One Anastomosis Gastric Bypass Versus Long Biliopancreatic Limb Roux-en-Y Gastric Bypass

Background Roux-en-Y gastric bypass (RYGB) is one of the most effective bariatric procedures. The study aimed to explore the value of lengthening the biliopancreatic limb (BPL) in RYGB compared to the outcome of one-anastomosis gastric bypass (OAGB). Methods This prospective study included morbidly obese patients divided into two groups. The RYGB group (n = 36) was subjected to long biliary limb Roux-en-Y gastric bypass (LPRYGB), and the OAGB Group (n = 36) had one anastomosis gastric bypass. During follow-up, weight, BMI, percentage of excess body weight loss (%EBWL), resolution of obesity-related comorbidities, and quality of life (QoL) were evaluated. Results There was no significant difference in weight and BMI after 3 and 6 months. At 12-month follow-up, weight loss was significantly higher in the OAGB group. After 12 months, the two groups showed significant improvement of comorbid conditions without significant difference between the two groups. The Qol was significantly higher in the LPRYGB group 3, 6, and 12 months after surgery compared to the OAGB group. Conclusions Extending the BPL length in RYGB to 150 cm is as effective as OAGB in remission of comorbidities, including diabetes. It was also equally effective in weight reduction in the short term. OAGB was more efficient in weight reduction and a significantly faster operation. LPRYGB showed a better QoL of life 1 year after surgery. Graphical abstract

Somatic status of adolescent girls with gynecological disorders born with low and excessive weight

In modern conditions, health problems (somatic, reproductive, mental) of adolescent girls occupy a special place in the health care system, as a reserve in reducing maternal and infant mortality, maintaining the fertility of the expectant mother. The aim. To study the frequency and character of extragenital diseases of adolescent girls with gynecological pathology, born with low and excessive body weight. Materials and methods. The project design is a population-based prospective cohort study. To achieve the goal and the implementation of the tasks, a prospective examination of girls and adolescent girls born with deficiency or excess body weight was carried out. The sample size was 77 people. Additionally, statistical processing was carried out using the Excell software. Results. Thus, the study of somatic health indicates its deterioration in the groups of girls born with polar values ​​of body weight. In groups 1 and 3, infectious diseases were identified, which can serve as a starting point in the development of reproductive system disorders. In girls of group 1, mumps prevailed (20.0%), which could cause damage to the follicular apparatus, while in group 3, girls were more likely to have influenza (25.8%), the virus of which has a damaging effect not only on the structure of the ovaries, but also on endometrium. Conclusions. Comparative analysis of the structure of somatic morbidity made it possible to identify the most significant pathology characteristic of each of the groups. Girls born with a large body weight have an increased risk of endocrine pathology. In girls born with low body weight, somatic diseases associated with manifestations of diseases of the musculoskeletal system prevail. This dictates the need to single out girls born with polar values ​​of body weight in the risk group for the development of somatic pathology and requires complex therapeutic and prophylactic measures.

Relationship between blood pressure and body mass index in young adult population: A national-level assessment in Bangladesh

Young adulthood is a crucial period for major physiological transitions. Environmental changes associated with these transitions can influence health behaviour and health (e.g., poor diet, high body weight and elevated blood pressure (EBP)). Excess body weight can lead to EBP; however, little is known about this relationship among young adults in developing countries. Focusing on Bangladesh, this study assessed the association between body mass index (BMI) and BP metrics (systolic BP [SBP], diastolic BP [DBP], and BP class [optimal, normal/high normal, and elevated]). Sex-specific analyses of these relationships were performed to assess any difference across sexes. Furthermore, associations of overweight/obesity with BP metrics were investigated. Young adults aged 18-24 years (n 2181) were included from nationally representative cross-sectional Bangladesh Demographic and Health Survey 2017-18. Multivariable linear and multinomial logistic regression models examined the relationships between BMI, overweight/obesity, and BP metrics. Findings reveal that higher BMI was associated with higher SBP (0.83; 95% CI 0.67, 0.99), DBP (0.66; 95% CI 0.54, 0.74), and higher odds of having EBP (adjusted odds ratio 1.24; 95% CI 1.17, 1.31). These relationships were stronger among males than females. Moreover, overweight/obese individuals had higher SBP, DBP, and higher odds of having EBP than individuals with normal BMI. Strategies to reduce body weight, improve healthy lifestyle, and awareness and monitoring of BP may help to address these serious health problems, particularly at an early age.

Nutritional Therapy in Persons Suffering from Psoriasis

Psoriasis is a chronic inflammatory skin disease. Immunological, genetic, and environmental factors, including diet, play a part in the pathogenesis of psoriasis. Metabolic syndrome or its components are frequent co-morbidities in persons with psoriasis. A change of eating habits can improve the quality of life of patients by relieving skin lesions and by reducing the risk of other diseases. A low-energy diet is recommended for patients with excess body weight. Persons suffering from psoriasis should limit the intake of saturated fatty acids and replace them with polyunsaturated fatty acids from the omega-3 family, which have an anti-inflammatory effect. In diet therapy for persons with psoriasis, the introduction of antioxidants such as vitamin A, vitamin C, vitamin E, carotenoids, flavonoids, and selenium is extremely important. Vitamin D supplementation is also recommended. Some authors suggest that alternative diets have a positive effect on the course of psoriasis. These diets include: a gluten-free diet, a vegetarian diet, and a Mediterranean diet. Diet therapy for patients with psoriasis should also be tailored to pharmacological treatment. For instance, folic acid supplementation is introduced in persons taking methotrexate. The purpose of this paper is to discuss in detail the nutritional recommendations for persons with psoriasis.

Respiratory pathophysiology in obesity

In the modern world, obesity is the most important medical and social problem that requires an interdisciplinary approach. Many diseases of the respiratory system are caused by obesity.Aim. The review analyzes scientific sources on respiratory disorders in patients with obesity from the open-access electronic libraries PubMed and eLibrary published in the last 15 years.Methods. A comparative systematical assessment of the results of these studies was carried out. The mechanical effects of excess body weight on the respiratory apparatus have been singled out. The current views about cellular and humoral effects of adipose tissue on the development of respiratory pathology have been given.Conclusion. The analysis results present evidence of the multifactorial negative influence of excessive body weight on the respiratory system. Some aspects of the role of obesity in the development of respiratory disorders require further study. Understanding the pathogenic mechanisms behind the influence of obesity on the respiratory apparatus is essential for developing the patient management strategy.

“The obesity paradox” in patients with atrial fibrillation according to the results of the REKUR-AF study

Introduction: to evaluate the effect of excess body weight (EBW) and obesity on the survival of patients with atrial fibrillation (AF) in the REKUR-AF study. Materials and methods: A subanalysis of patients with AF included in the REKUR-AF (382 people) study was performed. Survival rates were analyzed in three patient groups: patients with normal body mass index (BMI), EBW and obesity. Then the nature and significance of the influence of the studied factor on the prognosis in patients with AF were assessed. Results and discussion: Patients with AF and normal BMI were significantly older than those with obesity and EBW (p<0.001 and p=0.021, respectively). Among obese patients, hypertension was significantly (p=0.0015) more common (93.9%) compared to the group of patients with a normal BMI level (80.5%). The frequency of type 2 diabetes in obese patients prevailed over the same indicator in the groups of people with normal BMI and EBW (p=0.007 and p=0.020, respectively). The analysis of the survival rate of patients with AF depending on the BMI level showed that this factor had a significant impact (p=0.013) on the prognosis. The group of individuals with a normal BMI level had a significantly lower survival rate than the cohort of patients with EBW (p=0.011) and OB (p=0.025). The final model for Cox regression analysis (χ2=53.06, p<0.001) included the following factors: age, form of AF, BMI, presence/absence of type 2 diabetes, presence/absence of previous hospitalizations, presence/absence of hypertension, and presence/absence of oral anticoagulant (OAC) intake. Conclusion: The obtained results do not make it possible to unambiguously interpret obesity as a predictor of a positive outcome in this category of individuals.

LEFT VENTRICLE REMODELING IN PATIENTS WITH POSTINFARCTION CARDIOSCLEROSIS AND OBESITY, TAKING INTO ACCOUNT FABP 4 AND CTRP 3 LEVELS

The objective – to study the structural-functional condition of the left ventriclemyocardium (LV) in patients with postinfarction cardiosclerosis and surplus body weighttaking into account the levels of adipokines FABP4 and CTR3.Material and methods. The study involved 189 patients. The first group consisted of60 patients with postinfarction cardiosclerosis, the second group included 68 patientswith postinfarction cardiosclerosis and excess body weight (EBW), the third groupcomprised 61 patients with postinfarction cardiosclerosis and obesity. The content ofFABP 4 and CTRP 3 was determined by enzyme-linked immunosorbent assay. Statisticalprocessing of the survey results was performed using the licensed software package“IBM SPPS Statistics 27.0”. According to the sample size and distribution of indicators,the parametric Student’s test was used. Evaluation of the significance of the differencebetween the means of multiple comparisons for quantitative traits with normaldistribution using Bonferroni correction was performed by one-way analysis of variance(ANOVA).The mean and the error of the mean were determinedThe correlations of theindicators were determined using the Pearson correlation coefficient (r). At a value ofp˂0.05, the difference was considered significant.Results. Patients with post-infarction cardiosclerosis and obesity in comparison withpatients without excess body weight were found to have an increase in end-systolicvolume (ESV), end-diastolic volume, end-diastolic size (EDS), end-systolic size (ESS),stroke volume, thickness of interventricular septum, thickness of the posterior wallof the left ventricle, size of the left atrium, mass of the left ventricular myocardium,LVMMI. A direct relationship between FABP 4 and ESS, ESV, LVMMI1in patients withpostinfarction cardiosclerosis and obesity was determined. There was a significantinverse correlation between CTRP 3 and EDS, ESS, ESV, LVMMI1 in patients withpostinfarction cardiosclerosisand obesity.Conclusions. The study showed that in patients with postinfarction cardiosclerosi 34sand obesity there was an increase in echocardiographic parameters. The influence ofFABP 4 and CTRP 3 content on the structural and functional state of the left ventricularmyocardium was determined.

Anesthesia Management in Intramural Uterine Myoma and Obesity Morbid Patients Who Underwent Myomectomy Perlaparatomy

Introduction. Obesity is a condition that increases the challenges in the surgical process. Obesity increases the risk of sleep apnea and affects anaesthetics. This case report aims to discuss the management of anaesthesia in a patient with morbid obesity. Case. Female, 26 years old, with intramural uterine myoma and morbid obesity, will undergo myomectomy per laparotomy with ASA II physical status, performed anaesthesia with general anaesthesia intubation technique using the anaesthetic agent Propofol 1-2.5 mg/kg titration until the patient falls asleep, fentanyl 1-2 mcg/kg, then the patient was intubated in a ramped position with sleep non-apnea. After it was confirmed that the ETT was entered, 30 mg of a muscle relaxant (atracurium) was added. The operation lasts 1 hour 30 minutes, with a bleeding 250 cc, hemodynamically stable. Conclusion. Morbid obesity has extraordinary implications for anaesthetic management. Various considerations for patients with morbid obesity are needed starting from the preoperative, intraoperative, to postoperative periods. Regional anaesthesia is preferred because the physiological function of unhealthy obese patients is impaired due to excess body weight. Selection of anaesthetic agent and calculation of drug dose is crucial to know because there is a change in the volume of distribution. The pharmacokinetics of most general anaesthetics are affected by the adipose tissue mass, produce a prolonged drug effect, and less predictable.

Obstructive sleep apnea and associated factors among hypertensive patients attending a tertiary cardiac center in Tanzania: a comparative cross-sectional study

Background There is mounting evidence for a reciprocal yet bidirectional association between sleep-disordered breathing and hypertension. Obstructive sleep apnea (OSA), a common cause of systemic hypertension is an independent risk factor for hypertension-related cardiovascular morbidity and mortality. In this comparative hospital-based cross-sectional study, we sought to explore the burden of obstructive sleep apnea and its associated risk factors among hypertensive patients attending Jakaya Kikwete Cardiac Institute. Methodology A total of 1974 individuals (i.e. 1289 hypertensive and 685 normotensives) were consecutively enrolled in this study. The Berlin questionnaire and Epworth Sleepiness Scale were utilized in the assessment of OSA and excessive daytime sleepiness (EDS) respectively. Logistic regression analyses were employed in the determination of associated factors for OSA. Results The mean age was 53.4 years and females constituted the large majority (60.4%) of participants. About three quarters (74.1%) of participants had excess body weight, 11.6% had diabetes, 8.0% had asthma and 18.6% had history of recurrent nasal congestion. Positive family history of snoring was reported by 43.1% of participants and 36.9% had a personal history of snoring. Persons with hypertension displayed a higher frequency (42.1%) of OSA compared to their normotensive counterparts (11.8%), p < 0.001. Multivariate logistic regression analyses revealed hypertension (OR 5.1, 95% CI 3.2-8.2, p < 0.001), diabetes mellitus (OR 2.2, 95% CI 1.3-3.5, p < 0.01), chronic nasal congestion (OR 1.6, 95% CI 1.1-2.5, p = 0.01), obesity (OR 2.4, 95% CI 1.8-3.3, p < 0.001), increased neck circumference (OR 2.7, 95% CI 1.2-6.4, p = 0.02), family history of snoring (OR 5.5, 95% CI 4.0-7.5, p < 0.001), and working > 8 h/24 h (OR 0.6, 95% CI 0.4-1.0, p = 0.03) to have an independent association for OSA. Furthermore, participants with hypertension displayed superior odds for OSA compared to their normotensive counterparts across all subgroup analyses. Conclusion OSA is considerably common among patients with hypertension in a tertiary health care setting in Tanzania. Positive family history of snoring was the strongest associated factor; however, excess body weight proved to be the strongest modifiable risk factor. In view of its pervasiveness, OSA should be an integral part of the medical evaluation in hypertensive individuals.

Bioimpedance analysis of body composition in the diagnosis of physical development disorders in children and adolescents

Traditionally, anthropometric method is used in clinical practice for the diagnosis of excess body weight. Obesity is the excess development of primarily visceral and subcutaneous adipose tissue, which can be diagnosed by bioimpedance analysis (BIA). The study was aimed to assess the role of BIA of body composition in the diagnosis of the physical development disorders in children and adolescents. Anthropometric assessment and BIA were performed in 431 Samara school students aged 12–16 of the health status groups I and II (230 boys and 201 girls). The results were analyzed with the use of the regional regression scores, BAZ indices, and the body fat percentage values. The results of estimation using the regression scores showed that 22.61% of boys and 23.43% of girls were overweight, while more than 2/3 of the sample had a normal pattern of physical development. The BAZ indices revealed a significantly higher proportion of overweight children among boys (25.7%), than among girls (11.5%, p < 0.01). The body fat percentage fluctuations based on the BIA data were found not only in children with disharmonious physical development, but also in 60% of children with normal body weight. Moreover, the data of BIA confirmed the body weight fluctuations, revealed with the use of the regression scores, in the significantly larger number of cases compared to the low body weight and excess body weight, diagnosed based on the BAZ indices. Accordingly, anthropometric analysis with the use of the regional regression scores may be used at the baseline for the early diagnosis of the nutritional status disorders in children. To confirm overweight and obesity in children, as well as to provide further treatment, the reliable method for estimation of the body fat content is required, which may be the method of BIA.