1.Why was the French Revolution so important? What changed thereafter and how did this change affect the European statesâ system?
2.Critically evaluate the democratic peace theory. Use examples to support your view.
Sample Solution
4) Laboratory Investigations: Initial investigations include evaluation for cause and consequences of obesity. Specific testing for the endocrine disorders is done only if there is strong clinical suspicion. These are mentioned in Table 3. Genetic testing should be considered in children with early onset severe obesity, voracious appetites, family history of severe obesity and in those where a clinical suspicion of genetic obesity syndromes is present. Lab investigations currently available in India for monogenic obesity are; MC4R, Leptin and FTO gene. Leptin deficiency is rare and resistance is more common. TSH levels are often mildly elevated in obese children and are a major cause for referral. TABLE 7: Diagnostic evaluation for cause of obesity Disease suspected Investigation Hypothyroidism FT4, TSH Cushing disease Urine free cortisol S. cortisol: Morning & Evening GH deficiency IGF1 & IGFBP3 GH stimulation test Genetic syndromes DNA methylation: PWS CNS disorder MRI brain Monogenic obesity MC4R gene testing Leptin levels Fasting lipid profile, HBA1C, SGPT and Fasting plasma glucose should be checked in all over-weight and obese children after 3 years of age. An Oral Glucose Tolerance Test (OGTT) should be performed in obese children with a family history of T2DM as per guidelines mentioned in above section and in grossly obese children. Although obesity is associated with insulin resistance, diagnosis of insulin resistance by measuring plasma insulin concentration is no longer recommended, since the insulin assay is unreliable. ALT level greater than 25 and 22 in males and females respectively warrants ultrasonography of the liver followed by biopsy in those with a suspicion of cirrhosis. TABLE 8 HISTORY Mental retardation Genetic etiology Short stature/ decreased height velocity Endocrine etiology Medication history, eg. antipsychotics Medication etiology Snoring, morning headaches Obstructive sleep apnea Knee or hip pain Orthopedic morbidity Polyuria, polydipsia Type 2 Diabetes Hirsutism, irregular menses PCOS>
4) Laboratory Investigations: Initial investigations include evaluation for cause and consequences of obesity. Specific testing for the endocrine disorders is done only if there is strong clinical suspicion. These are mentioned in Table 3. Genetic testing should be considered in children with early onset severe obesity, voracious appetites, family history of severe obesity and in those where a clinical suspicion of genetic obesity syndromes is present. Lab investigations currently available in India for monogenic obesity are; MC4R, Leptin and FTO gene. Leptin deficiency is rare and resistance is more common. TSH levels are often mildly elevated in obese children and are a major cause for referral. TABLE 7: Diagnostic evaluation for cause of obesity Disease suspected Investigation Hypothyroidism FT4, TSH Cushing disease Urine free cortisol S. cortisol: Morning & Evening GH deficiency IGF1 & IGFBP3 GH stimulation test Genetic syndromes DNA methylation: PWS CNS disorder MRI brain Monogenic obesity MC4R gene testing Leptin levels Fasting lipid profile, HBA1C, SGPT and Fasting plasma glucose should be checked in all over-weight and obese children after 3 years of age. An Oral Glucose Tolerance Test (OGTT) should be performed in obese children with a family history of T2DM as per guidelines mentioned in above section and in grossly obese children. Although obesity is associated with insulin resistance, diagnosis of insulin resistance by measuring plasma insulin concentration is no longer recommended, since the insulin assay is unreliable. ALT level greater than 25 and 22 in males and females respectively warrants ultrasonography of the liver followed by biopsy in those with a suspicion of cirrhosis. TABLE 8 HISTORY Mental retardation Genetic etiology Short stature/ decreased height velocity Endocrine etiology Medication history, eg. antipsychotics Medication etiology Snoring, morning headaches Obstructive sleep apnea Knee or hip pain Orthopedic morbidity Polyuria, polydipsia Type 2 Diabetes Hirsutism, irregular menses PCOS>
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