Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0028754 (obesity)
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There was no significant difference between the assessments by two groups of randomly-selected general practitioners on the effectiveness of the drug treatment for 19 common clinical conditions. The treatment of simple iron deficiency anaemia was considered the most effective and gained the highest consensus. Least effective, but not matched by worst consensus, was the drug treatment for obesity. The most widespread disagreement among the practitioners was for the effectiveness of the drug treatment of gastroenteritis.
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PMID:The assessment by doctors of the effectiveness of drugs. 101 Dec 6

To evaluate the effectiveness of contraceptive usage, a 2-year (1985-87) review of pregnant women registered in a large group medical practice west of London was carried out. Altogether, 518 pregnancies were reported during the study period, 187 (36%) of which were unplanned. Broken down by age category, the unplanned pregnancy rate was: 15-19 years, 7.5; 20-24 years, 6.5; 25-29 years, 5.4; 30-34 years, 3.5; and 35-44 years, 2.0. The methods of contraception used at the time of the unplanned pregnancies were: no contraception, 61 women; condom, 49 women; combined oral contraceptive, 27 women; progesterone-only oral contraceptive, 14 women; IUD, 12 women; cap, 12 women; rhythm, 6 women; and withdrawal, 6 women. Of the 49 couples who were relying on the condom for fertility control, 16 had not been using this method at the probable time of conception. In the 27 pregnancies due to failure of the combined pill, 16 indicated they had missed some pills and 3 had gastroenteritis at the probable time of conception; similarly, of the 14 pregnancies involving failure of the progesterone pill, 6 women had forgotten pills and 1 had gastroenteritis. The most commonly cited reasons for nonuse of contraception were fear of or actual side effects (obesity, cancer, heart disease). Unplanned pregnancies in women under 25 years of age tended to be the result of not using any form of contraception or of using combined oral contraceptives incorrectly; in women over this age, unplanned pregnancies were most often associated with condom use. These results suggest several steps: 1) physicians should discuss contraception with all teenagers thought to be sexually active; 2) more time should be spent exploring patients' fears of side effects; 3) patients should be counseled about procedures to follow if a pill is missed; and 4) use of both the condom and combined oral contraceptives should be encouraged in younger women.
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PMID:Lessons from an audit of unplanned pregnancies. 314 Sep 75

Dr. Grayson (February 21, p. 445) asks about changes in vital statistics of 3rd world populations as they develop. Of African populations, those in Johannesburg and other large South African cities, while still in transition, have now reached a relatively high level of sophistication. Their health pattern is likely to be that of other African countries as they prosper. The (IMR) infant mortality rate of blacks in Soweto, Johannesburg, is about 40/1000 live births, although nearer 30 in the regularly employed elite. This figure is similar to that for blacks in New York in 1965 and for class 5 persons in the United Kingdom. Small-town dwellers have higher IMRs and in rural areas the rates are higher still although they are decreasing everywhere. Family size is decreasing; in urban areas the average family has 3-4 children and the elite have 2-3. In Johannesburg during the 1960s, the birth rate was about 40/1000 and it is now 25. While the rate is higher in rural areas, it is falling. In the very young, gastroenteritis with or without malnutrition is still the leading cause of sickness and death in both urban and rural areas. Rates are however decreasing. Deficiency diseases, especially pellagra, remain a health problem in some areas. Tuberculosis still continues to be a major hazard although it is being dealt with. With the rise in socioeconomic status and associated changes in diet and lifestyle, obesity, especially in urban areas and especially among women, is becoming very prominent. Hypertension is more common and is the leading cause of natural death among urban dwellers. The toll from coronary heart disease and noninfective bowel disease remains inexplicably low, but diabetes is only somewhat less prevalent than it is among whites. Changes in cancar pattern and rates are slight; however, esophageal cancer in men and cervical cancer in women are the main causes of concern in the urban centers and some rural areas. Rising alcohol consumption is a major problem with its ramifications in pancreatic, liver, and heart problems. Cigarette smoking is now as common as among whites. Because of low rates for most degenerative diseases, blacks have, at middle age, a life expectancy exceeding that of whites. As sections of the 3rd world population prosper, the IMR decreases enormously as does family size. However, infections and malnutrition among the very young and tuberculosis in older groups remain important problems. Among adults, rises occur in some degenerative diseases but not in others, and diseases linked with hypertension and alcohol consumption have become formidably common, as they have in other developing and developed countries.
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PMID:Third World policies and realities. 611 Sep 78

We created a predictive model for the area under the concentration versus time curve (AUC) of cyclosporin A (CsA) using routine monitoring results, and examined its clinical utility. Based on 48 clinical time courses accumulated from renal transplant patients, the AUC predictive model was created. An estimate of the AUC0-8 (integrated from time zero to 8 h) was then given as follows: AUC0-8 = 5673.1 x log(TL) + 9342.8 x log(OB) + 64.1 x Dprd x 869.4 x DTK - 168.9 x HCT - 161.2 x SCr - 11.3 x GPT + 3.0 x PL - 588.6 x SEX - 24794.5. In this model, the AUC0-8(ng.h/ml) is given as a function of the CsA through levels (TL, ng/ml), obesity (OB, %), daily dose of prednisolone (Dprd, mg/d), donor type of kidney (DTK), hematocrit (HCT, %), serum creatinine (SCr, mg/dl), glutamate-pyruvate transaminase activity (GPT, IU/l), plasma lipids (PL, mg/dl) and sex distinction (SEX). The Statistical significance of the multiple regression was p < 0.00001 (R2 = 0.862, n = 48), and the day after transplantation, neither the administered oral dose of CsA, or the patient's age had any contribution to the regression. The predictive performance of this model was almost equal to that of the existing method which used 3-point data on the concentration versus time curve. In clinical adaptation for renal transplant patients, the steady-state concentration of CsA (Css) based on the AUC0-8 predictive model was significantly decreased during acute gastroenteritis or before acute rejection, whereas nephrotoxicity was increased, even though CsA trough levels were within a normal therapeutic range (100-200 ng/ml). These findings suggest that the created AUC0-8 predictive model using routine monitoring results, i.e., the trough level of CsA, biochemical tests, a daily dose of predorinsolone (PRD), and basic patient information, is convenient as a monitoring device for CsA therapy, and is satisfactory in clinical practice.
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PMID:A predictive model for area under the concentration versus time curve of cyclosporin A using several routine monitoring results in renal transplant patients. 930 Jan 38

The present population in South Africa, roughly 43 million inhabitants, is made up of Africans (77.2%), whites (10.5%), Coloureds (mixed race) (8.8%) and Indians (2.5%). In 1900 the infant mortality rate (IMR) among Africans was 330 per 1,000 live births; this has now fallen to 50-60. In Soweto, a primarily African city, IMR averages 20-25. Life expectancy in the past was only 25-30 years; by 1995, this reached 63 years. However, this could fall again due to the rapidly spreading HIV/AIDS epidemic. Life expectancy could fall to 40-45 years by 2010 with the AIDS epidemic being the cause of half of all deaths--a disastrous change from the previous relatively commendable public health situation. Formerly, the most common causes of deaths in young people were infections, diseases associated with malnutrition and gastroenteritis. Adults died almost solely from infections, including typhoid, dysentery, malaria and tuberculosis (TB). Even though diseases associated with malnutrition are less common today, many infections still remain a major problem, particularly TB, which is increasing. As late as 1970, Africans who reached 50 years had longer life expectancy than whites due to the low prevalences of the chronic diseases of lifestyle. This is no longer so, due to the recent rises in non-communicable disorders/diseases, principally obesity in women, hypertension, diabetes, stroke and the cancers of prosperity. In the not so distant future, the level of control of HIV/AIDS related diseases will be the major health/disease regulating factor among Africans. Among white, Coloured and Indian populations, there have been falls in the mortality rates of the young and, despite rises in lifestyle diseases, increases in life expectancy are continuing. For all populations other important public health regulatory factors include water supply, sanitation, clinic/hospital services and personal environmental factors, employment, dietary pattern and intake, smoking practices and alcohol consumption and physical activity, particularly in urban dwellers. Unfortunately, public health expenditure, also a highly regulating factor, has fallen from 8.2% of the gross domestic product in 1994 to 4.1% in 2000.
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PMID:Changes in public health in South Africa from 1876. 1146 13

This report summarizes follow-up studies in 18 patients who underwent bilateral adrenalectomy for congenital adrenal hyperplasia. Three of these patients were young children with null/null mutations of CYP21, and the other 15 were adrenalectomized because of difficulties in their management on conventional therapy. The average duration of follow-up was 59 months and represents an aggregate of 90 postoperative years. The adrenals were removed laparoscopically in 13 patients and by open flank incisions in five. Adrenal crises associated with severe illnesses occurred in five patients at times when their glucocorticoid substitution was suboptimal. All were responsive to appropriate therapy. Two of these patients were young children who had hypoglycemia during gastroenteritis or febrile illness associated with poor food intake or vomiting. Significant elevations of adrenal steroid precursors, presumably from ectopic adrenal rests, were observed postoperatively in eight of the patients. Patients and parents were nearly unanimous in their enthusiasm for adrenalectomy. In most, signs of androgen excess have decreased, and obesity has become less of a problem with lowering the dose of glucocorticoid. We conclude that adrenalectomy is a safe and efficacious method of managing congenital adrenal hyperplasia in selected patients. Prophylactic adrenalectomy in young children with double null mutations remains experimental.
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PMID:The role of bilateral adrenalectomy in the treatment of congenital adrenal hyperplasia. 1284 31

Prader-Willi syndrome (PWS) is a complex condition with many medical and psychological features. In individuals with this syndrome, causes of death were studied. Data of 27 case reports were collected. Ages at death ranged from neonatal to 68 years. None of the individuals were treated with growth hormone (GH). Most cases were not completely documented and autopsy was performed in a minority of cases only. In five cases, death was considered not to be causally related to PWS. Hypotonia with hypoventilation was noted in the babies, and acute respiratory illness with unexpected sudden death was experienced in young children with PWS. Two young children died after a short period of fever and gastroenteritis. Obesity and its complications leading to death were pronounced in the adult group. One (possibly two) adult(s) died from gastric dilatation and shock. Based on these data, some cautious conclusions can be drawn. In babies with PWS hypoventilation is a risk factor; upper airway infection may be more serious than anticipated and any other clinical features pointing to an infection should be taken very seriously. Therefore, young infants with PWS hospitalized with an upper airway infection and/or hypoventilation or gastroenteritis symptoms, should be closely monitored. Early diagnosis and prevention of overweight is a major factor in preventing early causes of death in individuals with PWS. In the adult group, weight reduction is important but difficult to manage. Sleep apnea should be recognized and treated. Pain in the upper stomach and/or vomiting should be taken as a possible sign of acute intestinal dilatation; intravenous support may be life saving.
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PMID:Prader-Willi syndrome: causes of death in an international series of 27 cases. 1473 79

Inflammation, malnutrition and growth retardation during critical time-windows of development play a powerful role in ontogenetic programming of the life-long risk to many adult diseases (including metabolic syndrome, obesity and diabetes). Cellular mechanisms and the accurate timing and duration of critical periods for the liver remain obscure. To resolve this problem, we developed a postnatal suckling-weanling rat model of mild, moderate, and acute gastroenteritis challenged by a protozoan parasitic spread throughout the whole world, namely Cryptosporidium parvum. The physiological state of the liver was evaluated by hepatocyte ploidy and protein content that were measured by cytophotometry and image analysis on isolated cells. Hepatocyte ploidy is known to irreversibly increase after stress and is associated with the decrease in liver physiological capacity. Hepatocyte hypertrophy reflects cell functional loading. From our results, cryptosporidiosis is able to provoke a burst in premature hepatocyte polyploidization and hypertrophy (in proportion to parasitic load), and thus plays an important role in epigenetic programming of hepatocyte structure and function. We revealed two sensitive periods in liver growth. The first period (the less sensitive) covers the time before the establishment of homoiothermy, i.e. 6-9 days after birth. The second period (the more sensitive) covers the time of weaning when the change of type of nutrition and the peak of hepatocyte polyploidization and differentiation occurs. Thus, our data provide direct evidence that phenomenon of ontogenetic programming is reflected at the cellular level.
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PMID:Impact of neonatal cryptosporidial gastroenteritis on epigenetic programming of rat hepatocytes. 1733 45

Breastfeeding is associated with decreased risk for many early-life diseases and conditions, including otitis media, respiratory tract infections, atopic dermatitis, gastroenteritis, type 2 diabetes, sudden infant death syndrome, and obesity. Breastfeeding also is associated with health benefits to women, including decreased risk for type 2 diabetes, ovarian cancer, and breast cancer. Exclusive breastfeeding is defined as an infant receiving only breast milk and no other liquids or solids except for drops or syrups consisting of vitamins, minerals, or medicines. In 2007, Healthy People 2010 (HP2010) objectives for breastfeeding initiation and duration were updated to include two new objectives on exclusive breastfeeding (i.e., to increase the proportion of mothers who exclusively breastfeed their infants through age 3 months to 60% and through age 6 months to 25% [objectives 16-19d and 16-19e]). To monitor progress toward achieving HP2010 breastfeeding objectives, CDC analyzed data from the National Immunization Survey (NIS). This report describes the results of that analysis, which indicated that rates for breastfeeding initiation and duration increased among infants born during 2000-2004. Rates for exclusive breastfeeding through ages 3 months and 6 months among infants born in 2004 were 30.5% and 11.3%, respectively, below targets set by HP2010. Rates of exclusive breastfeeding were significantly lower among black infants (compared with white infants) and infants born to unmarried mothers (compared with married mothers). Additionally, older age, urban residence, higher education, and higher income of mothers all were positively associated with exclusive breastfeeding. Further research is needed to identify successful programs and policies to support exclusive breastfeeding, especially among subgroups with the lowest rates.
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PMID:Breastfeeding trends and updated national health objectives for exclusive breastfeeding--United States, birth years 2000-2004. 1767 96

The mammalian GI tract contains a large and diverse ecosystem of microorganisms that play a profound role in our development and physiology. Interestingly, the microbial make-up within the intestine has been found to be altered in many clinically important diseases, including inflammatory bowel disease, irritable bowel syndrome, Types 1 and 2 diabetes, and obesity. Barman et al. used a Salmonella-induced murine model of gastroenteritis to show that the intestinal microbiota are transiently altered during the host inflammatory response to infection. These findings are of interest as understanding how the microbiota are altered during disease states may offer insight into which microbial populations are important in maintaining intestinal homeostasis. Recently, probiotics have been shown to modulate the mucosal immune system and improve intestinal barrier function, validating their potential as therapeutics for gastrointestinal-associated diseases. As we begin to understand the benefits conferred to the intestine by microbiota, the use of probiotics to modify its composition is an attractive option to improve human health.
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PMID:Intestinal microbiota are transiently altered during Salmonella-induced gastroenteritis. 1816 Apr 81


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