Tuesday, 12 November 2013

Obesity and Cellutitis

A. Obesity is defined as a medical condition of excess body fat has accumulated overtime, while overweight is a condition of excess body weight relatively to the height. According to the Body Mass Index(BMI), a BMI between 25 to 29.9 is considered over weight, while a BMI of over 30 is an indication of obesity. According to the statistic, 68% of American population are either overweight or obese.

B. Cellutitis is defined as a condition of inflammation of the skin and the connected tissues just beneath the skin as a result of infection of certain types of bacteria.

C. How do calculate your BMI indexBMI= weight (kg)/ height (m2)

D. How Obesity associates with Cellutitis
1. In a study of "
Risk factors for community-associated methicillin-resistant Staphylococcus aureus cellulitis--and the value of recognition" by Khawcharoenporn T, Tice AD, Grandinetti A, Chow D. (Source from John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813, USA. thanak30@yahoo.com, Hawaii Med J. 2010 Oct;69(10):232-6.Hawaii Medical Journal Copyright 2010), posted in PubMed, researchers found that The presence of abscesses and obesity were significantly associated with CA-MRSA cellulitis. Empiric therapy with antibiotics active against MRSA should be guided by these risk factors.

2. According to the abstract of atudy of "Abdominal wall cellulitis in the morbidly obese" by Thorsteinsdottir B, Tleyjeh IM, Baddour LM. (Source from Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55902, USA. Thorsteinsdottir.bjorg@mayo.edu., Scand J Infect Dis. 2005;37(8):605-608), posted in PubMed, researchers indicated that Of the 260 cases of cellulitis identified, 24 (9.2%) had morbid obesity and abdominal wall cellulitis. The mean age of the 24 patients was 47 (range 22-70) y and over two-thirds of them were females. Their mean body mass index (BMI) was 62.3 (range 39.6-108.6). 17 (70.8%) had a remote history of abdominal surgery. 16 patients required 23 hospitalizations. Five patients developed cellulitis complications and 7 (29.1%) patients had recurrent bouts of cellulitis during the study period. Abdominal wall cellulitis is a unique infectious complication in patients with morbid obesity. Further study is needed to better define the pathogenesis of this illness to develop strategies in treatment and prevention.

3. In a study of "Obesity and dermatology" by Scheinfeld NS. (Source from Department of Dermatology, St. Luke's-Roosevelt Hospital Center and Beth Israel Medical Center, New York, New York, USA. scheinfeld@earthlink.net, Clin Dermatol. 2004 Jul-Aug;22(4):303-9.), posted in PubMed, researchers indicated in abstract that Obesity is associated with a number of dermatoses. It affects cutaneous sensation, temperature regulation, foot shape, and vasculature. Acanthosis nigricans is the most common dermatological manifestation of obesity. Skin tags are more commonly associated with diabetes than with obesity. Obesity increases the incidence of cutaneous infections that include: candidiasis, intertigo, candida folliculitis, furunculosis, erythrasma, tinea cruris, and folliculitis. Less common infections include cellulitis, necrotizing fasciitis, and gas gangrene. Leg ulcerations, lymphedema, plantar hyperkeratosis, and striae are more common with obesity. Hormonal abnormalities and genetic syndromes (Prader-Willi) are related to obesity and its dermatoses; however, cellulite is not related to obesity.

4. According to the study of "Dermatological complications of obesity" by GarcĂ­a Hidalgo L. (Source from Department of Dermatology, Salvador Zubiran National Nutrition Institute, Mexico City, Mexico. lindagh@avantel.net, Am J Clin Dermatol. 2002;3(7):497-506.), posted in PubMed, researcher found that This infection, most commonly candidiasis, is best treated with topical antifungal agents; systemic antifungal therapy may be required in some patients. Excess load on the feet can result in morphological changes that require careful diagnosis; insoles may offer some symptom relief while control of obesity is achieved. Obesity-related dermatoses associated with hospitalization, such as pressure ulcers, diminished wound healing, dermatoses secondary to respiratory conditions, and incontinence, must all be carefully managed with an emphasis on prevention where possible. Recognition and control of the dermatological complications of obesity play an important role in diminishing the morbidity of obesity.

5. In a study of "Obesity and the skin: skin physiology and skin manifestations of obesity" by Yosipovitch G, DeVore A, Dawn A. (Source from Departments of Dermatology, Regenerative Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA. gyosipov@wfubmc.edu,J Am Acad Dermatol. 2007 Jun;56(6):901-16; quiz 917-20.), posted in PubMed, researchers found that obesity is implicated in a wide spectrum of dermatologic diseases, including acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism and hirsutism, striae distensae, adiposis dolorosa, and fat redistribution, lymphedema, chronic venous insufficiency, plantar hyperkeratosis, cellulitis, skin infections, hidradenitis suppurativa, psoriasis, insulin resistance syndrome, and tophaceous gout. We review the clinical features, evidence for association with obesity, and management of these various dermatoses and highlight the profound impact of obesity in clinical dermatology. LEARNING OBJECTIVE: After completing this learning activity, participants should be aware of obesity-associated changes in skin physiology, skin manifestations of obesity, and dermatologic diseases aggravated by obesity, and be able to formulate a pathophysiology-based treatment strategy for obesity-associated dermatoses.

6. Etc.

E. Treatments of Obesity and Cellutitis
1. According to the study of "Critical care of the morbidly obese in disaster" by Geiling J. (Source from Veterans Affairs Medical Center, 215 North Main Street, White River Junction, VT 05009, USA. james.geiling@dartmouth.edu, Crit Care Clin. 2010 Oct;26(4):703-14. Epub 2010 Aug 8.Published by Elsevier Inc.), posted in PubMed, researchers indicated in abstract that The prevalence of obesity in the United States is increasing, with extreme morbid obesity of body mass index greater than 40 increasing twice as fast as obesity in general. With the increased weight comes an increased risk of comorbidities, including type 2 diabetes mellitus, cardiovascular disease, respiratory problems such as obstructive sleep apnea or restrictive lung disease, skin disorders such as intertrigo and cellulitis, and urinary incontinence. Thus, patients exposed to a variety of disasters not only are increasingly overweight but also have an associated number of coexistent medical conditions that require increased support with medical devices and medications. This article focuses on management of the morbidly obese patients during disasters.

2. In a study of "Serum piperacillin/tazobactam pharmacokinetics in a morbidly obese individual" by Newman D, Scheetz MH, Adeyemi OA, Montevecchi M, Nicolau DP, Noskin GA, Postelnick MJ. (Source from Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, Ann Pharmacother. 60611, USA. 2007 Oct;41(10):1734-9. Epub 2007 Aug 28), posted in PubMed, researchers found that Pathogens with elevated MICs may require altered dosing schemes with piperacillin/tazobactam. Future studies are warranted to assess increased dosages, more frequent dosing intervals, or continuous infusion dosing schemes for obese individuals with serious infections.

3. In abstract of the study of "Pharmacokinetics and pharmacodynamics of linezolid in obese patients with cellulitis" by Stein GE, Schooley SL, Peloquin CA, Kak V, Havlichek DH, Citron DM, Tyrrell KL, Goldstein EJ. (Source from Department of Medicine, Michigan State University, B320 Life Sciences Building, East Lansing, MI 48824-1317, USA. steing@msu.edu, Ann Pharmacother. 2005 Mar;39(3):427-32. Epub 2005 Feb 8), posted in PubMed, researchers found that Serum concentrations of oral linezolid in this patient population were diminished compared with those of healthy volunteers, but still provided prolonged serum inhibitory activity against common pathogens associated with skin/soft tissue infections. One treatment concern would be an obese patient receiving oral linezolid who was infected with a less susceptible (MIC > or =4.0 microg/mL) strain of S. aureus. Bactericidal activity was also observed against selective pathogens.

4. Etc.
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