obese patients given early revascularization after acute myocardial ischemia are less than half as likely to die within three years than normal-weight patients, researchers here reported.

CLEVELAND -- Neither age nor Medicare status should be determinants for gastric bypass surgery, researchers here found.

SAN DIEGO -- Gastric bypass surgery alters alcohol metabolism -- as many surgeons and patients suspected -- leading to faster peaks and prolonged effects without an increase in symptoms, researchers found.

CHICAGO -- A child who has a body mass index in the range of the 85th to 95th percentile for age and sex should be considered overweight, not "at risk of overweight".

PORTLAND, Ore. -- As a group, white men who served in the U.S. armed forces are twice as likely to die by their own hands as non-veterans, researchers here found.

SAN DIEGO -- Breast cancer survivors who eat properly and exercise may halve their mortality risk regardless of obesity, researchers here found.

UNIVERSITY PARK, Pa. -- Eating more water-rich foods, especially fruits and vegetables, helped women drop more pounds than simply moderating fat intake.

PORTO, Portugal -- As metabolic syndrome becomes more severe, symptomatic heart failure and several cardiac structural and functional abnormalities may increase progressively, researchers here reported.

BOSTON -- In a discovery that may explain the successes of the Atkins diet, investigators have found that a single hormone may switch on the use of stored fat for fuel when all else fails.

SAN DIEGO -- Men older than 50 with androgen deficiency are at a greater risk for all-cause mortality than their peers with age-appropriate testosterone, reported investigators here.

BOSTON -- Folate and B vitamins from food, but not from supplements, may be of modest help in fending off cancer of the pancreas.

We present a case of a 35-year-old man with fever and pancytopenia, who had rapid progression to acute respiratory distress syndrome (ARDS), multiorgan failure, and disseminated intravascular coagulopathy secondary to disseminated tuberculosis (TB). Although both sputum and bronchoalveolar lavage (BAL) fluid smears were negative for acid-fast bacilli, the polymerase chain reaction (PCR) assay on the BAL fluid was positive for Mycobacterium tuberculosis. This case emphasizes the need to include TB in the differential for ARDS and the value of PCR testing of BAL fluid, especially in high-risk patients.