Obesity

Obesity

Overweight is the term used when a person weighs more than the set limits for him or her. Obesity on the other hand is an excess of body fat.

Appropriateness of weight is measured by BMI (body mass index).

The formula for this is:-

Weight in Kilograms ÷ (Height in meters) 2

eg if a person weighs 80 kgs and his height is 1.6 meters than his BMI is

80/ 1.6 X 1.6 =80/2.56 =31.3.

A person with BMI > 25 but < 30 is considered overweight and > 30 obese. If BMI is > 35 a person is considered to have a severe problem.

Causes of overweight in children :

Being overweight or obese is always due to the accumulation of fat as the calories consumed are more than calories burnt by the body.

In children, obesity is often due to over indulgence in sweets, sugar in ice creams and beverages or cold drinks, lack of exercise, more fats in the diet.

Food habits in the family, genetics and overweight family members play a significant role.

Other factors are video games, TV, android phones, excess sleep etc. In some cases hormonal disorders or brain disorders may alter hunger and satiety and thus may cause obesity. These conditions are rare.

Childhood obesity persists into adulthood if the obesity is severe, if parents or other family members are obese and if no action is taken to correct the cause.

CKD (Chronic Kidney Disease)

CKD ( Chronic kidney disease)

Causes:

The  common causes of CKD are

  • Long standing Diabetes mellitus

  • Hypertension

  • Chronic glomerular diseases ( usually underlying cause is obscure)

  • Chronic interstitial diseases.

  • Stone disease or other obstructive diseases like enlarged prostate, narrowing of urethra, cancer of cervix in woman or prostate in man,

  • Genetic diseases Polycystic kidneys, vesicoureteric reflux

  • Acute kidney injury that does not recover, Analgesic abuse,

  • HIV related kidney disease etc.

Japanese Encephalitis (JE)

Japanese Encephalitis( JE)

It is caused by a virus called JE Virus or JEV. It is now endemic in Asia. Most cases occur in the beginning of rainy season.

The disease is spread by mosquitoes. The virus multiplies in pigs and aquatic birds. When a mosquito bites human beings after biting pigs the virus is transmitted to man. Pigs are the most important hosts due to very high levels of virus in their blood.

In man the virus multiplies but does not reach levels where a mosquito after biting one human being can transmit it to others. The name of mosquito spreading it most often is Culex Vishnui. However, it is found in other species of mosquitoes as well.

After a gap of 5 to 15 days (called incubation period), signs and symptoms of the disease appear.

Most of the cases where the bite transmits the virus are subclinical or mild. Only about 1% of the cases are severe and brain inflammation or encephalitis is seen.

In the beginning, there is fever and sometimes loose motions and body aches. Chills and rigors, headache and vomiting may occur. A few days later involvement of the brain is seen with the occurrence of fits, drowsiness, and patients may become unconscious.

Diagnosis is achieved by finding antibodies against this virus in the blood (ELISA Test) and rarely by finding viral particles (NAAT )

They may remain bedridden for weeks.

20 to 30 % of the patients who are hospitalised with JE die due to the illness. Of the survivors, 40 to 50 % may have permanent neurological damage.

Prevention is accomplished by preventing mosquito bites.

A vaccine grown in vera cell line given in doses of .5 ml on day 0 and 28 is available for adults. A live attenuated vaccine and other vaccines have also been manufactured. These vaccines may have side effects.

The efficacy of the vaccine is not yet clear.

Immunosuppression after Kidney Transplant

Immunosuppression after Kidney Transplant

The drugs are always taken on the advice of a physician experienced in dealing with transplants. Patients should never change doses on their own. Stopping of drugs may result in acute rejection and damage to or loss of the kidney. Usually three drugs are given. These are required to be taken lifelong.

The medicines may be Tacrolimus/ cyclosporine.

Older patients of functioning transplants may be on cyclosporine. These drugs are similar and called Calcineurin inhibitors. These drugs have a no of interactions with other drugs. Simultaneous intake of other drugs may increase or decrease the levels of these drugs.

Some common side efftects of CNI inhibitors are tremors, high BP, increase in urea and creatinine( due to kidney dysfunction) , swelling of the feet and high blood sugars. These also increase chances of infections.

Cyclosporine can also increase body hair, facial hair, or hair from the ears. This is called hirsutism and may be very unpleasant side effect in ladies. The dosage of these drugs are based on their blood levels which need to be checked periodically.

Azathioprine or mycophenolate.

These drugs are the other commonly used immunosuppressives. They may decrease blood cell formation (WBCs or RBCs or platelets or all three togather. They can also increase infections in the transplant recipient. Mycophenolate may cause abdominal cramps, diarrhoea or constipation.

These are expensive drugs and the blood levels are not easily available.

The interactions are fewer with other drugs.

Steroids

This is an important component of the immunosuppressive regime.

These drugs are started at very high levels in the 1st few days and rapidly reduced.

Though very effective in its action, these drugs are full of side effects. These drugs may cause weight gain, high sugars, high BP, dyslipidemias, behavioral disorders, hirsutism, rounding of the face, muscle weakness and sleeplessness. They can also cause bone weakness and increase chances of infections as do the other transplant medicines.

The drugs are always taken under medical supervision and sudden changes or stoppage of the drug may be catastrophic.

Obesity III Treatment of Obesity

Obesity III Treatment of Obesity

Obesity treatment or weight loss is important as weight loss reduces the complications of obesity. It decreases chances of heart disease, diabetes, high blood pressure, stroke or hyperlipidemias. After weight loss, the metabolism of the body slows down and fewer calories are consumed. Hence weight loss is never easy. Lost weight may be regained (Recidivism). A person has to watch his weight regularly, exercise regularly and continue diet precautions usually lifelong.

Some times losing weight rapidly by consuming a very low fat diet may result in iformation of gall bladder stones. In them increasing fat in diet may reduce the risk of gall stones.

How to reduce your weight?

There are only 2 options: either burn more calories or reduce their intake in food.

The first option is more troublesome as very little calories are consumed in daily activities. A person who is hardly doing any physical work consumes only 1200 to 1500 calories a day.

Each gram of fat provides 9 cal while proteins and carbohydrates provide about 4 cal each.

About 20 – 25 cal/kg body weight will maintain a constant body weight. In order to reduce the weight about 500 cal less than this would be sufficient.

The initial goal may be to reduce weight by 5 to 7 %. Most of the obese patients report less intake of food than they actually consume.

Fats should form only < 30 % of the calories and should preferably be polyunsaturated. Proteins can form upto 45% and remaining provided by carbohydrates. Very low calories, mediterranean and other various diets have been found to be less useful but are more fashionable in various countries.