30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients

30-day morbidity and mortality of sleeve gastrectomy, Roux-en-Y gastric bypass and one anastomosis gastric bypass: a propensity score-matched analysis of the GENEVA data

Background: There is a paucity of data comparing 30-day morbidity and mortality of sleeve gastrectomy (SG), Roux-en-Y gastric bypass (RYGB), and one anastomosis gastric bypass (OAGB). This study aimed to compare the 30-day safety of SG, RYGB, and OAGB in propensity score-matched cohorts. Materials and methods: This analysis utilised data collected from the GENEVA study which was a multicentre observational cohort study of bariatric and metabolic surgery (BMS) in 185 centres across 42 countries between 01/05/2022 and 31/10/2020 during the Coronavirus Disease-2019 (COVID-19) pandemic. 30-day complications were categorised according to the Clavien–Dindo classification. Patients receiving SG, RYGB, or OAGB were propensity-matched according to baseline characteristics and 30-day complications were compared between groups. Results: In total, 6770 patients (SG 3983; OAGB 702; RYGB 2085) were included in this analysis. Prior to matching, RYGB was associated with highest 30-day complication rate (SG 5.8%; OAGB 7.5%; RYGB 8.0% (p = 0.006)). On multivariate regression modelling, Insulin-dependent type 2 diabetes mellitus and hypercholesterolaemia were associated with increased 30-day complications. Being a non-smoker was associated with reduced complication rates. When compared to SG as a reference category, RYGB, but not OAGB, was associated with an increased rate of 30-day complications. A total of 702 pairs of SG and OAGB were propensity score-matched. The complication rate in the SG group was 7.3% (n = 51) as compared to 7.5% (n = 53) in the OAGB group (p = 0.68). Similarly, 2085 pairs of SG and RYGB were propensity score-matched. The complication rate in the SG group was 6.1% (n = 127) as compared to 7.9% (n = 166) in the RYGB group (p = 0.09). And, 702 pairs of OAGB and RYGB were matched. The complication rate in both groups was the same at 7.5 % (n = 53; p = 0.07). Conclusions: This global study found no significant difference in the 30-day morbidity and mortality of SG, RYGB, and OAGB in propensity score-matched cohorts

Medication Adherence Among Elderly With Hypertension: Johnson Model- based Program

Objectives Hypertension is the most common cause of stroke and kidney failure in the elderly and medication adherence is vital in controlling complications. This study aims to determine the effect of the Johnson model-based program on medication adherence among the elderly with hypertension.Methods & Materials The present study was a clinical trial that was performed on the elderly with hypertension referred to the Shahid Aval comprehensive health service center in Isfahan City, Iran. Through the convenience sampling method, 70 older adults were selected and randomly divided into intervention and control groups. For the intervention group, 6 sessions of a family-based medication adherence program were performed based on the Johnson model. Demographic characteristics questionnaire and sphygmomanometer were used to collect data. Data were analyzed by SPSS version 22 statistical software using independent t test, Chi-square, and repeated measures analysis of variance (ANOVA).Results No difference was observed between the two groups in terms of the distribution of demographic characteristics. Mean systolic and diastolic blood pressure before the intervention in the group were not significantly different, but immediately and three months after the intervention in the intervention group, it was significantly lower than the control group(P<0.05).Conclusion Johnson's model-based program was effective in lowering hypertension in the elderly. Therefore, the method used in the present study is proposed to older adults and elderly care nurses as a simple, non-invasive, low-cost, and effective method of reducing hypertension

The therapeutic consequences of laparoscopic hernia surgery through Totally Extraperitoneal (TEP) route with and/or without takers

Background: Inguinal hernia is a common and widespread disease in the world that millions of people suffer from. Inguinal hernia repair is one of the most common general surgeries. Despite the high prevalence of this disease, no type of surgery has ideal results and postoperative complications still remain. The aim of the current study was to evaluate therapeutic consequences of laparoscopic hernia surgery with totally extraperitoneal (TEP) with and/or without Takers. Methods: Out of 54 patients studied in this clinical trial study, 27 patients underwent TEP using Takers and 27 patients without Taker. The findings were recorded during the operation and compared in 6-month follow-up using a questionnaire. Findings: The duration of operation, the duration of hospitalization, the duration of postoperative pain, and the duration of return to work and normal daily activities were the same in both groups. In terms of hernia recurrence rate, one recurrence was observed in each group. Other complications including infection, neuralgia, and postoperative hematoma were not observed in any of the groups. Conclusion: The present study showed that in patients with inguinal hernia after repair by TEP method, it may not be necessary to use Takers for mesh fixation. © 2021 Isfahan University of Medical Sciences(IUMS). All rights reserved

The effect of home care on readmission and mortality rate in patients with diabetes who underwent general surgeries

BACKGROUND: More than one-half of people with diabetes need at least one surgery in their lifespan. Few studies have addressed how to manage the needs of these patients after discharge from the hospital. The present study is designed to determine the effect of home care on readmission of Type 2 diabetic patients who underwent surgical procedures. MATERIALS AND METHODS: The present study was a randomized clinical trial. Sixty-nine patients with Type 2 diabetes undergoing surgery were assigned to the intervention and control groups via blocking order in the selected educational hospitals of Isfahan 2019. Home care was performed for 3 months with interprofessional team approach. Data collection tools were re-admission checklist. Data were entered in SPSS software version 23 and were analyzed by nonparametric tests. RESULTS: The background characteristics in the intervention and control groups were not different. The frequency of readmission in the control and intervention groups from the time of discharge until 3 months later was 25.7 and 18.9, respectively. Frequency of readmission in the intervention and control groups was not significant in 3 months from discharge, P > 0.05. The mortality rate was 11.4 and 0 in control and intervention groups, respectively, P < 0.05. CONCLUSION: It can be argued that continued home care can decrease the rate of readmission and mortality rate in patients with Type 2 diabetes who will discharge from surgical wards

The Effect of Internal Mesh Fixation and External Fixation (Inguinal Hernia Truss) on Postoperative Complications in Patients with Inguinal Hernia Undergoing Totally Extraperitoneal Laparoscopic Hernioplasty

BACKGROUND: The present study evaluated the effect of internal mesh fixation and external fixation (inguinal hernia truss) on postoperative complications in patients with inguinal hernia. MATERIALS AND METHODS: This randomized clinical trial was performed on 64 patients that were candidates for inguinal hernia repair by laparoscopic method following the totally extraperitoneal procedure. These patients were randomly divided into two groups. In the first group, the mesh was fixed with a maximum of three absorbable tacks. In the second group, the inguinal hernia truss was used as the external fixation for 6 weeks immediately after the surgery. RESULTS: The results revealed that seroma, neuralgia, and recurrence were observed with the values of 6.4, 19.4, and 3.2 in Group A and 3.3, 13.3, and 3.3 in Group B (P > 0.05). Moreover, patients' pain scores 1 week and 1 month after the surgery in Group B were significantly lower than those of Group A (P 0.05). Furthermore, the duration of return to work in Group B with an average of 8.07 +/- 3.09 days was less than that of Group A with the average of 9.65 +/- 5.34 days (P > 0.05). CONCLUSION: The mentioned findings can trigger the use of external fixation and an inguinal hernia truss as a support for the abdominal wall to make the dream of not using a foreign body in the human body come true

Comparison of single absorbable tacker vs. conventional method in fixating the mesh in bilateral inguinal hernia undergoing laparoscopic transabdominal preperitoneal (TAPP): A randomized control trial study

Background: The current study aims to investigate the superior mesh fixation method, single absorbable tacker versus conventional method, in patients undergoing bilateral inguinal hernia repair through the laparoscopic total abdominal preperitoneal (TAPP) approach. Materials and Methods: The current randomized clinical trial has been conducted on 81 patients undergoing bilateral hernia repair through TAPP. The patients were randomly assigned into one of the mesh fixation groups including single absorbable tacker (Group S) (n = 41) and conventional method (Group C) (n = 40). All patients were assessed during the hospital stay and 1 month postoperatively to assess the surgery-associated complications and days for return to daily activity. Eura-Hs questionnaire was applied to assess the quality of life (QOL) after hernia surgery during 12-month follow-up. Results: The duration of bilateral inguinal hernia operation (P = 0.067), postoperative urinary catheterization (P = 0.813), and hospital stay duration (P = 0.779) did not differ between the groups; whereas Group C significantly required a longer time for returning to daily activity (P 0.05); however, a pain subscale was significantly less in Group S (P = 0.002). Conclusion: Based on the findings of this study, a single absorbable tacker was generally superior to the conventional method considering its less pre- and postoperative complications. However, the two methods did not differ regarding 1-year follow-up QOL

Assessment of endothelial function in Iranian healthy obese patients after bariatric surgery

Background: Endothelial function plays a critical role in cardiovascular homeostasis. Morbid obesity is associated with an enhanced risk of atherosclerosis and chronic inflammation. Bariatric surgery (BS) is a promising method used recently for weight loss; however, the number of studies that have examined the effect of BS on endothelial function is limited. This study aimed to investigate the association between endothelial function evaluated by flow-mediated dilation (FMD) and weight loss after BS. Materials and Methods: This is a cross-sectional study conducted in Isfahan, Iran, and included 40 healthy obese individuals who underwent BS as an intervention group and 40 healthy obese patients who did not undergo BS as a control group in a 6-month follow-up duration period. FMD as an indicator of endothelial function was evaluated in these participants. FMD < 7.1 is considered abnormal. Results: There was no significant difference between control and BS groups in terms of age and body mass index (BMI) at baseline. The mean & PLUSMN; standard deviation (SD) of FMD in the BS group pre- and post-intervention were 12.95 & PLUSMN; 6.90 and 37.65 & PLUSMN; 13.52 respectively and the mean & PLUSMN; SD of FMD in the control group were 15.88 & PLUSMN; 6.85 and 15.85 & PLUSMN; 5.83. The association between significant weight loss after BS and FMD was strongly significant (P < 0.001). Conclusions: According to the results of this study, it can be concluded that BS has been effective in terms of improving the FMD as an indicator of endothelial function

Cardiopulmonary protective effects of alprostadil and hydrocortisone against distant organ reperfusion after hind limb ischemia in rat model

Aim: This study was designed to investigate the possible protective effects of alprostadil and hydrocortisone as antioxidants on remote lung and myocardial injury by measuring glutathione level in an experimental rat model of hind limb ischemia-reperfusion. Methods: Ischemia was induced by infra renal aortic occlusion for 1 h in 32 male Wistar rats. Animals were divided into those receiving alprostadil (group IR/A, N.=8), those receiving hydrocortisone (group IR/H, N.=8), control group (group IR, N.=8), and sham group (N.=8). After 2 h of reperfusion blood sample, as well as lung and myocardial tissue samples were taken. Levels of glutathione, a compound used as indirect marker of oxidative stress, were measured in tissues and blood samples. All data were compared using the ANOVA test. Results: Comparison of the IR/A and IR/H vs the IR groups produced statistically significant higher concentration of lung, and blood glutathione in IR/A and IR/H groups. Treatment with alprostadil caused higher myocardial concentration of glutathione than IR rats; however myocardial glutathione levels were not significantly different between the IR/H and IR groups. Conclusion: Intravenous infusion of either alprostadil or hydrocortisone before reperfusion of an acutely ischemic lower limb can reduce the oxidative injury to lung and, myocardial tissue as well as circulation blood