Fat-Free Mass and Skeletal Muscle Mass Gain Are Associated with Diabetes Remission after Laparoscopic Sleeve Gastrectomy in Males but Not in Females

Besides massive body weight loss, laparoscopic sleeve gastrectomy (LSG) causes massive lean mass, including fat-free mass (FFM) and skeletal muscle mass (SM) that present higher metabolic rates in males. This study examines sex differences in FFM and SM changes of type 2 diabetes (T2D) remission at 12 months post-LSG. This cohort study recruited 119 patients (53.7% females) with T2D and obesity (body mass index 42.2 ± 7.0 kg/m2) who underwent LSG. Fat-mass (FM) loss was higher in males than in females (−12.8 ± 6.2% vs. −9.9 ± 5.0%, p = 0.02) after one-year post-operation. Regardless of the weight-loss difference, males had higher FFM and SM gain than did females (12.8 ± 8.0 vs. 9.9 ± 5.0% p = 0.02 and 6.5 ± 4.3% vs. 4.9 ± 6.2%, p = 0.03, respectively). Positive correlations of triglyceride reduction with FM loss (r = 0.47, p = 0.01) and SM gain (r = 0.44, p = 0.02) over 12 months post-operation were observed in males who achieved T2D remission. The T2D remission rate significantly increased 16% and 26% for each additional percentage of FFM and SM gain one year after LSG, which only happened in males. Increased FFM and SM were remarkably associated with T2D remission in males, but evidence lacks for females.

Use of Rituximab as an off-Label medication in Glomerular Diseases: Clinical Perspective

Objectives: We review rituximab (RTX) use and outcomes in immune-mediated glomerular diseases (GN) and compare it to established literature. Methods: Adult GN patients who received RTX between January 2014 and January 2018 in three public hospitals were reviewed. Membranous nephropathy (MN) and minimal change disease (MCD) were considered diseases with literature supporting RTX use. Lupus nephritis (LN), 1o focal segmental glomerulosclerosis (1o FSGS), IgA nephropathy (IgAN), IgG4 related disease, and C3GN had insufficient literature support for RTX use. Clinical Remission was assessed six months after receiving RTX. Results: A total of 61 cases analyzed. RTX was an add on therapy in 87%. Remission rate was 95% in MCD and MN vs. 56 % in off-label group (P=.002). LN patients had a mean initial eGFR of 69mL/min. All class III LN achieved remission, and 11 of 21 class IV achieved remission. Mean initial eGFR for 1o FSGS was 33mL/min and it did not improve, and only 2 of 5 had partial resolution of proteinuria. Proteinuria improved in 3 of 5 IgG4-related disease cases with eGFR stabilization but failed to improve in C3GN cases with eGFR deterioration. Vasculitis cases (6 ANCA-associated vasculitis and 2 IgA vasculitis) were analyzed separately. Remission achieved in only 2 ANCA vasculitis cases, and none in IgA vasculitis cases. Conclusion: Our data support RTX use in resistant MCD and MN. RTX showed success in LN and IgG4 related disease, but not FSGS or C3GN. The small vasculitis cases number does not allow drawing a conclusion on RTX effectiveness.

Longitudinal symptom and clinical outcome analysis of hospitalized COVID-19 patients

COVID-19 pandemics increased patient hospitalization impacting the hospital operations and patient care beyond COVID-19 patients. Although longitudinal symptom analysis may provide prognostic utility about clinical outcomes and critical hospitalization events of COVID-19 patients, such analysis is still missing. Here, we have analyzed over 10,000 hospitalized COVID-19 patients in the Houston Methodist Hospital at the Texas Medical Center from the beginning of pandemics till April of 2020. Our study used statistical and regression analysis over symptoms grouped into symptom groups based on their anatomical locations. Symptom intensity analysis indicated that symptoms peaked at the time of admission and subsided within the first week of hospitalization for most of the patients. Patients surviving the infection (n=9,263), had faster remission rates, usually within the first days of hospitalization compared to sustained symptom for the deceased patient group (n=1,042). The latter had also a longer hospitalization stay and more comorbidities including diabetes, cardiovascular, and kidney disease. Inflammation-associated systemic symptoms (Systemic) such as fever and chills, and lower respiratory system specific symptoms (Lower Respiratory System) such as shortness of breath and pneumonia, were the most informative for the analysis of longitudinal symptom dynamics. Our results suggest that the symptom remission rate could possess prognostic utility in evaluating patient hospitalization stay and clinical outcomes early in hospitalization. We believe knowledge and information about symptom remission rates can be used to improve hospital operations and patient care by using common and relatively easy to process source of information.

Correlation Analysis of Surgical Efficacy and Risk Factors of Cervical Spondylotic Myelopathy with High Signal Intensity on MRI-T2WI

Objectives: Objectives: The purpose of this study was to investigate the surgical efficacy and risk factors of cervical spondylotic myelopathy (CSM) patients with increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI-T2WI). Methods: We compared the surgical outcomes of CSM patients with and without ISI. In addition, we compared the efficacy of anterior and posterior cervical decompression in CSM patients with ISI. We also analyzed the risk factors of MRI-T2WI ISI in CSM patients. Results: The incidence of ISI among 153 CSM patients was 71.89%. The JOA score and JOA remission rate were better in the ISI-free than ISI group. The postoperative JOA score and JOA remission rate were better in the posterior than anterior approach surgery group. The disease duration and vertebral canal volume were risk factors for ISI in CSM patients. Conclusion: Among patients with CSM, the prognosis is worse for those with than without ISI. Posterior cervical decompression surgery produces a better curative effect than does anterior cervical decompression surgery in CSM patients with ISI. CSM patients who have a long disease duration and small vertebral canal volume should undergo surgical treatment as early as possible.

Screening of Translocation Ets-Leukemia-Acute-Myeloid-Leukemia-1 Fusion Gene and Expression Pattern of Multidrug Resistance Protein Protein in Children with Acute Lymphoblastic Leukemia

The study aimed to investigate the positive rate of TEL-AML 1 fusion gene in acute lymphoblastic leukemia (ALL) children and the clinical characteristics of ALL patients with TEL-AML 1 fusion gene positively expressed, as well as the expression level of MRP-1. 40 ALL children were selected, with their medical records collected. The TEL-AML 1 fusion gene was screened by nested RTPCR. Bone marrow specimens were taken for G-banded karyotype analysis and flow cytometry immunophenotyping of the marrow chromosome. A semi-quantitative RT-PCR method was used to study the mRNA expression level of MRP 1. The results showed that the positive rate of TEL-AML 1 fusion gene in ALL patients was 22.5% (9/40). The positive group exhibited lower gene expression level, the hepatosplenomegaly degree, the total number of peripheral white blood cells, the absolute count of naive cells, and the Hb level at the first visit, indicating that the tumor burden of children in the positive group was lower. The complete remission rate of the positive group was higher (P < 0.05). The mRNA expression level of MRP 1 gene positive group was lower. In conclusion, patients with positive TEL-AML 1 fusion gene were more sensitive to chemotherapeutic drugs, and their treatment responses and prognosis were better.

EFFICACY OF METHOTREXATE VERSUS LEFLUNOMIDE VERSUS COMBINATION OF BOTH IN ACTIVE RHEUMATOID ARTHRITIS

Objective: To determine the efficacy of Methotrexate versus Leflunomide versus combination of both among patients managed at Pak Emirates Military Hospital with active rheumatoid arthritis. Study Design: Prospective comparative study. Place and Duration of Study: Rheumatology/General Medicine Department, Pak Emirates Military Hospital Rawalpindi, from May 2019 to June 2020. Methodology: Patient of active rheumatoid arthritis who fulfilled American college of rheumatology criteria of 1997 were included in the study. They were randomly divided into three groups with group A receiving Methotrexate, group B receiving Leflunomide while group C received the combination of both Methotrexate and Leflunomide. Disease activity was assessed by using the Disease Activity Score-28 in all the three groups after three months of treatment. Results: Mean age of the study participants was 36.919 ± 6.85 years. One hundred and fifty (83.3%) patients were female while 30 (16.7%) were male. Out of 160 (88.9%) patients achieved remission according to Disease Activity Score-28 score at the end of three months while 20 (11.1%) did not achieve remission. Pearson chi-square test revealed that none of the factors studied including the treatment option had any statistically significant relationship with presence of remission among the target population (p-value 0.386, 0.815, 0.194 and 0.145 for age, gender, duration of symptoms and type of treatment respectively). Conclusion: Remission rate among the rheumatoid arthritis patients in response to treatment was overall good in the study. In terms of efficacy for symptoms of rheumatoid arthritis and achieving remission, after three months of treatment all the three options..................

Remission of comorbidities, weight loss, and adverse events after sleeve gastrectomy and Roux-en-Y Gastric Bypass in patients with obesity

Background: Despite the extensive literature on the outcome and impact of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on comorbidities and weight loss, clear evidence is still lacking. Our study aims to compare the short- and long-term efficacy and safety of the two procedures in patients with obesity. Methods: The primary endpoint of this retrospective registry study is to examine the adverse events after surgery, weight loss, and remission rate of comorbidities 12 months after surgery. Any result with a p-value of ≤ 5% corresponds to a significant outcome. Results: 27,882 patients had completed a one-year follow-up. 14,399 patients after SG and 13,483 after RYGB. The overall rate of intraoperative and postoperative complications was not significantly different between the two groups (overall p>5%). The %EWL was 62.4% in the SG group vs. 69.2% in the RYGB group; p<0.001. BMI reduction and mean weight loss were significantly different between the two groups in favor of SG. The RYGB group achieved significantly better remission of diabetes mellitus (T2DM; p<0.001), hypertension (28.8% vs. 23.5%; p < 0.001) and reflux 22.3% vs. 7.8%; p<0.001). Sleep apnea remission was similar between the two groups (10.2%; p<0.001). Conclusion: SG and RYGB are effective methods in the treatment of obesity. RYGB achieved better results in terms of remission of comorbidities and %EWL. However, further studies are needed to investigate the sustainability of weight loss and remission of comorbidities after both procedures.

Remission of comorbidities, weight loss, and adverse events after Sleeve Gastrectomy and Roux-en-Y gastric bypass in patients with obesity

Background: Despite the extensive literature on the outcome and impact of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) on comorbidities and weight loss, clear evidence is still lacking. Our study aims to compare the short- and long-term efficacy and safety of the two procedures in patients with obesity. Methods: The primary endpoint of this retrospective registry study is to examine the adverse events after surgery, weight loss, and remission rate of comorbidities 12 months after surgery. Any result with a p-value of 5% corresponds to a significant outcome. Results: 27,882 patients had completed a one-year follow-up. 14,399 patients after SG and 13,483 after RYGB. The overall rate of intraoperative and postoperative complications was not significantly different between the two groups (overall p>5%). The %EWL was 62.4% in the SG group vs. 69.2% in the RYGB group; p<0.001. BMI reduction and mean weight loss were significantly different between the two groups in favor of SG. The RYGB group achieved significantly better remission of diabetes mellitus (T2DM; p<0.001), hypertension (28.8% vs. 23.5%; p < 0.001) and reflux 22.3% vs. 7.8%; p<0.001). Sleep apnea remission was similar between the two groups (10.2%; p<0.001). Conclusion: SG and RYGB are effective methods in the treatment of obesity. RYGB achieved better results in terms of remission of comorbidities and %EWL. However, further studies are needed to investigate the sustainability of weight loss and remission of comorbidities after both procedures.

Clinical and Therapeutic Characteristics of Pituitary TSH-Secreting Adenoma in Adolescent-Onset Patients: Six Case Studies and Literature Review

BackgroundThyrotropin-secreting adenoma (TSH-oma) is a very rare kind of functional pituitary adenoma, especially that which occurs in adolescents. However, its potential clinical and therapeutic characteristics are still unknown.ObjectivesThe study was aimed to summarize the clinical and therapeutic characteristics of patients with adolescent-onset TSH-oma.MethodsWe retrospectively analyzed six (4.1%) adolescent-onset TSH-oma cases from 148 patients who were diagnosed with TSH-oma at our hospital between January 2012 and October 2020. A literature review was performed on the PubMed online database, and 14 adolescent-onset TSH-oma cases were retrieved. Then, the characteristics of clinical manifestations, treatment outcomes, and follow-ups were analyzed and compared to the adult TSH-oma patients.ResultsAltogether, 20 adolescent-onset cases were included in this study having mean onset age of 13.4 ± 3.3 years. Males were found to be slightly predominant (M: F = 1.5:1) in our study. The median baseline levels of TSH, FT3, and FT4 in adolescent-onset cases were found to be 6.30 [interquartile range (IQR) 9.82] µIU/ml, 9.18 (IQR 11.61) pg/ml, and 3.22 (IQR 1.90) ng/dl, respectively, which were all significantly higher than the adult patients of our hospital. Also, the adolescent-onset cases showed more large tumor ratio (36.8% vs. 9.3%, p = 0.007) compared to the adult patients. Compared to the patients of all ages in the literature, the biochemical remission rate of SSAs (57.1%) and remission rate of TSS (38.9%) were found to be considerably lower in adolescent-onset patients, while the recurrence rate (44.4%) was found to be considerably higher.ConclusionsAdolescent-onset TSH-oma patients showed higher TSH and thyroid hormone levels, more large tumors, and worse treatment outcomes than adult cases. Hence, early diagnosis, multidisciplinary therapy, and close follow-up should be highlighted to improve the prognosis.