PATHOGENESIS OF COMMON OBESITY

Obesity can result from increased energy intake, decreased energy expenditure, or a combination of the
two. Thus, identifying the etiology of obesity should involve measurements of both parameters. However, it is
difficult to perform direct and accurate measurements of energy intake in free-living individuals; and the
obese, in particular, often underreport intake. Measurements of chronic energy expenditure are possible

SPECIFIC SYNDROMES ASSOCIATED WITH OBESITY

Cushing's syndrome
Although obese patients commonly have central obesity, hypertension, and glucose intolerance, they lack
other specific stigmata of Cushing's syndrome (Chap. 342). Nonetheless, a potential diagnosis of Cushing's
syndrome is often entertained. Cortisol production and urinary metabolites (17OH steroids) may be
increased in simple obesity. Unlike in Cushing's syndrome, however, cortisol levels in blood and urine in the
basal state and in response to corticotropin-releasing hormone (CRH) or ACTH are normal; the overnight 1-
mg dexamethasone suppression test is normal in 90%, with the remainder being normal on a standard 2-
day low-dose dexamethasone suppression test. Obesity may be associated with excessive local reactivation

Importance of the smooth vascular cell

The tone of vascular smooth-muscle cells is governed by the autonomic nervous system and by the endothelium in tightly regulated
control networks. Autonomic neurons enter the blood vessel medial layer from the adventitia and modulate vascular smooth-muscle
cell tone in response to baroreceptors and chemoreceptors within the aortic arch and carotid bodies and in response to
thermoreceptors in the skin. These regulatory components include rapidly acting reflex arcs modulated by central inputs that

What is the vascular smooth muscle cell

The vascular smooth-muscle cell, the major cell type of the media layer of blood vessels, also contributes actively to vascular
pathobiology. Contraction and relaxation of smooth-muscle cells at the level of the muscular arteries controls blood pressure, and,
hence, regional blood flow and the afterload experienced by the left ventricle (see below). The vasomotor tone of veins, which is

Acute care settings

Acute Care Settings
In acute-care settings, anorexia, various diseases, test procedures, and medications can compromise dietary intake. Under such circumstances, the
goal is to identify and avoid inadequate intake and assure appropriate alimentation. Dietary assessment focuses on what patients are currently eating,
whether or not they are able and willing to eat, and whether or not they experience any problems with eating. Dietary intake assessment is based on
information from observed intakes; medical record; history; clinical examination; and anthropometric,

What are the factors that alter the need of eating

FACTORS ALTERING NUTRIENT NEEDS
The DRIs are affected by age, sex, rate of growth, pregnancy, lactation, physical activity, concomitant diseases, drugs, and dietary composition. If
requirements for nutrient sufficiency are close to levels indicating excess, dietary planning is difficult.
Physiologic Factors
Growth, strenuous physical activity, pregnancy, and lactation increase needs for energy and several essential nutrients. Energy needs rise during
pregnancy due to the demands of fetal growth and during lactation because of the increased energy required

ESSENTIAL NUTRIENT REQUIREMENTS

ESSENTIAL NUTRIENT REQUIREMENTS
Energy
For weight to remain stable, energy intake must match energy output. The major components of energy output are resting energy expenditure (REE)
and physical activity; minor sources include the energy cost of metabolizing food (thermic effect of food or specific dynamic action) and shivering
thermogenesis (e.g., cold-induced thermogenesis). The average energy intake is about 2600 kcal/d for American men and about 1900 kcal/d for
American women, though these estimates vary with body size and activity level. Formulas for estimating REE

The biology of aging

Thanks largely to the power of genetic analysis in model organisms such as Caenorhabditis
elegans (a nematode), Drosophila melanogaster (a fruit fly), and the laboratory mouse, major
advances have been made in the elucidation of what can be termed "public" modulations of
intrinsic biological aging—that is to say, commonalities of gene actions across widely diverse
phyla that explain, in part, the plasticity of processes of aging. There are hints that at least
one such conserved pathway may be operative in our own species. These observations,

THE EPIDEMIOLOGIC TRANSITION–CHANGES IN THE BURDEN OF DISEASE AND RISK FACTORS

The secular improvements in ages at death have been accompanied by changes in causes of death. In
the broadest terms, the proportion of deaths due to infectious disease and conditions associated with
pregnancy and delivery has fallen, and the proportion due to chronic, noncommunicable diseases, such
as heart and cerebrovascular diseases, diabetes, cancers, and age-related neurodegenerative
diseases such as Alzheimer's and Parkinson's diseases, has increased steadily and is expected to
continue to increase. Figure 70-5 shows results from an international comparative project that drew on

The effect of the financial conditions on the the health

There remains a great deal of diversity in health conditions both among and within national populations.
There is nothing inevitable about the mortality transition—in several African countries, the prevalence of
AIDS has been high enough to cause life expectancy to fall below the levels of 1980. Though none has
so far reached a scale to rival the AIDS epidemic, periodic outbreaks of new influenza viruses or

The future of life expectancy

The members of the population who could potentially become aged 80 and older in 2050 are those
aged 40+ who are alive today. The actual numbers who will be age 80 and older in 2050 will therefore
depend almost solely on adult and old age mortality rates over the next 40 years. The history of the
decline of mortality and increase in life expectancy suggests that improvements in the standard of living
including increased and improved education and improved nutrition coupled with improvements in

Demography of aging around the world

Current global life expectancy at birth is estimated to be 65.4 for men and 69.8 for women, with the
comparable figures for the more developed region being 73.6 and 80.5 years. Life expectancy in the
least developed countries averaged only 57.2 for women and 54.7 for men. Life expectancy at birth is
heavily influenced by infant and child mortality, which is considerably higher in poor countries. At older

REGIONAL AGING–NUMBERS AND PERCENTAGES OLDER THAN AGE 60 YEARS

REGIONAL AGING–NUMBERS AND PERCENTAGES OLDER THAN AGE 60 YEARS
Regions of the world are at very different stages of the demographic transition (Fig. 70-1). Of a world
population of 6.8 billion in 2009, approximately 11% were older than age 60 years, with Japan (30%)
and Europe (22%) being the oldest regions (Germany, Italy, and Sweden have the highest percentages,
25–26%), and the United States and Canada having 21% and 20%, respectively. The percentage of the
population older than age 60 years in the United States has remained lower than in Europe, due both tomodestly higher fertility rates and to higher rates of immigration. The Caribbean and some Latin
American countries average 10% older than age 60 years, with countries such as Uruguay, Cuba, and

Historical changes of population aging

Population aging around the world in recent decades has followed a broadly similar pattern, starting
with a decline in infant and childhood mortality that precedes a decline in fertility; at later stages,
mortality at older ages declines as well. Declining fertility began as early as the beginning of the
nineteenth century in the United States and France and extended to the rest of Europe and North
America and parts of East Asia by the middle of the twentieth century. Since World War II, fertility

Effect of population Aging on the community

Population aging is transforming the world in dramatic and fundamental ways. The age distributions of

populations have changed and will continue to change radically, due to long-term declines in fertility

rates and improvements in mortality rates (Table 70-1). This transformation, known as the

Demographic Transition, is also accompanied by an epidemiological transition, in which

noncommunicable chronic diseases are becoming the major causes of death and contributors to the

burden of disease and disability. A concomitant of population aging is the

Dubin-Johnson syndrome in brief

Dubin-Johnson syndrome is a very rare syndrome , which is genetic disorder in families , what is dubin johnson syndrome ? , what is the proper management ? , what exactly causes the syndrome ? . 

"Dubin-Johnson Syndrome" or "DJS" is a very rare genetic disorder that causes an individual to have the symptom of jaundice throughout their lifetime. This disorder causes the liver to have the inability to properly break down bilirubin

What a patient with Prader-willi syndrome should eat ?

Among one of the rarest syndromes is the Prader-willi syndrome , so the patients should have a certain diet plan to follow for more adaptation and better outcome of the condition . 
 Prader-Willi is a rare syndrome, affecting both males and females equally. It is caused by a deletion or mutation on chromosome 15, inherited from the father during the

Products mom put in mind for breastfeeding

 Products you should consider searching for in starting breastfeeding , as it will help moms searching for their needs 

  Breastfeeding is a natural process, but sometimes nature needs a little help. Up to 96% of breastfeeding mothers experience some degree of nipple pain or nipple trauma during the early weeks of breastfeeding. There are some fantastic breastfeeding products on the market that will make breastfeeding your baby easier. Here's a list of some

Breastfeeding and going to work is it difficult ?!

Running both breastfeeding and work seems to be hard act , specially for new mothers in their first turning days , how to run both ? , roles for going to work and more to learn about . 

Continue breastfeeding after returning to work - keeping up to produce more breast milk for your little one. 

A lot of breastfeeding mothers continue to breastfeed after returning to work.

questions and answers concerning starting breastfeeding

Step by step in starting breastfeeding , it is about the first days in starting breastfeeding needing more and more tips on how to start breastfeeding , knowing the ethics and the principles for starting breastfeeding . 

Motherhood is one of the major milestones in a woman's life. It marks a turn of events where your priority now becomes your children. As a mother, you must endow your child with an environment where he will be able to maximize his potential. Everything that your child will become in the future will depend on how you care for him. Let us start with the

Learning basics for breastfeeding

In the life for breastfeeding for mom in the first months it seems to be a hard matter to adapt with the new situation , here we can know basics for any mom just to start a good breastfeeding way . 

hroughout the 9 months of your pregnancy, nature ensures that your body will be prepared to breast feed your baby. Breastfeeding will give your baby the best source of nutrients, and result in a good healthy start for your baby.

Breastfeeding and nursing your baby is an acquired skill. For both mom and baby, this will require time and patience on both parts.

Recent types of breast pumps

Manual Breast Pumps

Manual breast pumps are good for occasional use.  They work well for exclusively breastfeeding moms, who will only be away from baby for short periods.  A manual pump can help draw out flat or inverted nipples.  It can also be helpful in relieving the temporary engorgement that can occur when your milk “comes in.”  The manual pump has a few disadvantages: it takes time to learn, it can be tiring for your hands, and in general, is more time consuming than semi-electric and electric pumps.

Semi-Electric (Battery Powered) Breast Pumps

Several battery-powered types of breast pumps are available.  They are good for the mom who needs to pump no more than once or twice a week.  They are small enough to carry in a purse

How to start breastfeeding ?

Cuddle your baby on your chest to welcome him or her gently into the world. When you and your baby are skin to skin, covered lightly together, your milk production and baby’s feeding reflexes are triggered. This means baby will start looking for the breast and more breast milk will be made sooner. Babies are often more alert and interested in feeding in the first hour following birth. Remain skin to skin with your baby until after a successful breastfeed. This will help baby to stay warm and reduce stress, helping you both to recover from the birth. For caesarean births, the mother or father can hold the baby skin to skin until the baby can enjoy his or her first feed.

How to Feed Your Baby

• Look for your baby’s early signs of wanting to feed, such as rooting, licking her lips or putting her hands to her mouth. Crying is a late hunger cue.
• Sit or lie down comfortably, using pillows for support and comfort if necessary.
• Relax your shoulders and bring your baby to your breast rather than your breast to baby.
• Hold your baby close, tummy to mummy, nose to nipple, chin to breast and bottom tucked in to your body. Support your baby’s neck and shoulders firmly without pushing the back of your baby’s head as this often makes the baby push away from the breast.
• Support your breast by holding four fingers underneath, away from the areola (dark area), with your thumb on top. Expressing a few drops of milk will awaken your baby’s senses of taste and smell.
• Rest your baby’s chin on the breast, nose to nipple until her mouth opens as big as a yawn and she moves her head back to take a big mouthful of the breast. You can also gently touch your baby’s lips until her mouth opens very wide.
• When your baby feels your nipple with her tongue, her lips will close over the areola and nipple and form a seal; both lips should be rolled outwards. You will feel your baby suckling gently at first and then deeply and rhythmically, one or two sucks per swallow, with little pauses to rest.
• When your baby comes off the breast or is no longer suckling actively, burp her and offer the other breast.
• If you need to take your baby off the breast, gently place a finger in the corner of her mouth until you break the suction.

There are many breastfeeding positions; find the one that is most comfortable for you and your baby. If you have had a caesarean birth, you may need help to position yourself and your baby comfortably. Ask for help from nurses, your doctor, midwife, or a lactation consultant.

Causes and risk factors of different types of diabetes

The precise Etiology of most cases of diabetes is uncertain, although certain contributing factors are as follows:

Type 1 diabetes

Type 1 Diabetes is autoimmune disease that affects 0.3% on average. It is result of destruction of beta cells due to aggressive nature of cells present in the body. Researchers believe that some of the Etiology and Risk factors which may trigger type 1 diabetes may be genetic, poor diet (malnutrition) and environment (virus affecting pancreas). Secondly, in

Different types of Insulin

Good control of blood glucose levels is important for your health, now and in the future. Understanding your insulin treatment will help you to control diabetes. It will also help you to fit the diabetes into your life, instead of trying to fit your life around the diabetes.

There are more than 20 types of insulin products available in four basic forms, each with a different time of onset and duration of action. The decision as to which insulin to choose is based on an individual's lifestyle, blood sugar level and a physician's

The main complication symptoms of diabetes

Once we have crossed the reversible stage of prediabetes and enter diabetes stage, certain changes start developing in our body. These changes occur due to high blood sugar level with instability in the hormones as well as blood vessels and nerves. When these changes become permanent in the body it develops into serious Diabetes Complications and body indicates these changes by steady symptoms.

Symptoms of the Diabetes Complications

• Diabetic retinopathy shows symptoms of pain in the eyes and may even result in loss of vision.
• Renal (kidney) disease shows symptoms of swelling (edema) in the feet and legs. It then passes over total body and as the disease progresses, blood pressure also increases.
• Tingling, burning, numbness, tightness, shooting or stabbing pain in the hands, feet or other parts of your body, especially at night. Digestive problems also occur if, the nerves controlling internal organs get damaged

Facts about Juvenile diabetes

Juvenile diabetes is an autoimmune disorder which can be due to environmental trigger or virus, which hampers the function of beta cell. Once the beta cells are destroyed the body is unable to produce insulin. It is also believed that Type 1diabetes results from an infectious or toxic insult to a child, whose immune system is predisposed to develop an aggressive autoimmune response either against molecules of the B cell or against altered pancreatic B antigens, resembling a viral protein. A child with diabetic siblings is more prone to develop juvenile diabetesthan the child from

Tips for good diabetic diet plan

Diet plays a significant role in controlling the diabetes. The diabetic diet may be used alone or else in combination with insulin doses or with oral hypoglycemic drugs. Main objective of diabetic diet is to maintain ideal body weight, by providing adequate nutrition along with normal blood sugar levels in blood. The diet plan for a diabetic is based on height, weight, age, sex, physical activity and nature of diabetes. While planning diet, the dietician has to consider complications such as high blood pressure, high cholesterol levels.

With respect to the above factors, a dietician will assess calories to be given, like scheming the carbohydrates

Importance of Grasp reflex in babies

In the early months of life there are many reflexes which ensure the wellness of the babies , among those is the grasp reflex , grasp reflex has an important significance . Here is some of pictures for grasp reflex .
Stimulus of grasp reflex
Grasp reflex stimulus is by placing the finger  of the doctor or the mother in the palm of the baby , the baby will grasp it .
Clinical significance of Grasp reflex 
There are 2 actions :
1- Is unilateral response , the baby here respond to the grasp reflex in one hand and do not respond in the other , this means neurological focal damage .
2- Persistence beyond the age of 4 months , and this indicates cerebral damage .

How to know that your child is diabetic clinically ?

The are many manifestations and signs in any diabetic patient , the age of the biabetic child to be manifested clinicaly is usually at the early school age and rare before that , which is called the type 1 diabetes mellitus or insulin dependent diabetes mellitus ( as the treatment is essentially insulin ) . From those

How to deal with any febrile patient at home ?

There are certain steps which we should follow in managing the febrile patient at home , as most of the patient will not need to be admitted to the hospital , most of the patients will be managed at home.

1-Bed rest is an important initial

Disadvantages of breast feeding

Disadvantages of breast feeding

Considering the above title there is no agreement about if there are actual disadvantages or side effects to breast feeding in general , but we can consider a group of risk factors that is associated with breast feeding :

1-Transmission of infections as the

Factors produce and Eject Breast milk and reflexes .

Factors produce and Eject Breast milk and reflexes .

The process of breast feeding is controlled by hormone and reflexes that regulate and control the breast feeding process .

FACTORS INCREASING THE PRODUCTION OF THE BREAST MILK :

1- Prolactin: is hormone from the anterior pituitary having receptors in the glands of the breast stimulates the production of milk 

2- Breast evacuation : stimulates the receptors for milk production , when the baby evacuates the mother's breast .

FACTORS THAT CONTROL THE EJECTION OF MILK :

1- oxytocin : from the posterior pituitary helps in ejection process 

 2- Suckling reflex : which may be psychological factor and also reflex at the same time , but it is proved it is the main factor that triggers milk ejection .

LET DOWN REFLEX :

Responsible for releasing of the milk in response to oxytocin.

Factors stimulating is : - Hearing the baby cry and thinking of the act 

                                     - Suckling reflex 

Factors that inhibit it is : fatigue , anxiety and stress .

Program of Brest feeding ( onset , pattern , duration ), clostrum and mature milk

There are certain important tips to achieve good and effective breast feeding 

ONSET : 

Breast feeding should start from the first day as early as possible , immediate after delivery the baby must be given to the mother for breast feeding . 

PATTERN :

The concept which must e respected here is that breast feeding is related to demand , once the baby demanded the mother should reply , average times per day is 8-10 times per day . Scheduling feeding is not preferred ( feeding on regular intervals ) , as it affects the flow of the milk. 

DURATION OF BREAST FEEDING :

An infant less than 6 months should be exclusively beast fed ( only breast milk ) . Starting from the 6 month weening should start with completion of breast feeding for 1 year or more . 

STAGES OF LACTATION ( COMPOSITION OF BREAST MILK AND STAGES OF ITS PRODUCTION) 

1-Colostrum : it is the earliest milk from the mother which is about 60 ml/day these amount is low but no other formulas or extras should be given. Colostrum is secreted in the first 2-3 days high in proteins and immunoglobulins and lower in fat and carbohydrates .

2- Transition milk : it starts 5-7 days after delivery ( after colostrum ) , and continues for about 2 weeks and it is midway between the clostrum and the mature milk . 

3- Mature milk : is the milk after the previous 2 stages and contains 87% water to meet the needs of the baby .

Causes for tall stature and obesity

Tall stature and obesity

What is tall stature ?

Tall stature is accurately estimated by growth curves , in growth curve tall stature is above 95^th percentile .

What are the causes of tall stature ?

There are 2 types of tall stature to be considered proportionate and disproportionate .

Proportionate tall stature is mainly

What is precocious puberty ?

Precocious puberty

Definition : Puberty at an age earlier than 8 years in females and 9 years in males .

There are 2 types of precocious puberty , true precocious puberty and pseudo precocious puberty .

True precocious puberty :

What is puberty

3 main events in puberty

Puberty is a period of life in which there is morphologlical and physiological changes in males and females in this period males and females is shifted to an adult stage from an infantile stage .

Age of onset of puberty :

Age of onset varies according to nutrition , socioeconomic status , racial and genetic

Causes of small head in babies .

Causes of small head in children (Microcephaly )

Causes of microcephaly is related closely to mental retardation , as in mental retardation the brain is not growing well and this leads to small head microcephaly .

A-        Genetic causes

1- Autosomal dominant

2- Autosomal recessive

3- Syndromes like Down Syndrome – Edwards Syndrome – cri du chat syndrome .

What is delayed puberty causes ?

Delayed puberty

What is delayed puberty ?

The puberty is delayed when the puberty is delayed to 13 years in females and 14 years in males .

The 5 most common causes of convulsions in a baby in the 1st 28 days of life

1- Decreased oxygen to brain tissue :

After failure of resuscitation after delivery 

 

2- Cerebral stroke ( mostly thrombosis) leading to infarction 

What is APGAR scores ? and Hypoxic Ischemic Encephalopathy .

Simply the APGAR score is a score suggest the baby status , determining whether the baby is breathing well or not , also it determines the degree of asphyxia if present . 

Causes of Brain asphyxia in a newly born ( neonate ) , Why the baby does not respond to resuscitation ?

In many occasions after we do resuscitation to a newly born neonate the neonate does not respond to all the steps we do , here there is a serious pathology or failure in the technique of resuscitation steps itself . The causes of failure may be : 

problems of preterm infant ( complications of prematurity )

Usually preterm infants are liable to many problems respiratory , cardiac , etc...... . This makes it is hard to deal with a preterm baby in the medical issue . 

 

1- Respiratory : 

- Respiratory distress syndrome is the major problem in the premature

What is moro reflex , when it diseppears ?

Moro reflex is one of the simple reflexes that can be made by the examiner or by the mother , the question here is what positive or negative moro reflex means , how it is done ? . First I will begin with the stimulus ( action made stimulate the appearance of moro reflex in the child . 

Failure to thrive ( When the baby is not growing well ? )

In many occasions babies are not growing well especially in the first year , which is the period of growth . There are many causes babies are not growing well in this topic I will mark the most common causes for that . There are 2 groups of causes babies are not growing well , first is non organic causes ( meaning that there are no diseases ) and this is the condition in about 95% in babies , the second one is organic here the babies have certain disease in 5% only . 

When and how to begin weaning ? and what types of food to introduce in weaning ?, How to start weaning ?

When and how to begin weaning ? 

The age of 4-6 months is ideal to begin weaning as :

1- iron stores of the baby become depleted at this age 

2- Caloric intake of breast milk alone is not sufficient . 

3- Digestive enzymes of the baby become mature

Factors indicating adequate breast feeding and minor problems with Breast feeding and its mangement .

Indicators of adequate breast feeding 

For the mother :

- Marked filling before breast feeding ( indicate good breast filling ) . 

- Let down sensation ( milk flow from one breast while nursing from the other ) . 

Proper Breast feeding positioning with video description , Signs of good baby attachment .

Positioning of breast feeding 

1- The infant should be elevated to the height of the breast 

2- The infant's body should face the mother , with all the body supported not only the neck 

3- The infant's neck should be straight . 

7 protective elements in breast milk

Breast milk has many advantages to the infant , as nutritional and immunologic benefits which makes the mother's milk the first choice especially in the first 6 months of the baby's life . In this topic we will concentrate on the protective ( immunologic ) advantages of the breast milk:

 

1- Bifidus factor : 

This factor is oligosaccharide in nature present in the colostrum ( milk in the first 2-3 days from the mother's breast ) and mature milk ( milk from the mother's  breast after the first 2-3 weeks of lactation ) , this factor favors

How to asses the Nutritional status of the baby

There are 4 ways by which we can asses the nutritional status of any baby as stated by the WHO :

1- Anthropometric measures : 

These are measures indicating the nutritional status of the baby :-

- Height for the age : for every child there is growth curve by which we can know if the baby is normal , low normal , etc..... , If the height is decreased in relation  to the age this indicate chronic malnutrition . 

-Weight for the age : if decreased it indicate acute malnutrition 

- Skin fold test : by punching the skin of the baby we can detect loss in the subcutaneous fat if present .