SummaryEvidence for the health impact of obesity has largely focussed on adults. We estimated the population prevalence and prevalence ratio of obesity‐associated comorbidities in children and adolescents aged 5 to 18 years. Five databases were searched from inception to 14 January 2018. Population‐based observational studies reporting comorbidity prevalence by weight category (healthy weight/overweight/obese) in children and adolescents aged 5 to 18 years from any country were eligible. Comorbidity prevalence, stratified by weight category, was extracted and prevalence ratios (relative to healthy weight) estimated using random effects meta‐analyses. Of 9183 abstracts, 52 eligible studies (1 553 683 participants) reported prevalence of eight comorbidities or risk markers including diabetes and nonalcoholic fatty liver disease (NAFLD). Evidence for psychological comorbidities was lacking. Meta‐analyses suggested prevalence ratio for prediabetes (fasting glucose ≥ 100 mg/dL) for those with obesity relative to those of a healthy weight was 1.4 (95% confidence interval [CI], 1.2‐1.6) and for NAFLD 26.1 (9.4‐72.3). In the general population, children and adolescents with overweight/obesity have a higher prevalence of comorbidities relative to those of a healthy weight. This review provides clinicians with information when assessing children and researchers a foundation upon which to build a comprehensive dataset to understand the health consequences of childhood obesity.

Introduction: Acute upper gastrointestinal bleeding (AUGIB) is an important gastroenterological emergency. Role of Rockall score in stratification of risk of mortality and rebleeding in Indian patients is uncertain. Methods: This study was prospectively conducted on 175 consecutive patients admitted with AUGIB who were 18 years or above. The clinical Rockall score and complete scores calculated at admission and after endoscopy were analyzed for association with the outcome (rebleeding and mortality) for both variceal and non-variceal bleeding. Results: The mean age of the patients was 48.4±16.4 years and 78.9% were males. History of inake of NSAIDs in patients of AUGIB was present in 13.7% and of antiplatelets in 13.7%. Variceal bleed was the most common etiology (45.7%) followed by peptic ulcer disease (24.0%). Overall rates of surgery, rebleed and mortality were 6.9%, 22.9% and 20% respectively. Both clinical and complete Rockall risk scoring systems were useful tools for stratifying patients with AUGIB into high and low risk categories for mortality. However, for the prediction of rebleed, the complete Rockall scoring system was found to be better than the clinical scoring system. These scoring systems performed much better in predicting the outcomes in non-variceal bleed than in patients with variceal bleed. Multivariate analysis showed that patients with age ≥65 years and albumin <3 g/dl were at an increased risk of mortality. Conclusion: Rockall scoring can be used to stratify patients with AUGIB and is more useful in non-variceal bleeding.

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IntrOductIOnThyroiditis is defined as a disorder that involves inflammation of the thyroid gland. Thyroiditis is mainly divided into two broad categories: painless and painful. Among the category of painful types of thyroiditis is subacute (de Quervain's thyroiditis) which is the most common cause of acute painful thyroiditis [1]. The patients usually present to the otorhinologists with complaints of neck pain, swelling and odynophagia. On examination, there is tenderness at the region of thyroid gland. Although the exact aetiology is unknown, is thought to be a viral inflammatory disorder [2]. The disorder is usually selflimiting over months with a triphasic course of hyperthyroidism followed by hypothyroidism and ending with euthyroidism.Subacute thyroiditis has been treated with either nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids for years. The response to steroids is often more dramatic and quicker than the response to NSAIDs, but steroids are well known for their side effects over NSAIDs. As subacute thyroiditis is a self-limiting condition, high dose of steroids might be irrelevant to some people. The usual initial dose is 1 mg/kg of prednisolone per day and tapered over six weeks although the basis for this dose has not been established yet by prospective studies [3].The current study was carried out to study if prednisolone in lower initial dose (20 mg/day tapered over four weeks) is effective in patients with acute painful thyroiditis. Thyroid tenderness and Erythrocyte Sedimentation Rate (ESR) were taken as the guidelines to either continue or discontinue the drug. The patients were followed up carefully and data were analysed. MAterIAls And MethOdsThis study was a prospective, cross sectional, observational study carried out in the Department of ENT, Manipal Teaching Hospital, Pokhara, Nepal from 1 st August 2012 to 31 st March 2015. All the patients with acute anterior neck pain of less than or equal to seven days duration were included in the study. Diagnosis was made in the clinical grounds according to history of anterior neck pain, tenderness thyroid region, tender and swollen thyroid gland, ultrasound of the neck showing increased vascularity of the thyroid gland and raised Erythrocyte Sedimentation Rate (ESR).Patients with clinical signs suggestive of subacute thyroiditis and ESR of more than 30 mm/h were finally included in the treatment group.Patients in whom there was contraindication to the use of prednisolone (severe gastritis, Diabetes, hypertension) were excluded from the study.The patients were administered prednisolone in a starting dose of 20 mg/day (10 mg twice daily) tapered over four weeks. The dose was 10 mg twice daily for 2 weeks and 10 mg once daily day for next 2 weeks. They were also co-prescribed with pantoprazole 40 mg twice daily for 2 weeks to lessen the gastric irritation caused by prednisolone. A performa was made, initial findings of severity of pain and tenderness and ESR were noted, and patients were closely observed for 4 weeks. ESR was repeated ...

Women having recently undergone breast reconstruction reported key deficiencies in information provided prior to surgery and identified preferred information delivery options. Addressing women's educational needs is important to achieve appropriate expectations and improve satisfaction.

Background: Previous studies have suggested favorable outcomes of hydrocortisone, ascorbic acid (vitamin C), and thiamine (HAT) therapy in patients with sepsis. However, similar results have not been duplicated in sequential studies. This meta-analysis aimed to reevaluate the value of HAT treatment in patients with sepsis. Methods: Electronic databases were searched up until October 2020 for any studies that compared the effect of HAT versus non-HAT use in patients with sepsis. Results: Data from 15 studies (eight randomized controlled trials [RCTs] and seven cohort studies) involving 67,349 patients were included. The results from the RCTs show no significant benefit of triple therapy on hospital mortality (risk ratio [RR], 0.99; P = 0.92; I 2 = 0%); intensive care unit (ICU) mortality (RR, 0.77; P = 0.20; I 2 = 58%); ICU length of stay (weighted mean difference [WMD], 0.11; P=0.86; I 2 =37%) or hospital length of stay (WMD: 0.57; P=0.49; I 2 =17%), and renal replacement therapy (RR, 0.64; P = 0.44; I 2 = 39%). The delta Sequential Organ Failure Assessment (SOFA) score favored treatment after a sensitivity analysis (WMD, -0.72; P=0.01; I 2 = 32%). However, a significant effect was noted for the duration of vasopressor use (WMD, -25.49; P < 0.001; I 2 = 46%). The results from cohort studies have also shown no significant benefit of HAT therapy on hospital mortality, ICU mortality, ICU length of stay, length of hospital stay, the delta SOFA score, the use of renal replacement therapy, or vasopressor duration. Conclusions: HAT therapy significantly reduced the duration of vasopressor use and improved the SOFA score but appeared not to have significant benefits in other outcomes for patients with sepsis. Further RCTs can help understand its benefit exclusively.

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Purpose -Around 50 per cent of carers of people with eating disorders (EDs) experience mental health difficulties. The purpose of this paper is to investigate well-being of carers of people with ED and carers of people with severe and enduring eating disorders (SEEDs). Design/methodology/approach -Carers (n ¼ 104) were recruited from UK support groups and stratified using duration of the care recipient's ED (0-2, 2-6, W6 years), with the W6 years category classified as SEED. Data were compared with existing carer well-being studies of other patient groups. Findings -Carers of people with SEED were not significantly different on reported well-being to carers of people with ED. However, carers of people with ED reported significantly less well-being than community norms, carers of people with brain injury and of people with dementia. Specifically, poorer social functioning was reported.Research limitations/implications -Further research on carers of people with SEED is warranted as carers of people with SEED were not equally balanced in gender. It would be beneficial if support groups and skill-based workshops were more available for carers. Originality/value -This is the first known study to compare carer well-being of people with SEED with carers of other clinical populations. Further research is required to identify the needs of carers.