Goutham Rao

Childhood obesity and type 2 diabetes mellitus.

Until recently, the majority of cases of diabetes mellitus among children and adolescents were immune-mediated type 1a diabetes. Obesity has led to a dramatic increase in the incidence of type 2 diabetes (T2DM) among children and adolescents over the past 2 decades. Obesity is strongly associated with insulin resistance, which, when coupled with relative insulin deficiency, leads to the development of overt T2DM. Children and adolescents with T2DM may experience the microvascular and macrovascular complications of this disease at younger ages than individuals who develop diabetes in adulthood, including atherosclerotic cardiovascular disease, stroke, myocardial infarction, and sudden death; renal insufficiency and chronic renal failure; limb-threatening neuropathy and vasculopathy; and retinopathy leading to blindness. Health care professionals are advised to perform the appropriate screening in children at risk for T2DM, diagnose the condition as early as possible, and provide rigorous management of the disease.

Bismuth revisited: an effective way to prevent travelers' diarrhea

J Travel Med 2004; 11:239–242. Approximately 35 million people travel from the rich world to developing countries annually.1 Of these, 20% to 50% will develop travelers’ diarrhea (TD), defined as the passage (during or up to 10 days after travel) of two or more watery or unformed stools over a 24-h period, or the passage of any number of stools when associated with fever, vomiting, or abdominal cramps.2 The mean duration of TD is only 3.6 0.1 days,2 and severe complications are rare.The impact of TD,however, is considerable, since it causes significant discomfort and loss of leisure time. Among healthy people, children and young adults are at increased risk.3,4 Young adults aged 20 to 29 years are thought to be at increased risk due to higher food consumption, riskier food and drink choices,or less prior exposure to etiologic agents.5 The most common causes of TD are bacteria, including enterotoxigenic Escherichia coli, Campylobacter jejuni, Salmonella spp. and Shigella spp. In 10% to 40% of cases no pathogen is isolated.5 To avoid TD,travelers should take sensible food and water precautions, such as avoiding untreated water and ice cubes, raw fruits and vegetables, unpasteurized milk and undercooked meat.6 Chemoprophylactic agents include bismuth subsalicylate, probiotics and antibiotics.There is evidence for the usefulness of probiotics to treat certain conditions.7 Their use to prevent TD, however, is rare and the value of this approach is uncertain. Antibiotics are sometimes prescribed for the prevention of TD. Fluoroquinolones, trimethoprim– sulfamethoxazole (TMP-SMX) and tetracyclines are all effective in preventing a significant proportion of cases. Side effects, cost and bacterial resistance, however, are significant concerns.Fluoroquinolones including ciprofloxacin, for example, are highly effective in preventing TD.8 They cover a wide range of species of bacteria, but resistance of Campylobacter spp.and E.coli is already emerging in many parts of the world.9,10 Side effects are common and include nausea, vomiting, rash, headache, dizziness and, less commonly, serious cardiac arrythmias.11 A 2-week course of ciprofloxacin (500 mg q.d.) costs a fairly substantial

Pediatric Obesity-Related Counseling in the Outpatient Setting

70 to

Evaluation and Management of Childhood Obesity in Primary Care Settings

80.12 TMP-SMX and tetracyclines also have common side effects but are considerably less expensive. It is important to keep in mind that, because antibiotics are normally available only by prescription, the cost of a doctor’s visit contributes to the overall cost of treatment.Overall, the Centers for Disease Control have concluded that the benefits of prophylactic antibiotic treatment are outweighed by the drawbacks, and do not recommend such treatment to prevent TD.13 Bismuth subsalicylate is a non-antimicrobial medication and the active compound in Pepto-Bismol. It has been used for many years to prevent TD and is widely available in North America without a prescription in both liquid and tablet forms.Unfortunately, availability is limited in Europe, Australia and New Zealand. A 2-week course costs only

Carvedilol reduced mortality and hospitalization in severe chronic heart failure

10 to

A nicotine patch plus nicotine nasal spray was more effective than a nicotine patch alone for smoking cessation

15.14 The purpose of this systematic review is to determine the effectiveness of bismuth subsalicylate in the prevention of TD among healthy travelers.

Bupropion alone or with a nicotine patch increased smoking cessation rates

OBJECTIVE To determine rates of pediatric obesity-related counseling in the outpatient setting. METHODOLOGY The 1993-2002 data from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Care Survey (NHAMCS) were extracted for estimates of 1) percentage of all pediatric encounters that included obesity-related counseling and 2) percentage of all pediatric encounters that included general growth/ development counseling. Obesity-related counseling rates were compared with corresponding growth/development counseling rates and with the number of pediatric-obesity articles listed in Medline for each year. RESULTS The rate of obesity-related counseling steadily improved and was correlated with the number of published obesity articles (Spearmans rho .721) between 1993 and 2002. In 1995, for example, 4.3% of encounters included such counseling, compared with 19.0% in 2001 and 15.4% in 2002. CONCLUSIONS Obesity-related counseling has become an important part of ambulatory care, which suggests increasing awareness of this serious problem.

Insulin Resistance Syndrome

Publisher Summary The well-publicized epidemic of obesity affects both adults and children. In the United States, 31.9% of children are either overweight or obese, 16.3% are obese. Many other developed countries are similarly affected. The combined prevalence of overweight and obesity is higher than 15% in Canada, the United Kingdom, and several Mediterranean countries. Childhood obesity is now a significant problem in many developing countries as well. Roughly 11% of middle-class Indian children, for example, are obese. Among adults, obesity is strongly associated with type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, biliary tract disease, and asthma. There is also a strong association between obesity and cancer of the colon, breast in postmenopausal women, endometrium, esophagus, and kidney. Disturbingly, childhood obesity has become so serious that some of these problems are now emerging in children. A generation ago, type 2 diabetes was rare among children. Today, in some settings, it constitutes nearly half of all new cases of diabetes diagnosed among children. This chapter aims to provide practical recommendations for busy primary care physicians for the evaluation and management of common obesity-related illnesses among overweight and obese children and to offer strategies for helping children achieve or maintain a healthy weight. The chapter makes use of a case study to describe a stepwise approach to the problem.

Childhood obesity: highlights of AMA Expert Committee recommendations.

Source Citation Packer M, Coats AJ, Fowler MB, et al., for the Carvedilol Prospective Randomized Cumulative Survival Study Group. Effect of carvedilol on survival in severe chronic heart failure. N...

Physician numeracy: Essential skills for practicing evidence-based medicine

Source Citation Blondal T, Gudmundsson LJ, Olafsdottir I, Gustavsson G, Westin A. Nicotine nasal spray with nicotine patch for smoking cessation: randomized trial with six year follow up. BMJ. 1999...