CURRENT MEDICAL
JOURNAL OF INDIA
VOL XII NO.8 NOVEMBER 2006
Current Medical
Journal was launched from Chandigarh in January 1995,
with the objective of bringing the latest information from the
medical world and of improving the day to day clinical practices
of all medical men. Current medical journal of India has
completed 11 years of its publications and have given 140
monthly issues (12 issues per year).
Its chief editor
is Dr. M. L. Bansal.
One of the
special features of CMJ is that on the TITLE, they
give a photograph of a scientist (each time different)
who has contributed in large way towards his/her speciality &
has invented something for the ailing humanity.
In this issue there
is a photograph of Christian N. Barnad who pioneered open
heart surgery and organ transplant on 3rd December
1967, lasting 9 hours.
v
First patient lived
for 18 days but died of pneumonia.
v
Second patient
survived more than a year.
v
One of his
transplant patients survived for 24 hours.
A unique feature
of CMJ is the MCQ Sets (unsolved as well as solved
ones) in the journal. Current Medical journal is the only
medical journal in the world giving MCQ on each write-up. To
encourage the family physicians and service doctors they give 12
mementos each month for the best MCQ answer sheets.
CMJ has got state award
for excellence in health care and medical journalism on 15th
August, 2005.
PRICE
Single Copy:
Rs.60/-
|
|
Issues |
Rate |
|
One year |
12 |
700 |
|
Two years |
24 |
1300 |
|
Three years |
36 |
1800 |
|
LM |
- |
7000 |
ADDRESS
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CURRENT MEDICAL
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CONTENTS
Ø
PEDIATRICS
·
OBESITY IN CHILDHOOD
PROF. ANIL KAUSHIK
Ø
GYNAECOLOGY
·
PRIMARY AMENORRHOEA
DR. ANUJA BHALERO
Ø
CARDIOLOGY
·
ISOLATED
SYSTOLIC HYPERTENSION (ISH)
PROF. PRANESH NIGAM
Ø
DERMATOLOGY
·
ROLE OF DIET N
DERMATOLOGICAL PRACTICE
DR. SATYADARSHI
PATNAIK
Ø
GERIATRICS
·
EPILEPSY IN ELDERLY
PROF. D. N. MOHARANA
Ø
GYNAECOLOGY
·
COMPLICATIONS OF
CAESAREAN SECTION (CS)
PROF. S. CHHABRA
Ø
ABSTRACTS
FROM OTHER JOURNALS
OBESITY IN CHILDHOOD
PROF. ANIL KAUSHIK,
HEAD, DEPT. OF PAEDIATRICS, MLB MEDICAL COLLEGE & HOSPITAL,
JHANSI.
Obesity
can be defined as a disorder or disease in which excess body fat
either impairs health or places an individual at risk for health
related problems.
Diseases such as
Type 2 diabetes, coronary heart disease (CHD), hyperlipidemia
etc. begin childhood and these manifest due to interaction
between various risk factors, one of these being obesity
Prevalence:
The prevalence of
obesity seems to be increasing in most parts of world, even it
is used to be rare in India. It is a paradoxical situation,
while we have about 55% children who suffer from under
nutrition; there is an emerging class which is suffering from
obesity.
The calculated
global prevalence of overweight (including obesity) in children
of 5- 17 years of age group is estimated by International
Obesity Task Force to be approximately 10%, with prevalence
ranging over 30% in America to less than 25 in Africa.
Clinical
classification of obesity
|
Parameters |
Mild |
Moderate |
Severe |
Very severe |
|
v
Excess weight
for height |
120-130% |
131-140% |
141-150% |
Above150% |
|
v
Triceps skin
fold thickness |
|
|
a)
Preschool children |
12 mm |
14 mm |
16 mm |
> 16 mm |
|
b)
School children 7-10 yrs
|
14-16 mm |
16-18 mm |
18- 20 mm |
> 20 mm |
|
c)
11 to 15 yrs |
16-18 mm |
18-20 mm |
20- 22 mm |
> 22 mm |
WHO recommendation
for childhood obesity
Age in
Years BMI (Kg/ m2)
≤
14 19- 20
15
25
≥
16 28
WHO classification
for adults
BMI > 25 over weight
BMI > 30 obesity
BMI > 40 morbid
obesity
Other Markers of
Obesity
|
Waist
circumference |
Highly
sensitive and measure of central obesity. Cut off value
for risk. > 102 cm for adult males, 88 cm for adult
females; 61 cm pre pubertal children |
|
Waist- Hip
ratio (WHR Ratio) |
≥ 0.9 =
central obesity |
|
Bio-electrical
impedance analysis |
Non invasive,
safe, cheap, reliable estimation of body composition using
a small portable instrument |
|
Dual energy
X-ray absorptiometry(DEXA) |
Accurately
estimates whole body as well as regional bone mineral
density, lean mass and fat mass over range of age and body
sizes. Cut off values for body fat %: adult males ≥25 %
and females ≥ 35 % |
|
Air displacement
plethysmography |
A
sophisticated new technique, but very expensive. |
Etiology of Obesity
Simple Obesity
In this group no
cause could be found on clinical and laboratory examinations.
Probably these are cases of
a.
Familial or Genetic
Obesity
(most common cause of obesity. Usually at least one of the
parents has obesity)
b.
Constitutional
Obesity:
It is the constitution of a particular child which results in
obesity.
Secondary Obesity
In this group the
etiology is established
a.
Habitual over eating
b.
Psychogenic or Emotional factors
c.
Lack
of physical activity and exercise
d.
Cultural factors
e.
Dietetic factors: Traditionally micro nutrient rich foods are
being replaced by energy dense highly processed micro nutrient
poor junk foods.
f.
Temporary obesity in adolescents: Because of endocrine imbalance
and psychological factors.
g.
Hypothalamic factors: Tubercular meningitis may cause
hypothalamic damage that may cause obesity. Similarly tumours in
the region of the hypothalamus may cause Cushing’s syndrome.
h.
Endocrine disorders: Endocrine disorders like hypogonadism,
hypothyroidism, and hypopitutarism may cause obesity.
i.
Pre-diabetic state or trait
j.
Syndromes associated with obesity: Prader willi, Laurence
Moon Biedle, Ashitrome, Chohen, Carpenter, Borjesons
Forssman Lehmann, Turner’s Syndrome, Beckwith- Wiedemann
Syndrome (gigantism), Weaver Infant Overweight Syndrome, Soto’s
cebral gigantism, Ruvalcaba Syndrome, Familial Hip dystrophy
etc.
Types of Adipose
Tissues:
1.
White
Adipose Tissue: Fat is mostly stored and this tissue is
metabolically less active.
2.
Brown
Adipose Tissue: Stored fat is less in amount but this tissue is
metabolically very active and this tissue is almost absent in
obese persons.
Complications of
Obesity
v
Dislipidemias
v
Hypertension
v
Early puberty Type
II Diabetes
v
Coronary Heart
Disease
v
Cerebrovascular Disease
v
Osteoporosis
v
Flat foot etc.
Management of
Obesity
General Approach to
Therapy
·
Institute small,
gradual and permanent changes, not short term diets and exercise
programs aimed at rapid weight loss
·
Involve the family
and care providers in the treatment programme. Intervention
should begin early 9later than three yrs of age but earlier than
adolescence.
·
Clinicians should
encourage as well as sympathize and not criticize
Principles of
therapy
·
Reduced Calorie
intake
·
Behavioural modifications:
o
Self monitoring
o
Stimulus control
o
Changing eating behaviour
o
Reinforcement
o
Cognitive
behavioural techniques: this has to be planned for risk
stimulations like social gatherings
·
Increased activity
levels
o
At the parents-
child level
o
At the school-
student level
o
At a government-
community level
·
Family involvement
| 
