In Search of an Ideal Obesity Assessment Tool : Is Body Mass Index Reliable Enough?

Obesity, a global pandemic, has become a chronic health problem within a modern western society. Obesity mimics the iceberg phenomenon wherein there is more to it than what we perceive resulting in various physical and psychological problems. Obesity is defined as surplus body weight for given height. . Obesity has been triggered by the growth of economy caused as an effect of industrialization, and urbanization, associated sedentary lifestyle, and transition of nutrition to canned foods. In the last few years, globally, countries have witnessed the spike in the rate of obesity. The endangering effects presented by obesity lead to numerous comorbidities that are being masked by the body dysmorphism. Metabolic disorders like diabetes mellitus type 2 and various cardiovascular risks hamper the regular metabolism of the body. Exploring the cascading effects in changing sedentary lifestyles draws many parallels to the surge in overweight and obesity among the people following such lifestyles. Increased adoption of sedentary lifestyles has resulted in a cascading effect on various metabolic disorders associated with obesity, globally. To address this surging concern, researchers around the globe have come up with multiple indices and parameters such as BMI, ABSI, VAI, BIA, DEXA, waist-hip ratio, and waist circumference, to quantify obesity in one final equation. However, these parameters have failed to give a conclusive summation that helps to identify the pre-symptoms of obesity. Similarly, variations in physical size and different body compositions for different weight categories usually pose tremendous challenges to quantify obesity. To make things more complicated various forms of obesity are being described and each has got its implication as far as the development of cardiovascular burden is concerned.This challenge presents the need to derive and identify a much robust, accurate and explicit index that would apply universally to all forms of obesity and would guide preventive and therapeutic strategies thereoff. In this article, an effort is being made to compare various parameters available globally to tail off the better and more reliable indicator available.

Acute Exacerbation of COPD Triggered by Pneumonia, and Secondary Spontaneous Pneumothorax (SSP).

Secondary Spontaneous Pneumothorax (SSP) can rarely complicate Chronic Obstructive Pulmonary Disease (COPD). Infections are common triggers for exacerbations of COPD. COPD with acute exacerbation presents with increasing dyspnoea. We present a rare case of a 75 year old female, who was a known case of COPD and developed right middle lobe pneumonia with partial collapse of the middle lobe along with a secondary spontaneous pneumothorax.

Hashimoto s Encephalopathy (HE) - Early Manifestation of Impending Thyroid Storm.

Dear Dear HyperthyroidismiHyHyperthyroidism may be associated with various neuropsychiatric manifestations like anxiety, irritability, restlessness, decrease in concentration, dementia, lack of judgement and planning.[1] Rarely, seizures, myoclonus, chorea, or catatonia can occur. Encephalopathy may be present in only 1% of cases.

Acute Disseminated Encephalomyelitis (ADEM) versus Multiple Sclerosis (MS)- A Diagnostic Challenge in an Adult.

Acute Disseminated Encephalomyelitis (ADEM) is a demyelinating disease of Central Nervous System (CNS). It usually is followed by infection and vaccinations. It commonly occurs in the paediatric age group. Its occurrence in adults is rare. When present in adults, a diagnostic dilemma always occurs between ADEM and Multiple Sclerosis (MS), because of overlapping clinical, and neuroimaging features. We present a case of a 46 year old female who presented to us with variable neurologic manifestations and later was diagnosed with ADEM. This case tries to embark on arguments so as to differentiate ADEM from MS while dealing with such cases.Acute Disseminated Encephalomyelitis (ADEM) and Multiple Sclerosis (MS) are both considered as immune mediated inflammatory demyelinating diseases of the central nervous system.1,2 Although considered as different conditions, the clinical presentation of both these conditions may overlap. The only gold standard differentiation is pathologically determined. Perivenous demyelination is a feature of ADEM and discrete confluent demyelination (plaque) is signature of MS. Still hybrid cases showing pathological features of both ADEM and MS may co-exist.ADEM, typically though not always is preceded by some infection or vaccination. The course of ADEM is usually monophasic and prognosis is better than MS which commonly presents with a relapsing and remitting course. Each exacerbating event worsens the clinical course in MS. Different clinical and/or radiological criteria to differentiate between the two spectrums of diseases have been proposed, but none of those unequivocally differentiate them.Hartung and Grossmann hypothesized that ADEM may be a part of the MS spectrum, rather than a different entity.3 The characteristic demyelination in ADEM is perivenous as opposed to MS where the demyelination is confluent. 4Acute Disseminated Encephalomyelitis (ADEM) is a demyelinating disease associated with inflammation and demyelination of the Central Nervous System (CNS) in a monophasic pattern. ADEM occurs commonly in paediatric age group often following viral infections, bacterial infections, or vaccinations.[5,6] The clinical characteristics include a sub-acute development of focal neurologic deficits, accompanied by encephalopathy. 5,6 It can rarely occur in middle-aged or elderly adults. The course is usually fulminant, but typically there is recovery in 50–75% of cases, with progression to multiple sclerosis in up to 20% of cases.[5,6]

High-Sensitivity C-Reactive Protein in Metabolic Healthy Obesity (MHO)..

Metabolically Healthy Obesity/Metabolic Healthy Obesity (MHO) is a paradox in scientific medical literature and discussion is still on regarding the safety status of MHO phenotype. It is an obesity phenotype where the subjects have BMI more than or equal to 30 Kg/m2 but are devoid of conventional metabolic complications such deranged lipid profile, altered glucose tolerance, or metabolic syndrome as they have less adverse inflammatory profile, low visceral fat, less disturbed insulin signalling, and lipid metabolism. But recently studies are coming up with robust evidence that MHO is not a benign condition. It may lead to metabolic syndrome in future and it is also associated with cardiometabolic risks.METHODSThis cross-sectional study was done in a tertiary care hospital conducted for a period of two years from October 2017 to October 2019. After obtaining institutional ethical clearance, this cross-sectional study was conducted on 120 MHO subjects, 120 metabolic syndrome (MS) and 120 Metabolic Healthy Non-Obese (MHNO) subjects. Anthropometric data was obtained, and hs-CRP was estimated and compared with MS and MHNO group. The data was analysed using appropriate statistical significance tests.RESULTSIn one-way Analysis of Variance (ANOVA), anthropometric determinants and metabolic variables differed significantly across the groups (p<0.0001). The mean hs-CRP in MHO was; 4.45 ± 1.46 and in the control group it was 1.84 ± 0.77 (p<0.0001). Using Pearson’s correlation coefficient, significant positive correlation was found between hs-CRP with other anthropometric and metabolic parameters. In multiple regression analysis, Body Mass Index (BMI), Waist Circumference (WC), were significantly associated with elevated hs-CRP. Adjusted odd’s (AOR) of abnormal hs-CRP in MHO was 1.9 times that of MHNO subjects.CONCLUSIONSMHO phenotype is associated with increased hs-CRP levels as compared to MHNO phenotype suggesting that obesity even if associated with a healthy metabolic profile, still harbour subclinical inflammation. So, subjects with MHO should be targeted for appropriate preventive strategies in the form of health education, lifestyle alterations to avoid future cardiovascular morbidities. MHO phenotype with evidence of subclinical vascular inflammation should not be considered a benign condition.