Both pre-pregnant obesity and gestational weight gain increases the risk of GDM. The underlying genetic, physiological, and environmental factors behind the development of GDM are not fully understood. There are suggestions interpregnancy weight change as part of the causal mechanism behind the risk of GDM and other adverse pregnancy outcomes in the second pregnancy.
Several meta-analyses of randomised trials and prospective cohort studies and ecological studies, largely done in European and North American countries showed either no association or a lower risk between saturated fatty acid consumption with total mortality and CVD events. This “well accepted” dietary recommendation is now being questioned
A 30 year old female patient attended Nuclear Medicine for a Parathyroid Scan to identify a parathyroid adenoma as the cause of Primary Hyperparathyroidism. The patient was suffering from recurrent renal calculi, and presented with hypercalcaemia [Ca2+ level of 2.89mmol/L (normal = 2.1-2.6)] and increased parathyroid hormone level [PTH level of 39pmol/L (normal = 1.5-9.9)].
Research on the safety and efficacy of these agents are well tested in adults but their use in younger patients is still debated. In particular, there have been few studies on the use of SRNIs in paediatric depression and anxiety. Severe adverse events including increased suicidal thoughts are well recognised. The last meta-analysis on the role of SSRIs and SNRIs in paediatric depression, anxiety, OCD and PTSD was more than 10 years ago. Since then there have been at least a dozen more primary studies on the subject.
It is not rocket science to recognise that the lean with no metabolic abnormalities have the lowest incidence of CV events. It is also not rocket science that the overweight or obese have the highest incidence of CV events of the lot. The MHO used to be considered “lucky” and since they did not have any metabolic abnormalities, were thought to be as good as the lean with no metabolic abnormalities. Are they really that benign?
Opioids are increasingly used for post operative pain management. They are often started while the patient is in hospital but most of the time, there are no plans for how long they should be on opioids when they come home. Often, there are no instructions and it is left with the GP to manage. Hospital based clinicians and general practitioners frequently have different views on how long the opioids are needed for.
While the adipocyte has a pretty much unlimited capacity to expand, their expansion can be limited by the limit of oxygen and nutrients. Hence, hypoxia is an early determinant that limits healthy expansion. We sometimes forget that expansion requires a highly coordinated response from many other different cell types – endothelial precursor cells , immune cells and pre adipocytes.
Odyssey House has a rich history of offering residential detoxification and rehabilitation for alcohol and drug users. They have now expanded our community services and are able to provide free community based detoxifications for suitable patients.
SSW GP Link AGM 2017
November 16, 2017
The views expressed are views of the authors and do not necessarily represent the views of the board of SSW GP Link