Chronic cough and obesity
Publication date: Available online 25 February 2019Source: Pulmonary Pharmacology &TherapeuticsAuthor(s): Laurent GuilleminaultAbstractWith respective prevalence of 13% and 9.6%, obesity and chronic cough are two common conditions worldwide. The crucial role of obesity has been highlighted in the development and progression of many respiratory diseases. According to the results of epidemiological studies, obesity, particularly abdominal obesity, may also be associated with chronic cough (CC). CC seems to be more severe in obese patients compared to normal-weight subjects. The management of CC may differ slightly in obese patients compared to non-obese patients. Indeed, asthma and reflux diseases, which are considered key factors in the onset of CC, are characterised by more severe symptoms in obese patients. Asthma is associated with a resistance to usual treatments in obese patients but no data are available on the effect of inhaled therapies in obese subjects with cough variant asthma. Other emergent causes of CC have been reported in obese patients. Obstructive sleep apnoea and diabetes may also be involved in the development of CC and should be taken into account in obese patients with CC. The beneficial effect of weight loss on chronic cough has been suggested.
Antipsychotic medications are a vital part of controlling psychosis in schizophrenic patients. However, when those patients live in nursing facilities, we are obligated by CMS to undertake gradual dose reductions of antipsychotic medication if possible. Sometimes, these efforts are successful and sometimes they fail. Antipsychotic medications have many side effects, including sedation, diabetes, hyperlipidemia, weight gain, motor rigidity, impaired gait, and falls. Monitoring of blood glucose, lipids, and extrapyramidal symptoms is mandatory.
Management of diabetes in post-acute settings needs special considerations. Hypoglycemia in the skilled nursing and rehabilitation facilities can lead to readmissions and complications including falls. Current EHR care-sets may not make a distinction between hospital and post-acute settings regarding diabetes management. The current diabetes management care-set in the EHR of our large healthcare system includes checking the blood sugar QID/AC/HS (before breakfast, lunch and dinner, and bedtime).
The geriatric population is at high risk of severe low blood glucose (LBG) events due to diminished homeostatic mechanisms, especially on hypoglycemic medications. Moderate to severe LBG events in these patients can contribute to behavior changes such as agitation, change in level of consciousness, disruption of sleep, instability and increased risk of myocardial infarction, stroke and falls. Rapid recognition and appropriate treatment and prevention of LBG and recurrences can reduce risk for hospitalization in the geriatric population.
CONCLUSIONS.: Our results confirm the multidimensional nature of mania. Hyperactivity, increased speech, and thought disorder appear as core features of the clinical construct. The mood experience could be heterogeneous, depending on the co-occurrence of euphoric (elevated mood) and dysphoric (irritability and depressive mood) emotions of varying intensity. Results are also discussed regarding their relationship with other constitutive elements of bipolar disorder, such as mixed and depressive states. PMID: 32093802 [PubMed - in process]
Authors: Lee YM, Park SH, Lee DH Abstract OBJECTIVE: The aim of this paper is to propose a new hypothesis for the role of lipophilic chemical mixtures stored in adipose tissue in the development of dementia. Specifically, we present how the dynamics of these chemicals can explain the unexpected findings from the Action for Health in Diabetes (Look AHEAD) study, which failed to show long-term benefits of intentional weight loss on cognition, despite substantial improvements in many known risk factors for dementia. Moreover, we discuss how the role of obesity in the risk of dementia can change depending on the dynami...
Publication date: Available online 25 February 2020Source: Evaluation and Program PlanningAuthor(s): Tanis J. Walch, Richard R. Rosenkranz, Michaela A. Schenkelberg, Bronwyn S. Fees, David A. Dzewaltowski
Publication date: Available online 25 February 2020Source: The Lancet Respiratory MedicineAuthor(s): Jaclyn A Smith, Michael M Kitt, Alyn H Morice, Surinder S Birring, Lorcan P McGarvey, Mandel R Sher, Yu-Ping Li, Wen-Chi Wu, Zhi Jin Xu, David R Muccino, Anthony P Ford, Jaclyn Smith, Lorcan McGarvey, Surinder Birring, James Hull, Warner W Carr, Alan B Goldsobel, Gary N Gross, John R Holcomb, Iftikhar Hussain
Publication date: Available online 25 February 2020Source: The Lancet Respiratory MedicineAuthor(s): Richard S Irwin, Cynthia L French, J Mark Madison
Publication date: Available online 25 February 2020Source: NeuroImage: ClinicalAuthor(s): Bart van den Munckhof, Anne F. Zwart, Lauren C. Weeke, Nathalie H.P. Claessens, Joost D.J. Plate, Alexander Leemans, Hugo J. Kuijf, Heleen C. van Teeseling, Frans S.S. Leijten, Manon J.N. Benders, Kees P.J. Braun, Linda S. de Vries, Floor E. Jansen