Influence of bariatric surgery on the use of some major drug classes

Introduction Patients undergoing bariatric surgery are severely obese and characterized by multidrug use for multiple comorbidities. Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. Aim To study the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type and number of medications and daily dosage. Methods A retrospective and prospective observational study was carried out in Medical Centre Leeuwarden. After having obtained written informed consent drug dispensing data from pharmacies were collected from patients undergoing their first bariatric surgery between January 2008 and September 2011. Dispensing data from 6 months before until 12 months after surgery were analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD). Results 450 patients were included (20.2% male). Mean age (SD) was 43.4 (10.1) yr; mean BMI (SD) was 44.9 (6.7) kg/m2. Roux-en-Y gastric bypass was performed in 74% of the patients. Mean BMI (SD) 12 months after surgery was 31.1 (5.6) kg/m2. The mean number of drugs per patient (95% CI) decreased from 3.66 (3.37-3.99) to 3.25 (3.04- 3.56). The mean number of drugs per patient decreased by 71%, 36%, 27%, 47%, 24% and 33% for antidiabetics, diuretics, beta blockers, agents acting on the reninangiotensin system, lipid modifying agents, and drugs for obstructed airway diseases respectively 12 months after surgery. From those drug classes patients used lower DDD 12 months after surgery. In contrast, a higher DDD was observed for thyroid hormone with no change in the mean number of drugs per patient. Conclusion Twelve months after bariatric surgery the use of drugs decreases in terms of mean number of drugs per patient and, for some major drug classes, in dose intensity. Dispensing data from pharmacies may provide detailed information on the use of medication by patients after bariatric surgery

Influence of bariatric surgery on the use of medication

PURPOSE: Bariatric surgery can influence the prevalence and incidence of comorbidities, as well as the pharmacokinetics of drugs. This might lead to changes in the use of drugs. This study aimed to assess the influence of bariatric surgery on the use of medication in patients before and after surgery, focusing on type, number of medications, and daily dosage.METHODS: In a retrospective and prospective observational study, drug dispensing data from pharmacies of patients undergoing their first bariatric surgery between January 2008 and September 2011 was collected. Dispensing data from 1 month before until 12 months after surgery was analyzed. Drugs were classified according to the WHO-ATC classification system. Dosages of drugs were compared using defined daily dose (DDD).RESULTS: Among 450 patients, 12 months after surgery, the mean number of drugs per patient for antidiabetics, drugs acting on the cardiovascular system, anti-inflammatory and antirheumatic drugs, and drugs for obstructed airway diseases decreased by, respectively, 71.3 % (95 % CI 57.2 to 85.4), 34.5 % (95 % CI 28.2 to 43.0), 45.5 % (95 % CI 13.3 to 72.6), and 33.1 % (95 % CI 15.3 to 53.2). Patients used lower median DDD of oral antidiabetics, beta-blocking agents, and lipid-modifying drugs.CONCLUSIONS: For some major drug classes 12 months after bariatric surgery, the use of drugs decreases in terms of mean number per patient. A reduction in dose intensity was observed for oral antidiabetics, beta-blocking agents, and lipid-modifying drugs. Dispensing data from pharmacies may provide detailed information on the use of medications by patients after bariatric surgery.</p

Hemoglobin levels and new-onset heart failure in the community

Background In established cardiovascular disease and heart failure (HF), low hemoglobin levels are associated with unfavorable outcome. Whether hemoglobin levels are associated with the development of new-onset HF in the population is unclear. This study sought to investigate the relationship between hemoglobin levels and development of new-onset HF in the community. Methods In 6,744 patients from PREVEND, a prospective, community-based, cohort study, we analyzed the relationship between hemoglobin levels and the risk of new-onset HF. Results Mean age (+/- SD) was 53 +/- 12 years, 49.8% was male, and mean hemoglobin level was 13.7 +/- 1.2 g/dL. During a median follow-up of 8.3 years (interquartile range 7.8-8.9), 217 subjects (3.2%) were newly diagnosed with HF. The association between hemoglobin levels and the risk for new-onset HF was U shaped (P 16 g/dL or women >15 g/dL; P = .041), whereas on the other side of the distribution, only severe anemia (men Conclusions The impact of hemoglobin level on the risk of new-onset HF in the community is best described as U shaped. Interestingly, higher hemoglobin levels, already within the high-reference range, are associated with an increased incidence. This in contrast to anemia, where a higher annual HF incidence was only observed for severe anemia

Towards absolute plate motions constrained by lower-mantle slab remnants

Since the first reconstruction of the supercontinent Pangaea, key advances in plate tectonic reconstructions have been made1. Although the movement of tectonic plates since the start of the mid-Cretaceous period (~100 million years (Myr) ago) is relatively well understood1, 2, the longitudinal position of plates before this period is not constrained at all. Here, we use a global mantle tomography model to estimate the longitude of past oceanic subduction zones. We identify 28 remnants of oceanic plates that were subducted into the lower mantle and link these to the mountain building zones from which they are likely to have originated. Assuming that these remnants sank vertically through the mantle, we reconstruct the longitude at which they were subducted. Our estimates for the location of the subduction zones are offset by up to 18° compared with plate tectonic reconstructions for the corresponding period. We did not detect oceanic plate remnants from the Carboniferous period (~300–360 Myr ago), or before, suggesting that the tomographic visibility of subduction is limited to the past 300 Myr

Southwest Pacific Absolute Plate Kinematic Reconstruction Reveals Major Cenozoic Tonga-Kermadec Slab Dragging

Tectonic plates subducting at trenches having strikes oblique to the absolute subducting plate motion undergo trench-parallel slab motion through the mantle, recently defined as a form of “slab dragging.” We investigate here long-term slab-dragging components of the Tonga-Kermadec subduction system driven by absolute Pacific plate motion. To this end we develop a kinematic restoration of Tonga-Kermadec Trench motion placed in a mantle reference frame and compare it to tomographically imaged slabs in the mantle. Estimating Tonga-Kermadec subduction initiation is challenging because another (New Caledonia) subduction zone existed during the Paleogene between the Australia and Pacific plates. We test partitioning of plate convergence across the Paleogene New Caledonia and Tonga-Kermadec subduction zones against resulting mantle structure and show that most, if not all, Tonga-Kermadec subduction occurred after ca. 30 Ma. Since then, Tonga-Kermadec subduction has accommodated 1,700 to 3,500 km of subduction along the southern and northern ends of the trench, respectively. When placed in a mantle reference frame, the predominantly westward directed subduction evolved while the Tonga-Kermadec Trench underwent ~1,200 km of northward absolute motion. We infer that the entire Tonga-Kermadec slab was laterally transported through the mantle over 1,200 km. Such slab dragging by the Pacific plate may explain observed deep-slab deformation and may also have significant effects on surface tectonics, both resulting from the resistance to slab dragging by the viscous mantle