Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management

Bariatric surgery is today the most effective long-term therapy for the management of patients with severe obesity, and its use is recommended by the relevant guidelines of the management of obesity in adults. Bariatric surgery is in general safe and effective, but it can cause new clinical problems and is associated with specific diagnostic, preventive and therapeutic needs. For clinicians, the acquisition of special knowledge and skills is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present recommendations, the basic notions needed to provide first-level adequate medical care to post-bariatric patients are summarised. Basic information about nutrition, management of co-morbidities, pregnancy, psychological issues as well as weight regain prevention and management is derived from current evidences and existing guidelines. A short list of clinical practical recommendations is included for each item. It remains clear that referral to a bariatric multidisciplinary centre, preferably the one performing the original procedure, should be considered in case of more complex clinical situations

Breast cancer, psychological distress and life events among young women

Since 1983, studies have suggested an interaction between the severe life events, psychological distress and the etiology of Cancer. However, these associations are still under dispute

Implikasi Resentralisasi Kewenangan Pertambangan Timah Terhadap Potensi Pendapatan Daerah di Bangka Belitung

Kebijakan hukum pertambangan di Indonesia dipengaruhi oleh berbagai faktor, termasuk politik hukum domestik, fluktuasi harga pasar global, ketersediaan sumber daya, dan persaingan internasional. Pasal 33 Ayat (3) Undang-Undang Dasar 1945 menjadi dasar konstitusional tertinggi dalam pengelolaan pertambangan mineral dan batubara di Indonesia, yang memberikan tanggung jawab kepada negara dalam mengatur, mengelola, dan mengawasi sektor ini. Namun, perkembangan kebijakan pertambangan, terutama terkait dengan pengalihan kewenangan dari pemerintah daerah ke pemerintah pusat, memiliki implikasi signifikan. Penelitian ini bertujuan untuk mengelaborasi implikasi kebijakan resentralisasi pertambangan timah pasca penetapan UU No. 3 Tahun 2020 tentang Mineral dan Batubara di Bangka Belitung. Dengan metode penelitian yuridis-normatif dan pendekatan konseptual serta perundang-undangan, penelitian ini menelaah konsekuensi dalam hubungan kewenangan dan perimbangan keuangan untuk menemukan relevansi antara das sollen dan das sein dalam manajemen pertambangan timah dan pembangunan daerah. Hasil penelitian ini menunjukan resentralisasi kewenangan pertambangan menghasilkan implikasi langsung pada depresi pendapatan daerah dari sektor Pendapatan Asli Daerah (PAD) dan Dana Bagi Hasil (DBH) Minerba. Kontribusi industri ekstraktif terhadap postur ekonomi menghasilkan dependensi yang tinggi terhadap timah, sehingga peralihan kewenangan mereduksi kompetensi pemerintah daerah provinsi dalam mengendalikan penerimaan dari sektor PAD dan DBH. Sementara implikasi tidak langsung dari resentralisasi adalah kompleksitas tata kelola pertambangan yang menyulitkan daerah untuk melakukan penataan, terutama sebelum peraturan pelaksana dapat diberlakukan secara optimal. Penambangan ilegal yang masih menjamur berkontribusi pada kerusakan lingkungan dan degradasi fungsi lahan, sungai, dan perairan yang menyurutkan potensi pengembangan sektor ekonomi non-ekstraktif. Dengan demikian, strategi dan kebijakan kolektif menjadi urgensitas yang tidak terhindarkan guna mengoptimalkan hubungan kewenangan dan perimbangan keuangan pusat dan daerah secara holistik

Managing the Unpredictable: Mechanistic Analysis and Clinical Recommendations for Lamotrigine Treatment after Bariatric Surgery

Bariatric surgery may alter the absorption and overall bioavailability of oral drugs. Lamotrigine is a major antiepileptic and mood stabilizer, that its use after bariatric surgery has not yet been studied. In this article, we provide a thorough mechanistic analysis of the effects of bariatric surgery on multiple mechanisms important for the absorption, bioavailability and overall pharmacokinetics of lamotrigine. Attributable to its pharmacokinetic properties and drug characteristics, the use of lamotrigine after bariatric surgery may be challenging. The complex situation in which some mechanisms may lead to increased drug exposure (e.g., decreased metabolism, weight loss) while others to its decrease (e.g., hampered dissolution/solubility, decreased gastric volume), may result in lowered, unchanged, or enhanced lamotrigine plasma levels after the surgery. We conclude with a set of clinical recommendations for lamotrigine treatment after bariatric surgery, aiming to allow better patient care, and emphasizing the extra caution that needs to be taken with these patients

Treatment of COVID-19 Patients Post-Bariatric Surgery: Issues for Consideration

As COVID-19 has been expanding rapidly around the world, the types of patients and their backgrounds vary. The substantially altered GI anatomy/physiology after bariatric surgery presents new challenges to the field of oral drug therapy. In this report we highlight issues for consideration when treating COVID-19 patients who previously underwent bariatric surgery and provide practical tools to allow optimal care of these patients. Post-bariatric absorption/pharmacokinetic changes may warrant dose adjustment, as well as the use of liquid oral dosage forms or parenteral routes of administration, if available. Realizing the potentially altered pharmacokinetics of various drugs after bariatric surgery is essential for providing optimal pharmacological therapy and overall patient care

Individual and community-level factors associated with caesarean section in Haiti: secondary analysis of data from the 2016–2017 Haitian Demographic and Health Survey

Abstract Introduction For several decades, the rate of caesarean section (CS) has been increasing in the world. In some countries, the CS rate is below the WHO recommended range (10–15%), while in other countries, it is significantly higher. The aim of this paper was to identify individual and community-level factors associated with CS in Haiti. Methods Secondary data analysis was conducted on nationally representative cross-sectional survey data from the 2016–2017 Haitian Demographic and Health Survey (HDHS). The analysis was restricted to 6303 children born in 5 years prior the survey (of the interviewed women). The study population’ characteristics, and the prevalence of CS were analysed using descriptive analysis (univariate/bivariate). In addition, multilevel binary logistic regression analysis was performed to identify factors associated with CS. Both descriptive and multivariate analysis were conducted using STATA 16.0 software (Stata Corp, Tex, USA). Statistical significance was declared at p < 0.05. Results The overall prevalence of CS delivery was estimated at 5.4% (95% CI 4.8–6.0) in Haiti. Results also revealed that mothers aged 35 and above (aOR = 1.38; 95% CI 1.00–1.96); who attended secondary (aOR = 1.95; 95% CI 1.39–2.76) and higher education level (aOR = 3.25; 95% CI 1.92–5.49); who were covered by health insurance (aOR = 2.57; 95% CI 1.57–4.19); with less than 3 children (aOR = 4.13; 95% CI 2.18–7.85) or 3–4 children (aOR = 2.07; 95% CI 1.09–3.94); who received 9 or more antenatal visits (aOR = 2.21; 95% CI 1.40–3.50) were significantly more likely to deliver by CS. Children in communities with high preponderance of private health facilities had greater odds to be delivered through CS (aOR = 1.90; 95% CI 1.25–2.85). Furthermore, children with an average birth weight (aOR = 0.66; 95% CI 0.48–0.91) were less likely to be delivered through CS than their counterparts with high birth weight. Conclusions While the CS prevalence was low in Haiti, it masks significant geographic, social and economic disparities. To better develop and implement maternal and child health programs that address CS deliveries, the government authorities and NGOs operating in the field of women’s health in Haiti should take these disparities into account

Increased Paracetamol Bioavailability after Sleeve Gastrectomy: A Crossover Pre- vs. Post-Operative Clinical Trial

Oral drug bioavailability may be significantly altered after laparoscopic sleeve gastrectomy (LSG), the most popular bariatric procedure worldwide. Paracetamol (acetaminophen) is the post-bariatric analgesic/antipyretic drug of choice. In this work we studied and analyzed the LSG effects on systemic bioavailability and pharmacokinetics of paracetamol after oral administration of solid vs. liquid dosage form. A 4-armed, pharmacokinetic, crossover trial was performed in patients enrolled for LSG. Single paracetamol dose (500 mg), as caplet (n = 7) or syrup (n = 5), was administered before vs. 4&ndash;6 months post-LSG. Bioavailability was enhanced after LSG; in the caplet groups, average AUC0&ndash;t increased from 9.1 to 18.6 &micro;g&middot;h/mL with AUC0&ndash;t difference of 9.5 &micro;g&middot;h/mL (95% CI 4.6&ndash;14.5, p = 0.003). Cmax increased from 1.8 (95% CI 1.2&ndash;2.5) to 4.2 &micro;g/mL (3.6&ndash;4.8) after LSG (p = 0.032). In the syrup groups, AUC0&ndash;t increased from 13.4 to 25.6 &micro;g&middot;h/mL, with AUC0&ndash;t difference of 12.2 &micro;g&middot;h/mL (95% CI 0.9&ndash;23.5, p = 0.049). Cmax changed from 5.4 (95% CI 2.5&ndash;8.4) to 7.8 &micro;g/mL (6.1&ndash;9.6), and systemic bioavailability was complete (102%) after the surgery. Overall, decreased paracetamol exposure in obesity, with recovery to normal drug levels (caplet) or even higher (syrup) post-LSG, was revealed. In conclusion, attention to paracetamol effectiveness/safety in obesity, and after bariatric surgery, is prudent