Obesity Medicine

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SEATTLE -- Obese men diagnosed with prostate cancer in middle age are at a 2.6-fold higher risk of dying from the disease than are patients of normal weight, according to a case-control study.

TOKYO -- Obstructive sleep apnea patients have a high rate of silent brain infarctions that can be seen by magnetic resonance imaging, according to researchers here.

BOSTON -- Middle-age volunteers whose parents survived to age 85 or older had significantly better Framingham risk scores than those whose parents died younger, suggesting that cardiovascular longevity may reside in the genes.

LOS ANGELES -- The higher the body mass index, the lower the likelihood that patients hospitalized for ischemic stroke would be discharged directly home, found UCLA researchers.

STANFORD, Calif. -- Women who followed the low-carbohydrate, high-protein Atkins diet for a year lost more weight than women assigned to three other diets with a high or higher carbohydrate intake, researchers here reported.

Boutonneuse Fever

A 42-year-old woman returned from a 2-month stay in India with a rash and alow-grade fever. She also complained of fatigue, nausea, anorexia, and weightloss. Despite treatment with amoxicillin for a presumed streptococcal rash,her symptoms worsened. The pruritic rash spread over the patient’s body;only the face was spared.

The prevention of symptomaticcoronary heart diseaseand other vascular disordersrepresents a significanthealth care priority, especiallyin a population that is growingolder and more obese. However,a recent survey has shownthat many laypersons-and evensome physicians-do not know allthe target lipid levels that are associatedwith optimal reduction ofcardiovascular risk.

ABSTRACT: A 4-pronged approach that includes patient education, skin and nail care, appropriate footwear, and proactive surgeries can effectively prevent diabetic foot problems. Teach patients with diabetes to examine their feet daily to detect new onset of redness, swelling, breaks in the integrity of the skin, blisters, calluses, and macerated areas. Have them follow a daily foot care regimen that includes warm water soaks and lubrication, and have them keep toenails properly trimmed. Recommend that patients select shoes that fit properly and have sufficient padding and toe box space; have them use inserts, lifts, orthoses, or braces--as recommended-to correct abnormal gait patterns. Finally, if deformities develop, simple proactive surgical procedures can correct these problems before they result in the development of wounds.

ABSTRACT: In patients with jaundice and normal liver function, the cause of hyperbilirubinemia is an isolated disorder of bilirubin metabolism. In patients with hyperbilirubinemia who have abnormal liver enzyme levels, hepatocellular disease must be differentiated from cholestatic liver injury. In general, if the cause of jaundice is global hepatocellular dysfunction, the serum alanine aminotransferase and aspartate aminotransferase levels will be predominantly elevated. If the cause is cholestasis, the serum alkaline phosphatase and gγ-glutamyl peptidase levels will be elevated. In most patients, imaging studies will be needed. The initial workup should include abdominal ultrasonography, which can identify dilated intrahepatic and extrahepatic biliary ducts as well as findings that may suggest cirrhosis or signs of portal hypertension, including splenomegaly and ascites.

WALTHAM, Mass. -- Pulse pressure, the difference between systolic and diastolic pressures, may be a risk factor for the onset of atrial fibrillation independent of arterial pressure and other known factors, researchers said.