CHANGES IN EATING BEHAVIOURS FOLLOWING BARIATRIC SURGERY: A PROSPECTIVE STUDY

Adopting healthy eating behavior is important in achieving successful weight loss after bariatric surgery. This study aims to determine the changes in eating behaviors 6 months after surgery. Fifty-seven patients who went through bariatric surgery in two tertiary referral hospitals were recruited and interviewed before surgery (T0), three (T1), and six (T2) months after surgery. Eating behaviors were assessed using the Dutch Eating Behavior Questionnaire (DEBQ), which measured emotional, external, and restrained eating. Higher subscale scores indicate strong behavioral traits. Other information including psychological distress, quality of life, socio-demography, and morbidity were collected. Generalized Estimating Equation (GEE) model was developed to study the change in eating behaviors and its’ predictors over time. Participants of the study were mostly women, from the Malay ethnic group and the average age at the time of surgery was 39.4 years. Emotional and external eating scores changed significantly over time with the values recorded at various time intervals as follows: 2.06 and 2.86 before surgery; 1.64 and 2.25 three months after surgery; and 1.81 and 2.40, 6 months after surgery. Reduction in the third month followed by a slight increase at the sixth was noted. Restrained eating did not show a significant change. The presence of diabetes was also associated with higher emotional and external eating scores. Further, higher anxiety scores were associated with higher external eating. Favorable changes in eating behaviors were noted after bariatric surgery. However, a risk of a reversal in the improvement was present. The emotional and external eating behaviors in surgical candidates should be identified and addressed accordingly with special attention to diabetic patients

Immunophenotyping of gastritis, gastric ulcer and gastric cancer using a cluster of differentiation (CD) antibody microarray

One of the factors that contribute to the development of gastric cancer is the host immune response. Extensive immunophenotype of gastric cancer can be identified by using antibody microarray technique that profiles more than 100 cluster of differentiation (CD) antigens in parallel. In this study, we used DotScanTM antibody microarray to profile CD antigen expression in patients with distinct digestive diseases for surface antigen disease-signatures. Patients’ blood samples with gastric disorders and healthy controls were taken and processed for leukocytes isolation using Histopaque density gradient centrifugation. Leukocytes were captured onto DotScanTM slides and cell binding densities were analyzed using DotReaderTM. Different groups of gastric diseases were found to be characterized by differentially expressed distinct CD antigens. Compared to normal healthy controls, 17, two and four highly expressed CD antigens were identified in gastritis, gastric ulcer and gastric cancer patients, respectively. The 17 CD antigens that show differential expression in gastritis were CD15, CD16, CD20, CD23, CD24, CD25, CD28, CD34, CD37, CD77, CD102, CD103, CD122, CD128, CD10, CD183, and CD184. High expression of CD64 and CD69 were found in gastric ulcer, whereas CD52, CD126, CD135, and CD121a were highly expressed in gastric cancer. CD antigens involve in T-cell functions had reduced expression in gastric cancer, while proinflammatory cytokines shows increased expression. These results demonstrate specific immunophenotype of CD antigens in patients with various gastric diseases and identification of differential expressed surface antigens may have clinical significance for diagnostic and therapeutic purposes

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Is bariatic surgery the cure for diabetes mellitus?

Obesity is a life-long, progressive, life-threatening, costly, genetically-related, multi-factorial disease of excess fat storage with multiple co-morbidities. Bariatric Surgery is currently the most effective therapy available for morbid obesity and can result in improvement or complete resolution of obesity related co-morbidities including diabetes mellitus

Retro umbilical abscess mimicking infected urachal cyst: A rare presentation from migratory fish bone ingestion

Foreign body ingestion, especially food bolus like a fishbone, is prevalent in the adult population, usually ingested accidentally with only a small percentage developing a complication. Once complications arises, it will have a wide variety of clinical manifestations. We present a case of a patient with an abdominal wall abscess resulting from migrating ingested fishbone that was treated with antibiotic therapy, drainage of the abscess, and removal of the foreign body.A 58-year-old gentleman presented to our hospital with chronic abdominal pain complaint from the right iliac fossa migrating to the umbilical region. His physical examination revealed swelling, redness, and tenderness over the umbilical region. Computed tomography showed a hypodense rim enhancing collection noted at the umbilical region with extension into the anterior peritoneal cavity with a thin linear dense structure within the collection measuring 4cm in length, likely representing a foreign body. He received antibiotic therapy and subsequently underwent abscess drainage and removal of a foreign body. He had an uneventful postoperative course, and follow up showed no recurrent. An abdominal wall abscess can arise from a complication of migratory fishbone ingestion. Unexplained abdominal wall abscess in an otherwise healthy individual should also raise suspicions of foreign body causing bowel perforation, and treatment should be tailored to the patient's presentation

An innovative technique for surgical positioning in head and neck surgery

Patient positioning is a vital in ensuring patient comfort, dignity and good access to the operative site. Accurate positioning helps in minimising the risk of injury to the patient. An in-house airbag made from recyclable medical supplies can be used to replace the conventional sandbag for head and neck surgeries. It involves the use of an empty irrigation bottle, a valve and suction tubing. Its shape and volume is readily adjustable by altering the volume of inflated air. Moreover, compressible air moulds the bag to the curvature of the patient’s external surface reducing the risk of pressure sores in prolonged surgery. Ultimately this serves as an innovative technique which is financially savvy with the use of recyclable items

A Rare Case of Intussusception Associated with Metastasize Small Cell Carcinoma of Lung

Intussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, The diagnosis may be difficult because of asymptomatic nature of thisbowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness,loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he wastransfused with packed cells. On gastrointestinal (GI) endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CT)scan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed,‘Whipple’s procedure’ was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding

A LESS INVASIVE METHOD OF REDUCING THE INCIDENCE OF POST-ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY PANCREATITIS: INTRAVENOUS DICLOFENAC SODIUM VERSUS PLACEBO

Objective: The purpose of this study is to reduce the incidence of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) by the administration of intravenous (IV) diclofenac sodium.Methods: This is a prospective, randomized, double-blinded control study. This study was performed in the hepatobiliary unit of general surgery department in University Kebangsaan Malaysia Medical Centre (UKMMC) from May 2015 to May 2016. A total of 128 patients were enrolled in this study. 59 patients were randomized into the treatment arm, while 63 were randomized into the control group. Patients were randomized by envelope system, and patients in the treatment arm received 75 mg of diclofenac sodium intravenously, within 30 min of ERCP commencement. Both groups were observed for PEP post-ERCP and their pain score recorded. Patients' demographic data were also observed.Results: A total of 122 patients were included in the study, with 59 patients randomized into the treatment arm and 63 into the placebo arm. There was an increase of 7.6% PEP rates in the placebo group (12.7% vs. 5.1% in the treatment arm). However, this was not statistically significant (p=0.142)Conclusion: This study shows that IV diclofenac sodium can decrease PEP but is not statistically significant