scholarly journals The rate of in-patient medical admissions post-bariatric surgery for medical complications during COVID-19 pandemic

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Sama Abdulrazzaq ◽  
Turki Faris Al-Ahbabi ◽  
Mohammed Aly Elsherif ◽  
Ahmed Ghazy ◽  
Samer Hammoudeh
Keyword(s):  
Weight Loss ◽  
Hospital Admissions ◽  
Gastrointestinal Symptoms ◽  
Medical Complications ◽  
Time Interval ◽  
Bariatric Patients ◽  
The Mean ◽  
Post Bariatric Surgery ◽  
Neuromuscular Complications

Background: A rising number of bariatric surgeries (BS) are associated with a rise in medical complications including protein malnutrition and neuromuscular complications (NM). Although BS were minimized during the COVID-19 pandemic, the number of admissions due to complications continued to increase. Proper outpatient follow-up was negatively affected during the pandemic. We aim to address the rising rate of post-BS admissions during COVID-19 pandemic compared to the previous six years' admissions with a similar diagnosis. Methods: This is a retrospective observational study of 33 patients admitted with malnutrition and/or NM complications post-BS at Hamad General Hospital, Qatar, from 1st Jan 2014–30th Aug 2020. Patients’ data were retrieved from the electronic medical records and bariatric patients’ database. Malnutrition was evaluated using serum albumin, total protein, minerals, and vitamins. Nerve conduction study/electromyography confirmed NM complications. Risk factors addressed were interval between BS and admission, gastrointestinal symptoms, total weight loss (TWL %), excess weight loss (EWL %), and irregular multivitamins intake. Results: The study included 21 patients, admitted from 1st Jan 2014-31th Dec 2019, compared to 12 patients during the period 1st Jan-30th August 2020. The patients’ mean age was 26.90 ± 9.81 years, and females were 18 (59%). The mean pre-operative weight, Body Mass Index (BMI), post-operative weight, BMI were: 123.48 kg, 44.37 kg/m2 and 84.61 kg – 30.67 kg/m2, respectively. The mean weight loss, EWL% and TWL% was 38.04 kg, 73.26%, and 30.57%, respectively. The time interval between BS and admission was 7.18 ± 8.99 months. Seventeen patients (51.5%) had malnutrition, while 16 (58.5%) had NM complications, 87.9% were off multivitamins, and 66% had gastrointestinal symptoms. All patients showed minerals and vitamins deficiencies, especially for vitamin D (81.8%) and potassium (30.3%). Conclusion: Despite a reduction in the number of BS during the COVID-19 pandemic, an increase in the rate of hospital admissions with medical complications after BS was observed.

Abstract P199: Keep Moving, Your Health Depends On It: Impact Of Improved Physical Activity And Weight Loss In A Wellness Program

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Ebenezer T Oni ◽  
Ehimen Aneni ◽  
Maribeth Rouseff ◽  
Thinh Tran ◽  
Henry Guzman ◽  
...  
Keyword(s):  
Physical Activity ◽  
Blood Pressure ◽  
Weight Loss ◽  
Intervention Program ◽  
South Florida ◽  
Metabolic Equivalents ◽  
Baseline Weight ◽  
The Mean ◽  
The Difference

Negative impact of CVD as the leading cause of death in the US is worsened by the significant burden of obesity and associated morbidity and concerns about the growing population inactivity. The American Heart Association has emphasized worksite-based interventions to improve CV health. We evaluated the benefits of improved physical activity(PA) and weight loss(WL) among employees of the Baptist Health South Florida enrolled in a wellness intervention program. Methods: Employees with two or more Cardio-metabolic risk factors , such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were enrolled in an intervention program themed “My unlimited potential”. Interventions were focused on diet and PA modifications. We defined improved physical activity as the difference in the metabolic equivalents (METs) at 12 weeks follow-up and at baseline. WL (lbs) was the difference in weight at follow-up. The relationship between WL and changes in METs was explored in an ordered logistic regression. Results: Overall 203 (48±10 years, 78% females) employees were enrolled with a retention rate of 89% (n=181) at 12 weeks follow-up. At baseline the median weights was 211 lbs., and mean METs- 8.6, while at follow-up the median weight was 200 lbs, and the mean METs 11. At 12 weeks follow up 38% had significant WL (lost >5% of baseline weight). The median WL was 8.4 (IQR 4.8-13.0) lbs and the mean change in METs was 2.4±1.8. Median WL increased with increasing tertiles of METs change; tertile1- 6.5(4-11) lbs., tertile2- 9(6-13)lbs. tertile3- 11(7-15)lbs. Increased PA was related to increased WL across BMI categories adjusting for age, gender and baseline weight. Conclusion: This study points strongly toward the benefit of increasing PA among other lifestyle modification interventions in controlling weight. Although further follow-up of this population to evaluate sustainability of change is needed, our results clearly relate improved PA and health.

scholarly journals Prevalence of All-Cause Mortality and Suicide among Bariatric Surgery Cohorts: A Meta-Analysis

2018 ◽  
Vol 15 (7) ◽  
pp. 1519 ◽  
Author(s):  
Russell Lim ◽  
Melvyn Zhang ◽  
Roger Ho
Keyword(s):  
Bariatric Surgery ◽  
Analytical Study ◽  
Meta Analysis ◽  
Well Being ◽  
Mortality Rates ◽  
Pooled Prevalence ◽  
All Cause Mortality ◽  
Bariatric Patients ◽  
Post Bariatric Surgery

Introduction: Prior meta-analysis has reported mortality rates among post-operative bariatric patients, but they have not considered psychiatric factors like suicide contributing to mortality. Objectives: The current meta-analysis aims to determine the pooled prevalence for mortality and suicide amongst cohorts using reported suicides post bariatric surgery. It is also the aim of the current meta-analytical study to determine moderators that could account for the heterogeneity found. Results: In our study, the pooled prevalence of mortality in the studies which reported suicidal mortality was 1.8% and the prevalence of suicide was 0.3%. Mean body mass index (BMI) and the duration of follow-up appear to be significant moderators. Conclusions: Given the prevalence of suicide post bariatric surgery, it is highly important for bariatric teams to consider both the medical and psychiatric well-being of individuals pre- and post-operatively.

scholarly journals Health benefits and risks during 10 years after Roux-en-Y gastric bypass

2020 ◽  
Vol 34 (12) ◽  
pp. 5368-5376
Author(s):  
M. Chahal-Kummen ◽  
O. B. K. Salte ◽  
S. Hewitt ◽  
I. K. Blom-Høgestøl ◽  
H. Risstad ◽  
...  
Keyword(s):  
Weight Loss ◽  
Gastric Bypass ◽  
Weight Regain ◽  
Rating Scale ◽  
Gastrointestinal Symptoms ◽  
Percent Excess Weight Loss ◽  
Gastrointestinal Symptom Rating Scale ◽  
Laparoscopic Rygb ◽  
Prospective Longitudinal

Abstract Background Long-term evaluations 10 years after Roux-en-Y gastric bypass (RYGB) are limited. We report the development in weight and cardiovascular risk factors during 10 years after laparoscopic RYGB, with evaluation of gastrointestinal symptoms and quality of life (QoL) at 10-year follow-up. Methods We performed a prospective longitudinal cohort study. Patients operated with laparoscopic RYGB from May 2004 to November 2006 were invited to 10-year follow-up consultations. Gastrointestinal Symptom Rating Scale (GSRS) questionnaire and two QoL questionnaires were used for analyses of gastrointestinal symptoms and QoL. Results A total of 203 patients were operated; nine (4.4%) died during follow-up. Of 194 eligible patients, 124 (63.9%) attended 10-year follow-up consultations. Percent excess weight loss (%EWL) and percent total weight loss (%TWL) at 10 years were 53.0% and 24.1%, respectively. %EWL > 50% was seen in 53.2%. Significant weight regain (≥15%) from 2 to 10 years was seen in 63.3%. Remission rates of type 2 diabetes, dyslipidemia, and hypertension were 56.8%, 46.0%, and 41.4%, respectively. Abdominal operations beyond 30 days after RYGB were reported in 33.9%. Internal hernia and ileus (13.7%) and gallstone-related disease (9.7%) were the most common causes. Vitamin D deficiency (<50nmol/L) was seen in 33.3%. At 10 years, bothersome abdominal pain and indigestion symptoms (GSRS scores ≥3) were reported in 42.9% and 54.0%, respectively, and were associated with low QoL. Conclusion We observed significant weight loss and remission of comorbidities 10 years after RYGB. Significant weight regain occurred in a substantial subset of patients. Gastrointestinal symptoms were common and negatively impacted QoL.

scholarly journals Banded Sleeve Gastrectomy Improves Weight Loss Compared to Nonbanded Sleeve: Midterm Results from a Prospective Randomized Study

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Paolo Gentileschi ◽  
Emanuela Bianciardi ◽  
Leandro Siragusa ◽  
Valeria Tognoni ◽  
Domenico Benavoli ◽  
...  
Keyword(s):  
Weight Loss ◽  
Sleeve Gastrectomy ◽  
Weight Regain ◽  
Randomized Study ◽  
Banded Sleeve Gastrectomy ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
To Receive

Background. Weight regain after laparoscopic sleeve gastrectomy (LSG) is nowadays a growing concern. Sleeve dilatation and loss of food restriction is considered the main mechanism. The placement of a silicon ring around the gastric tube seems to give benefits in the short term. We report the results of a randomized study comparing LSG and laparoscopic banded sleeve gastrectomy (LBSG) over a 4-year follow-up. Objectives. To evaluate the efficacy of banded sleeve gastrectomy compared to standard sleeve in the midterm. Methods. Between 01/2014 and 01/2015, we randomly assigned 50 patients to receive one of the two procedures. Patients’ management was exactly the same, apart from the band placement. We analyzed differences in weight loss, operative time, complication rate, and mortality, with a median follow-up of 4 years. Results. Twenty five patients were assigned to receive LSG (Group A) and 25 LBSG (Group B). The mean preoperative BMI (body mass index) was 47.3 ± 6.58 kg/m2 and 45.95 ± 5.85 kg/m2, respectively. There was no significant difference in the operative time. No intraoperative or postoperative complications occurred. At 12-month follow-up, the mean BMI was 29.72 ± 4.40 kg/m2 in Group A and 27.42 ± 4.47 kg/m2 in Group B (p=0.186). After a median follow-up of 4 years, the mean BMI in Group B was significantly lower than Group A (24.10 ± 4.52 kg/m2 vs 28.80 ± 4.62 kg/m2; p=0.00199). Conclusions. LBSG is a safe procedure, with no impact on postoperative complications. The banded sleeve showed a significant greater weight loss in the midterm follow-up. Considering the issue of weight regain observed after LSG, the placement of a perigastric ring during the first procedure may be a strategy to improve the results. This trial is registered with NCT04228185.

scholarly journals Evaluation of adult celiac disease from a tertiary reference center: a retrospective analysis

2020 ◽  
Vol 66 (1) ◽  
pp. 55-60
Author(s):  
Omer Burcak Binicier ◽  
Ferahnaz Tosun
Keyword(s):  
Celiac Disease ◽  
Autoimmune Disease ◽  
Autoimmune Diseases ◽  
Gastrointestinal Symptoms ◽  
Single Type ◽  
Adult Celiac Disease ◽  
Antibody Positivity ◽  
The Mean ◽  
Time Of Admission

SUMMARY OBJECTIVE It has been observed that celiac disease (CD) is not restricted to a single type characterized by diarrhea but also has atypical, asymptomatic (silent), and latent forms. The prevalence of this autoimmune disease, which affects approximately 1% of the world, is estimated to be around 3%, including atypical and asymptomatic cases. In our study, we aimed to evaluate adult celiac patients. METHODS Between December 2008-2015, patients diagnosed with CD over the age of 18 years old were included in the study. Patients’ symptoms at admission, frequency and type of anemia, transaminase levels, and celiac antibody positivity, and autoimmune diseases diagnosed at follow up were evaluated retrospectively. RESULTS Of 195 patients, 151 (77.4%) were female. The mean age of the patients was 35.73 ± 12.19 years (range, 18-71 years). A hundred patients (51.3%) had gastrointestinal symptoms. At the time of admission, 118 patients (60.5%) had anemia, and 52 (26.7%) had hypertransaminasemia. During the mean follow-up period of 58 months (36-120 months), 84 (43.1%) of the patients presented at least one autoimmune disease, and this rate was 96.6% in individuals diagnosed above the age of 50 years. CONCLUSION In adult CD, resistant anemia, dyspepsia, and hypertransaminasemia are very common findings at the time of diagnosis, and the association with other autoimmune diseases, especially Hashimoto’s thyroiditis, is high.

scholarly journals the Effects of Deferasirox on Iron in Pituitary, Pancreas and Thyroid Glands: An Observational Case-Control Study

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4892-4892
Author(s):  
Sule Unal ◽  
Munevver Bas ◽  
Tuncay Hazirolan ◽  
A. Murat Tuncer ◽  
Mualla Cetin ◽  
...  
Keyword(s):  
Conflicts Of Interest ◽  
Iron Chelation ◽  
Thalassemia Major ◽  
Iron Accumulation ◽  
Iron Chelators ◽  
Time Interval ◽  
Iron Loading ◽  
Thyroid Glands ◽  
The Mean

Abstract In the absence of adequate chelation therapy, cardiomyopathy caused by iron overload is the leading cause of death in patients with β-thalassemia major (BTM). Additionally, more than half of the adult patients with BTM suffer from hypogonadism (HG), osteoporosis, diabetes mellitus (DM) or hypothyroidism. The use of iron chelators is the mainstay of treatment in patients with BTM to ameliorate these complications. In this study, we aimed to compare the chelation effects of deferasirox (DFX) and other iron chelators on iron in heart, liver, in addition to pituitary, pancreas and thyroid glands. The study included a total of 37 patients with BTM, who were on the same iron chelator for at least 1 year of duration and above 7 years of age. All of the patients were on iron chelation therapies with either monotherapy with DFX (n=29), desferrioxamine (n=4), deferiprone (n=1) or combination therapy of desferrioxamine and deferiprone (n=3). The mean dose of DFX was 30.8 ± 6.3 mg/kg/day (20-40), the mean dose of desferrioxamine 43.1 ± 5.3 mg/kg/day (39-50) and mean dose of deferiprone was 73.26 ± 9.45 mg/kg/day (70-90). All of the patients were compliant to chelation treatment. Cardiac T2*, hepatic T2*, thyroid T2 and R2, pituitary T2 and R2, pancreas T2* and R2* MRI were ordered twice to the patients in order to measure the accumulation of iron. The median time interval between the two MRI was 6 months (range 6-11 months). The effect of DFX (n=29) on iron measurements in different organs were compared to the effects of other chelators group (OCG) (n=8). The mean age of patients participating in the study was 20.8 ± 6.3 years (7.1-36.8). Of the study group, 7.1% of the patients had DM, 8.1% had hypothyroidism and 13.5% had HG at enrollment. According to our previous study for the cut-off value determinations for iron accumulation in BTM with comparison to healthy controls (data unpublished), all of the patients in both groups were found to have pituitary iron accumulation at initial MRI. The changes in iron measures in various organs were summarized in Table 1, indicating a decrease in cardiac, pituitary and pancreas iron loading in both drug groups in follow-up MRI’s (p>0.05). On the other hand δ Liver T2* was negative direction indicating a decrease in hepatic iron loading in DFX group, wheras positive in OCG indicating an increase in follow-up, although insignificant (Table 1, p=0.9). In both groups iron loading in thyroid was found to increase in follow-up and there was no difference between drug groups (Table 1). In conclusion, DFX is as effective as other drugs in chelation of iron from cardiac, hepatic, pituitary, pancreas and thyroid. The increase in iron in thyroid gland during follow-up in both groups may indicate that iron chelation may not be as efficient in thyroid as it is in other organs. Although, all patients had pituitary iron accumulation, only 13.5% were found to have HG, indicating that patients become symptomatic only occur after a threshold of accumulation was achieved. Our study is initiative for the measurements of iron accumulation with MRI in thyroid. Table 1. δT2* and δR2 change values between first and second MRI assessments Chelation type Mean±SD Median Range p δ Liver T2 * a (ms) Deferasirox -0.06 -8.5-7.20 0.90 Other chelators 0.79 -0.98-4.40 δ Cardiac T2 * b (ms) Deferasirox -3.83±9.5 0.88 Other chelators -3.2±8.82 δ Pituitary T2 b (ms) Deferasirox -0.7±11.3 0.09 Other chelators -1.4±6.4 δ Pituitary R2 a (Hz) Deferasirox 0.10 -6,20-3,10 0.25 Other chelators 0.20 -4,60-1,30 δ Thyroid R2 a (Hz) Deferasirox -1.4 -6,1-12,7 0.06 Other chelators -0.1 -3,80-8,1 δ Thyroid T2 a (ms) Deferasirox 4.8 -59,8-14,6 0.08 Other chelators 0.4 -20,6-20,1 δ Pancreas T2* b (ms) Deferasirox -7.46±21.6 0.99 Other chelators -7.52±9.63 δ Pancreas R2 * b (Hz) Deferasirox 9.24±45.23 0.11 Other chelators 56.4±73.3 SD: Standard Deviation; aNon-parametric variable, median values were provided; bParametric variables, mean±SD were provided. Disclosures No relevant conflicts of interest to declare.

scholarly journals Regression to the mean contributes to the apparent improvement in glycemia 3.8 years after screening – the ELSA-Brasil Study

2020 ◽  
Author(s):  
Maria Inês Schmidt ◽  
Paula Bracco ◽  
Scheine Canhada ◽  
Joanna MN Guimarães ◽  
Sandhi Maria Barreto ◽  
...  
Keyword(s):  
Weight Loss ◽  
Real World ◽  
Complete Regression ◽  
Regression To The Mean ◽  
Free Living ◽  
Before And After ◽  
Baseline Values ◽  
The Mean ◽  
Design And Methods

<b>Objective </b> <p>Glycemic regression is common in real world settings, but the contribution of regression to the mean (RTM) has been little investigated. We aimed to estimate glycemic regression before and after adjusting for RTM in a free-living cohort of adults with newly ascertained diabetes and intermediate hyperglycemia (IH). </p> <p><b>Research Design and Methods</b></p> <p>ELSA-Brasil is a cohort study of 15,105 adults screened between 2008-2010 with standardized OGTT and HbA1c, repeated after 3.84 (0.42) years. After excluding those receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline values for RTM. </p> <p><b>Results</b></p> <p>Regarding newly ascertained diabetes, partial or complete regression was seen in 49.4% (95%CI 45.2 – 53.7); after adjustment for RTM, in 20.2% (95%CI 12.1 – 28.3). Regarding IH, regression to normal levels was seen in 39.5% (95%CI 37.9 – 41.3) or in 23.7% (95%CI 22.6% – 24.3%) depending on the WHO or the ADA definition, respectively; after adjustment, corresponding frequencies were 26.1% (95%CI 22.4 – 28.1) and 19.4% (95%CI 18.4 – 20.5). Adjustment for RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes; 3118 to 1986 cases of WHO-defined IH; and 6182 to 5711 cases of AD-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes (RR=1.52 95%CI 1.26-1.84) and IH (RR=1.30 95%CI 1.17-1.45). </p> <p><b>Conclusions</b></p> <p>In this quasi-real-world setting, regression from diabetes at ~4 years was common, less so for IH. Regression was frequently explained by RTM, but, in part, also related to improved weight loss and homeostasis over the follow-up. </p>

scholarly journals Regression to the mean contributes to the apparent improvement in glycemia 3.8 years after screening – the ELSA-Brasil Study

2020 ◽  
Author(s):  
Maria Inês Schmidt ◽  
Paula Bracco ◽  
Scheine Canhada ◽  
Joanna MN Guimarães ◽  
Sandhi Maria Barreto ◽  
...  
Keyword(s):  
Weight Loss ◽  
Real World ◽  
Complete Regression ◽  
Regression To The Mean ◽  
Free Living ◽  
Before And After ◽  
Baseline Values ◽  
The Mean ◽  
Design And Methods

<b>Objective </b> <p>Glycemic regression is common in real world settings, but the contribution of regression to the mean (RTM) has been little investigated. We aimed to estimate glycemic regression before and after adjusting for RTM in a free-living cohort of adults with newly ascertained diabetes and intermediate hyperglycemia (IH). </p> <p><b>Research Design and Methods</b></p> <p>ELSA-Brasil is a cohort study of 15,105 adults screened between 2008-2010 with standardized OGTT and HbA1c, repeated after 3.84 (0.42) years. After excluding those receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline values for RTM. </p> <p><b>Results</b></p> <p>Regarding newly ascertained diabetes, partial or complete regression was seen in 49.4% (95%CI 45.2 – 53.7); after adjustment for RTM, in 20.2% (95%CI 12.1 – 28.3). Regarding IH, regression to normal levels was seen in 39.5% (95%CI 37.9 – 41.3) or in 23.7% (95%CI 22.6% – 24.3%) depending on the WHO or the ADA definition, respectively; after adjustment, corresponding frequencies were 26.1% (95%CI 22.4 – 28.1) and 19.4% (95%CI 18.4 – 20.5). Adjustment for RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes; 3118 to 1986 cases of WHO-defined IH; and 6182 to 5711 cases of AD-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes (RR=1.52 95%CI 1.26-1.84) and IH (RR=1.30 95%CI 1.17-1.45). </p> <p><b>Conclusions</b></p> <p>In this quasi-real-world setting, regression from diabetes at ~4 years was common, less so for IH. Regression was frequently explained by RTM, but, in part, also related to improved weight loss and homeostasis over the follow-up. </p>

Long-term outcomes of laser-assisted uvulopalatoplasty in 168 patients with snoring

2006 ◽  
Vol 120 (11) ◽  
pp. 932-938 ◽  
Author(s):  
T Iyngkaran ◽  
J Kanagalingam ◽  
R Rajeswaran ◽  
C Georgalas ◽  
B Kotecha
Keyword(s):  
Weight Loss ◽  
Telephone Survey ◽  
Subjective Improvement ◽  
Long Term Outcomes ◽  
Sleep Studies ◽  
The Mean ◽  
Term Benefit ◽  
Sleep Nasendoscopy

Laser-assisted uvulopalatoplasty (LAUP) is an established treatment for snoring. Our institution has been using a modification of the Kamami technique since 1995. Between January 1995 and December 2001, 469 patients underwent LAUP for snoring. A telephone survey of these patients and their partners was conducted retrospectively. One hundred and sixty-eight patients and their partners were interviewed and the findings analysed.Of the 168 patients, 122 had LAUP alone, 42 had LAUP and tonsillectomy and four had LAUP and septoplasty. The median follow-up time was 59 months (range 19 to 98 months).Seventy-four per cent reported improvement at six weeks, 69 per cent reported improvement at nine months and 55 per cent reported improvement at the time of interview. To assess the degree of improvement, patients and their partners were asked to grade any improvement in percentage terms. The mean subjective improvement scores were 57 per cent at six weeks (95 per cent confidence interval (CI) 50–64 per cent), 45 per cent at nine months (95 per cent CI 38–59 per cent) and 30 per cent at the time of interview (95 per cent CI 23–35 per cent). Patients who reported weight gain since surgery did not have a poorer outcome than those who reported no weight change or weight loss. Neither did weight loss predict a better outcome. The procedure was generally well tolerated, with only 30 patients (18 per cent) reporting complications (mainly minor).The benefits of LAUP wane with time and the results are best in the first 12 months following surgery. Our study suggests that 55 per cent of patients selected after sleep studies and sleep nasendoscopy will enjoy long-term benefit.

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