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1.
Ann N Y Acad Sci ; 1533(1): 145-155, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38385953

RESUMO

This review aims to summarize pharmacological interventions that may affect adiposity and metabolic equilibrium in individuals with obesity. Pharmacological therapy is frequently used to treat medical conditions that are both directly related to obesity (such as hypertension and type 2 diabetes) and indirectly related to obesity (such as asthma, insomnia, and type 1 diabetes). This pharmacological therapy may result in weight gain and alterations in the metabolic profile. Many medication classes are implicated in the pharmacologic causes of weight gain, including antipsychotics, glucocorticoids, beta-adrenergic blockers, tricyclic antidepressants, antihistamines, insulin, neuropathic agents, sleep agents, and steroids. This article describes the mechanisms of action and pathways of pharmacological interventions causing obesity.


Assuntos
Antipsicóticos , Diabetes Mellitus Tipo 2 , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Obesidade/tratamento farmacológico , Aumento de Peso , Antipsicóticos/uso terapêutico , Insulina
2.
Curr Opin HIV AIDS ; 19(1): 1-5, 2024 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-37916907

RESUMO

PURPOSE OF REVIEW: People with HIV (PWH) on antiretroviral therapy (ART) globally are disproportionately affected by obesity, with prevalence rates highest among women with HIV. The purpose of this review is to discuss rates of obesity, factors associated with obesity, and adverse consequences of obesity among PWH. RECENT FINDINGS: Among PWH on ART, rates of obesity have increased over the last several decades and tend to be higher than the general population. Weight gain with the initiation of new ART regimens such as integrase strand transfer inhibitor (INSTI)-based regimens are thought to contribute to higher rates of obesity among PWH on ART. Other factors, such as sex and ethnicity, also are associated with obesity among PWH on ART. Higher obesity rates among PWH may contribute to heightened cardiometabolic disease risk and lower health-related quality of life. SUMMARY: Prospective studies which identify factors associated with increased obesity prevalence and weight gain among PWH are necessary for the development and implementation of obesity prevention and treatment strategies among PWH on ART and, in turn, reduce the prevalence of obesity in this population.


Assuntos
Infecções por HIV , Inibidores de Integrase de HIV , Humanos , Feminino , Estudos Prospectivos , Qualidade de Vida , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Obesidade/complicações , Obesidade/epidemiologia , Aumento de Peso
3.
Prog Cardiovasc Dis ; 78: 11-16, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37120120

RESUMO

While the prevalence of obesity in US men and women is nearly equivalent, obesity management in women requires a different approach that considers age and life stage in development including sexual maturation/reproduction, menopause and post-menopause. In this review, the diagnosis and treatment of obesity using lifestyle modification, pharmacotherapy and metabolic and bariatric surgery are discussed from a women's health perspective, with emphasis on management during pregnancy and post-partum.


Assuntos
Cirurgia Bariátrica , Saúde da Mulher , Gravidez , Masculino , Humanos , Feminino , Obesidade/diagnóstico , Obesidade/epidemiologia , Obesidade/terapia , Cirurgia Bariátrica/efeitos adversos
4.
J Hosp Med ; 17(5): 410-411, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35535944
5.
Chest ; 159(6): 2373-2383, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34099131

RESUMO

BACKGROUND: Increased pleural pressure affects the mechanics of breathing of people with class III obesity (BMI > 40 kg/m2). RESEARCH QUESTION: What are the acute effects of CPAP titrated to match pleural pressure on cardiopulmonary function in spontaneously breathing patients with class III obesity? STUDY DESIGN AND METHODS: We enrolled six participants with BMI within normal range (control participants, group I) and 12 patients with class III obesity (group II) divided into subgroups: IIa, BMI of 40 to 50 kg/m2; and IIb, BMI of ≥ 50 kg/m2. The study was performed in two phases: in phase 1, participants were supine and breathing spontaneously at atmospheric pressure, and in phase 2, participants were supine and breathing with CPAP titrated to match their end-expiratory esophageal pressure in the absence of CPAP. Respiratory mechanics, esophageal pressure, and hemodynamic data were collected, and right heart function was evaluated by transthoracic echocardiography. RESULTS: The levels of CPAP titrated to match pleural pressure in group I, subgroup IIa, and subgroup IIb were 6 ± 2 cmH2O, 12 ± 3 cmH2O, and 18 ± 4 cmH2O, respectively. In both subgroups IIa and IIb, CPAP titrated to match pleural pressure decreased minute ventilation (IIa, P = .03; IIb, P = .03), improved peripheral oxygen saturation (IIa, P = .04; IIb, P = .02), improved homogeneity of tidal volume distribution between ventral and dorsal lung regions (IIa, P = .22; IIb, P = .03), and decreased work of breathing (IIa, P < .001; IIb, P = .003) with a reduction in both the work spent to initiate inspiratory flow as well as tidal ventilation. In five hypertensive participants with obesity, BP decreased to normal range, without impairment of right heart function. INTERPRETATION: In ambulatory patients with class III obesity, CPAP titrated to match pleural pressure decreased work of breathing and improved respiratory mechanics while maintaining hemodynamic stability, without impairing right heart function. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT02523352; URL: www.clinicaltrials.gov.


Assuntos
Resistência das Vias Respiratórias/fisiologia , Obesidade/fisiopatologia , Cavidade Pleural/fisiopatologia , Respiração , Volume de Ventilação Pulmonar/fisiologia , Esôfago/fisiopatologia , Humanos , Pressão , Troca Gasosa Pulmonar
6.
J Pediatr Hematol Oncol ; 43(5): e661-e665, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-33885042

RESUMO

BACKGROUND: No validated questionnaires have been published that are specific for identifying respiratory infections in children with sickle cell disease (SCD). METHODS: A questionnaire was developed that included 6 respiratory symptoms (difficulty breathing, wheezing, fever, cough, runny or stuffy nose, and sore throat) to identify respiratory events for a clinical trial. The questionnaire results were compared with identification of viral respiratory pathogens from nasal samples by reverse transcriptase polymerase chain reaction. RESULTS: Eighty questionnaire responses (40 with symptom/s and 40 without) paired with isolation of viral respiratory pathogen from nasal samples were obtained from 53 children with SCD, ages 4 to 18 years over 2 separate periods in different seasons. The questionnaire yielded a sensitivity of 82%, specificity of 72% with an overall accuracy of 76%. The kappa value was 0.53, indicating moderate agreement, and the Fleiss' kappa test statistic was 4.77 with P<0.001, indicating that agreement between the 2 methods was not by chance. CONCLUSION: These results provide evidence for validity of this 6-symptom respiratory questionnaire in identification of respiratory viral infections for use in SCD-related research.


Assuntos
Anemia Falciforme/complicações , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Estudos Prospectivos , Inquéritos e Questionários
7.
Cureus ; 12(1): e6605, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-32064187

RESUMO

A 57-year-old woman with class I obesity (BMI = 31.42 kg/m2) and a medical history significant for binge-eating disorder with emotionally-triggered eating, post-traumatic stress disorder, and untreated depression and anxiety, presented for follow-up of weight management with laboratory values revealing acutely-worsened hyperlipidemia and elevated liver enzymes. Abdominal ultrasound showed a mildly heterogenous and echogenic liver, without focal lesions, suggestive of non-alcoholic fatty liver disease. The only significant change from previous consultation four months prior was introduction of a ketogenic diet consisting of eggs, cheese, butter, oil, nuts, leafy green vegetables and milk (almond and coconut). The patient reported a reduction in hunger on this diet. Immediate discontinuation of the diet resulted in modest reduction of low-density lipoprotein cholesterol (LDL-C) and liver enzymes two weeks later. Resolution of liver enzymes was seen within eight months and LDL-C levels normalized one year later. This case report discusses the rationale, benefits and risks of a ketogenic diet and encourages increased vigilance and monitoring of patients on such a diet.

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