1Obesity paradox, obesity orthodox, and the metabolic syndrome: An approach to unity 1 Obesity paradox and the metabolic syndrome. Abstract: 26Obesity and the accompanying metabolic syndrome are strongly associated with heightened morbidity 27 and mortality in older adults. In our review of more than 20 epidemiologic studies of major infectious 28 diseases, including leaders such as tuberculosis, community-acquired pneumonia, and sepsis, obesity was 29 associated with better outcomes. A cause-and-effect relationship between over-nutrition and survival with 30 infection is suggested by results of two preliminary studies of infections in mice, where high fat feeding 31 for 8-10 weeks provided much better outcomes. The better outcomes of infections with obesity are 32 reminiscent of many recent studies of "sterile" non-infectious medical and surgical conditions where 33 outcomes for obese patients are better than for their thinner counterparts ---and given the tag "obesity 34 paradox". Turning to the history of medicine and biological evolution, we hypothesize that the metabolic 35 syndrome has very ancient origins and is part of a lifelong metabolic program. While part of that program 36 (the metabolic syndrome) promotes morbidity and mortality with aging, it helps infants and children as 37 well as adults in their fight against infections and recovery from injuries, key roles in the hundreds of 38 centuries before the public health advances of the 20th century. We conclude with speculation on how 39 understanding the biological elements that protect obese patients with infections or injuries might be 40 applied advantageously to thin patients with the same medical challenges. experts to predict that obesity will shortly become the leading personal health problem worldwide. 52Obesity and the accompanying metabolic syndrome are typically associated with shortened life 53 expectancy, premature disability, and heightened prevalence of cardiovascular disorders, cancer, diabetes, 54and Alzheimer disease as well as multiple other disorders linked to advancing age. 55 ( ¶2) In the jeremiads inspired by obesity, the modest but deeply rooted health advantages of 56 obesity are typically neglected (Table 1). In this paper we add further to the list of advantages of obesity; 57 we review over 20 epidemiology studies of six serious infectious diseases, including tuberculosis, 58 pneumonia, and sepsis, where outcomes are inversely related to body mass index. The consistency of the 59 obesity advantage is especially remarkable because the usual measurements to express adiposity i.e. body 60 mass index (BMI; the weight in kilograms divided by the square of the height in meters) as well as waist 61 circumference or neck circumference are such rough approximations of total body fat or of visceral fat or 62 of metabolic syndrome. The connection between body mass index and the metabolic syndrome in 63 epidemiology studies is further loosened by impressive ethnic differences (Figure 1) [1] and changes in 64 individuals with aging. ...

Creutzfeldt-Jakob disease (CJD), the most common form of human prion diseases, is a fatal condition with a mortality rate reaching 85% within one year of clinical presentation. CJD is characterized by rapidly progressive neurological deterioration in combination with typical electroencephalography (EEG) and magnetic resonance imaging (MRI) findings and positive cerebrospinal spinal fluid (CSF) analysis for 14-3-3 proteins. Unfortunately, CJD can have atypical clinical and radiological presentation in approximately 10% of cases, thus making the diagnosis often challenging. We report a rare clinical presentation of sporadic CJD (sCJD) with combination of both expressive aphasia and nonconvulsive status epilepticus. This patient presented with slurred speech, confusion, myoclonus, headaches, and vertigo and succumbed to his disease within ten weeks of initial onset of his symptoms. He had a normal initial diagnostic workup, but subsequent workup initiated due to persistent clinical deterioration revealed CJD with typical MRI, EEG, and CSF findings. Other causes of rapidly progressive dementia and encephalopathy were ruled out. Though a rare condition, we recommend consideration of CJD on patients with expressive aphasia, progressive unexplained neurocognitive decline, and refractory epileptiform activity seen on EEG. Frequent reimaging (MRI, video EEGs) and CSF examination might help diagnose this fatal condition earlier.

Zinc chloride smoke bomb exposure is frequently seen in military drills, combat exercises, metal industry works, and disaster simulations. Smoke exposure presents with variety of pulmonary damage based on the intensity of the exposure. Smoke induced severe acute respiratory distress syndrome (ARDS) is often fatal and there are no standard treatment guidelines. We report the first survival of smoke induced severe ARDS in the United States (US) with prolonged use of high dose steroids (five weeks) and lung protective ventilation alone. Previously reported surviving patients in China and Taiwan required extracorporeal membrane oxygenation (ECMO) and other invasive modalities. We suggest that an extended course of high dose corticosteroids should be considered for the treatment of smoke inhalation related ARDS and should be introduced as early as possible to minimize the morbidity and mortality. We further suggest that patients with smoke inhalation should be observed in the hospital for at least 48 to 72 hours before discharge, as ARDS can have a delayed onset. Being vigilant for infectious complications is important due to prolonged steroid treatment regimen. Patients must also be monitored for critical illness polyneuromyopathy. Additionally, upper airway injury should be suspected and early evaluation by otorhinolaryngology may be beneficial.