Associations between zinc deficiency, taste changes and salivary flow rate following gastric bypass and sleeve gastrectomy surgeries

Background. The prevalence of taste change (hypogeusia) and its association with zinc deficiency is unclear due to differences in methods of assessment. We investigate the prevalence of hypogeusia using mixed methods and link it with changes in zinc levels following mini gastric bypass (MGB) and sleeve gastrectomy (SG). Methods. This was a prospective observational study of MGB (N = 18) and SG (N = 25). Hypogeusia was evaluated by using a validated questionnaire and by taste strips procedure along with serum zinc levels and salivary flow rate measurements. Results. The mean age was 40.0 ± 9.7 years; 60.5% were female. By using a questionnaire, MGB patients experienced greater hypogeusia than SG at 3 months (72.0% vs 36.0%; ()), but not at 6 months (56.0% vs 45.0%; ()), respectively. Using taste strips, at 6 months, more MGB patients experienced hypogeusia compared with SG (44.0% vs 11.0%; ). Zinc level was reduced following MGB at 6 months (85.6 ± 16.9 μgm/dl vs 67.5 ± 9.2 μgm/dl; ()) but was increased at 6 months following SG (76.9 ± 11.4 vs 84.9 ± 21.7 μgm/dl). Reduction in the rate of salivary flow was observed in 66.0% and 72.0% of MGB and SG patients, respectively, at 3 months and in 53.0% and 70.0% at 6 months. Conclusion. Taste change is more prevalent following MGB compared with SG, especially at 6 months postoperation which parallel with changes in zinc levels. More than half of all patients who had undergone bariatric surgery (BS) had low to very low salivary flow rates during the follow-up. This study suggests an association between low zinc levels and reduced salivary flow with hypogeusia following BS

Diabetic Ketoacidosis Following Bariatric Surgery in Patients With Type 2 Diabetes

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Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Medium to long-term outcomes of bariatric surgery in older adults with super obesity

Background: Indications and outcomes of bariatric surgery in older adults suffering from morbid obesity remain controversial. We aimed to evaluate safety and medium to long-term outcomes of bariatric procedures in this patient population.Setting: University Hospital, Canada.Methods: This is a single-center retrospective study of a prospectively-collected database. We included patients aged ≥60years who underwent sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB) or biliopancreatic diversion with duodenal switch (BPD/DS) between January 2006-December 2014 and had at least 2 years of follow-up.Results: 104 patients underwent 115 bariatric surgeries (11 patients had two procedures). Sixty-six patients were super-obese (BMI>50kg/m2). Seventy-four percent had SG, 16% RYGB, and 8% underwent BPD/DS. Mean age and BMI were 63.3±2.6years and 51.7±8.1kg/m2, respectively. Average follow-up time was 42±19months. At baseline, 78% had hypertension (HTN), 60% had type-2 diabetes mellitus (T2D), and 30% had obstructive sleep apnea (OSA). There was no 30-day mortality. Complication rate was 14%(n=16): 2 leaks post-RYGB, 1 leak post-BPD/DS, 1 obstruction post-SG, 1 bleeding requiring transfusion, 1 liver injury with bile leak, 2 port-site hernias, 1 myocardial infarction, 2 gastro-jejunal strictures, 1 wound infection, 1 urinary tract infection, and 3 gastric reflux exacerbations. Mean percent excess weight loss (%EWL) at 2 years was 52.2±23.8. Remission rates of HTN, T2D and OSA were 26%, 44% and 38%, respectively.Conclusion: Bariatric surgery is safe and effective in improving obesity-related comorbidities in older patients suffering from morbid obesity. Age alone should not preclude older patients from getting the best bariatric procedure for obesity and related comorbidities.Contexte : Les indications et les résultats de la chirurgie bariatrique chez les personnes âgées souffrant d'obésité morbide demeurent controversés. Nous visions à évaluer la sécurité et les résultats à moyen et à long terme des procédures bariatriques dans cette population de patients. Lieu : Hôpital universitaire, Canada. Méthodes : Il s'agit d'une étude rétrospective monocentrique d'une base de données prospectivement collectée. Nous avons inclus des patients âgés de ≥ 60 ans qui ont subi une gastrectomie verticale (SG), une dérivation gastrique en anse en-Y (RYGB) ou une dérivation biliopancréatique avec un switch duodénal (BPD/DS) entre janvier 2006 et décembre 2014 et qui avaient ai minimum 2 ans de suivi. Résultats : 104 patients ont subi 115 chirurgies bariatriques (11 patients ont eu deux procédures). Soixante-six patients étaient super-obèses (IMC> 50 kg / m2). Soixante-quatorze pour cent avaient SG, 16% RYGB, et 8% ont subi BPD/DS. L'âge moyen et l'IMC étaient respectivement de 63,3 ± 2,6 ans et de 51,7 ± 8,1 kg / m2. Le temps moyen de suivi était de 42 ± 19 mois. Au départ, 78% souffraient d'hypertension (HTN), 60% de diabète sucré de type 2 (DT2) et 30% d'apnée obstructive du sommeil (AOS). Il n'y avait pas de mortalité de 30 jours. Le taux de complication était de 14% (n = 16): 2 fuites post-RYGB, 1 fuite post-BPD/DS, 1 obstruction post-SG, 1 saignement nécessitant une transfusion, 1 blessure hépatique avec fuite de bile, 2 hernies, 1 infarctus du myocarde, 2 sténoses gastro-jéjunales, 1 infection de la plaie, 1 infection des voies urinaires et 3 exacerbations du reflux gastrique. Le pourcentage moyen de perte de poids excédentaire à 2 ans était de 52,2 ± 23,8. Les taux de rémission de HTN, DT2 et AOS étaient de 26%, 44% et 38%, respectivement.5Conclusion : La chirurgie bariatrique est sûre et efficace pour améliorer les comorbidités liées à l'obésité chez les patients âgés souffrant d'obésité morbide. L'âge seul ne devrait pas empêcher les patients plus âgés d'obtenir la meilleure procédure bariatrique pour l'obésité et ses comorbidités

Recent Advances in Protective Vaccines against Hepatitis Viruses: A Narrative Review

Vaccination has been confirmed to be the safest and, sometimes, the only tool of defense against threats from infectious diseases. The successful history of vaccination is evident in the control of serious viral infections, such as smallpox and polio. Viruses that infect human livers are known as hepatitis viruses and are classified into five major types from A to E, alphabetically. Although infection with hepatitis A virus (HAV) is known to be self-resolving after rest and symptomatic treatment, there were 7134 deaths from HAV worldwide in 2016. In 2019, hepatitis B virus (HBV) and hepatitis C virus (HCV) resulted in an estimated 820,000 and 290,000 deaths, respectively. Hepatitis delta virus (HDV) is a satellite virus that depends on HBV for producing its infectious particles in order to spread. The combination of HDV and HBV infection is considered the most severe form of chronic viral hepatitis. Hepatitis E virus (HEV) is another orally transmitted virus, common in low- and middle-income countries. In 2015, it caused 44,000 deaths worldwide. Safe and effective vaccines are already available to prevent hepatitis A and B. Here, we review the recent advances in protective vaccines against the five major hepatitis viruses