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BMI versus waist to hip ratio

 DEFINITION  Obesity is a state of excess adipose tissue mass. It is often viewed as equivalent to an increased body weight. This is not true because muscular individuals may have increased body weight but are not obese. Weight follows a continuous distribution pattern in human population. The point at which mortality and morbidity becomes statistically significant is the cut-off to call a patient obese.  METHODS  Various methods have been used to measure obesity. These include: 1) Anthropometry (skin-fold thickness) 2) Densitometry (underwater weighing) 3) CT/MRI 4) Electrical impedance. Still the most common techniques used in clinical practice are: 1) BMI measurement 2) Waist-to-hip ratio measurement.  BMI  It is not an accurate measure of obesity but since it is simple to calculate, it is the most frequently measured parameter. At similar BMI, women usually have more fat than men. When the BMI > 25 Kg/m2, morbidity starts to increase and if associated with ris

Alcoholic liver disease

 INTRODUCTION  Chronic and excessive use of alcohol is one of the major causes of liver disease. 90% of daily heavy drinkers (>60 g alcohol/day) as well as binge drinkers have fatty liver but a smaller percentage (10-35%) of drinkers progress to alcoholic hepatitis which is a precursor for cirrhosis. The long-term risk is 9 times higher in patients with alcoholic hepatitis compared to those with fatty liver alone. Some population-based surveys have documented that men must drink 40 to 80 g of alcohol daily and women must drink 20 to 40 g daily for 10 to 12 years to achieve a significant risk of liver disease. Liver pathology consists of  3 major lesions  that are progressive and rarely exist in a pure form: 1) fatty liver (usually reverses quickly with abstinence), 2) alcoholic hepatitis and 3) cirrhosis. Prognosis of severe alcoholic liver disease (ALD) is bad. Mortality of patients with alcoholic hepatitis concurrent with cirrhosis id nearly 60% at 4 years. Alt

Voltaire - Medical quote no longer valid

Times have changed Monsieur Voltaire. Your quote is no longer valid in our "Evidence Based Medicine" world. The quote's accuracy is stunning though if applied to quacks. Our advice to young practitioners : DO NOT BLINDLY FOLLOW WHAT A SENIOR DOCTOR IS DOING. Try to  understand why he did something for that specific problem. Always ask if you do not understand. Article resources: 1)  "Voltaire lisant L’année littéraire de Fréron", huile sur toile de Jacques Augustin Catherine Pajou, 1811 Last reviewed on: 2 September 2015

Menopause - Definition, symptoms and hormone replacement therapy

 Menopause   refers to a point in time that follows 1 year after the permanent cessation of menstrual periods that occurs naturally or is induced by surgery, chemotherapy or radiation. On average, natural menopause occurs between 50 and 51 years (range 45–59) and is part of the process of normal ageing. It has been noted that smoking advances the age of menopause by approximately 2 years. The diagnosis can only be made retrospectively and it is usually preceded by months or years of irregular cycles, that is not associated with some other physiological or pathological causes. If the cessation of menses occurs before the age of 40, then it is referred to as the "Premature ovarian failure". The older terms perimenopause or climacteric generally refer to the time period in the late reproductive years, usually late 40s to early 50s. Characteristically, it begins with menstrual cycle irregularity and extends to 1 year after permanent cessation of menses. The more correct t


Introduction: Homocysteine is a sulphur containing amino acid that is produced during the conversion of methionine to cysteine. Hyperhomocysteinemia results when there is an abnormality in the homocysteine metabolism. It is an independent risk factor for stroke, MI, peripheral arterial disease and venous thrombotic disease. Even mild to moderate hyperhomocysteinemia is a significant risk factor for vascular disease. Pathophysiology: The amino acid homocysteine is normally metabolized via the transsulfuration pathway by the enzyme cystathionine-β-synthase (CBS), which requires vitamin B6 as co-factor and via the remethylation pathway by the enzymes methylenetetrahydrofolate reductase (MTHFR), which is folate dependent and methionine synthase, which requires vitamin B12 as co-factor. 1 - Methylenetetrahydrofolate reductase 2 - Methionine synthase Hyperhomocysteinemia can be either: 1) Inherited or 2) Acquired. Inherited Inherited severe hyperhomocyste

kussmaul breathing pattern - description and causes

This type of breathing pattern was first described by Adolph Kussmaul, a german physician in 1874. He noticed that his patients with diabetic ketoacidosis had a pattern of breathing which he first labelled as having "air hunger". In the Kussmaul type of breathing, the patient is breathing heavily i.e hyperventilating along with tachypnea. So we will find that the amplitude of the breaths along with the rate will be increased. There is usually no pauses between the breaths. This is not specific for diabetic ketoacidosis. It can also appear in other types of severe metabolic acidoses e.g alcoholic ketoacidosis .

Adverse effects of Amiodarone

1) Hypotension can occur especially with the intravenous form due to vasodilation and depressed myocardial performance. Long-term oral therapy can also cause depressed contractility but it is unusual. 2) Nausea can sometimes be seen during the loading phase. All we have to do is to decrease the daily dose of the medication. 3) Pulmonary fibrosis is the most serious adverse effect during chronic amiodarone therapy. The fibrosis can be rapidly progressive and fatal. The risk factors include: underlying lung disease, doses of 400 mg/day or more and recent pulmonary insults such as pneumonia. Early amiodarone toxicity can be detected using pulmonary function tests and serial chest X-rays. 4) Other adverse effects that may be seen during long-term therapy include a) corneal microdeposits (which often are asymptomatic), b) hepatic dysfunction, c) vivid and disturbing dreams d) neuromuscular symptoms (most commonly peripheral neuropathy or proximal muscle weakness), e) photosensitiv