The data suggest a causal association between the pancreatic disease and PHPT. This may be correlated to the higher calcium values. Until more information is available, it would be prudent to check serum calcium in all patients presenting with unexplained pancreatic disease.
Obesity is a major public health problem and is implicated in the rising prevalence of cardiac disease and type 2 diabetes mellitus in India. Management of an obese patient includes therapeutic lifestyle changes of increasing physical activity and reducing calorie intake. This combination can result in about a 10% loss of initial body weight. To reinforce this intervention, behavioral therapy needs to be incorporated into the overall intervention under the belief that obesity is a result of maladaptive eating behaviors and exercise patterns. This review explains the principles of behavioral therapy, including the underlying assumptions and characteristics. The common components of behavioral therapy for obesity are explained. The different settings where behavioral therapy can be administered are mentioned. The review focuses on how behavioral therapy can be incorporated in the routine clinical management of obesity by primary and secondary care physicians who encounter obese patients.
The natriuretic system consists of the atrial natriuretic peptide (ANP) and four other similar peptides including the wrongly named brain natriuretic peptide (BNP). Chemically they are small peptide hormones predominantly secreted by the cardiac myocytes in response to stretching forces. The peptide hormones have multiple renal, hemodynamic, and antiproliferative effects through three different kinds of natriuretic receptors. Clinical interest in these peptide hormones was initially stimulated by the use of these peptides as markers to differentiate cardiac versus noncardiac causes of breathlessness. Subsequently work has been done on using these peptides to prognosticate patients with acute and chronic heart failure and those with acute myocardial infraction. Synthetic forms of both atrial- and brain-natriuretic peptides have been studied and approved for use in acute heart failure with mixed results. This review focuses on the biochemistry and physiology of this fascinating hormone system and the clinical application of these hormones.
Aims and objectives: To study the clinical and laboratory features of patients admitted with vitamin B 12 deficiency-related (B 12 def) neurological syndromes. Settings and Design: A hospital-based retrospective and prospective study conducted at a referral teaching hospital. Materials and Methods: Consecutive patients admitted with vitamin B 12 deficiency-related neurological disorders during a three-year period from June 2000 to May 2003 were included. Data regarding clinical and laboratory features were obtained. Follow-up was done at least six months following treatment with parenteral vitamin B 12. Chi-square test was used for statistical analysis. Results: A total of 63 patients (52 males) with a mean age of 46.2 years were studied. The mean duration of symptoms at presentation was 10.3 months. Myeloneuropathy (54%) was the commonest neurological manifestation, followed by myeloneuropathy with cognitive dysfunction (34%), and peripheral neuropathy (9%). Neuropsychiatric manifestations and dementia were observed in 38% and 19% of patients respectively. All the patients had megaloblastic changes in the bone marrow smear. Eleven (17.5%) patients had both hemoglobin and the mean corpuscular volume (MCV) within the normal range. Follow-up after at least six months of therapy with parenteral B12 showed improvement in 54% patients. Conclusions: A high index of suspicion of B 12 def is required in patients presenting with myelopathy, cognitive decline, or neuropathy. A normal hemoglobin or MCV does not exclude B 12 def; therefore, other tests such as bone marrow smear and serum vitamin B 12 assay are essential, as the condition is often reversible with treatment.
As our understanding of the underlying aetiology of hypertension is far from adequate, over 90% of patients with hypertension receive a diagnosis of essential hypertension. This non-specific diagnosis leads to suboptimal therapeutics and a major problem with non-compliance. Understanding the normal control of blood pressure (BP) is, hence, important for a better understanding of the disease.This review attempts to unravel the present understanding of BP control. The local mechanisms of BP control, the neural mechanisms, renal-endocrine mechanisms, and a variety of other hormones that have a bearing in normal BP control are discussed and the possible role in the pathophysiology is alluded to.
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