Search

Background: A significant number of patients face the issue of weight gain (WG) or inadequate weight loss (IWL) post-bariatric surgery for obesity. Several studies have been published evaluating the role of glucagon-like peptide-1 receptor agonists (GLP1RA) for weight loss post-bariatric surgery. However, no systematic review and meta-analysis (SRM) till date has evaluated the efficacy, safety and tolerability of GLP1RA in this clinical scenario. Hence, this SRM aimed to address this knowledge gap. Methods: Databases were searched for randomized controlled trials (RCTs), case–control, cohort and observational studies involving use of GLP1RA in the intervention arm post-bariatric surgery. Primary outcome was weight loss post at least 3 months of therapy. Secondary outcomes were evaluation of body composition parameters, total adverse events (TAEs) and severe adverse events (SAEs). Results: From initially screened 1759 articles, 8 studies (557 individuals) were analysed. Compared to placebo, patients receiving liraglutide had significantly greater weight loss after 6-month therapy [MD − 6.0 kg (95% CI, − 8.66 to − 3.33); P < 0.001; I2 = 79%]. Compared to liraglutide, semaglutide had significantly greater percent reduction in body weight after 6-month [MD − 2.57% (95% CI, − 3.91 to − 1.23); P < 0.001; I2 = 0%] and 12-month [MD − 4.15% (95% CI, − 6.96 to − 1.34); P = 0.004] therapy. In study by Murvelashvili et al. (2023), after 12-month therapy, semaglutide had significantly higher rates of achieving > 15% [OR 2.15 (95% CI, 1.07–4.33); P = 0.03; n = 207] and > 10% [OR 2.10 (95% CI, 1.19–3.71); P = 0.01; n = 207] weight loss. A significant decrease in fat mass [MD − 4.78 kg (95% CI, − 7.11 to − 2.45); P < 0.001], lean mass [MD − 3.01 kg (95% CI, − 4.80 to − 1.22); P = 0.001] and whole-body bone mineral density [MD − 0.02 kg/m2 (95% CI, − 0.04 to − 0.00); P = 0.03] was noted with liraglutide. Conclusion: Current data is encouraging regarding use of GLP1RAs for managing WG or IWL post-bariatric surgery. Deterioration of bone health and muscle mass remains a concern needing further evaluation. Trial Registration: The predefined protocol has been registered in PROSPERO having registration number of CRD42023473991. [ABSTRACT FROM AUTHOR]

This document is a letter published in the journal Obesity Surgery. The letter responds to a previous article by Deep Dutta et al. on the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) for weight management after bariatric surgery. The author of the letter appreciates the perspectives shared in the previous article and agrees with the potential benefits of GLP-1RAs as adjunctive therapy in post-operative care. The letter also mentions the importance of implementing a multifaceted maintenance program, including dietary modifications, physical activity, and pharmacological interventions. The author highlights the interest in exploring the use of twincretin tirzepatide and the importance of continuous treatment with GLP-1RAs to sustain weight loss benefits. [Extracted from the article]

Summary: The Indian Society for Bone and Mineral Research (ISBMR) has herein drafted clinical practice guidelines for the diagnosis and management of osteoporosis for the people of India. Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India. Purpose: In India, osteoporosis is a major public health problem. However, in the absence of any robust regional guidelines, the screening, treatment, and follow-up of patients with osteoporosis are lagging behind in the country. Methods: The Indian Society for Bone and Mineral Research (ISBMR), which is a multidisciplinary group of physicians, researchers, dietitians, and epidemiologists and who study bone and related tissues, in their annual meeting, drafted the guidelines for the diagnosis and management of osteoporosis that would be appropriate in a resource constraint setting like India. Results: Diagnosis of osteoporosis can be made in a patient with minimal trauma fracture without the aid of any other diagnostic tools. In others, bone mineral density measured by dual-energy X-ray absorptiometry remains the modality of choice. Data indicates that osteoporotic fractures occur at an earlier age in Indians than in the West; hence, screening for osteoporosis should begin at an earlier age. FRAX can be used for fracture risk estimation; however, it may underestimate the risk of future fractures in our population and still needs validation. Maintaining optimum serum 25-hydroxyvitamin D levels is essential, which, in most cases, would require regular vitamin D supplementation. Pharmacotherapy should be guided by the presence/absence of vertebral/hip fractures or the severity of risk based on clinical factors, although bisphosphonates remain the first choice in most cases. Regular follow-up is essential to ensure adherence and response to therapy. Conclusions: Implementation of the position statement in clinical practice is expected to improve the overall care of patients with osteoporosis in India. [ABSTRACT FROM AUTHOR]

The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts—treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring. Funding: Sanofi. [ABSTRACT FROM AUTHOR]

Immiscible kerosene-water two-phase flows in microchannels connected by a T-junction were numerically studied by a Lattice Boltzmann (LB) method based on field mediators. The two-phase flow lattice Boltzmann model was first validated and improved by several test cases of a still droplet. The five distinct flow regimes of the kerosene-water system, previously identified in the experiments from Zhao et al., were reproduced. The quantitative and qualitative agreement between the simulations and the experimental data show the effectiveness of the numerical method. The roles of the interfacial tension and contact angle on the flow patterns and shapes of droplets were discussed and highlighted according to the numerical results based on the improved two-phase LB model. This work demonstrated that the developed LBM simulator is a viable tool to study immiscible two-phase flows in microchannels, and such a tool could provide tangible guidance for the design of various microfluidic devices that involve immiscible multi-phase flows. [ABSTRACT FROM AUTHOR]

The problem of the efficient design of material microstructures exhibiting desired properties spans a variety of engineering and science applications. The ability to rapidly generate microstructures that exhibit user-specified property distributions can transform the iterative process of traditional microstructure-sensitive design. We reformulate the microstructure design process using a constrained generative adversarial network (GAN) model. This approach explicitly encodes invariance constraints within GANs to generate two-phase morphologies for photovoltaic applications obeying design specifications: specifically, user-defined short-circuit current density and fill factor combinations. Such invariance constraints can be represented by differentiable, deep learning-based surrogates of full physics models mapping microstructures to photovoltaic properties. Furthermore, we propose a multi-fidelity surrogate that reduces expensive label requirements by a factor of five. Our framework enables the incorporation of expensive or non-differentiable constraints for the fast generation of microstructures (in 190 ms) with user-defined properties. Such proposed physics-aware data-driven methods for inverse design problems can be used to considerably accelerate the field of microstructure-sensitive design., (© 2021. The Author(s), under exclusive licence to Springer Nature America, Inc.)