The levels of obesity rising worldwide are causing some of the most significant public health problems faced today. Patient education and self-empowerment are essential strategies for weight reduction in any individual. However, there are many challenges facing both the people who want to lose weight and the clinicians who help them. This article looks at the problem of obesity, focusing on how pharmacological treatments can be used to assist weight loss, the problems faced in the past using particular treatments, the treatments currently available and the treatments that may be available in the future.

Owing to the worldwide obesity epidemic there is an increased demand for bariatric surgery, which has proven effective in reducing obesity-related morbidity and mortality. As a prerequisite for successful treatment, careful pre-operative evaluation and life-long post-operative care within an interdisciplinary setting is mandatory. The scope of this review is to summarize current knowledge on peri-operative complications, post-operative nutritional deficiencies and treatment options after bariatric surgery. Among the most common complications related to surgery are vomiting and bleeding, as well as chronic nutritional deficiency. The major macronutrient deficiency is protein malnutrition leading to oedema and other related consequences. Micronutrients, which comprise water- and fat-soluble vitamins, essential minerals and trace elements, need to be substituted in most patients. Many patients already suffer from nutritional deficiencies prior to bariatric surgery, which, if not corrected, can cause the patient to deteriorate. Recognition of nutritional deficiencies is important to avoid short- and long-term adverse effects. Depending on the bariatric procedure, the requirement of supplementation and the follow-up schedule might be different. In this regard, studies on optimizing post-operative supplementation strategies, as well as those on avoiding chronic complications, are greatly encouraged.

In addressing the topic of appetite regulation, energy balance and physical activity, there are many reasons why it is appropriate to consider these issues conjointly in relation to the phenomenon of obesity. Firstly, it is widely recognized that obesity arises from a mismatch between energy taken in and energy expended, although this is not a simple matter of calculating the algebraic sum of two numbers. Secondly, recent evidence has revealed that appetite control (responsible for energy intake) is closely related to the energy requirements of the body, in contrast to the conventional approach of appetite emerging from the regulation of body fat (lipostatic hypothesis). Thirdly, physical activity is obviously implicated in energy balance and therefore connected to both energy intake (appetite control) and the control of body tissue stores (obesity). Finally, for the management of obesity, increasing physical activity (moving more) and decreasing dietary intake (eating less) are two of the major principles in the medical and public health arenas. This review will deal with research and theory relating to human obesity, with the objective of providing a synthesis relevant to understanding the predicament that this phenomenon is causing. One major reason for addressing the problem in this way is because, in recent years, it has become apparent that the observed increase in obesity, worldwide, is associated with an overconsumption of food (a problem related to appetite control) and a sedentary lifestyle (a problem related to physical activity), and the relationship between the two (an issue related to energy balance). Accordingly, investigations in this area should provide insights into how to deal with overconsumption and with sedentariness for the management of obesity. This review is about energy intake and energy expenditure and how they influence the human capacity to live healthily in a modern world.

Bariatric and metabolic surgery has become the most effective treatment for achieving stable weight loss and metabolic improvements in morbidly obese patients. This reviews summarizes the most commonly performed bariatric procedures used today, their indications and contraindications and provides recently published data on the metabolic outcome in type 2 diabetes mellitus patients.

Obesity has reached epidemic levels and is a significant public health and social problem. Countries working towards prevention of malnutrition in children are also faced with the challenge of preventing child obesity. Obesity in children has long-term physical and mental health effects that last into adulthood and become an economic burden to the individual and to the nation. A lifestyle of sedentary behaviour and unhealthy eating habits is a major governing factor. Fewer facilities for physical activity in schools and residential areas promote an obesogenic environment. Unhealthy food marketing through electronic media is gaining the attention of children and adolescents. Various interventions for child obesity have been implemented effectively in developed countries, and developing countries are also beginning to apply some of these interventions. Enforcing strategies and policies for healthy living and developing healthy environments for children would curb rising obesity levels and promote healthier future generations and a better economy.

Camptothecin (CPT) and taxol are secondary metabolites found, respectively, in the wood bark of Camptotheca acuminata, a native of China, and Taxus brevifolia, found in the Pacific north-west coastal region of the USA. The compounds were isolated by the bioassay-guided fractionation of the crude plant material and their structures established by single crystal X-ray analysis. Both compounds have unique mechanisms of antitumour activity. Camptothecin inhibits an enzyme, topoisomerase I, involved in DNA replication. Taxol binds to a protein, tubulin, thus inhibiting cell division. Currently, two analogues of camptothecin, topotecan (Hycamtin®, GlaxoSmithKline, Brentford, UK) and irinotecan (Campto®, Pfizer Ltd, New York, NY, USA), and taxol and its analogues, docetaxel (Taxotere®, Sanofi-Aventis Ltd, Guilford, UK) and cabazitaxel (Jevtana®, Sanofi-Aventis Ltd, Guilford, UK), are approved for clinical use in the USA by the Food and Drug Administration (FDA). The camptothecin analogues are used to treat ovarian, colorectal and small-cell lung cancers. Taxol is used extensively to treat refractory ovarian, breast and non-small-cell lung cancers and Kaposi's sarcoma. Docetaxel has been a very important drug for the treatment of breast cancer and cabazitaxel is FDA approved for the treatment of hormone-refractory prostate cancer.

Leprosy, or Hansen's disease, is one of the world's oldest infectious diseases. It affects the skin and nerves and, if left untreated, leads to deformity. Every 2 minutes someone is diagnosed with leprosy, but, because of the lack of education and the stigma surrounding the disease, some people are diagnosed too late and develop life-changing disabilities. Through a simple course of medication, leprosy is an entirely curable disease. Literature, such as reported cases and review papers, on leprosy in pregnancy was obtained using various internet search engines. Leprosy in pregnancy is a rarely reported event, but nine countries in Africa, Asia and Latin America have considered it a public health problem. An effective cure for leprosy is available in the form of multidrug therapy, taken for some months, but if treatment is delayed until a later stage, there is a high risk of disability. Pregnancy is hazardous for women with leprosy. It is most dangerous during the third trimester when infection can lead to adverse obstetric and fetal outcomes, such as low birthweight, prematurity, exfoliative dermatitis in the newborn and erythema nodosum in the pregnant mother. Documentation on leprosy in pregnancy indicates that pregnancy is not only a trigger for leprosy but also an ideal in vivo model for research. Leprosy in pregnancy can be treated safely and effectively by combined drug therapy. However, early detection, well-planned health education for leprosy patients and the highest standard of clinical supervision during pregnancy are key strategies in reducing problems associated with the disease and are also the best way to prevent disability.

Gene therapy is the use of genes to heal diseases at the genetic level. It involves insertion, correction or inactivation of specific genes in organisms suffering from genetic disorders. Ever since it was introduced as a hypothesis in the 1960s, gene therapy has gone on to become a medical wonder that promises relief from the likes of Parkinson's disease and multiple sclerosis. Today, the technique is used to manipulate the genome of not only somatic cells but also the germline cells of early embryos and gametes with a vast range of viral and non-viral vectors. The diseases targeted by gene therapy are among the deadliest on the planet: they are categorized into cancers, genetic deficiencies and autoimmune diseases. On the one hand, gene therapy is deemed by some to be an ethically and technically problematic technology because of its cost, its treatment of human dignity and its questionable accuracy and safety. In contrast to what its opponents say, the pro-gene therapy arguments support the technique by highlighting its remarkable efficiency, long-term cost-effectiveness and ability to cure unique diseases, among others.

This study aimed to estimate the prevalence of depression among adults with diabetes mellitus attending an outpatient clinic in a tertiary care centre in the United Arab Emirates (UAE) and to identify factors related to its increased risk, including gender differences. The study design was a descriptive study (cross-sectional survey). A random sample of 72 type 1 and type 2 diabetic patients, 18–75 years of age, of whom 32 were male and 40 female, were interviewed during the period from March to June 2013 using a pre-structured questionnaire to gather information regarding sociodemographic data for each patient. The risk of developing depression was then identified using a self-administered questionnaire – the K6 depression scale. Of the 72 patients who completed the interview, 36.1% had a score above 20 on the K6 questionnaire, indicating high risk of depression. This study found that more than one-third of diabetic patients attending our clinics are at high risk of developing depression and both males and females are equally affected. It suggests that all patients with diabetes mellitus should be routinely screened for depression, and the provision of psychological services in diabetic clinics would help to address this issue. There is a high prevalence of diabetes mellitus and depression in our population. The presence of depression may adversely affect the outcome of diabetic individuals. A quick, reliable and easy to use screening tool is essential for identifying patients at risk who can benefit from appropriate interventions.

The effectiveness of a modified Lord–Miller procedure in the management of pilonidal sinus disease, in terms of wound complications, healing rate and recurrence, was assessed. This is a retrospective study of 44 patients with simple and complicated pilonidal sinus disease, operated on using a modified Lord–Miller procedure from September 2011 to May 2013. Patients were seen in the clinic once a week until completely healed, and again 1 year after surgery. Patients were observed for complications and recurrence. A total of 23 (52%) sinuses were complicated. A total of 21 (48%) patients had a history of previous surgery. All the patients were followed for a period of 12–32 months (median: 17.5 months). Three patients (6.8%) developed wound infection. Complete healing was achieved in 2–7 weeks (mean: 3.6 weeks). The disease recurred in 2 (4.5%) patients, and 42 (94.5%) of the patients were completely cured. A total of 37 (84%) cases were carried out as day case surgery. A modified Lord–Miller procedure was shown to be highly effective in treating complicated pilonidal sinus with a low recurrence rate.

Ceramide occupies a central role in sphingolipid-mediated signalling events and therefore its level is tightly regulated by enzymes such as ceramidases. Ceramidases cleave the N-acyl linkage of ceramide, generating sphingosine and its subsequent product sphingosine-1-phosphate. Recently, we purified and characterized a neutral ceramidase (CBCDase I) with a molecular weight of 100 kDa from camel brain. In the present study, we purified and characterized a second, more hydrophobic, neutral ceramidase from camel brain (CBCDase II). The purification protocol includes Triton X-100 extraction followed by a series of column chromatography. The purified CBCDase II appears as a single band corresponding to a molecular weight of ≈ 120 kDa, showing maximum activity at pH 8.0. When compared with CBCDase I, CBCDase II is less glycosylated, and enzyme activity is inhibited by the metal ions Zn²⁺ and Cu²⁺, while Ca²⁺ stimulates activity. Phospholipids, such as phosphatidic acid, phosphatidylserine and phosphatidylglycerol, totally inhibited the enzyme activity, even at low concentrations. All thiol group-containing compounds that were tested inhibited the activity of CBCDase II. Nucleotides such as ADP, ATP, UMP and TMP inhibited enzyme activity even at low concentrations, whereas AMP inhibited the enzyme at higher concentrations only.

The objective was to estimate the prevalence of and reasons for using complementary and alternative medicine (CAM) for various musculoskeletal conditions and to determine the most common musculoskeletal problems for which CAM is used. A cross-sectional study was conducted using 305 subjects, which included the doctors and staff members of Gulf Medical University and Gulf Medical Hospital, 20 years of age and over. Data were analysed using the SPSS program. Of the subjects documented, 51.1% admitted that they used alternative medicine, of which 30.1% used it alongside conventional medicine. Most subjects interviewed used Ayurveda (34%) and the most common use of CAM was to relieve general aches and pains (46.8%). A total of 30.2% of CAM users stated that 'conventional medicine was not effective', 23% of them felt that CAM 'relieves stress' and 22.6% felt that it could reduce the severity of the condition. Painkillers were the most common conventional medicine used alongside alternative medicine (48.2%). No significant difference was found between the effectiveness of CAM alone and CAM with conventional medicine. More than half the participants were making increasing use of CAM. Hospitals can provide CAM alongside conventional medicine in the UAE

Urticaria persisting beyond 6 weeks is classified as chronic urticaria. It is further divided into two categories: autoimmune and idiopathic. Chronic autoimmune urticaria accounts for 45% of cases, and chronic idiopathic urticaria is seen in the other 55% of cases. Sixty patients with chronic urticaria, consulted over a 2-year period, were evaluated. Complete blood count, a thyroid function test and an antithyroid antibody evaluation were advised. Patients positive for antithyroid antibodies were given immunosuppressive therapy (methotrexate) as well as antihistamines. After 6 months of treatment with methotrexate, repeat titres of antithyroid antibodies were carried out. There was a significant decline in antithyroid antibody levels. Clinically these patients could discontinue antihistamines. Five patients showed recurrence of symptoms 3 months after discontinuation of treatment, but the symptoms were mild and easily controlled with antihistamines.

Asymptomatic, rare and incidental are the most common words in the literature describing jejunal diverticulosis, yet this disease might be fatal if not anticipated and treated when presenting acutely with massive haemorrhage. Of the pulsion type, and present on the mesenteric side of the small bowel at the entrance site of arteries, jejunal diverticula account for about 80% of small bowel diverticula (another 15% occur on the ileum and the other 5% manifest at both sites). We report a case of symptomatic proximal jejunal diverticulosis in a 66-year-old patient who presented with abdominal pain and melaena. The clinical significance, diagnostic evaluation and treatment of jejunal diverticulosis are reviewed.

Oral–facial–digital syndrome type 1 (OFD1) is a male-lethal X-linked dominant disorder characterized by a dysmorphic face, associated with oral cavity and digital anomalies. Polycystic kidney disease is another typical feature of this syndrome. Heterozygous mutations in the OFD1 gene are responsible for this condition. This gene encodes a centrosomal and basal body cilia protein that plays an important role in the early development of the brain, face, limbs and kidneys. In this study we clinically evaluated an affected Emirati female child exhibiting features of OFD1 syndrome. Screening of the OFD1 gene was carried out using a Sanger DNA sequencing method. Moreover, bioinformatics tools were used to predict the pathogenicity of the identified mutation. As a result, we identified a heterozygous single-nucleotide deletion in the donor splice site of exon 20 (c.2757+1delG). Both parents were homozygous for the wild-type alleles. The deletion might be a de novo mutation in nature, but we cannot exclude the possibility of mosaicism in the mother. Prediction analyses showed that the deletion abolishes the authentic splice site leading to the generation of a cryptic splice site. Subsequently, this mutation will result in a frameshift and premature termination codon (p.Lys920ArgfsX2). In this report, we describe the clinical features and molecular studies of an Emirati child with OFD1 syndrome. To our knowledge this is the first report of the clinical and molecular aspect of OFD1 from the UAE.