More than 66% of U.S. adults are categorized as overweight or obese, and the prevalence of obesity is increasing rapidly in most of the industrialized world.
Children and adolescents also are becoming more obese, indicating that the current trends will accelerate over time.
Obesity is associated with an increased risk of multiple health problems, including hypertension, type 2 diabetes, dyslipidemia, obstructive sleep apnea, nonalcoholic fatty liver disease, degenerative joint disease, and some malignancies.
Thus, it is important for physicians to identify, evaluate, and treat patients for obesity and associated comorbid conditions.
Obesity - Pathophysiology, Etiology and management Aneesh Bhandary
Obesity is a state of excess adipose tissue mass. A massive psychosocial, pathophysiological problem that results in a high rate of mortality as well as morbidity. The basic mechanisms of the illness and its management as of 2017 are described in this presentation
explained about the reasons for obesity, its pathology, how to prevent obesity and how to overcome it. also discussed about the genes, receptors, enzymes and hormones involved in obesity.
Obesity - Pathophysiology, Etiology and management Aneesh Bhandary
Obesity is a state of excess adipose tissue mass. A massive psychosocial, pathophysiological problem that results in a high rate of mortality as well as morbidity. The basic mechanisms of the illness and its management as of 2017 are described in this presentation
explained about the reasons for obesity, its pathology, how to prevent obesity and how to overcome it. also discussed about the genes, receptors, enzymes and hormones involved in obesity.
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
IT INCLUDES ANATOMY, PHYSIOLOGY AND PATHOLOGY OF LIVER .
THE SOURCES ARE:-
THE MEDICAL TEXT BOOK OF ROBBIN'S PATHOLOGY
AND OTHERS
IMAGES SOURCE :- ATLAS BOOKS AND INTERNET
A Powerpoint presentation on the epidemiology, etiology, pathogenesis, clinical features, diagnostic work up and treatment of the common types of amyloid.
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
Obesity is a chronic heath problem ,the no.of people having obese rising rapidly world wide and making obesity 1 of the fastest developing peoples health problem
Diabetes mellitus (DM) has routinely been described as a metabolic disorder characterized by hyperglycemia that develops as a consequence of defects in insulin secretion, insulin action, or both.
Such a deficiency results in increased concentrations of glucose in the blood, which in turn damage many of the body's systems, in particular the blood vessels and nerves.
1. Microvascular (due to damage to small blood vessels).
2. Macrovascular (due to damage to larger blood vessels).
IT INCLUDES ANATOMY, PHYSIOLOGY AND PATHOLOGY OF LIVER .
THE SOURCES ARE:-
THE MEDICAL TEXT BOOK OF ROBBIN'S PATHOLOGY
AND OTHERS
IMAGES SOURCE :- ATLAS BOOKS AND INTERNET
A Powerpoint presentation on the epidemiology, etiology, pathogenesis, clinical features, diagnostic work up and treatment of the common types of amyloid.
chronic myeloid leukemia, CML, epidemiology, BCR ABL1 gene, philadelphia chromosome, t(9;22), CML incidence, etiology of CML, pathophysiology of CML, phases of CML, treatment of CML, Allogenic stem cell transplant, TKI therapy for CML, Sokal index for CML,
Obesity is a chronic heath problem ,the no.of people having obese rising rapidly world wide and making obesity 1 of the fastest developing peoples health problem
Preventing diabetes and obesity in mental health disordersHealthXn
Diabetes is common in people with mental health disorders. This presentation discusses why and what therapies may worsen the disorder and how to prevent obesity and diabetes
Childhood obesity the other aspect of malnutritionvckg1987
this presentation mainly deals with childhood obesity where the current trends of it in India and statewise has been shown, there are various classification which are made for childhood obesity but there is confusion which one to choose, so this confusion is removed in this presentation, then moving on the strategies made for preventing the childhood obesity in various countries has been mentioned.
Learn the basics of Diabetes Prevention, reversal and Management. The Science is clear, follow the five key behavior changes to live a diabetes-free life.
Musculoskletal manifestations of Obesityfathi neana
Systemic disorders and musculoskeletal manifestations are interrelated. With Diagnosed systemic disorders We expect musculoskeletal manifestations and the Musculoskeletal manifestations will guide us to the hidden systemic disorder. There is a Countless sources of information
Like Plain X-rays which can can tell a lot. Even the lifestyle and food selection can help in future expectations
Obesity is not only a problem of adipose tissue. It is the spark for other sequential systemic disorders including the musculoskeletal system.
Polymerase chain reaction is a technique used in molecular biology to amplify a single copy or a few copies of a segment of DNA across several orders of magnitude, generating thousands to millions of copies of a particular DNA sequence
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Obesity
1. Definition
2. Classification
3. Epidemiology
4. Etiology
5. Pathophysiology
6. General Consequences/ complications
7. Role of obesity in cancer
8. Management of obesity
3. Introduction
• More than 66% of U.S. adults are categorized as overweight or obese,
and the prevalence of obesity is increasing rapidly in most of the
industrialized world.
• Children and adolescents also are becoming more obese, indicating
that the current trends will accelerate over time.
• Obesity is associated with an increased risk of multiple health
problems, including hypertension, type 2 diabetes, dyslipidemia,
obstructive sleep apnea, nonalcoholic fatty liver disease, degenerative
joint disease, and some malignancies.
• Thus, it is important for physicians to identify, evaluate, and treat
patients for obesity and associated comorbid conditions.
4. Definition :
1) Obesity is a state of excess adipose
tissue mass.2
2) Obesity is a disease of caloric imbalance
that results from an excess intake of calories
that exceeds their consumption by the body.1
The WHO definition is:
a BMI greater than or equal to 25 is overweight
a BMI greater than or equal to 30 is obesity.
5. BMI/Quetlet index
it is a classification of weight status NOT by mere
it is emphasized here that, muscularity & height
also affect weight.
weight
So, BMI or Quetlet index used to Classify obesity
Body Mass Index (BMI)
Most widely used
BMI= Weight(kg)
Height(mtr)2
6. BMI/ Quetelet index
• This index is a classification of weight status and not merely weight.
• It is emphasized here that, Muscularity and height also affect weight.
• Most widely used used Body mass Index/ Quetelet index is calculated
as-
BMI= Weight(kg)
Height(mtr)2
7.
8. Values of BMI are age independent & same for both
At similar BMI, fat content in women > men
BMI 30 is threshold for obesity.
sexes.
BMI 25 - 30 medically significant & requires intervention
• Morbidity and mortality increase with BMI similarly
for men and women
• Risk at a given BMI can vary between populations.
9.
10. Other Indices
Broca’s index = Height (cms) – 100
Corpulance index = Actual weight / Desirable
Ponderal index =
Height (cms)
Weight (Should
not exceed 1.2 for
normal)
Cube root of body weight ( kg )
Lorentz’s formula =
(Height (cms) – 100) -
Height (cms) – 150
2(women) or 4(men)
11. Other methods
Waist hip ratio - >0.9 for women is obese
- > 1 for men is obese
Anthropometry ( skin fold thickness
Harpenden skin caliper to measure skin fold thickness
in lumber area
< 40 mm in males, < 50 mm in females
)
Densitometry (under water weighing)
CT Scan, MRI, Electric impedance
12. Prevalence
• Obesity is perhaps the most prevalent form of malnutrition. As a
chronic disease, prevalent in both developed and developing
countries, and affecting children as well as adults, it is now so
common that it is replacing the more traditional public health
concerns including undernutrition.
• It is one of the most significant contributors to ill health.
• For industrialized countries, it has been suggested that such increase
in body weight have been caused primarily by reduced levels of
physical activity, rather than by changes in food intake or by other
factors.
• It is extremely difficult to assess the size of the problem and compare
the prevalence rates in different countries as no exact figures are
available.3
13. Prevalence
• Obesity is a major public health problem in developed countries and
an emerging health problem in developing nations, such as India.
Globally, the World Health Organization estimated that by 2015, 700
million adults would be obese.
• In India, the non-communicable risk factor survey phase 2 was carried
out in the year 2007-2008, in the states of Andhra Pradesh, Kerala,
Madhya Pradesh, Maharashtra, Tamil Nadu, Uttarakhand and
Mizoram. The survey shows high prevalence of overweight in all age
groups except in 15-24 years group.
• Overweight prevalence was higher among females than males and in
urban areas than in rural areas.
14. Prevalence
• Low prevalence was recorded among lower level of education (ill-
literate and primary level), and in people whose occupation was
connected with agriculture or manual work. 3
• In India, 1.3 per cent males and 2.5 per cent females aged more than
20 years were obese in the year 2008. Compared to U.S. where 66% of
adults are categorized in overweight and obese in 2014, it is also
expected that Indian data too raise a lot.3
16. Obesity can be due to adipocyte hypertrophy and/or hyperplasia…
17. What causes obesity?
• Lack of energy balance.
• Genes and family history.
• Endocrine: Hypothyroidism, Cushing’s Syndrome, and PCOD.
• Drugs : Corticosteroids, antidepressants and seizure medications.
• Emotional factors.
• Alcoholism.
• Smoking cessation.
18. What causes obesity?
• Pregnancy.
• Lack of sleep.
• An inactive lifestyle.
• Lack of access to healthy foods.
• Lack of neighborhood sidewalks and safe places for recreation.
19. What causes obesity?
• Even though genetic influences play an important role in weight
control, but obesity is a disease that depends on the interaction
between multiple factors.
• After all, regardless of genetic makeup, obesity would not occur
without intake of food.
21. Energy balance
3 components
1. Afferent/peripheral system
- Generates signals from various sites
- Composed of
Leptin, Adiponectin - by Fat cells,
Ghrelin from Stomach,
Peptide YY (PYY) from Ileum, Colon,
Insulin from Pancreas
22. 2.Arcuate nucleus in hypothalamus
-Processes & integrates neurohumoral peripheral
-Generates efferent signals
-Composed of 2 subsets of first order neurons
1. POMC (pro-opiomelanocortin) &
CART (cocaine amphetamine-regulated transcripts)
neurons
signals
2. Neuron containing Neuropeptide Y &
AgRP (agouti-related peptide)
These first order neurons communicate with second
order neurons in hypothalamus
23. 3. Efferent system
Carries signals from second order neurons of
hypothalamus to control food intake and energy
expenditure
24.
25. Neurohumoral circuits in Hypothalamus
• POMC/CART neurons enhance energy expenditure and weight loss
through the production of the anorexigenic α-melanocyte-stimulating
hormone (MSH), and the activation of the melanocortin receptors 3
and 4 (MC3/4R) in second-order neurons. These second order
neurons are in turn responsible for producing factors such as thyroid
releasing hormone (TSH) and corticotropin releasing hormone (CRH)
that increase the BMR and catabolic metabolism, thus favoring weight
loss.
• By contrast, the NeuropeptideY/AgRP neurons promote food intake
(orexigenic effect) and weight gain, through the activation of Y1/5
receptors in secondary neurons. These secondary neurons then
release factors such as melanin-concentrating hormone (MCH) and
orexin, which stimulate appetite.
26.
27.
28. Vagal Afferent ie.
Neuronal Signals
• Vagal efferent are stimulated
by the nutrient and stretch
receptors from stomach after
food intake.
• These signal goes to Nucleus
tractus solitaries in hind brain
and accordingly decreases
feeding, causes gastric
emptying and increase
metabolic rate.
29. Humoral components in detail
• Adipocytes
• Leptine
• Adiponectine
• Cytokines (TNF, IL 6, IL 1, IL 18, chemokine, steroid hormones)
• Ghrelin –From stomach and arcuate nucleus of Hypothalamus
• Peptide YY – from ileum and Colon.
• Pancreatic Polypeptide , Insulin and Amylin.
30. Is a 16kD hormone produced by adipocytes
Product of "ob" gene
Provides signal for “energy
sufficiency”.
Abundant fat Leptin
secretion
Regulated by insulin stimulated
glucose metabolism
It is absent in mice (so they eat
voraciously)
Leptin
has OB-R receptor
(type 1 CK-R family)
NPY/AgRP
neurons
+POMC/CART
Neurons
Anorexic
neuropeptides-
(MSH)
Not to produce
orexinergic
neuropeptides
It stimulates thermogenesis,
activity, energy expenditure
-
Increase energy
expenditure
Not to take
food
31. MC4R (Melanocortin receptor 4 (on 2nd order neuron
activated by MSH)) mutations are more frequent,
cause of 5% massive obesity
No sensing of satiety (anorexinergic) signal generated
Patient behaves as if undernourished, eat voraciously
Insufficiency of Brain-derived neurotrophic
factor (BDNF) – (a component of MC4R
downstream signaling in hypothalamus) A/w
obesity in WAGR syndrome
32. Adiponectin
Produced mainly by adipocytes
levels are low obesity, more in lean.
Stimulates fatty acid oxidation
So it is also called as “Fat-burning molecule”
“Guardian angel against
obesity”
AdipoR1 (in skeletal
muscle),
AdipoR2 (in liver, brain)
+ cAMP activated
protein kinase
Inactivates acetyl
coenzyme A carboxylase
(Key enzyme in Fatty acid
synthesis)- No obesity
It reduces fatty acid influx in liver, and
gluconeogenesis from liver
It protects against Metabolic
Syndrome, by increasing insulin
sensitivity
33. Adipocytes also produce TNF, IL-6, IL-1, IL-18, chemokine,
Steroids
leading to Chronic sub-clinical/pro-inflammatory state (^ CRP)
So these are acted upon by macrophages and accordingly macrophages
are considered to be regulating adipocyte function.
This shows that adipocytes acts as link between lipid
metabolism, nutrition, inflammation.
34. These are short term meal initiators and terminatoprs
Ghrelin (stomach, arcuate nucleus)- only orexenergic
gut hormone
It stimulates NPY/AgRP neurons of hypothalamus
and
Ghrelin acts by binding the growth hormone secretagogue
receptor, which is abundant in the hypothalamus and the
pituitary.
35. PeptideYY (secreted by endocrine cells of ileum,
and colon)
Level of PYY are found reduced in Prader willi
syndrome.
These observations have led to ongoing work to
produce PYYs for the treatment of obesity.
36. Amylin
secreted along with insulin by pancreatic ß
cells),
it reduces food intake and weight gain.
Both PYY and amylin act centrally by stimulating
POMC/CART neurons and inhibiting NPY/AgRP in the
hypothalamus, causing a decrease in food intake.
37. WHY is it HARD to maintain the weight loss for those
who lose after dietary restriction?
38. WHY is it HARD to maintain the weight loss for those
who lose after dietary restriction?
• On dieting, adipocytes number never reduces.
Adipocyte numbers are tightly controlled and loss of fat
mass in an adult person occurs through shrinkage of existing
adipocytes. Adipocytes number remain constant.
39. WHY is it HARD to maintain the weight loss for those
who lose after dietary restriction?
• On dieting, adipocytes number never reduces.
Adipocyte numbers are tightly controlled and loss of fat
mass in an adult person occurs through shrinkage of existing
adipocytes. Adipocytes number remain constant.
• Adipocyte number is already higher in obese.
40. ..
SO maintaining and not allowing
it to increase in number in
childhood is important.
43. Type 2 Diabetes
• Obesity is associated with insulin resistance and hyperinsulinemia,
which are the important features of type 2 diabetes, and weight loss is
associated with improvements in these abnormalities.
• 80% type 2 DM are found to be obese.
• Excess insulin, play a role in the retention of sodium, expansion of
blood volume, production of excess norepinephrine, and smooth
muscle proliferation that are the hallmarks of hypertension.
• Regardless of the nature of the pathogenic mechanisms, the risk of
developing hypertension among previously normotensive persons
increases proportionately with weight.
46. Cardiovascular system Obesity
Obesity is a independent
risk factor for CAD, CHF Insulin Resistance
Waist – Hip ratio
Predictor for CVS complication
best
↑ Insulin Abdominal
associated
obesity
with
atherogenic lipid
Excess glucose causes
retention of sodium- water
leading to Hypertension.
profile
↑ FFA
↑ Triglyceride, HDL
48. Abdominal obesity (visceral and intra abdominal adipocyte
deposition)
Insulin resistance
Hypertriglyceridemia
Low serum HDL
↑ risk of CAD
Seen more in Indians, probably due to low levels of
adiponectin
Syndrome X or Metabolic syndrome
52. Apnoeic pauses during sleep
Hypersomnolence at both day
Polycythemia
& night
Eventually right sided heart falure
Obesity hypoventilation syndrome (Pickwikian syndrome)
55. Obesity predisposes to Gall stones, Pancreatitis, Abdominal hernia,
NAFLD
Gall stones
Fasting enhanced mobilization cholesterol from fat depots
↑ cholesterol Enhanced billiary excretion of
cholesterol Super saturated bile Cholelithiasis
local inflammatory state risk for GB Cancer
Gall stones are six times more common in obese than in lean
subject.
GIT
56. This condition is strongly associated with Obesity,
Dyslipidemia, Type 2 DM.
Presents like – Steatosis & Steatohepatitis
10 – 20 % develops to Cirrhosis and fibrosis
57. Stroke
Due to ↑ Blood pressure and also due to pulomonary
embolism, particularly in those with decreased mobility.
Type 2 DM
Elevated cholesterol levels
Depression –
Is more commonly due to Sleep disturbances
58. Bones, Joints, Cutaneous disorders
Osteoarthritis and Gout :
results from increased weight-bearing on joints due to
increased adiposity and the injurious effects that inflammatory
adipokines such as resistin - have on joint synovia and muscle
function.
Skin –
Acanthosis nigrans,
Friability of skin, enhancing the risk of fungal and
yeast infection
59. Cushing‟s Syndrome –
↑ cortisol levels
Promotes deposition of adipose
Upper face – Moon Facies
Inter scapular area – Buffelow
tissue in peculiar distribution
Hump
Mesenteric bed – Truncal obesity
Hypothyrodism –
Wt. gain inspite of poor appetite
Obesity here is mainly due to fluid retention
60. Insulinoma-
Wt. gain occurs here as a result of over eating by the
patient to avoid hypoglycemia symptoms
Craniopharyngioma –
Tumor arising from Ratheke‟s pouch
Pressure effect on hypothalamus stimulation anabolic
(NPY/AgRPR) and reduced catabolic (POMC/CART) -
Obesity
61. Complications in Pregnancy-
• Obesity is a risk factor for preeclampsia and eclampsia of pregnancy,
in which increased adipokines include RAS, prostaglandins, and
other fatty-acid derivatives.
• Adipocytes also secrete these substances, which exacerbates
hypertension and fluid retention in this syndrome.
• Endarteritis within the placenta may also be related to the increased
inflammatory adipokines that contribute to preeclampsia.
62. Both sexes affected equally with high mortality rate
In males – Ca. esophagus, colon, rectum, pancreas, liver
& prostate
In females – Ca. gall bladder, bile duct, breast,
endometrium, cervix, ovaries
64. How they are related?
1) Elevated insulin levels.
65. How they are related?
1) Elevated insulin levels.
Insulin resistance hyperinsulinemia
inhibits the production of the IGFBP-1 and IGFBP-2,
rise in levels of free insulin-like growth factor-1 (IGF-1).
(IGF-1 is a mitogen, and its receptor, IGFR-1, is highly expressed in
many human cancers.)
It binds with high affinity to the IGFR-1 receptor.
Binding activates the RAS and PI3K/AKT pathways, which promote
the growth of both normal and neoplastic cells.
66. How they are related?
2) Obesity has effects on steroid hormones that regulate cell
growth and differentiation in the breast, uterus, and other tissues.
Obesity increased synthesis of estrogen from androgen precursors
through an effect of adipose tissue aromatases
increases androgen synthesis in ovaries and adrenals,
enhances estrogen availability by inhibiting the production of sex-
hormone-binding globulin (SHBG) in the liver.
71. Obesity is preventable.
Worldwide obesity has more than doubled since 1980.
In 2008, 1.5 billion adults, 20yr age and older, were
overweight. Of these over 200 million men and nearly
300 million
65% of the
overweight
women were obese.
world's population live in countries were
and it said that obesity kills more people
than underweight.
Nearly 43 million children under the age of five were
overweight in 2010.
74. References
1. Vinay Kumar, Abul K. Abbas, Jon C. Aster-Robbins and Cotran. Pathologic Basis of
Disease-Saunders. 9Ed,2015.
2. Harrison. Harrison’s Principles of Internal Medicine. 19Ed,2015.
3. K Park. Park’s text book of preventive and social medicine. 23Ed,2016
4. Redinger RN. The Pathophysiology of Obesity and Its Clinical
Manifestations. Gastroenterology & Hepatology. 2007;3(11):856-863.
Editor's Notes
Gm everyone, todays topic of presentation is Pathology of Obesity.
Which will be covered under headings
To universalize the definition WHO has fixed a index named as ……………………..
Asian criteria of BMI is nearly same; except upper limit for Normal in Asia is reduced to 22.9 in place of 24.9.
Definition for overweight is also changed and term “pre obese” is introduced in for Asian population.
According to Harrison’s text book table no 416 disease risk is increased from overweight to Extreame obesity as high- very high- extremely high.
No w coming to the etiology…….
MCH- melanocorticorticotrophic hormone
AgRP- agouti related peptide
CART- Cocaine and amphetamine related peptide
In a simplified way the neurohumoral mechanisms that regulate energy balance can be subdivided into three components:
Afferent system- Arcuate nucleus in hypothalamus- and efferent system.
The figure from Robbins depicting the energy balance.
POMC- pro opiomelanocortine
CART- cocain and amphetamine regulated transcript
POMC/CART neurons enhance energy expenditure and weight loss through the production of the anorexigenic MSH, and the activation of the melanocortin receptors 3 and 4 (MC3/4R) in second-order neurons. These second order neurons are in turn responsible for producing factors such as thyroid releasing hormone (TSH) and corticotropin releasing hormone (CRH) that increase the BMR and anabolic metabolism, thus favoring weight loss.
NPY/AgRP neurons promote food intake (orexigenic effect) and weight gain, through the activation of Y1/5 receptors in secondary neurons. These secondary neurons then release factors such as melanin-concentrating hormone (MCH) and orexin, which stimulate appetite.
Vagal efferent are stimulated by the nutrient and stretch receptors from stomach after food intake.
These signal goes to Nucleus tractus solitaries in hind brain and accordingly decreases feeding, causes gastric emptying and increase metabolic rate.
AgRP- Agouti relted protein
POMC- pro opiomelanocortine
CART- cocain and amphetamine regulated transcript
MSH- Melanocortine stimulating hormone
AgRP- Agouty related protein.
SNS- Sympathetic nervous system
Apnoeic pause - which results from accumulation of extra adipose tissue within the confines of the upper respiratory tract, and hypopharynx, which adversely affects ventilation,
It may lead to secondary hypoxia and even hypercapnia
NAFLD- Non alcoholic fatty liver disease
NAFLD- Non alcoholic fatty liver disease
Osteoarthritis and gout – a degenerative joint disease that
Now question comes in mind is……
RAS- Renin angiotensin substance.
IGF- insulin like growth factor
IGFBP - insulin like growth factor binding protein
IGF- Insulin like growth factor
IGFBP - Insulin like growth factor binding protein
SHBG- Sex hormone binding globulin
At last, there was a very funny minion quote I found on internet , in which patient asks doctor-
Thank You for Patient listening and Thank you Macdonalds for making people fat since 1940.