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115

Metabolism: Starvation versus Stress

<p>Not feeding an injured or ill patient is not that same as a normal individual who is fasting.&nbsp;&nbsp; A pound of weight loss in the stress patient is significantly different than a pound of weight loss in someone on a diet.&nbsp;&nbsp;A basic understanding of stress metabolism is needed prior to a discussion of nutrition.&nbsp; </p>  
Jeffrey S. Guy, MD, FACS
almost 9 years ago
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186

Chronic Pulmonary Aspergillosis by David Denning

Prof. Denning describes chronic pulmonary aspergillosis (CPA) as a long-term invasive disease, generally episodic in nature. Common symptoms are cough, shortness of breath, weight loss, tiredness, coughing up blood and aching or discomfort of the chest.  
Aspergillus Website
almost 9 years ago
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22

Myelofibrosis

Marrow fibrosis and splenomegaly, de novo or following transformation of PV or ET Usually >50 years old Abnormal megkaryocytes produced in increased numbers. PDGF and TGFβ are released by megakaryocytes, stimulating fibrosis. Haematopoietic stem cells move to the spleen and liver Presentation: fatigue, weight loss, splenomegaly, splenic pain, portal hypertension, bleeding varices, ascites and hepatomegaly  
almostadoctor.com - free medical student revision notes
over 5 years ago
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30

Weight loss: Is the secret in your bacteria? - BBC News

Researchers say changing the type of bugs found in the gut may be more effective at helping people to lose weight than cutting calories alone - but can it be that simple?  
BBC News
over 5 years ago
Www.bmj
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30

A man with a palpable abdominal mass and night sweats

A 78 year old man presented with an eight week history of left sided abdominal pain and back pain, associated with anorexia, 3 kg weight loss, and night sweats. He was previously well, had no medical history of note, was taking no regular drugs, and was an ex-smoker.  
bmj.com
over 5 years ago
Www.bmj
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33

What is the most effective operation for adults with severe and complex obesity?

Accessing, undergoing, and achieving a successful outcome from surgery for “severe and complex obesity” is difficult and requires determination and effort. Here, we consider “severe and complex obesity” to mean that an individual’s health is compromised by his or her weight to the extent that surgery can be considered to be an appropriate option.1 Surgery may be offered to adults with a body mass index (BMI) of ≥40, or a BMI of ≥35 with an obesity related disease, and it can be very successful. An average 50% of excess weight may be lost in the first few years after surgery, and if this is sustained it is associated with long term reduction in overall mortality and decreased incidences of diabetes, myocardial infarction, stroke and cancer.1 2 This treatment, however, requires careful consideration and serious commitment, with the need to demonstrate full engagement in a structured weight loss programme, to have tried all appropriate non-invasive measures of weight loss, and persevered for referral to a specialist surgical team.1 Once surgery is approved it is necessary to choose which operation to undergo.  
bmj.com
over 5 years ago
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31

Weight loss in an adolescent girl

A 15 year old girl who had been previously fit and well presented to the child and adolescent mental health services (CAMHS) team with weight loss, irregular menstrual periods, excessive exercise, restriction of energy intake during the day, and binging during the evening, followed by vomiting. Her symptoms had been present for a year, since her father had experienced a myocardial infarction. Clinically her symptoms were in keeping with anorexia nervosa, as shown by her completed eating disorder questionnaire.1 Her body mass index (BMI) was 16 and her weight for height was 85% of the median (50th centile) for age and sex. She had a distorted body image, believing her stomach and ankles were too fat, and she had an extreme fear of gaining weight.  
bmj.com
over 5 years ago
Www.bmj
1
28

What is the most effective operation for adults with severe and complex obesity?

Accessing, undergoing, and achieving a successful outcome from surgery for “severe and complex obesity” is difficult and requires determination and effort. Here, we consider “severe and complex obesity” to mean that an individual’s health is compromised by his or her weight to the extent that surgery can be considered to be an appropriate option.1 Surgery may be offered to adults with a body mass index (BMI) of ≥40, or a BMI of ≥35 with an obesity related disease, and it can be very successful. An average 50% of excess weight may be lost in the first few years after surgery, and if this is sustained it is associated with long term reduction in overall mortality and decreased incidences of diabetes, myocardial infarction, stroke and cancer.1 2 This treatment, however, requires careful consideration and serious commitment, with the need to demonstrate full engagement in a structured weight loss programme, to have tried all appropriate non-invasive measures of weight loss, and persevered for referral to a specialist surgical team.1 Once surgery is approved it is necessary to choose which operation to undergo.  
bmj.com
over 5 years ago
Static.www.bmj
1
36

Hoarseness in a 79 year old woman

A 79 year old woman was referred to our ear, nose, and throat outpatient clinic with a history of hoarse voice. This symptom had been present for around three months. It initially fluctuated in severity but eventually became constant. There was no associated pain, weight loss, cough, dysphagia, odynophagia, or other upper airway symptoms. She had not recently had surgery or experienced trauma. Her medical history was of chronic obstructive pulmonary disease, and she was an ex-smoker.  
bmj.com
over 5 years ago
Www.bmj
1
21

A man with a palpable abdominal mass and night sweats

A 78 year old man presented with an eight week history of left sided abdominal pain and back pain, associated with anorexia, 3 kg weight loss, and night sweats. He was previously well, had no medical history of note, was taking no regular drugs, and was an ex-smoker.  
bmj.com
over 5 years ago
Www.bmj
1
44

Diagnosis and management of prolactinomas and non-functioning pituitary adenomas

It is vital to assess pituitary function at the time of diagnosis and doctors should have a low threshold for initiating hydrocortisone when there are features suggestive of adrenocorticotrophic hormone deficiency (for example, lethargy, fatigue, weight loss, hypotension)  
bmj.com
almost 5 years ago
Www.bmj
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51

Bariatric surgery for obesity and metabolic conditions in adults

This review summarizes recent evidence related to the safety, efficacy, and metabolic outcomes of bariatric surgery to guide clinical decision making. Several short term randomized controlled trials have demonstrated the effectiveness of bariatric procedures for inducing weight loss and initial remission of type 2 diabetes. Observational studies have linked bariatric procedures with long term improvements in body weight, type 2 diabetes, survival, cardiovascular events, incident cancer, and quality of life. Perioperative mortality for the average patient is low but varies greatly across subgroups. The incidence of major complications after surgery also varies widely, and emerging data show that some procedures are associated with a greater risk of substance misuse disorders, suicide, and nutritional deficiencies. More research is needed to enable long term outcomes to be compared across various procedures and subpopulations, and to identify those most likely to benefit from surgical intervention. Given uncertainties about the balance between the risks and benefits of bariatric surgery in the long term, the decision to undergo surgery should be based on a high quality shared decision making process.  
bmj.com
almost 5 years ago
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1
93

Science of Weight-Loss: Pathophysiology of Obesity

The science of weight loss explains why losing weight is more complicated than simply eating less and exercising more. In this introduction to the physiology...  
YouTube
almost 5 years ago
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1
14

Hypertension - Treatment Thresholds and Lifestyle Modifications

A discussion of how high BP must be before starting anti-hypertensive therapy, and the 4 major non-pharmacologic treatments of hypertension (weight loss, low...  
YouTube
almost 5 years ago
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1
15

Weight loss surgery reduces diabetes risk - BBC News

Weight loss surgery can dramatically reduce the odds of developing type 2 diabetes, according to a major study.  
BBC News
almost 5 years ago
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1
10

Inherited bugs may help weight loss - BBC News

Our genes influence whether we are fat or thin by shaping which types of microbes thrive in our gut, say experts.  
BBC News
almost 5 years ago
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2274

Science of Weight-Loss: Pathophysiology of Obesity

This tutorial explores the science of weight loss and explains why losing weight is more complicated than simply eating less and exercising more.  
YouTube
over 4 years ago
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1
15

Hypertension - Treatment Thresholds and Lifestyle Modifications

A discussion of how high BP must be before starting anti-hypertensive therapy, and the 4 major non-pharmacologic treatments of hypertension (weight loss, low...  
YouTube
over 4 years ago
Www.bmj
1
28

Screening tests for tuberculosis before starting biological therapy

Before starting treatment, exclude active tuberculosis by asking about symptoms (such as cough, fever, weight loss, and night sweats) and possible exposure to or history of tuberculosis, and with a chest radiograph  
bmj.com
over 4 years ago
Www.bmj
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Cough and weight loss in a young man

A 28 year old man was referred to the emergency department by his general practitioner after presenting with a two day history of haemoptysis. He described coughing up a teaspoon of fresh blood in the morning after a month of coughing up rusty coloured sputum. This was on a background of eight months of persistent cough associated with progressive lethargy and weight loss, with isolated episodes of night sweats. His travel history showed no exposure to high risk areas for tuberculosis or HIV, and he denied any high risk behaviours for contracting HIV. He had never smoked.  
bmj.com
over 4 years ago