Laparoscopic sleeve gastrectomy for treatment of type 2 diabetes mellitus in adolescents

Background Metabolic diseases have been associated with childhood obesity no longer restricted to adults as previously known. Hypertension and diabetes mellitus (DM) have been reported in children with morbid obesity. Laparoscopic sleeve gastrectomy (LSG) has been used as a primary procedure for weight control among children and adolescents with acceptable records of effective weight loss together with evidence of improvement of associated co-morbidities. Results Thirty-two patients were diagnosed with morbid obesity and DM presented to obesity and nutrition clinic and were included in this study. Laparoscopic sleeve gastrectomy (LSG) was the chosen operation to treat their obesity and associated co-morbidities. Fasting blood sugar and HbA1c were measured before the operation and 1 year after surgery. Twenty-seven patients had significant improvement of their glycemic profile and managed to stop the hypoglycemic medication. Conclusion LSG may play an important role as a metabolic control procedure rather than a bariatric restrictive procedure only.

Radiographic Measurement of Gastric Remnant Volume After Laparoscopic Sleeve Gastrectomy: Assessment of Reproducibility and Correlation with Weight Loss

Background As a restrictive procedure, laparoscopic sleeve gastrectomy (LSG) relies primarily on the reduction of gastric volume. It has been suggested that an immediate postoperative gastric remnant volume (GRV) may influence long-term results of LSG; however, there are no consensus in this matter. The aim of this study was to assess the reproducibility of different radiographic methods of GRV calculation and evaluate their correlation with the weight loss (WL) after surgery. Methods This retrospective study evaluated 174 patients who underwent LSG in the period from 2014 to 2017. Using UGI, GRV was measured with 3 different mathematical methods by 2 radiologists. Intraobserver and interobserver calculations were made. Correlation between GRV and WL were estimated with calculations percentage of total weight loss (%TWL) and percentage of excess weight loss (%EWL) after 1, 3, 6, 12, 18, and 24 months postoperatively. Results During analysis of intraobserver similarities, the results of ICC calculation showed that reproducibility was good to excellent for all GRV calculation methods. The intraobserver reproducibility for Reader I was highest for cylinder and truncated cone formula and for Reader II for ellipsoid formula. The interobserver reproducibility was highest for ellipsoid formula. Regarding correlation between GRV and WL, significant negative correlation has been shown on the 12th month after LSG in %TWL and %EWL for every method of GRV calculation, most important for ellipsoid formula (%TWL – r(X,Y) = -0.335, p < 0.001 and %EWL – r(X,Y) = -0.373, p < 0.001). Conclusion Radiographic methods of GRV calculation are characterized by good reproducibility and correlate with the postoperative WL. Graphical Abstract

Thiamine deficiency after sleeve gastrectomy

The prevalence of morbid obesity has risen to global epidemic proportions. Bariatric surgery has been proven to be a safe and effective treatment for obesity with weight reduction, resolution of obesity-related co-morbidities, improved quality of life and an increased life expectancy. Sleeve gastrectomy (SG) is the most commonly performed bariatric procedure worldwide. Obesity is associated with micronutrient deficiencies that results in the high prevalence of deficient vitamins status prior to bariatric surgery. After bariatric surgery, these micronutrient and vitamins deficiencies increase or occur de novo, and they may be threatening when left unattended. This presented clinical case demonstrates the clinical features of thiamine deficiency as well as the principles of laboratory and instrumental diagnostics. Electromyo­graphy is an informative method for diagnostic of muscle weakness. The lower serum thiamine level, neurological symptoms and electromyography results are the most important for the diagnosis of thiamine deficiency. Pathogenetic treatment can improve the patient’s condition in a short period of time. Although the SG is a purely restrictive procedure with no malabsorptive component, microelement or vitamin deficiency can occur in patients after procedure. The presented clinical case demonstrates the importance of timely thorough diagnosis and correct treatment of thiamine deficiency in patients after SG. Thus, patients after the LRS in deficiency of vitamin B1 may cause the development of neurological comp­lica­tions of varying severity, in particular dysmetabolic polyneuropathy. This condition is reversed and administration of an adequate and timely substitution therapy in patients with thiamine insufficiency allows be avoided the development of fatal complications.

Research of Malting Procedures for Winter Hard Wheat Varieties—Part II

This paper examines the influence of malting process parameters on the wheat malt quality obtained from the assortment of winter red wheat. For this assortment, previous research established that strongly restrictive and strongly intensive malting processes are not suitable, that is, they do not significantly improve the quality of the obtained wheat malts, and in some segments, they even disturb it. Therefore, modifications were introduced to both procedures, and malting was performed with moderately intensive procedure D and moderately restrictive procedure E. Starting wheat, indicators of micromalting process success, and finished wheat malts were analyzed. The results showed that the moderately restrictive malting process (E) significantly improves not only the values for soluble N for almost all tested varieties, but also the values of cytolytic degradation success (wort viscosity, filtration time), and extract yield. The moderately intensive procedure did not improve the determined indicators; for many varieties, the modification even resulted in poorer values. Furthermore, the moderately restrictive procedure allows a strong individual response of a particular variety to the process conditions during malting, which is very important for the assessment of the malting potential for a particular variety. Namely, when assessing the actual malting quality of an individual variety, it is necessary to include amylolytic indicators and indicators of enzymatic strength. In this way, a group of varieties were established which had an increased initial share of total N (varieties no. 7, 8, 9, 10, 12, 13, and 16). These varieties, by this procedure, gave the best quality wheat malts in the entire examined assortment.

Research of Malting Procedures for Winter Hard Wheat Varieties—Part I

This paper examines the influence of the malting process of red hard wheat varieties (which have many characteristics of soft wheat varieties and represent a transitional form between durum and soft wheat). According to the values of total and soluble proteins and viscosity of wort these wheat varieties belong to the second malting quality group. To establish the individual response of each variety and estimate how the chosen varieties respond in groups to different process conditions, sixteen varieties were selected and malted according to the standard procedure (A), restrictive procedure (B), and intense procedure (C). Starting wheat, indicators of micromalting process success, and finished malts were analyzed. It was found that the restrictive procedure (B) gives poor results for the values of proteolysis performance parameters (soluble N, free amino nitrogen (FAN)) with simultaneous disturbance and values of cytolytic degradation (viscosity and filtration time) and extract yield. At the same time, this procedure lacks a stronger individual response of an individual variety to the process conditions during malting (F/C difference and extract yield). The optimal malting process for the specified assortment would include the modification of processes B and C in a way to alleviate the restrictive conditions in process B, or in a way to reduce the intensity of the decomposition in process C.

Sleeve gastrectomy without bougie is safe and effective operation: case report

Sleeve gastrectomy (SG) is an effective method for weight loss; it is done by laparoscopy or open approach; it is a restrictive procedure and involves removing part of the stomach by cutting over bougie, which ensures that stenosis doesn’t occur. Bougie may cause esophageal perforation. There are studies that show the size of bougie used and weight loss are related. We show a case of open SG without using bougie at all. It is an effective and safe method and results in ~30% of weight loss 3 months after the operation without complications; thus, we conclude that SG can be done without bougie.

A case of Gastric Sleeve Stricture Resistant to Endoscopic Dilatation

Obesity is becoming an increasingly common disease across the world. Various restrictive and malabsorbptive surgical procedures have been developed to tackle morbid obesity. These procedures though efficient in causing weight loss and decrease in co – morbidities present with their own unique complications. Sleeve gastrectomy is one of the more recent, mainly restrictive procedure which has been gaining rapid popularity. Stricture of the gastric sleeve pouch is a rare and distressing complication of this procedure. Here we present a case of a 44-year-old woman who underwent Sleeve gastrectomy in Gulf 5 years back. She developed a stricture of the sleeve pouch for which she underwent two endoscopic dilatations which did not provide much relief. She was finally treated with a Roux – en – y gastro-jejunostomy which finally improved her symptoms.

The state of dyslipidemia after laparoscopic sleeve gastrectomy

Background: Obesity and dyslipidemia have a strong relation to the development of cardiovascular diseases. Bariatric surgery is directed towards the loss of patients weight and resolution of comorbidities as hyperlipidemia. Laparoscopic sleeve gastrectomy, a feasible restrictive procedure, is one the most popular and successful operations for achieving this purpose. The aim of present study was to evaluate the effect of laparoscopic sleeve gastrectomy on the lipid profile, comparing preoperative with postoperative results 12 months after surgery.Methods: This study included fifty morbidly obese cases that underwent laparoscopic sleeve gastrectomy (LSG). Preoperative and postoperative BMI and lipid parameters were documented and analysed at 12 months postoperatively.Results: The mean age of the studied group ±SD was 32.7±9.2 years, female predominance was found. BMI improved significantly after the LSG procedure with a mean±SD of 32.2±4 kg/m2. A significant improvement of dyslipidemia was found with a p-value (<0.001) regarding the mean level±SD of total cholesterol (TC) (180.5±25mg/dl), triglycerides (TG) (127.2±14.7mg/dl), low density lipoprotein (LDL) (94.2±14.5mg/dl) and high density lipoprotein (HDL) (48.4±5.6 mg/dl).Conclusions: Laparoscopic sleeve gastrectomy is a feasible and successful operation in reducing the body weight and subsequently improving the dyslipidemia of the morbid obese individuals.

Regulatory requirements for Vaccine registration in United States

Vaccination is one among the foremost cost-efficient health interventions out available, saving a lot of individuals from illness, incapacity, and death annually. No alternative countermeasures are effective in reducing or eliminating the prevalence of infectious diseases reminiscent of measles, mumps, rubella, smallpox, and diphtheria. Vaccines are products of biological origin that exhibit some inherent variability. They are characterized by advanced manufacturing processes and are administered to a huge number of healthy youngsters, adolescents, and adults. Their quality cannot be assessed by testing the ultimate product alone. The vaccine industry is highly regulated. Vaccines development maybe an advanced and long method. Before a new vaccine is approved for release into the market, a rigorous restrictive procedure to assess quality, effectiveness, and safety should be undertaken. The Office of Vaccines Research and Review (OVRR) at the Center for Biologics Evaluation and Research (CBER), U.S. Food and Drug Administration (FDA) are responsible for the regulation of Vaccines. Current authority for the regulation of vaccines is in Section 351(a) of the Public Health Service Act (PHS). Throughout the lifecycle of development, from preclinical studies to licensure, vaccines are subjected to rigorous testing and oversight. Manufacturers should adhere to good manufacturing practices and management procedures to make sure the quality of vaccines.

Laparoscopic greater curvature plication as a stomach sparing gastric sleeve: is it a worthy weight losing procedure for morbid obesity?

Background: Although laparoscopic sleeve gastrectomy (SLG) considered a gold standard way of management of morbid obesity, it still has serious complications as bleeding and staple line leak. Laparoscopic greater curvature plication (LGCP) was introduced as a trial gastric restrictive procedure and recently modified and standardized to obtain a gastric sleeve without resection and hence lower complications rates with the advantage of being a reversible procedure.Methods: 28 patients suffered from morbid obesity with body mass indices less than 50 kg/m2 filling the selection criteria of the study were prepared for Stomach Sparing Gastric Sleeve (SSGS). After devascularization of the greater curvature, double in-folding of the greater curvature using non-absorbable 2-0 sutures starting at the angle of His to 3-4 cm proximal to the pylorus, were done.Results: 28 patients with preoperative mean total body weight (TBW) of 118.7±15.5 kg and a mean BMI of 38±6.5 kg/m2 were the target of this study. The mean operative time was 103±11 min. Early minor postoperative complications were detected in 18 patients (64%) and included nausea, vomiting and sialorrhea. Postoperative reflux esophagitis was detected in 2 patients (7%). Postoperative % EWL (excess weight loss) was 32.2% at 1 month, 48.9% at 3 months, 53.3% at 6 months, 66.7% at 12 months and 70.2% at 15 months. The improvement of the pre-existent co-morbidities occurred in 7 patients (53.8%).Conclusions: SSGS is a promising low cost restrictive bariatric operation. It is reversible and effective weight losing procedure in the short term.