Validation of Doi’s weighted average glucose as a measure of post-load glucose excursion for clinical use

In this study, we examined the performance of a novel index of glucose excursion (Doi’s weighted average glucose [dwAG]) in relation to the conventional measure of area under the oral glucose tolerance test (A-GTT) and the homeostatic model assessment for insulin sensitivity (HOMA-S) and pancreatic beta cell function (HOMA-B). A cross-sectional comparison of the new index was conducted using 66 oral glucose tolerance tests (GTTs) performed at different follow-up times among 27 participants who had undergone surgical subcutaneous fat removal (SSFR). Comparisons across categories were made using box plots and the Kruskal-Wallis one-way ANOVA on ranks. Passing-Bablok regression was used to compare the dwAG against the conventional A-GTT. The Passing-Bablok regression model suggested a cutoff for normality for the A-GTT of 15.14 mmol/L·2h-1 compared to the dwAG’s suggested threshold of 6.8 mmol/L. For every 1 mmol/L·2h-1 increase in A-GTT, the dwAG value increased by 0.473 mmol/L. The glucose area under the curve correlated well with the four defined dwAG categories, with at least one of the categories having a different median A-GTT value (KW Chi2 = 52.8 [df = 3], P < 0.001). The HOMA-S tertiles were also associated with significantly different levels of glucose excursion measured through both the dwAG value (KW Chi2 = 11.4 [df = 2], P = 0.003) and A-GTT measure (KW Chi2 = 13.1 [df = 2], P = 0.001). It is concluded that the dwAG value and categories serve as a simple and accurate tool that can be used for interpreting glucose homeostasis across clinical settings.

Date Palm Thorn Injury: A Literature Review and a Case Study of Extensive Hand Haematoma.

Date palm thorn injuries require a high level of clinical suspicion and careful management as they can lead to severe complications, such as tissue inflammation, synovitis, and extensive haematoma. Although it is associated with serious injuries, this type of injury is often underdiagnosed and is not sufficiently reported in the literature. We describe a case report of an 18-year-old male patient who presented with significant progressive swelling of the right hand that extended to the distal third of the forearm, having received a date thorn injury the day before. The patient underwent multiple incisions and hand fasciotomy to reduce the haematoma and relieve compartment pressure in his hand

The impact of prior obesity surgery on glucose metabolism after body contouring surgery: A pilot study

Body contouring surgery enhances physical appearance by means of surgical subcutaneous fat removal (SSFR). However, it remains unclear how SSFR may affect glucose metabolism and its broader effects on the endocrine system, especially in individuals who have undergone obesity (bariatric) surgery. This study aimed to evaluate the impact of SSFR on glucose excursion and insulin resistance in such patients, by examining them over three visits (within 1 week before surgery, 1 week after surgery, and 6 weeks after surgery). The independent impact of SSFR and history of obesity surgery on glucose homeostasis was evaluated in 29 participants, of whom ten patients (34%) had a history of obesity surgery. Indices of glucose metabolism were evaluated using cluster robust-error logistic regression. Results indicated that SSFR led to a gross improvement in insulin resistance at 6 weeks after the surgery in all patient’s irrespective of BMI, type 2 diabetes mellitus (T2D) status, or history of obesity surgery (OR 0.22; p = 0.042). However, no effect was observed on glucose excursion except for a transient increase at visit 2 (1 week after surgery) in those without prior obesity surgery. Interestingly, participants with a history of obesity surgery had approximately half the odds being in the upper tertile for HOMA-IR (OR 0.44; p = 0.142) and ten-folds lower odds of having severely abnormal glucose excursion (OR 0.09; p = 0.031), irrespective of their BMI, T2D status, or time post SSFR. In conclusion, this study showed that body contouring surgery through SSFR resulted in (at least) short-term improvement in insulin resistance (independent of the participant’s BMI, T2D status, or history of obesity surgery) without affecting glucose excursion under the GTT. On the contrary, obesity surgery may have a long-term effect on glucose excursion, possibly due to sustained improvement of pancreatic ß-cell function

Metabolic aspects of surgical subcutaneous fat removal: An umbrella review and implications for future research

Although obesity is a preventable disease, maintaining a normal body weight can be very challenging and difficult, which has led to a significant increase in the demand for surgical subcutaneous fat removal (SSFR) to improve physical appearance. The need for SSFR is further exacerbated because of the global rise in the number of bariatric surgeries, which is currently the single most durable intervention for mitigating obesity. Fat tissue is now recognized as a vital endocrine organ that produces several bioactive proteins. Thus, SSFR-mediated weight (fat) loss can potentially have significant metabolic effects; however, currently, there is no consensus on this issue. This review focuses on the metabolic sequelae after SSFR interventions for dealing with cosmetic body appearance. Data was extracted from existing systematic reviews and the diversity of possible metabolic changes after SSFR are reported along with gaps in the knowledge and future directions for research and practice. We conclude that there is a potential for metabolic sequelae after SSFR interventions and their clinical implications for the safety of the procedures as well as for our understanding of subcutaneous adipose tissue biology and insulin resistance are discussed

The Economic Impact of Optimizing a COVID-19 Management Protocol in Pre-Existing Cardiovascular Disease Patients

This study answers the question of whether the health care costs of managing COVID-19 in preexisting cardiovascular diseases (CVD) patients increased or decreased as a consequence of evidence-based efforts to optimize the initial COVID-19 management protocol in a CVD group of patients. A retrospective cohort study was conducted in preexisting CVD patients with COVID-19 in Hamad Medical Corporation, Qatar. From the health care perspective, only direct medical costs were considered, adjusted to their 2021 values. The impact of revising the protocol was a reduction in the overall costs in non-critically ill patients from QAR15,447 (USD 4243) to QAR4337 (USD 1191) per patient, with an economic benefit of QAR11,110 (USD 3051). In the critically ill patients, however, the cost increased from QAR202,094 (USD 55,505) to QAR292,856 (USD 80,433) per patient, with added cost of QAR90,762 (USD 24,928). Overall, regardless of critical care status, the optimization of the initial COVID-19 protocols in patients with preexisting CVD did not reduce overall health care costs, but increased it by QAR80,529 (USD 22,117) per patient

Validation of a risk prediction model for COVID-19: the PERIL prospective cohort study.

This study aims to perform an external validation of a recently developed prognostic model for early prediction of the risk of progression to severe COVID-19. Patients were recruited at their initial diagnosis at two facilities within Hamad Medical Corporation in Qatar. 356 adults were included for analysis. Predictors for progression of COVID-19 were all measured at disease onset and first contact with the health system. The C statistic was 83% (95% CI: 78%-87%) and the calibration plot showed that the model was well-calibrated. The published prognostic model for the progression of COVID-19 infection showed satisfactory discrimination and calibration and the model is easy to apply in clinical practice.d.This study was approved by the medical ethics committee of Qatar University and Hamad Medical Corporation (protocol nuos. QU-IEB 1434-E/20 and MRC 05-137, respectively) and written informed consent was obtained from all participants

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Metabolic changes after surgical fat removal: Current gaps and suggestions for future studies

Dear Editor, We read with interest the letter by Seretes et al. discussing the findings and limitations of our evidence synthesis regarding the metabolic implications of surgical subcutaneous fat removal (SSFR).1 It is true that existing studies were of small sample size, heterogeneous in terms of baseline body mass index (BMI), type and amount of SSFR, gender differences, as well as participants' behaviour in terms of diet and exercise.2 While this has a bearing on the results of this paper, a meta-analysis generates an average effect over the multiple studies and those till date3, 4, 5, 6, 7, 8 have failed to generate consensus because they did not address the heterogeneity in follow-up duration among the included studies. Our dose-response meta-analysis (DRMA)1 aimed not only to pool previous studies to reach a bigger sample size and stronger conclusion, but also to account for differences in follow-up time. Thus, regardless of the existing heterogeneity in patient characteristics, there was a metabolic effect demonstrable for SSFR and these results are consistent with the observation that even a small amount of fat reduction can have a significant metabolic benefit on insulin sensitivity, inflammation, and blood pressure.9, 10 With the current advancement in our understanding regarding fat tissue being an active endocrine organ rather than an energy store, as well as the accelerating increase in demand for such body contouring surgeries (that lead to SSFR) to improve body shape quickly, it is essential to further investigate the metabolic changes after these surgeries, not only to confirm the safety of these procedures, but also to help us to understand the mechanisms underpinning the link between obesity and metabolic diseases and the impact of various patient differences on metabolic sequalae. Our meta-analysis is reassuring in that metabolic safety seems plausible and therefore the focus now needs to be on additional sources of population heterogeneity such as existing comorbidities such as diabetes mellitus and history of previous bariatric surgery,11 which could alter the metabolic trajectory after SSFR. As Seretes aptly concludes, future controlled studies with homogenous samples, proper methodology, and adequate follow-up remain of high importance to clarify the role of different patient factors on metabolism after surgical1 (SSFR) and non-surgical12 (NSSFR) subcutaneous fat removal.This project was supported by the Medical Research Office at Hamad Medical Corporation ( #01-20-466 ) and the Qatar National Research Fund (Project #NPRP14S-0406-210153 )