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Introduction: Bariatric surgery (BS) has emerged an effective intervention in achieving significant and sustained weight loss in patients with type 2 diabetes (T2D). However, comprehensive data on the long-term impact of BS on hypertension is scarce. We aimed to investigate the long-term impact of BS on blood pressure management in individuals within a T2D cohort. Methods: This retrospective cohort study was conducted on 119 patients who underwent BS between 2009 and 2012. Baseline and follow-up observations, including blood pressure, HbA1c, BMI, and antihypertensive medication use were obtained from electronic patient records at regular intervals up to and beyond 10-year follow-up. Results: The median follow-up period for the 119 patients was 11.5 years. Mean fall in BMI 4–8 weeks post-surgery was 12%. A sustained reduction in systolic BP was observed up to 10 years post-surgery (154.5 mmHg pre-op vs. 132.8 mmHg at 10 years; p < 0.0001. From 5 years onwards, there were increases in mean glycated hemoglobin (HbA1c) and body mass index (BMI). At latest follow-up (> 5 years after bariatric surgery), the number of individuals prescribed an antihypertensive agent started to increase. This is in the context of the number of the number of individuals on 2–3 antihypertensive agents declining up until 5 years post-BS. Specifically, there was a reduction in the number of prescriptions of an antihypertensive agent over time from 164 prescriptions pre-operatively to 81 at 8 weeks post-operatively, 78 at 6 months, 72 at 1 year, 66 at 5 years before rising at 10 years to 95 prescriptions. Conclusions: Our study shows an overall benefit in the years after bariatric surgery in terms of blood pressure and requirement for antihypertensive medication. However, at 5 years and beyond after surgery, the beneficial effect of bariatric surgery diminishes with respect to an increase in number of antihypertensive medication prescriptions, BMI, and HbA1c. [ABSTRACT FROM AUTHOR]

Bariatric surgery improves dyslipidaemia and reduces body weight, but it remains unclear how bariatric surgery modulates gene expression in fat cells to influence the proprotein convertase subtilisin/kexin type 9 (PCSK-9) and low-density lipoprotein receptor (LDLR) gene expression. The expression of the PCSK9/LDLR/tumor necrosis factor-alpha (TNFα) gene in adipose tissue was measured in two groups of Zucker Diabetic Sprague Dawley (ZDSD) rats after Roux-en-Y gastric bypass (RYGB) surgery or 'SHAM' operation. There was lower PCSK9 (p = 0.02) and higher LDLR gene expression (p = 0.02) in adipose tissue in rats after RYGB. Weight change did not correlate with PCSK9 gene expression (r = −0.5, p = 0.08) or TNFα gene expression (r = −0.4, p = 0.1). TNFα gene expression was positively correlated with PCSK9 gene expression (r = 0.7, p = 0.001) but not correlated with LDLR expression (r = −0.3, p = 0.3). Circulating triglyceride levels were lower in RYGB compared to the SHAM group (1.1 (0.8–1.4) vs. 1.5 (1.0–4.2), p = 0.038) mmol/L with no difference in cholesterol levels. LDLR gene expression was increased post-bariatric surgery with the potential to reduce the number of circulating LDL particles. PCSK9 gene expression and TNFα gene expression were positively correlated after RYGB in ZDSD rats, suggesting that the modulation of pro-inflammatory pathways in adipose tissue after RYGB may partly relate to PCSK9 and LDLR gene expression. [ABSTRACT FROM AUTHOR]

Summary: Bariatric surgery in people with obesity can lead to long‐term remission of type 2 diabetes mellitus (T2DM) and a reduction in the incidence of macrovascular complications. The impact of bariatric surgery on microvascular complications is less clear. In this narrative review, we sought to evaluate the effect of bariatric surgery on microvascular complications in patients with and without diabetes. The risk of developing microvascular complications is increased in people with obesity, and this is amplified in those with T2DM. The impact of metabolic surgery on microvascular complications is limited to a subgroup analysis of studies or statistical modeling to predict the glycemia‐independent effect of bariatric surgery. While bariatric surgery halts the progression of retinopathy in those with minimal retinopathy, it may worsen in those with advanced retinopathy. Bariatric surgery improves proteinuria and major renal outcomes, regardless of the severity of renal impairment. Bariatric surgery in patients with obesity with or without diabetes is associated with an improvement in neuropathic symptoms and regeneration of small nerve fibers. In conclusion, bariatric surgery is associated with an improvement in microvascular complications. Further studies are needed to elucidate the underlying mechanisms for the favorable effect of bariatric surgery on microvascular outcomes. [ABSTRACT FROM AUTHOR]

Rapid industrialization is consuming too much energy, and non-renewable energy resources are currently supplying the world's majority of energy requirements. As a result, the global energy mix is being pushed towards renewable and sustainable energy sources by the world's future energy plan and climate change. Thus, hydrogen has been suggested as a potential energy source for sustainable development. Currently, the production of hydrogen from fossil fuels is dominant in the world and its utilization is increasing daily. As discussed in the paper, a large amount of hydrogen is used in rocket engines, oil refining, ammonia production, and many other processes. This paper also analyzes the environmental impacts of hydrogen utilization in various applications such as iron and steel production, rocket engines, ammonia production, and hydrogenation. It is predicted that all of our fossil fuels will run out soon if we continue to consume them at our current pace of consumption. Hydrogen is only ecologically friendly when it is produced from renewable energy. Therefore, a transition towards hydrogen production from renewable energy resources such as solar, geothermal, and wind is necessary. However, many things need to be achieved before we can transition from a fossil-fuel-driven economy to one based on renewable energy. [ABSTRACT FROM AUTHOR]

We have reviewed the genetic basis of chylomicronaemia, the difference between monogenic and polygenic hypertriglyceridaemia, its effects on pancreatic, cardiovascular, and microvascular complications, and current and potential future pharmacotherapies. Severe hypertriglyceridaemia (TG > 10 mmol/L or 1000 mg/dL) is rare with a prevalence of <1%. It has a complex genetic basis. In some individuals, the inheritance of a single rare variant with a large effect size leads to severe hypertriglyceridaemia and fasting chylomicronaemia of monogenic origin, termed as familial chylomicronaemia syndrome (FCS). Alternatively, the accumulation of multiple low-effect variants causes polygenic hypertriglyceridaemia, which increases the tendency to develop fasting chylomicronaemia in presence of acquired factors, termed as multifactorial chylomicronaemia syndrome (MCS). FCS is an autosomal recessive disease characterized by a pathogenic variant of the lipoprotein lipase (LPL) gene or one of its regulators. The risk of pancreatic complications and associated morbidity and mortality are higher in FCS than in MCS. FCS has a more favourable cardiometabolic profile and a low prevalence of atherosclerotic cardiovascular disease (ASCVD) compared to MCS. The cornerstone of the management of severe hypertriglyceridaemia is a very-low-fat diet. FCS does not respond to traditional lipid-lowering therapies. Several novel pharmacotherapeutic agents are in various phases of development. Data on the correlation between genotype and phenotype in FCS are scarce. Further research to investigate the impact of individual gene variants on the natural history of the disease, and its link with ASCVD, microvascular disease, and acute or recurrent pancreatitis, is warranted. Volanesorsen reduces triglyceride concentration and frequency of pancreatitis effectively in patients with FCS and MCS. Several other therapeutic agents are in development. Understanding the natural history of FCS and MCS is necessary to rationalise healthcare resources and decide when to deploy these high-cost low-volume therapeutic agents. [ABSTRACT FROM AUTHOR]

Taking the importance of Pakistan's dire need for energy breakthrough, in this paper, we explore how the country's vast estimated reserves of 175 billion tons of Thar coal is a useful source for the clean and efficient production of good quality liquid fuel. Coal to liquid (CTL) technology has gathered increasing attention among many countries with a sufficient volume of coal reserves, and this technology can also be implemented in Pakistan, which in result can also reduce harmful greenhouse gas (GHG) emissions in the environment. In this study, the Fischer Tropsch Synthesis (FT) liquefaction method was used, and the reactor design, chemical reactions, syngas ratio fraction, and Anderson-Schulz-Flory and Langmuir model were all obtained from the Aspen Plus simulation. The results showed that, at the optimum syngas flow rate of 9 Kg/s, the FT model produced diesel fuel at 0.00134 Kg/s. Per this calculation, the massive amount of Thar coal reserves can be transformed into 123.22 million barrels of diesel. The design of the reactor is very critical, and, in this study, it was prioritized to design a reactor that produces liquid fuel only of composition C12+; during the production of liquid fuel, the quantity of methane is not high; and it can still be further reduced on optimized conditions. On the other hand, CO2 gas, which is a sole contributor of GHG emissions, was also reduced by up to 98%. [ABSTRACT FROM AUTHOR]

The genesis of ketone bodies by organisms is a protective mechanism. This metabolic process helps organisms to survive acute metabolic derangements in times of nutrient deficiency. When prolonged, ketogenesis leads to ketoacidosis, which is a potentially life-threatening metabolic disorder due to the accumulation of keto-acids in the body. The most common cause is diabetic ketoacidosis, though starvation ketoacidosis and alcoholic ketoacidosis are not uncommon. The presentation of all ketoacidotic states is similar-being generally unwell, abdominal pain, rapid and shallow breathing, vomiting and dehydration. Non-diabetic ketoacidotic states are very commonly overlooked due to relative unawareness among the clinicians, leading to misdiagnosis and thereby inappropriate management culminating in added mortality and morbidity. We describe here six cases of alcoholic and starvation ketoacidosis, review the literature currently available and discuss the common pitfalls in managing such cases. [ABSTRACT FROM AUTHOR]

The article presents the discussion on burden of living with T1D and the complexities of insulin therapy self management being identified as contributory factors to suboptimal glycaemic control. Topics include data being collected from electronic records and clinical database of diabetes devices; and first follow-up being defined as sensor glucose values coinciding with first HbA1c obtained after HCL initiation.

OBJECTIVE: To determine the effect of topical Dexamethasone on intra-ocular pressure when used after phacoemulsification and intra-ocular lens implantation. STUDY DESIGN: A Cross Sectional Study. PLACE AND DURATION OF STUDY: At Eye "B" Unit Khyber Teaching Hospital Peshawar from 1st March 2009 to 1st March 2010. METHODOLOGY: The study was carried out on patients who underwent phacoemulsification with intraocular lens implantation by same surgeon. Goldmann applanation tonometer was used to measure the intra-ocular pressure on 1st post-operative day. Patients were started on topical Dexamethasone (0.1%) along with Tobramycin (0.3 %) eye drops for control of postoperative inflammation. Follow up was at 7th and 30th postoperative days and at each visit intra-ocular pressure (IOP) was measured. RESULTS: Among 59 patients the mean age was 61.45 ± 6.22 years with male to female ratio of 1.56: 1. Intra -ocular pressure measured on 1st post-operative day, ranged between 15.00 mmHg to 17.00 mmHg with a mean of 15.93 ± 0.583. On 7th post operative day IOP ranged between 15.00 mmHg to 18.00 mmHg with mean of 15.89 ± 0.824. On 30th post operative day in about 6 patients a clinically significant rise in IOP was noted. In about 6 patients IOP got increased above normal limit of 21 mmHg with a range between 15.00 mmHg to 24.00 mmHg with a mean of 17.08 ± 2.68. CONCLUSION: Use of topical Dexamethasone after cataract surgery is associated with a risk of raised intra-ocular pressure (IOP). We recommend further studies to compare other corticosteroids and NSAIDs to find out most safe drug. [ABSTRACT FROM AUTHOR]

The mineralization of C-labelled naphthalene was studied in pristine and oil-contaminated soil slurry (30% solids) under denitrifying conditions using a range of concentrations from below to above the aqueous phase saturation level. Results from sorption-desorption experiments indicated that naphthalene desorption was highly irreversible and decreased with an increase in the soil organic content, thus influencing the availability for microbial consumption. Under denitrifying conditions, the mineralization of naphthalene to CO occurred in parallel with the consumption of nitrate and an increase in pH from 7.0 to 8.6. When the initial substrate concentration was 50 ppm (i.e. close to the aqueous phase saturation level), about 90% of the total naphthalene was mineralized within 50 days, and a maximum mineralization rate of 1.3 ppm day was achieved after a lag period of approx. 18 days. When added at concentrations higher than the aqueous phase saturation level (200 and 500 ppm), similar mineralization rates (1.8 ppm day) occurred until about 50 ppm of the naphthalene was mineralized. After that the mineralization rates decreased logarithmically to a minimum of 0.24 ppm day for the rest of the 160 days of the experiments. For both of these higher concentrations, the reaction kinetics were independent of the concentration, indicating that desorption of the substrate governs the mineralization rate. Other results indicated that pre-exposure of soil to oil contamination did not improve the degradation rates nor reduce the lag periods. This study clearly shows the potential of denitrifying conditions for the biodegradation of low molecular weight PAHs. [ABSTRACT FROM AUTHOR]