dr. auriela szekelyobezitatea si diabetul zaharat în sindromul prader willi english

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Dr. Székely Aurelia

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Obesity

yIs a defining characteristic of Prader Willi Syndrome (PWS)

y

 An important clue for the suspicion of diagnoses

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Obesity

y Body weight exceeds ideal weight by 20%

y BMI - weight (kg) / height 2 (m2)y Normal: 19-25

y Overweight: 25-30

y Obesity I: 30-35

y Obesity II: 35-40

y Severe obesity (morbid): 40

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Venus of Willendorf 

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Rubens The Three Graces

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Picasso The Young Ladies of Avignon

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Twiggy

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Oana

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Complicationsy Cardio-pulmonary deficiencies

y Diabetes mellitus type II

y Thrombophlebitis

y Chronic Edema

y

Hernias

y Eczema

y Arthrosis

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In PWSy The essence of care for patients with PWS = fight against

obesity 

y The main cause of obesity in PWS = hyperphagia

y  Adjusting the sensation of hunger - the hypothalamusy Feedbacks :

Blood glucose

Fats

Leptin

Cholecy stokinin PYY 

Serotonin

Endorphins

etc..

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In PWSy Decreases the sensitivity of the hypothalamus to

regulating substances

In obesity

y I

t is

a deficit of leptin and melanocortin

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Other mechanisms of obesity in PWS

yMuscle hypotonia

yPs ychological structure

y A possible hypothyroidism orhypogonadism

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Treatment with growth hormone

yHelps to normalize weight

y Increases muscle mass

yR educes the risk of diabetes

y I

ncreas

es

immunores

is

tance

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In the fight for normal weight participate

yThe patient

yThe family 

yThe medical component

yT

hes

ocial component

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Obesity is realized only by excessivefood intake.

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Energetic imbalance...... from positive has to be changed to negative by:

1. Lifestyle

2. Diety Doctor

y Nutritionist

y Support groups

y

Documentation provided by patient organizations

3. Monitoring access to food

4. Phy sical activity 

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Physical activity

y Free phy sical activities - 1 hour per day, 5-6 times a

 week, regularly:y  Walk

y Bicycle

y Swimming

y

Gamesy In specialized institutions

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Speed of weight loss

y 0,5 0,6 kg per week

y 1 2 kg per month

Preventing obesity, weight loss of obese patients  with PWS ensure a better quality of life and

prevents complications.

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Diabetes mellitus type IIy Is not the consequence of PWS

y It is the complication of obesity in PWS

Signs of developing diabetes mellitus

y Weakening

y

Polydips

iay Polyuria

y Low energy 

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Diagnosis of diabetes mellitus

y Hyperglycemia

y Glycosuria

 Altered metabolism of lipids and proteins.

R esult: degenerative damage of large and smallarteries.

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Complications

y Ischemic cardiomyopathy 

y Atherosclerosis

y Obliterative arteriopathy 

y Nephropathy 

y R etinopathy 

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Causes of decompensations

y Not respecting the diet

y Discontinuation of medicationy Excessive phy sical effort

y Exhaustion, ps ychical stress

y Surgery y Infections 

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Treatment of diabetes mellitusy Diet planned by the DOCTOR 

y Number of Kcal

yMeal composition

y Schedule of the meals

y Exercise

y Body hygiene

y  Wounds

y Teeth

y Foot hygiene

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Treatment of diabetes mellitus

yMedications

y To be initiated only in hospitalsy  Antidiabetic tablets

y Insulin Injections

y Lifelong duration

y Hydro-mineral therapy 

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Conclusion

 With early diagnosis, by uniting all forces andresources that are available to care for people with

PWS, morbid obesity can be prevented, can bereduced and this way diabetes mellitus and its 

complications can be avoided.

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I wish you success in this fight!