Obesity is a serious socioeconomic, and also increasingly clinical problem. Between -1 / 3 of population in the developed countries can be classified as obese. Four major etiological factors for development of obesity are genetic determinants, environmental fac tors, f ood i ntake a nd exercise. O besity i ncreases the risk of t he de velopment of v arious pathologic conditions including: insulin-resistant di abetes m ellitus, cardiovascular disease, non-alcoholic fatty l iver di sease, endocrine problems, and certain forms of cancer. Thus, obesity is a negative prognostic factor for longevity. In this review w e pr ovide br oad ove rview of pa thophysiology of obe sity w e a lso di scuss va rious a vailable, a nd e xperimental therapeutic methods. We also highlight functions of adipocytes including fat storing capacity and secretory activity resulting in numerous endocrine effects like leptin, IL-6, adiponectin, and resistin. The anti-obesity drugs are classified according to their primary action on energy balance. Major classes of these drugs are: appetite suppressants, inhibitors of fat absorption (i.e. orlistat), stimulators of thermogenesis and stimulators of fat mobilization. The appetite suppressants are further divided into noradrenergic agents, (i.e. phentermine, phendimetrazine, benzphetamine, diethylpropion), serotoninergic agents (i.e. dexfenfluramine), and mixed noradrenergic-serotoninergic agents (i.e. sibutramine). Thus, we highlight recent advances in the understanding of the central neural control of energy balance, current treatment strategies for obesity and the most promising targets for the development of novel anti-obesity drugs.

Overutilization of routine gastrointestinal (GI) prophylaxis has been a focus of research for more than a decade in North American and European countries given its potential to increase costs and cause adverse clinical effects. 1,2 Prescription of antacids in inpatient units and their prolonged use cause changes in the intestinal microbiota with consequent increased risk for Clostridium difficile-associated disease 3-5 and nosocomial pneumonia. 1,2,6,7 According to the Choosing Wisely recommendation by the Society of Hospital Medicine, routine GI prophylaxis is not recommended for adults on general medical or surgical floors. 8 The American Society of Health System Pharmacists "Therapeutic Guidelines on Stress Ulcer Prophylaxis" state that patients admitted to the noncritical care hospital setting with ,2 risk factors for bleeding should not receive routine stress ulcer prophylaxis. 9 In pediatric patients, established risk factors for clinically significant stress ulcer-related bleeding and thus potential need for acid suppression include respiratory failure with the need for mechanical ventilation, coagulopathy, a Pediatric Risk of Mortality Score of $10, 10 shock, and thermal injuries. 11,12 There is currently a paucity of formal guidelines on GI prophylaxis outside the ICU in pediatric patients. Whether GI prophylaxis is routinely used in pediatric surgery patients outside the critical care setting without specific evidence based criteria is unknown. Given its potential to cause negative effects and inappropriately high use rates in adults on medical-surgical floors (up to 85%), 13-15 we believe this is an important issue to address in the pediatric population. Therefore, the purpose of this study was to establish the current rate of postoperative GI prophylaxis in pediatric appendectomy patients on regular nursing floors in a single center and factors associated with its use. We hypothesized that a more complicated postoperative course, prolonged nothing-by-mouth status, and concomitant nonsteroidal antiinflammatory drug (NSAID) use might be associated with acid suppression prescriptions. METHODS We conducted a retrospective single-center cohort study at Cleveland Clinic Children' s in Cleveland, Ohio, after gaining approval from the Institutional Review Board. Given that acute appendicitis is the most common diagnosis requiring an urgent general surgical procedure with an associated low risk of bleeding and an expected short