Minimally invasive surgical interventions in the treatment of primary persistent hyperinsulinemic hypoglycemia of infancy

Hyperinsulinemia, diagnosed by laboratory tests, should be diagnosed and treated as soon as possible to prevent fatal complications such as neurological damage. Patients who are resistant to medical therapy should be treated surgically. Minimally invasive surgery, a newly developed approach, is a good choice among surgical procedures to avoid unnecessary extensive pancreatectomy. Here, a 12-year-old boy is presented with diagnosis of hyperinsulinemic hypoglycemia who had recurrent attacks of hypoglycemia and seizures from infancy. Because of his unresponsiveness to medical therapy and his family�s preference, he underwent laparoscopic pancreatectomy to reduce morbidity and hospital stay. Two years postsurgical follow-up revealed a normo-glycemic state. © 2015, Sociedade Brasileira de Endocrinologia e Metabologia. All rights reserved

FedAnchor: Enhancing Federated Semi-Supervised Learning with Label Contrastive Loss for Unlabeled Clients

Federated learning (FL) is a distributed learning paradigm that facilitates collaborative training of a shared global model across devices while keeping data localized. The deployment of FL in numerous real-world applications faces delays, primarily due to the prevalent reliance on supervised tasks. Generating detailed labels at edge devices, if feasible, is demanding, given resource constraints and the imperative for continuous data updates. In addressing these challenges, solutions such as federated semi-supervised learning (FSSL), which relies on unlabeled clients' data and a limited amount of labeled data on the server, become pivotal. In this paper, we propose FedAnchor, an innovative FSSL method that introduces a unique double-head structure, called anchor head, paired with the classification head trained exclusively on labeled anchor data on the server. The anchor head is empowered with a newly designed label contrastive loss based on the cosine similarity metric. Our approach mitigates the confirmation bias and overfitting issues associated with pseudo-labeling techniques based on high-confidence model prediction samples. Extensive experiments on CIFAR10/100 and SVHN datasets demonstrate that our method outperforms the state-of-the-art method by a significant margin in terms of convergence rate and model accuracy

Bariatric Surgical Practice During the Initial Phase of COVID-19 Outbreak

There is no data on patients with severe obesity who developed coronavirus disease 2019 (COVID-19) after bariatric surgery. Four gastric bypass operations, performed in a 2-week period between Feb 24 and March 4, 2020, in Tehran, Iran, were complicated with COVID-19. The mean age and body mass index were 46 ± 12 years and 49 ± 3 kg/m2. Patients developed their symptoms (fever, cough, dyspnea, and fatigue) 1, 2, 4, and 14 days after surgery. One patient had unnoticed anosmia 2 days before surgery. Three patients were readmitted in hospital. All 4 patients were treated with hydroxychloroquine. In two patients who required admission in intensive care unit, other off-label therapies including antiretroviral and immunosuppressive agents were also administered. All patients survived. In conclusion, COVID-19 can complicate the postoperative course of patients after bariatric surgery. Correct diagnosis and management in the postoperative setting would be challenging. Timing of infection after surgery in our series would raise the possibility of hospital transmission of COVID-19: from asymptomatic patients at the time of bariatric surgery to the healthcare workers versus acquiring the COVID-19 infection by non-infected patients in the perioperative period. © 2020, Springer Science+Business Media, LLC, part of Springer Nature

Anemia outcome after laparascopic mini bypass: Analysis of 107 consecutive patients

Background: The prevalence of obesity has dramatically increased globally. Weight loss procedures are known to be an effective and reliable method with relatively low complication rate and satisfactory results. Laparoscopic mini-gastric bypass (LMGB) is known as a modified Mason loop procedure with compatible results to laparoscopic Roux-en-Y gastric bypass (LRYGB), and is believed to have even less complication rate. Despite adequate and meticulous supplement therapy, anemia is one of the challenges in patients undergoing LMGB. Thus, we aimed to review the prevalence and severity of anemia in patients undergoing LMGB. Method: A prospectively-maintained database of patients referring to Hazrat Rasoul Akram hospital who underwent LMGB from December 2013 to October 2014 was reviewed retrospectively. Results: A total of 113 consecutive patients were included in the study. The mean age was 38.7 ± 9.8 years. Mean Body mass index (BMI) was 45.5 ± 6.1 kg/m2 preoperatively and 36.7 ± 5.5 kg/m2 and 33.0 ± 5.3 kg/m2 three and six months after the procedure, respectively. (P = 0.001) Mean excess body weight loss after the procedure was 20 and 53 at three and six months post operatively. Serum hemoglobin (Hb) level decreased significantly in three months (P = 0.036) and remained unchanged in six months compared to 3-month (P = 0.385). Vitamin B12 level increased significantly in three months (P = 0.010) and then decrease in six months to the preoperative level (P = 0.889). Conclusion: LMGB is a safe, feasible and an effective alternative weight loss procedure. Simply, anemia can be prevented by utilizing therapeutic dose of multivitamin in patients who underwent this procedure. © 2016, Universa Press. All rights reserved