Factors that determine patients considering medication for the disease of obesity: an IMI2 SOPHIA study.

OBJECTIVE: Obesity-related problems can now be managed with effective nutritional therapy, pharmacotherapy, and surgeries that achieve >10% weight loss. Assessing patient preferences, treatment choices, and factors affecting patients can improve treatment compliance and efficacy. Our aim was to identify factors affecting patient preference and subsequent choice of pharmacotherapy among those seeking treatment for obesity-related disorders. METHODS: A participatory action study using purposeful sampling recruited 33 patients with obesity complications. They were referred to specialist clinics in non-alcoholic fatty liver disease, diabetes mellitus, hypertension, and chronic kidney disease. Sixteen males and seventeen females aged 18-70 years, with BMI > 35 kg/m2 were recruited. Before the interview, participants watched a 60-minute video explaining nutritional therapy, pharmacotherapy, and surgery in equipoise. Data were collected in semi-structured interviews; Reflective thematic analysis was used. This sub study focuses only on patients who expressed specific attitudes (positive or negative) towards pharmacotherapy. RESULTS: Ten (30%) patients expressed a view on pharmacotherapy. Eight (24%) patients chose pharmacotherapy alone, whereas two (6%) patients chose pharmacotherapy combined with nutritional therapy. In this sub study focusing on pharmacotherapy, five themes were identified related to choosing whether or not to take medication: (1) attitudes towards pharmacotherapy, (2) attitudes toward size of obesity and its complications, (3) weighing the benefits and risks of treatment, (4) knowledge and reassurance of health professionals, and (5) costs associated with drug therapy. CONCLUSION: The primary concerns regarding pharmacotherapy for intentional weight loss were efficacy, side effects, lifelong dosing, pharmacokinetics, and cost. Providing access to information about all the pharmacotherapies and the benefits is likely to result in greater penetrance of treatment.

Termination is not the treatment of choice for severe hyperemesis gravidarum: Successful management using prednisolone.

Severe hyperemesis gravidarum causes profound maternal morbidity. Termination of pregnancy is still offered before the use of medical therapy. This report describes management of a woman who had undergone two previous terminations for hyperemesis, and additionally presents the dosage profile of prednisolone used to successfully manage a consecutive series of 33 women with severe hyperemesis gravidarum. The treatment protocol is described. The group had a median weight loss in pregnancy of 5.5 kg (range 2.0-12.5 kg), had been admitted on a median of 3.0 (range 0-9) occasions and had spent 7.5 (range 0-25) days on i.v. fluids. Continuing vomiting prevented oral steroid therapy in 14 women and i.v. hydrocortisone (50 mg t.i.d.; two women required 100 mg t.i.d.) was used initially for 24-48 h. Nineteen women commenced prednisolone 10 mg t.i.d. and this achieved suppression of vomiting within 48 h in all but two women who required 15 mg t.i.d. Two distinct subtypes of hyperemesis gravidarum were identified. Remitting hyperemesis spontaneously ceases between 14 and 22 weeks gestation and accounts for approximately 80% of cases. In contrast, full-term hyperemesis persists until minutes after delivery. These separate sub-types have not previously been described. Steroid treatment of hyperemesis should be considered in women who fulfil the criteria of severe disease.

Differences in physician compliance with guideline on lipid profile determination within 24 h after acute myocardial infarction.

OBJECTIVE: To evaluate the American College of Cardiology/American Heart Association guidelines on blood lipid testing within 24 h of the onset of chest pain in patients with myocardial infarction. SUBJECTS AND METHODS: This is a cross-sectional observational study on 83 patients (77 male, 6 female) admitted into the Coronary Care Units of the Al-Amiri and Mubarak Al-Kabeer Hospitals, Kuwait with myocardial infarction. The lipid profiles were obtained within 24 h of the onset of chest pain. Twenty patients were on treatment with statins prior to admission. Diagnosis of myocardial infarction in all patients was based on standard criteria. Total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, and triglycerides (Tg) were measured and low-density lipoprotein (LDL) cholesterol was calculated. RESULTS: Twenty-three patients had normal cardiac markers on admission but later developed increased serum markers and ECG changes of acute myocardial infarction. Mean (95% confidence interval) TC, HDL, Tg and LDL were 5.1 (4.8-5.4); 0.93 (0.88-0.98); 1.85 (1.56-2.14), and 3.39 (3.13-3.65) mmol/l, respectively. 70% of the patients had normal or only mild elevations of LDL with low HDL and poor HDL:TC ratio (<20%). Thirty-eight patients had low HDL (<0.9 mmol/l) and only 22 (27%) patients met the National Cholesterol Education Program guideline of target LDL <2.6 mmol/l. Fifty-six patients were classified as having the metabolic syndrome according to the criteria of the WHO. CONCLUSION: The findings indicate that HDL appears to be the main lipid risk factor in patients presenting with AMI in Kuwait, therefore primary prevention strategies should focus on treatment modalities that increase HDL. We recommend that the lipid profile should be done within 24 h of admission and lipid-lowering therapy initiated as part of secondary prevention strategy.

Plasma leptin concentration in patients with Type 2 diabetes: relationship to cardiovascular disease risk factors and insulin resistance.

AIMS: The aim of this study was to evaluate the relationship of obesity, leptin, insulin resistance and C-reactive protein (CRP) with coronary heart disease (CHD) risk factors in patients with Type 2 diabetes mellitus (DM) with CHD compared with those with Type 2 DM without CHD. METHODS: Leptin, CRP (high sensitivity assay), fasting plasma insulin, glucose, HbA(1c) and full lipid profile were determined in 58 Type 2 diabetic patients with CHD and 87 Type 2 DM patients without CHD. RESULTS: were compared between those with and without CHD. Univariate correlation as well as logistic regression analyses were used to relate these markers with traditional CHD risk factors. RESULTS: Leptin showed significant correlations with BMI (r = 0.59; P < or = 0.0001), waist circumference (r = 0.45; P < 0.0001), CRP (r = 0.36; P < 0.0001), and fasting insulin (r = 0.53; P < 0.0001) as well as with systolic (r = 0.23; P = 0.007) and diastolic (r = 0.23; P = 0.007) blood pressure. However, when those with and without CHD were compared only age (P < 0.0001), duration of diabetes (P < 0.001) and degree of microalbuminuria (P = 0.02) were significantly higher in patients with CHD. Leptin (P = 0.49), CRP (P = 0.19) and lipid parameters were not significantly different between the two groups. CONCLUSION: Our study confirms a relationship between leptin and CRP with CHD risk factors. The lack of significant difference when patients with and without CHD are compared may be due to the potential confounding effects of treatment with aspirin and statins.