Ethno-botanical uses and taxonomic composition of some Aju Mbaise (Mbaise wraps)

This document focuses on the ethnobotanical uses and taxonomic composition of some Aju Mbaise (Mbaise wraps). A total of 31 plant species belonging to 24 families were identified in the wraps collected from the study area. These plants are used in the treatment of ailments such as hypertension, typhoid, malaria, boost fertility in females, post-partum (immediately after birth), treatment of diabetes, treatment of arthritis, and induce weight loss. Annonaceae family constituted 9.68% of the total plant family, followed by Acanthaceae, Combretaceae, Fabaceae, Malvaceae, and Rubiaceae with 6.45% each. Among the plant species, Cnestis ferruginea (Connaraceae) occurred in five wraps. This is followed by Alternanthera bettzickiana (Amaranthaceae), Craterispermum cerinanthum (Rubiaceae), and Napoleona imparalis (Lecythidaceae) found in four wraps while Acanthus montanus (Acanthaceae), Barteria nigritana (Passifloraceae), Nephrolepis exaltata (Nephrolepidaceae), Oxytenanthera abyssinica (Poaceae), Palisota hirsuta (Commelinaceae), Scleria naumanniana (Cyperaceae), and Sida rhomboidea (Malvaceae) are in three ailments each. These plant species and families with high occurrence are the most effectively used plant groups in the study for the treatment of these diseases.

Sodium-Glucose Co-transporter-2 Inhibitors and Nephroprotection in Diabetic Patients: More Than a Challenge

Diabetic nephropathy is the most common cause of end-stage renal disease worldwide. Control of blood glucose and blood pressure (BP) reduces the risk of developing this complication, but once diabetic nephropathy is established, it is then only possible to slow its progression. Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are a novel class of oral hypoglycemic agents that increase urinary glucose excretion by suppressing glucose reabsorption at the renal proximal tubule. SGLT2is lower glycated hemoglobin (HbA1c) without increasing the risk of hypoglycemia, induce weight loss and improve various metabolic parameters including BP, lipid profile, albuminuria and uric acid. Several clinical trials have shown that SGLT2is (empagliflozin, dapagliflozin canagliflozin, and ertugliflozin) improve cardiovascular and renal outcomes and mortality in patients with type 2 diabetes. Effects of SGLT2is on the kidney can be explained by multiple pathways. SGLT2is may improve renal oxygenation and intra-renal inflammation thereby slowing the progression of kidney function decline. Additionally, SGLT2is are associated with a reduction in glomerular hyperfiltration, an effect which is mediated by the increase in natriuresis, the re-activation of tubule-glomerular feedback and independent of glycemic control. In this review, we will focus on renal results of major cardiovascular and renal outcome trials and we will describe direct and indirect mechanisms through which SGLT2is confer renal protection.

Surgical Technique of Diverted One-Anastomosis Gastric Bypass

Laparoscopic diverted one-anastomosis gastric bypass (D-OAGB) is a bariatric procedure combining the principles of restriction, malabsorption, and other factors to induce weight loss. It is achieved by creating a narrow, long gastric pouch and bypassing a part of the small bowel (biliopancreatic limb). D-OAGB was first described by Dr. Ribero in 2013 and is technically a variation of the very heterogeneous group of Roux-en-Y gastric bypass operations. There are different technical variants to perform D-OAGB and to organize pre- and postoperative care. The following article is based on the approach to bariatric surgery as taken at the Department of General Surgery at the Medical University of Vienna. This article focuses on patient preparation before bariatric/metabolic surgery with mandatory and optional preoperative examinations to find the surgical procedure best suited for each individual patient and to decrease the patient’s risk. The surgical technique of D-OAGB itself, including positioning of the patient and related technical highlights, as well as the specifics of the postoperative course, are described. D-OAGB is an effective procedure for patients with symptomatic gastroesophageal reflux for adequate weight loss and remission of comorbidities with a low risk of malnutrition. For D-OAGB to be successful, important technical steps, such as creating a narrow, long pouch, exact length of the biliopancreatic and alimentary limb, and additional hiatoplasty (if necessary), should be taken. In terms of the postoperative course, regular checkups are vital to ensure desirable outcome in the long-term follow up and early detection of adverse developments.

Impact of Environmental and Pharmacologic Changes on the Upper Gastrointestinal Microbiome

Diseases of the upper gastrointestinal tract have become more prevalent over time. Mechanisms of disease formation are still only partially understood. Recent literature has shown that the surrounding microbiome affects the propensity for disease formation in various parts of the upper gastrointestinal tract. A review was performed of any literature to our best knowledge concerning the effects of pharmacologic agents, environmental changes, and surgical intervention on the microbiome of the upper gastrointestinal tract. Searches of the literature were performed using specific keywords related to drugs, surgical procedures, and environmental factors. Many prescription and nonprescription drugs that are commonly used have varying effects on the upper gastrointestinal tract. Proton pump inhibitors may affect the relative prevalence of some organisms in the lower esophagus and have less effect in the proximal esophagus. Changes in the esophageal microbiome correlate with some esophageal diseases. Drugs that induce weight loss have also been shown to affect the microbiomes of the esophagus and stomach. Common surgical procedures are associated with shifts in the microbial community in the gastrointestinal tract. Environmental factors have been shown to affect the microbiome in the upper gastrointestinal tract, as geographic differences correlate with alterations in the microbiome of the gastrointestinal tract. Understanding the association of environmental and pharmacologic changes on the microbiome of the upper gastrointestinal tract will facilitate treatment plans to reduce morbidity from disease.

The Function of Gastrointestinal Hormones in Obesity—Implications for the Regulation of Energy Intake

The global burden of obesity and the challenges of prevention prompted researchers to investigate the mechanisms that control food intake. Food ingestion triggers several physiological responses in the digestive system, including the release of gastrointestinal hormones from enteroendocrine cells that are involved in appetite signalling. Disturbed regulation of gut hormone release may affect energy homeostasis and contribute to obesity. In this review, we summarize the changes that occur in the gut hormone balance during the pre- and postprandial state in obesity and the alterations in the diurnal dynamics of their plasma levels. We further discuss how obesity may affect nutrient sensors on enteroendocrine cells that sense the luminal content and provoke alterations in their secretory profile. Gastric bypass surgery elicits one of the most favorable metabolic outcomes in obese patients. We summarize the effect of different strategies to induce weight loss on gut enteroendocrine function. Although the mechanisms underlying obesity are not fully understood, restoring the gut hormone balance in obesity by targeting nutrient sensors or by combination therapy with gut peptide mimetics represents a novel strategy to ameliorate obesity.

Approach to Obesity in the Elderly

Until recently, weight loss in the elderly obese was feared due to ensuing muscle loss and frailty. Facing overall increasing longevity, high rates of obesity in older subjects (≥65 years) and a growing recognition of the health and functional cost of the number of obesity years, abetted by evidence that intentional weight loss in older obese subjects is safe, this approach is gradually, but not unanimously, being replaced by more active principles. Lifestyle interventions that include reduced but sufficient energy intake, age-adequate protein and micronutrient intake, coupled with aerobic and resistance exercise tailored to personal limitations can induce weight loss with improvement in frailty indices. Sustained weight loss in this age can prevent/ameliorate diabetes. More active steps are controversial. The use of weight loss medications, particularly GLP-1 analogs (liraglutide as the first example), provides an additional treatment tier. Its safety and cardiovascular health benefits have been convincingly shown in elderly obese subjects with type 2 diabetes. In our opinion, this option should not be denied to obese subjects with prediabetes or other obesity-related comorbidities based on age. Finally, many reports now provide evidence that bariatric surgery can be safely performed in older subjects as the last treatment tier. Risk-benefit issues should be considered with extreme care and disclosed to candidates. The selection process requires good presurgical functional status, individualized consideration of the sequels of obesity and reliance on centers which are highly experienced in the surgical procedure as well as short and long term subsequent comprehensive care and support.

Worker Size Diversity Has No Effect on Overwintering Success under Natural Conditions in the Ant Temnothorax nylanderi

Winter is a difficult period for animals that live in temperate zones. It can inflict high mortality or induce weight loss with potential consequences on performance during the growing season. Social groups include individuals of various ages and sizes. This diversity may improve the ability of groups to buffer winter disturbances such as starvation or cold temperature. Studies focusing on the buffering role of social traits such as mean size and diversity of group members under winter conditions are mainly performed in the laboratory and investigate the effect of starvation or cold separately. Here, we experimentally decreased worker size diversity and manipulated worker mean size within colonies in order to study the effect on overwintering survival in the ant Temnothorax nylanderi. Colonies were placed under natural conditions during winter. Colony survival was high during winter and similar in all treatments with no effect of worker size diversity and mean worker size. Higher brood survival was positively correlated with colony size (i.e., the number of workers). Our results show that the higher resistance of larger individuals against cold or starvation stresses observed in the laboratory does not directly translate into higher colony survival in the field. We discuss our results in the light of mechanisms that could explain the possible non-adaptive size diversity in social species.

Energy Balance Dynamics: Exercise, Appetite, Diet, and Weight Control

Individuals seeking to achieve weight loss are encouraged to achieve a negative energy balance, essentially eat less and move more. The complex relationship between energy expenditure and intake is often overlooked, leaving individuals and practitioners underwhelmed by the results of weight loss efforts. Independently, physical activity and diet interventions can yield modest weight loss and when combined have synergistic effects that promote sustained weight loss. Although physical activity benefits appetite suppression, reduces food rewards, and can be considered a gateway to healthy eating, high levels of daily activity are needed to induce weight loss. Diet is an important component to achieving weight loss, and high-protein diets have the potential for supporting weight loss as well. This column will be focused on the benefits of physical activity in reducing body weight, more specifically, the interdependent relationship between dietary intake and physical activity in achieving weight reduction.