Metabolic surgery: a concise overview and understanding of potential complications

Bariatric surgery, despite a relatively short history, has had a tremendous impact on the discipline of surgery. In addition, it has had a profound influence on the development of laparoscopic surgery and the treatment of the worldwide epidemic of obesity. Contrary to the expectations of the 1990s, that obesity surgery would converge into a single procedure, there has been a trend favouring the safest and least invasive surgery on the one hand, and a diligence towards the most effective and complicated surgery on the other hand. The latter, being the biliopancreatic diversion with duodenal switch, requires advanced laparoscopic skills and an experienced medical team. This review will focus predominantly on the laparoscopic Roux-en-Y bypass, a recognised procedure which is performed in 80% of patients going to theatre for bariatric surgery.Keywords: obesity, bariatric surgery, gastric bypas

Bariatric surgery: risks and recommendations for the prevention of perioperative thromboembolism

No AbstractKey words: obesity; DVT; prophylaxis; surger

The epidemic of childhood obesity

No abstract available

Die operasionalisering van ‘n model vir die ontwikkeling van kliniese verplegingstandaarde

One of the requirements for a nursing model in any field of nursing is its practical implementation. The purpose of this article is to describe how the model for the development of nursing standards in a nursing service was implemented and evaluated An exploratory and descriptive research design was followed, with a simple pilot study during which 9 nurses were requested to give their view on the model. The model was successfully implemented in the nursing service of an academic hospital. Evaluation revealed that the implementation facilitated quality nursing, the resocialising of values and the professional and personal growth of nurses in that nursing service

Micro-milling work-holding devices employing adhesive forces

IngenieursweseBedryfsingenieursweseMicro-parts are often very fragile rendering conventional, mechanical work-holding fixtures unsuitable for them since they exert large straining forces. Furthermore, macroworkholding devices occupy a large space which impedes high precision required in micromilling. Although some micro-clamping fixtures exist, they are limited to specific part shapes and in most cases expensive to manufacture. Hence this paper focuses on the application of adhesive forces namely electrostatic, surface tension and van-der-Waals forces; in work-holding strategies for micro-milling operations. An analysis is given as to their applicability with reference to micro-milling cutting forces

Hookah pipe smoking among health sciences students

BACKGROUND: Hookah pipe smoking is a social practice and has gained popularity, especially among South African youth. The extent of this practice among health sciences students, and their knowledge regarding the health risks, are unknown. This is important, as these students will become future health professionals possibly influencing the practice of individuals and communities. OBJECTIVE: To explore the knowledge, attitudes and practices of hookah pipe smoking among students at the Faculty of Health Sciences, University of Cape Town. METHODS. A cross-sectional study was conducted among undergraduate and postgraduate students. A self-administered questionnaire was distributed as a hard copy and online survey. RESULTS: Of 228 participants, 66% had smoked a hookah pipe before, with 18% still smoking. Most began smoking in high school, with 25% initiating at university. Of the current smokers, 65% smoked occasionally socially, commonly at friends' houses for 30 - 60 min/session. A further 11% smoked cigarettes concurrently and 30% added other substances, mainly cannabis, to pipes. Most current hookah smokers had no interest in quitting (84%). Only 30% of participants had prior health information about hookah pipe smoking. Most knew that it was harmful (91%), with many not knowing why. A total of 80% of participants perceived that the practice was socially acceptable and 84% would recommend it to others.CONCLUSION; The poor knowledge about the dangers of hookah pipe smoking and the extent of its practice among health sciences students is alarming. These findings highlight the need for school and university health promotion campaigns, and for better regulation of hookah pipe smoking

Ethnic differences in lipid metabolism in two groups of obese South African women

There is a higher prevalence of ischemic heart disease (IHD) in South African white than black women. The objective of this study was to determine biochemical explanations for this prevalence. The study group contained 15 obese black women (OBW) and 14 obese white women (OWW), ah premenopausal, who were examined after an overnight fast. Anthropometric measurements and blood concentrations of glucose, non-esterified fatty acids (NEFAs), catecholamines, plasminogen activator inhibitor-1, C-peptide, proinsulin, lipograms, cortisol, growth hormone, and post-heparin Lipoprotein Lipase activity were measured during an oral glucose tolerance test (OGTT), Body composition was measured using bioelectrical impedance analysis, and subcutaneous and visceral fat mass were assessed with CT-scans. Visceral fat area was higher in OWW (139.7 +/- 10.7 cm(2)) than in OBW (72.3 +/- 3.9 cm(2)) (P < 0.01), as were fasting and 3 h triglyceride concentrations (P < 0.05 for all). OWW also had higher NEFA levels than OBW at 3 and 4 h compared, with OBW (P < 0.05 for both). Fasting cortisol (266 +/- 24 vs. 197 +/- 19 nmol/l; P < 0.05) was higher in OWW than in OBW. These data demonstrate that OWW have higher visceral fat mass than OBW, which may lead to a more atherogenic fasting and postprandial Lipid profile. The higher cortisol levels of the OWW may promote visceral fat deposition. - Punyadeera, C., M-T. van der Merwe, N.J. Crowther, M. Toman, C. P. Schlaphoff, and I. P. Gray. Ethnic differences in lipid metabolism in two groups of obese South African women

Association of the ENPP1 rs997509 polymorphism with obesity in South African mixed ancestry learners

Background: The Ectonucleotide Pyrophosphatase Phosphodiesterase1 (ENPP1) polymorphisms have been associated with metabolic traits. There is no data on the effect of ENPP1 in South African children or adults. Objective: To investigate the role of K121Q (rs1044498), rs997509 and rs9402349 in obesity and other components of the metabolic syndrome. Design: A case-control study. Subjects: Sixty four obese and 64 lean mixed ancestry learners. Setting: Western Cape, South Africa. Main outcome measure: The EN PP1 rs997509T allele is independently associated with obesity in children of mixed ancestry from South Africa. Results: The T allele frequency of the rs997509 differed significantly between obese and controls, p=0.0100 and increased the risk of being obese, p = 0.0238. Furthermore, the estimated effect of the T allele was an increase of 8.6 cm in waist circumference, 10.2 kg in weight and a corresponding 4.9 kg/m2 in BMI. Individuals carrying both the 121Q and the T allele of rs997509 were more associated with obesity (odds ratio = 3.85, 95% CI: 1.13 to 13.09) whilst those carrying the C allele of rs997509 in the presence of 121Q were likely to be lean with odds ratio of obesity 0.41 (95% CI: 0.19 to 0.87). Conclusion: Our findings suggest that ENPP1 polymorphisms may contribute to different metabolic characteristics, all of which are associated with insulin resistance in mixed ancestry children of South Africa. However, a larger study is required to confirm findings of this study.East African Medical Journal Vol. 87 No. 8 August 201

Lipid accumulation and alkaline phosphatase activity in human preadipocytes isolated from different body fat depots

Background: Alkaline phosphatase (ALP) controls intracellular lipid accumulation in human preadipocytes, but it is not known whether ALP is expressed in all body fat depots, or whether it has a similar role at all sites.Design: Cross-sectional.Setting and subjects: Subjects undergoing breast reduction and abdominal fat biopsies operations at Charlotte Maxeke Johannesburg Academic Hospital.Outcome measures: This study compared intracellular lipid accumulation and ALP activity in the presence and absence of ALP inhibitors in preadipocytes that were obtained from different adipose depots. Abdominal and mammary gland preadipocytes were isolated from women and induced to differentiate in culture. ALP activity and intracellular lipid levels were measured at baseline and after 12 days of differentiation in the presence and absence of the ALP inhibitors, histidine and levamisole.Results: ALP activity was detected in nondifferentiated abdominal (134 ± 7.5 mU/mg protein) and mammary gland (136 ± 9.6 mU/mg protein) preadipocytes. Its activity had increased significantly (p-value &lt; 0.0005 for both) by day 12 of differentiation (388 ± 55 for abdominal and 278 ± 28 mU/mg protein for mammary). Preadipocytes treated with histidine had lower fat accumulation (p-value &lt; 0.0005) and ALP activity (p-value &lt; 0.005) than nontreated cells on day 12, while those treated with levamisole had lower fat accumulation (p-value &lt; 0.005), but elevatedALP activity (p-value &lt; 0.05), compared to nontreated cells. Lipid  accumulation (p-value &lt; 0.005) and ALP activity (p-value &lt; 0.05) were higher in abdominal than mammary gland preadipocytes by day 12.Conclusion: ALP is involved in the control of intracellular lipid accumulation in human preadipocytes that are isolated from both adipose depots. The ability of levamisole to inhibit this process while activating ALP, suggeststhat this molecule acts via an ALP-independent pathway, while histidine attenuates both lipid deposition and ALP activity