Oneirotherapy in Overweight and Obesity.

Oneirotherapy is a form of psychotherapy that is based on visual imagery and symbolism. In this communication. We discuss the role of oneirotherapy, or using vivid imagery, as adjuvant therapy in obesity care. Oneirotherapy can be used to promote acceptance of, and adherence to, prescribed therapy. It may also help improve quality of life and enhance self-esteem. However, oneirotherapy alone, without following a healthy lifestyle and or taking antiobesity medication, will help manage weight only in one's dreams.

The Mood-Muscle Meta Bridge (Brain Muscle Axis).

Psychological well-being is essential for the maintenance of good metabolic health. Modern management of most chronic metabolic disorders rightly focusses on improving the health-related quality of life of persons living with disease. In this brief communication we describe the bidirectional association between muscle function and mood (psychological health), explore the various pathways that link these aspects of health, and underscore their clinical implications. This paper emphasizes the importance of maintaining good mental health through exercise and vice a versa.

Communication in Chronic Disease Care: A Collaborative Conversation Map.

Chronic diseases require long term commitment from both the patient and the treating physician for improving their clinical outcomes. This journey can be made more easier if a proper communication bridge can be made between both of them. This paper describes an alliterative C-based flow-chart to describe a Collaborative Conversation Map for chronic disease care. It crafts a map which serves as a checklist for chronic health care providers, especially those dealing with obesity and diabetes. This conversation map is concordant with the WATER (welcome warmly, ask and assess, tell truthfully, explain with empathy, reassure and return) conversation approach described earlier.

Glucokathexis.

Glucokathexis is a clinical state characterized by low plasma glucose levels, in the presence of adequate glucose precursor stores. We conceive and construct this rubric to initiate interest and inspire insight into this field of metabolic medicine. We list various conditions that can cause true as well as pseudo-glucokathexis.

Enhancing teeth segmentation using multifusion deep neural net in panoramic X-ray images.

BACKGROUND: Precise teeth segmentation from dental panoramic X-ray images is an important task in dental practice. However, several issues including poor image contrast, blurring borders of teeth, presence of jaw bones and other mouth elements, makes reading and examining such images a challenging and time-consuming task for dentists. Thus, developing a precise and automated segmentation technique is required. OBJECTIVE: This study aims to develop and test a novel multi-fusion deep neural net consisting of encoder-decoder architecture for automatic and accurate teeth region segmentation from panoramic X-ray images. METHODS: The encoder has two different streams based on CNN which include the conventional CNN stream and the Atrous net stream. Next, the fusion of features from these streams is done at each stage to encode the contextual rich information of teeth. A dual-type skip connection is then added between the encoder and decoder to minimise semantic information gaps. Last, the decoder comprises deconvolutional layers for reconstructing the segmented teeth map. RESULTS: The assessment of the proposed model is performed on two different dental datasets consisting of 1,500 and 1,000 panoramic X-ray images, respectively. The new model yields accuracy of 97.0% and 97.7%, intersection over union (IoU) score of 91.1% and 90.2%, and dice coefficient score (DCS) of 92.4% and 90.7% for datasets 1 and 2, respectively. CONCLUSION: Applying the proposed model to two datasets outperforms the recent state-of-the-art deep models with a relatively smaller number of parameters and higher accuracy, which demonstrates the potential of the new model to help dentists more accurately and efficiently diagnose dental diseases in future clinical practice.

Autonomic Hygiene and Diabetes.

Autonomic hygiene is referred to as conditions and practices that help to maintain normal autonomic nervous system health, and prevent the development and spread of autonomic neuropathy and its complications. In this article the authors describe the importance of autonomic hygiene in patients with diabetes. Different methods of practicing autonomic hygiene at the individual, familial and societal level have been described. Its role in preventing and worsening of autonomic neuropathy has been highlighted.

Use of Dairy Products in people living with diabetes.

Dairy products are a good source of protein, energy and calcium. Unfortunately, because of various misconceptions, they are often avoided by people living with diabetes. This article enumerates the wide variety of dairy products available in the South Asian cuisine, explores their nutritional characteristics, and explains how to consume them in a healthy manner. Furthermore, this manuscript also highlights the utility of dairy products in people living with diabetes and its impact on improving glycemic control.

Fibre and Water, The mega nutrients of metabolic health.

Nutrients are conventionally classified as macronutrients (carbohydrates, fat and protein), and micronutrients (vitamins, minerals, electrolytes). This classification is based upon the quantity required to maintain health, and also, perhaps, the caloric value of the concerned nutrient. We support the use of the descriptor meganutrient for fibre and water. The latter is required in significantly larger quantities to maintain health, and manage metabolic disease such as diabetes and obesity. Fibre has a chemical mega-structure, and its description as a meganutrient reinforces its functions, which are different from other carbohydrates.

The Insulin: Glucagon Ratio and Obesity.

This communication discusses the physiology and pathology of the insulin glucagon ratio, with respect to obesity. Though high insulin levels are associated with obesity in this manuscript the authors specifically highlight its role in the causation and clinical management of obesity. It suggests that the term insulin glucagon ratio be used in preference to glucagon insulin ratio, and shares insights which may be helpful in informing future research.

Refractory and Resistant obesity: Dynamic Concepts, Contemporary Definitions.

Obesity is a chronic disease requiring a multi-disciplinary approach for its management. Despite multiple evolving and potent therapeutic options like GLP-1RA's and bariatric surgery, some patients do not achieve significant weight loss or expected metabolic outcomes. This manuscript highlights the concept of resistant and refractory obesity and provides an operational framework to assess adequacy of therapy, to rule out non-adherence, and to screen for non-adiposity related and iatrogenic causes of weight gain. This would help clinicians to assess clinical outcomes and plan management protocols in their clinical practice. Furthermore, a clear understanding of these concepts would streamline research in this area and facilitate policy making.

Hidden Obesity.

This communication proposes the term "hidden obesity" to describe normal weight obesity, or increased adiposity without a corresponding increase in body mass index. It uses the concept of hidden hunger to craft semantics which will generate greater attention to this condition from all stake-holders, including policymakers and planners. The article describes simple tools which can be used to suspect and confirm the diagnosis of hidden obesity. This phenotype is very commonly seen in the south Asian population.

Diabetes and the prostate.

Here we discuss the interactions between prostatic health and diabetes. Diabetes may be associated with changes in prostatic anatomy, physiology, clinical morbidity, and clinical outcomes. Certain glucose-lowering drugs may impact prostatic health, and some prostato-tropic medications can influence glycaemic control. One should be vigilant for symptoms and signs of prostate health in diabetes.

From Newtonian Concepts To A Quantum Understanding: The Evolution Of Endocrinology And Metabolism.

Conventional endocrinology is based upon linear or Newtonian feedback mechanisms. Thisframework helpsin learning and sharing science in a lucid and simple manner, just as Newton's Laws clarified our understanding of physics. Modern endocrinology and metabolism are more confusing, as exemplified by the multifarious etiopathogenic factors that continue to be unearthed for various diseases, such as obesity and diabetes. These diseasestend to follow a modelsimilar to that of quantum physics. We propose a Quantum theory of baro-mechanics to help understand the complexity that surrounds metabolic disease, especially obesity. Hopefully, thisinsight will help mitigate the frustration that one encounters while managing these conditions.

Setting Up An Obesity Clinic - The SMART Approach.

Management of obesity is often complex and requires a multidisciplinary team approach. There is an emerging need for establishing more dedicated bariatric clinicsin the south Asian region. These clinics help to provide an individualized patient centric management through different specialists involved in obesity therapy under one roof. Furthermore, these clinics help to facilitate obesity management like any other chronic disease which requires long term follow-up. This article details the essential components required in setting up an obesity clinic in the south Asian region. The SMART approach (S-Setting; M Management team; A-Algorithmic approach; R-Research and referral; T-Technology) is an easy to grasp summary of the essential components required for setting a bariatric clinic.

Barometric Nervosa.

In this article, we conceptualize and critique the condition, barometric nervosa, which we define as "an extreme obsession with measuring one's weight and other anthropometric parameters, leading to ill-health". Barometric nervosa may be related to, but is different from, anorexia nervosa, which is characterized by extremely low body weight, along with either restrictive eating or binge eating, and purging. We suggest that this aspect of psychobarocrinology be addressed as a part of clinical evaluation, and be explored in future research in bariatric medicine.

The etiopathogenesis and management of obesity: The quintessential quincunx.

This communication uses the quincunx, i.e, a quadruple surrounding a central point, to create a model that describes the etiopathogenesis, as well as informs the management strategy of obesity. With the energy fulcrum (mismatch between energy intake and expenditure) at its centre, the model lists two external influencers-the physical environment and psychosocial environment, and two internal influencers- the hypothalamo-bariatric axis and the endocrine system, to explain the etiopathogenesis of obesity. Genetics factors are included with the hypothalamo-bariatric axis. The same model can be used to explain the five pillars of management: lifestyle and nutritional modification at the centre, along with environmental optimization, behavioural therapy, baro-thalamic modulation, and endocrine optimization.

Allotriophagy And Allotriodipsia In Endocrinology.

Allotriophagy is defined as food cravings that are different from the expected or the norm. It gives clinical pointers to an underlying diagnosis. We propose a new term, allotriodipsia which suggests a preference for beverages that are different from the norm. Taken together, these two entities may point towards certain endocrinological abnormalities and iatrogenic sequelae. In this communication we highlight the clinical relevance of allotriophagy and allotriodipsia.

The Bariatric Pyramid: A framework for therapeutic targets.

The Bariatric Pyramid is a model which serves to explain the goals of obesity management, act as a milestone for monitoring of therapy, and to benchmark the utility of various anti-obesity medications and interventions. Built upon a base of sustainability, it lists three more desired aspects of care: sufficiency (sufficient strength) safety and security. Each of the four aspects of the pyramid: sustainability, sufficiency safety and security have three angles, which allows the reader to understand them easily. The model that we propose is useful in training health care professionals, in therapeutic patient education, for assessing various anti-obesity therapies, and in reaching the right decision while managing obesity.

Lipokathexis: A fat paradox.

'Lipokathexis' is derived from the term 'Lipo' meaning fat and 'kathexis' which means retention. We propose this name for describing a clinical situation wherein despite excessive stores of fat are noted in the body but lower levels of circulating lipids are present in the blood. Different disease conditions that express such a phenotype including Tangier's disease, metabolic healthy obesity and those coming under the domain of obesity paradox have been described in this manuscript. This paper will invoke the readers interest on different facets of lipid metabolism in context of metabolic medicine and explore this concept of "Fat Paradox".

Baro-buddies: Supporting the fight against obesity.

Obesity has reached pandemic proportions across the world. Though novel therapies continue to emerge to promote weight loss, long term maintenance of the lost weight is one of the major challenges in obesity management. A multidisciplinary team approach is often useful in recommending the best patient centric method of losing weight, but this requires constant motivation, guidance, support and need for troubleshooting at times of need. To address this, we propose a new avatar in the obesity management of obesity called the "Baro-Buddy" which is a portmanteau, derived from 'baros'(weight) and buddy (friend). This brief manuscript describes the eligibility, role and utility of a barobuddy in day-to-day management of obesity.