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Background and objectives Weight loss is the mainstay of management for women with polycystic ovarian syndrome (PCOS). However, lifestyle and dietary modifications, and gastric banding have generally poor long-term efficacy. We aimed to investigate whether gastric bypass is equally efficacious in women with or without PCOS. Methods We performed a matched case–control study of primary Roux-en-Y gastric bypass surgery in women with PCOS (cases, n = 30) compared to women without PCOS (controls, n = 60) matched for baseline age, body mass index (BMI) and presence or absence of type 2 diabetes (T2D). Data shown represent mean values. Results At 24 months after surgery the 90 participants (age 36.1 years) experienced significant reductions in BMI (53.4 vs. 34.9 kg/m2, p Conclusion In women with PCOS with morbid obesity, gastric bypass resulted in significant weight loss and metabolic outcomes similar to women without PCOS.

Background Emerging evidence suggests an association between impaired high-density lipoprotein (HDL) functionality and cardiovascular disease (CVD). HDL is essential for reverse cholesterol transport (RCT) and reduces inflammation and oxidative stress principally via paraoxonase-1 (PON1). RCT depends on HDL’s capacity to accept cholesterol (cholesterol efflux capacity [CEC]) and active transport through ATP-binding cassette (ABC) A1, G1, and scavenger receptor-B1 (SR-B1). We have studied the impact of Roux-en-Y gastric bypass (RYGB) in morbidly obese subjects on RCT and HDL functionality. Methods Biomarkers associated with increased CVD risk including tumour necrosis factor-α (TNF-α), high-sensitivity C-reactive protein (hsCRP), myeloperoxidase mass (MPO), PON1 activity, and CEC in vitro were measured in 44 patients before and 6 and 12 months after RYGB. Overweight but otherwise healthy (mean body mass index [BMI] 28 kg/m2) subjects acted as controls. Twelve participants also underwent gluteal subcutaneous adipose tissue biopsies before and 6 months after RYGB for targeted gene expression (ABCA1, ABCG1, SR-B1, TNF-α) and histological analysis (adipocyte size, macrophage density, TNF-α immunostaining). Results Significant (P Conclusion RYGB enhances HDL functionality in association with a reduction in adipose tissue and systemic inflammation.

Abigail E Derbyshire,1 Michelle L MacKintosh,1 Christina M Pritchard,1 Arya Pontula,2 Basil J Ammori,3,4 Akheel A Syed,4,5 Rebecca J Beeken,6 Emma J Crosbie1,2 1Department of Obstetrics and Gynaecology, Manchester University NHS Foundation Trust, Manchester, UK; 2Division of Cancer Sciences, University of Manchester, Manchester, UK; 3Department of Surgery, Salford Royal NHS Foundation Trust, Salford, UK; 4Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK; 5Department of Obesity Medicine, Diabetes & Endocrinology, Salford Royal NHS Foundation Trust, Salford, UK; 6Leeds Institute of Health Sciences, University of Leeds, Leeds, UKCorrespondence: Emma J CrosbieDivision of Cancer Sciences, University of Manchester, Manchester, UK, Tel +44 161 701 6942, Email emma.crosbie@manchester.ac.ukIntroduction: Endometrial cancer rates are rising in parallel with the global obesity epidemic. Our aim was to assess the willingness of women at greatest risk of obesity-related endometrial cancer to engage with risk-reducing strategies and establish perceived barriers that may preclude their participation in a randomized controlled trial of primary endometrial cancer prevention.Materials and Methods: Women attending gynecology, obesity and sleep apnea clinics in Manchester Academic Health Sciences Centre-affiliated hospitals with obesity classes II (BMI 35– 39.9kg/m2) and III (BMI ≥ 40kg/m2) were invited to participate in a cross-sectional survey. We asked women about their perceived risk, knowledge of risk factors and willingness to engage with endometrial cancer risk-reducing interventions.Results: Seventy-four women with a median age of 51 years (range 22– 73) and BMI of 47kg/m2 (range 34– 81) took part in the study. Two-thirds (65.6%) knew that obesity was a risk factor for endometrial cancer but few were able to recall other major risk factors. Just over half (53.5%) perceived their risk of developing endometrial cancer to be higher than average. Women were prepared to lose weight (94%), eat healthily (91%), exercise more (87%), take a pill every day (74%) or receive an intra-uterine device (49%) for primary endometrial cancer prevention. Perceived barriers included cost, forgetting, willpower, finding time, physical fitness, social anxiety, possible side effects and previous bad experiences.Conclusion: Women at highest risk of obesity-related endometrial cancer may not always appreciate their susceptibility. However, willingness to engage in risk-reducing strategies suggests recruitment to a randomized controlled trial for primary endometrial cancer prevention could be feasible.Keywords: endometrial cancer, obesity, risk reducing interventions, weight loss, exercise, chemoprevention, levonorgestrel-releasing intrauterine system, metformin

Hyperthyroidism is a well-recognised cause of significant metabolic changes with most patients experiencing weight loss in the acute illness This article is protected by copyright. All rights reserved.

Background The 2015 American Thyroid Association (ATA) Guidelines recommend the following size cut-offs based on sonographic appearances for subjecting nodules to fine-needle aspiration (FNA) biopsy: low risk: 15 mm and intermediate risk and high risk: 10 mm. Objective We conducted a ‘real-world’ study evaluating the diagnostic performance of the ATA cut-offs against increased thresholds, in the interest of safely limiting FNAs. Methods We performed a retrospective analysis of prospectively collected data on 604 nodules which were sonographically risk-stratified as per the ATA Guidelines and subsequently subjected to ultrasound-guided FNA. Nodules were cytologically stratified into ‘benign’ (Bethesda class 2) and ‘non-benign’ (Bethesda classes 3–6). We obtained the negative predictive value (NPV), accuracy, FNAs that could be spared, missed ‘non-benign’ cytologies and missed carcinomas on histology, according to the ATA cut-offs compared to higher cut-offs. Results In low-risk nodules, the high performance of NPV (≈91%) is unaffected by increasing the cut-off to 25 mm, and accuracy improves by 39.4%; 46.8% of FNAs could be spared at the expense of few missed B3–B6 cytologies (7.9%) and no missed carcinomas. In intermediate-risk nodules, a 15 mm cut-off increases the NPV by 11.3% and accuracy by 40.7%. The spared FNAs approach 50%, while B3–B6 cytologies are minimal, with no missed carcinomas. In high-risk nodules, low NPV ( Conclusion It would be clinically safe to increase the ATA cut-offs for FNA in low-risk nodules to 25 mm and in intermediate-risk nodules to 15 mm.

Intrauterine progestin is a treatment option for women with atypical hyperplasia or low-risk endometrial cancer who wish to preserve their fertility, or whose poor surgical fitness precludes safe hysterectomy. We hypothesized that in such women with obesity, weight loss during progestin treatment may improve oncological outcomes. We conducted a prospective nonrandomized study of women with obesity and atypical hyperplasia or low-grade stage 1a endometrial cancer undergoing progestin treatment. Women with a body mass index (BMI) ≥ 35 kg/m2 were offered bariatric surgery; those who declined and those with a BMI of 30 to 34.9 kg/m2 were encouraged to lose weight by low-calorie diet. We assessed uptake of bariatric surgery; weight lost during progestin treatment; and the impact of more than 10% total body weight loss on progestin treatment response at 12 months. 71 women [median age 58 years (interquartile range; IQR 35–65); mean BMI 48 kg/m2 (SD 9.3)] completed the study. Twenty-three women (32%) had bariatric surgery, on average 5 months (IQR 3–8) after progestin treatment commenced. Weight change during progestin treatment was −33.4 kg [95% confidence interval (CI) −42.1, −24.7] and −4.6 kg (95% CI −7.8, −1.4) in women receiving bariatric surgery and low-calorie diet, respectively (P < 0.001). Forty-three women (61%) responded to progestin, while 23 (32%) showed stabilized and 5 (7%) progressive disease. Response at 12 months was not predicted by age or baseline BMI, but women who lost more than 10% of their total body weight were more likely to respond to progestin than those who did not (adjusted odds ratio 3.95; 95% CI 1.3, 12.5; P = 0.02). Thus weight loss may improve oncological outcomes in women with obesity-associated endometrial neoplastic abnormalities treated with progestin. Prevention Relevance: This study found that weight loss improves response rates in women with obesity and atypical hyperplasia or low-risk endometrial cancer undergoing conservative management with intrauterine progestin. Given the additional benefits of weight loss for fertility, cardiovascular health and quality of life, future research should focus on how best to accomplish it.

Weight loss of 5%-10% is advised in medical weight management (MWM) programmes prior to bariatric surgery but it remains to be established whether it influences postoperative weight loss outcomes. We studied postoperative percent total weight loss (%TWL) in 168 patients categorized by preoperative referral weight loss

Bardet-Biedl syndrome (BBS) is a rare genetic condition, characterized by ciliary protein dysfunction, leading to multi-organ damage. People with BBS can develop early-onset severe obesity and associated problems including the metabolic syndrome, type 2 diabetes and coronary heart disease. Weight management can be challenging with the lack of effective medical therapies so far. We report a patient with BBS who underwent successful weight reduction through the use of glucagon-like peptide-1 receptor agonists.

Background: Obesity poses significant challenges to healthcare globally, particularly through its bi-directional relationship with co-morbid metabolic conditions such as type 2 diabetes and hypertension. There is also emerging evidence of an association between obesity and chronic kidney disease (CKD) which is less well characterized. Methods: A literature search of electronic libraries was conducted to identify and present a narrative review of the interplay between obesity and CKD. Findings: Obesity may predispose to CKD directly as it is linked to the histopathological finding of obesity-related glomerulopathy and indirectly through its widely recognized complications such as atherosclerosis, hypertension, and type 2 diabetes. The biochemical and endocrine products of adipose tissue contribute to pathophysiological processes such as inflammation, oxidative stress, endothelial dysfunction, and proteinuria. The prevention and management of obesity may prove critical in counteracting both the development and advancement of CKD. Moreover, measures of abdominal adiposity such as waist circumference, are generally associated with worse morbidity and mortality in individuals receiving maintenance hemodialysis. Conclusion: Obesity is a risk factor for the onset and progression of CKD and should be recognized as a potential target for a preventative public health approach to reduce CKD rates within the general population. Future research should focus on the use of glucagon-like peptide-1 receptor agonists and sodium–glucose cotransporter 2 inhibitors in patients with CKD and obesity due to their multi-faceted actions on major outcomes.

Background Obesity is associated with adverse cardiovascular outcomes and this is improved following bariatric surgery. Oxidised phospholipids (OxPL) are thought to reflect the pro-inflammatory effects of lipoprotein(a) [Lp(a)], and both are independent predictors of cardiovascular disease. Objective Our study sought to determine the impact of bariatric surgery on OxPL, biomarkers of oxidised LDL (OxLDL) and Lp(a). Methods This is a prospective, observational study of 59 patients with severe obesity undergoing bariatric surgery. Blood samples were obtained prior to surgery and at 6 and 12 months after. Sixteen patients attending the tertiary medical weight management clinic at the same centre were also recruited for comparison. Lipid and metabolic blood parameters, OxLDL, OxPL on apolipoprotein B-100 (OxPL-apoB), IgG and IgM autoantibodies to MDA-LDL, IgG and IgM apoB-immune complexes and Lp(a) were measured. Results Reduction in body mass index (BMI) was significant following bariatric surgery, from median 48 kg/m2 at baseline to 37 kg/m2 at 6 months and 33 kg/m2 at 12 months. OxPL-apoB levels decreased significantly at 12 months following surgery [5.0 (3.2–7.4) to 3.8 (3.0–5.5) nM, p = 0.001], while contrastingly, Lp(a) increased significantly [10.2 (3.8–31.9) to 16.9 (4.9–38.6) mg/dl, p = 0.002]. There were significant post-surgical decreases in IgG and IgM biomarkers, particularly at 12 months, while OxLDL remained unchanged. Conclusions Bariatric surgery results in a significant increase in Lp(a) but reductions in OxPL-apoB and other biomarkers of oxidised lipoproteins, suggesting increased synthetic capacity and reduced oxidative stress. These biomarkers might be clinically useful to monitor physiological effects of weight loss interventions.

INTRODUCTION Subjects with obesity have metabolic risk factors for nerve fibre damage. Because bariatric surgery improves these risk factors we have assessed whether this can ameliorate nerve fibre damage. METHODS Twenty-six obese subjects without diabetes (age: 46.23 ± 8.6, BMI: 48.7 ± 1.5, HbA1c: 38.0 ± 4.5) and 20 controls (age: 48.3 ± 6.2, BMI: 26.8 ± 4.2, HbA1c: 39.1 ± 2.6) underwent detailed assessment of neuropathy at baseline and 12 months after bariatric surgery. RESULTS Obese subjects had normal peroneal (45.9 ± 5.5 vs. 48.1 ± 4.5, P = 0.1) and sural (46.9 ± 7.6 vs. 47.9 ± 10.6, P = 0.1) nerve conduction velocity, but a significantly higher neuropathy symptom profile (NSP) (4.3 ± 5.7 vs. 0.3 ± 0.6, P = 0.001), vibration perception threshold (VPT) (V) (10.2 ± 6.8 vs. 4.8 ± 2.7, P

ObjectiveTo analyze rates of reported severe adverse events after immunization (sAEFI) attributed to SARS-CoV-2 vaccines in the United States (US) using safety surveillance data.MethodsObservational study of sAEFI reported to the vaccine adverse events reporting system (VAERS) between December 13, 2020, to December 13, 2021, and attributed to SARS-CoV-2 vaccination programs across all US states and territories. All sAEFI in conjunction with mRNA (BNT-162b2 or mRNA-1273) or adenovector (Ad26.COV2.S) vaccines were included. The 28-day crude cumulative rates for reported emergency department (ED) visits and sAEFI viz. hospitalizations, life-threatening events and deaths following SARS-CoV-2 vaccination were calculated. Incidence rate ratios (IRRs) of reported sAEFI were compared between mRNA and adenovector vaccines using generalized Poisson regression models.ResultsDuring the study period, 485 million SARS-CoV-2 vaccines doses were administered nationwide, and 88,626 sAEFI reported in VAERS. The 28-day crude cumulative reporting rates per 100,000 doses were 14.97 (95% confidence interval, 14.86–18.38) for ED visits, 5.32 (5.26–5.39) for hospitalizations, 1.72 (1.68–1.76) for life-threatening events, and 1.08 (1.05–1.11) for deaths. Females had two-fold rates for any reported AEFI compared to males, but lower adjusted IRRs for sAEFI. Cumulative rates per dose for reported sAEFI attributed to adenovector vaccine were 2–3-fold higher, and adjusted IRRs 1.5-fold higher than mRNA vaccines.ConclusionsOverall cumulative rates for reported sAEFI following SARS-CoV-2 vaccination in the US over 1 year were very low; single-dose adenovector vaccine had 1.5-fold higher adjusted rates for reported sAEFI, which may however equate with multiple-doses mRNA vaccine regimens. These data indicate absence of high risks of sAEFI following SARS-CoV-2 vaccines and support safety equipoise between mRNA and adenovector vaccines. Public health messaging of these data is critical to overcome heuristic biases. Furthermore, these data may support ongoing adenovector vaccine use, especially in low- and middle-income countries due to affordability, logistical and cold chain challenges.

This research reports the first-ever study on abundantly available, environmentally friendly, low-cost and ready-for-use Nutraceutical Industrial Cumin Seed Spent (NICUS) as an innovative adsorbent for bioremediation of a bisazo Acid Red 119 (AR119) dye, a probable mutagen from textile industrial effluents (TIEs). The experiment at the laboratory scale is designed to suit the concepts of sustainability and valorisation under the domain of circular economy. The experimental qe value obtained was 96.00 mg g−1. The optimised conditions of parameters are as follows: pH of 2; adsorption time, 210 min; adsorbent dosage, 0.300 g L−1; particle size, 175 µM; initial dye concentration, 950 mg L−1; orbital shaking, 165 rpm and temperature, 50 °C, producing an impressive value of 748 mg of dye adsorbing on 1 g of dry NICUS. The adsorption capacity of NICUS obtained from the quadratic model developed for process optimisation gave values of 748 mg g−1. As a prelude to commercialisation, five variables that affect the adsorption process were experimentally studied. For the feasibility and efficiency of the process, a two-level fractional factorial experimental design (FFED) was applied to identify variables that influence the adsorption capacity of NICUS. The identified variables were applied to scale experiments by three orders. Nine isotherm models were used to analyse the adsorption equilibrium data. The Vieth–Sladek adsorption isotherm model was found to be the best fit. The pseudo-second-order reaction was the appropriate mechanism for the overall rate of the adsorption process. Mechanistic studies related to mass transfer phenomena were more likely to be dominant over the diffusion process. Techniques such as SEM, FTIR and CHN analysis were used to characterise NICUS. The dye-adsorbed NICUS obtained as “sludge” was used as a reinforcing material for the fabrication of composites using plastic waste. The physicomechanical and chemical properties of thermoplastic and thermoset composite using dye-adsorbed NICUS were evaluated and compared with NICUS composites. Prospects of integrating Small and Medium Enterprises (SMEs) into the circular economy of Nutraceutical Industrial Spent (NIS) are discussed.

Introduction Day-long fasting creates considerable metabolic stress that poses challenges in people with diabetes and those who have undergone bariatric surgery. Clinical knowledge of glucose fluctuations and the risks for such patients during fasting is limited. Objectives This study examined the effect of intermittent fasting on glucose excursions, hypoglycemia, and hyperglycemia in people with or without diabetes who had sleeve gastrectomy compared with healthy individuals. Methods This open-label, prospective study compared interstitial glucose profiles measured with continuous glucose monitoring system for 72 h during fasting and non-fasting periods between four groups comprising 15 participants each: people with obesity and medicine-treated type 2 diabetes (T2D) only, obesity and T2D treated with sleeve gastrectomy, obesity without T2D treated with sleeve gastrectomy, and healthy, normal-weight non-diabetic controls. Results The mean 72-h glucose concentration was significantly lower during the fasting period for all groups (p ≤ 0.041), with the highest glucose concentrations in the medicine-treated T2D-only group and the lowest concentrations in the sleeve gastrectomy in non-T2D group. The mean glucose profiles of all the groups showed a marked increase in interstitial glucose on breaking the fast, which was exaggerated in the two diabetes groups. The mean amplitude of glycemic excursions did not differ significantly within each group between fasting and non-fasting. No significant difference was noted in the fraction of time in the hypoglycemic range between the fasting and non-fasting periods in any group. Conclusion Intermittent fasting had no adverse effect on glycemic control in people with or without diabetes who had undergone sleeve gastrectomy.

We conducted a narrative review of the medical and surgical management of people with obesity and diabetes. Results of this review showed that a 5-10% loss in body weight can be achieved with a change in lifestyle, diet and behaviour and with approved pharmacological therapies in people with obesity and diabetes. New targeted therapies are now available for patients with previously untreatable genetic causes of obesity. Compared to medical treatment, metabolic and bariatric surgery is associated with significantly higher rates of remission from type 2 diabetes and lower rates of incident macrovascular and microvascular complications and mortality. The National Institute for Health and Care Excellence and the American Diabetes Association endorse metabolic and bariatric surgery in obese adults with type 2 diabetes and there may also be a role for this in obese individuals with type 1 diabetes. The paediatric committee of the American Society for Metabolic and Bariatric Surgery have recommended metabolic and bariatric surgery in obese adolescents with type 2 diabetes. Earlier and more aggressive treatment with metabolic and bariatric surgery in obese or overweight people with diabetes can improve morbidity and mortality.

Objective\ud Thyroid status in the months following radioiodine treatment for Graves’ disease can be unstable.Our objective was to quantify frequency of abnormal thyroid function post-radioiodine and compare effectiveness of common management strategies.\ud \ud Design\ud Retrospective, multi-centre, observational study.\ud \ud Patients\ud Adult patients with Graves’ disease treated with radioiodine with 12 months’ follow-up.\ud \ud Measurements\ud Euthyroidism was defined as both serum thyrotropin (TSH) and free thyroxine (FT4) within their reference ranges or, when only one was available, it was within its reference range; hypothyroidism as TSH ≥ 10 mu/L, or subnormal FT4 regardless of TSH; hyperthyroidism as TSH below and FT4 above their reference ranges; dysthyroidism as the sum of hypo- and hyperthyroidism; subclinical hypothyroidism as normal FT4 and TSH between the upper limit of normal and

The economic viability of adsorbing crystal violet (CV) using pepper seed spent (PSS) as a biosorbent in an aqueous solution has been studied. A parametrical investigation was conducted considering parameters like initial concentration of dye, time of contact, pH value, and temperature variation. The analysis of experimental data obtained was carried out by evaluating with the isotherms of Freundlich, Sips, Tempkin, Jovanovic, Brouers–Sotolongo, Toth, Vieth–Sladek, Radke–Prausnitz, Langmuir, and Redlich–Peterson. The adsorption kinetics were studied by implementing the Dumwald-Wagner, Weber-Morris, pseudo-first-order, pseudo-second-order, film diffusion, and Avrami models. The experimental value of adsorption capacity ( Q m = 129.4 mg g − 1 ) was observed to be quite close to the Jovanovic isotherm adsorption capacity ( Q m = 82.24 mg g − 1 ) at ( R 2 ), coefficient of correlation of 0.945. The data validation was found to conform to that of pseudo-second-order and Avrami kinetic models. The adsorption process was specified as a spontaneous and endothermic process owing to the thermodynamic parametrical values of Δ G 0 , Δ H 0 , and Δ S 0 . The value of Δ H 0 is an indicator of the process’s physical nature. The adsorption of CV to the PSS was authenticated from infrared spectroscopy and scanning electron microscopy images. The interactions of the CV-PSS system have been discussed, and the observations noted suggest PSS as a feasible adsorbent to extract CV from an aqueous solution.

Purpose Autoantibodies against apolipoprotein A-1 have been associated with cardiovascular disease, poorer CV outcomes and all-cause mortality in obese individuals. The impact of bariatric surgery (BS) on the presence of circulating anti-apoA-1 IgG antibodies is unknown. This study aimed to determine the effect of bariatric surgery on auto-antibodies titres against Apolipoprotein A-1 (anti-apoA-1 IgG), looking for changes associated with lipid parameters, insulin resistance, inflammatory profile and percentage of excess body mass index loss (%EBMIL). Materials and Methods We assessed 55 patients (40 women) before, 6 and 12 months post-operatively. Baseline and post-operative clinical history and measurements of body mass index (BMI), serum cholesterol, triglycerides, high- and low-density lipoprotein cholesterol (HDL-C and LDL-C), apoA-1, highly sensitive C-reactive protein (hsCRP), fasting glucose (FG), glycated haemoglobin (HbA1c) and HOMA-IR were taken at each point. Human anti-apoA-1 IgG were measured by ELISA. Results The mean age of participants was 50 years. BS significantly improved BMI, %EBMIL triglycerides, HDL-C, apoA-1, hsCRP, HBA1c, FG and HOMA-IR. Baseline anti-apoA-1 IgG seropositivity was 25% and was associated with lower apoA-1 and higher hsCRP levels. One year after BS, anti-apoA-1 IgG seropositivity decreased to 15% (p = 0.007) and median anti-apoA-1 IgG values decreased from 0.70 (0.56–0.84) to 0.47 (0.37–0.61) AU (p Conclusion Bariatric surgery results in significant reduction in anti-apoA-1 IgG levels, which may adversely influence weight loss. The exact mechanisms underpinning these results are elusive and require further study before defining any clinical recommendations. Graphical abstract

As of April 22, 2021, around 1.5 million individuals in three districts of Kerala, India had been vaccinated with COVID-19 vaccines. Over 80% of these individuals (1.2 million) received the ChAdOx1-S/nCoV-19 vaccine. In this population, during this period of 4 weeks (mid-March to mid-April 2021), we observed seven cases of Guillain-Barre syndrome (GBS) that occurred within 2 weeks of the first dose of vaccination. All seven patients developed severe GBS. The frequency of GBS was 1.4- to 10-fold higher than that expected in this period for a population of this magnitude. In addition, the frequency of bilateral facial weakness, which typically occurs in

Severe obesity is a disease associated with multiple adverse effects on health. Metabolic bariatric surgery (MBS) can have significant effects on multiple body systems and was shown to improve inflammatory markers in previous short-term follow-up studies. We evaluated associations between changes in inflammatory markers (CRP, IL6 and TNFα) and circulating proteins after MBS. Methods: Sequential window acquisition of all theoretical mass spectra (SWATH-MS) proteomics was performed on plasma samples taken at baseline (pre-surgery) and 6 and 12 months after MBS, and concurrent analyses of inflammatory/metabolic parameters were carried out. The change in absolute abundances of those proteins, showing significant change at both 6 and 12 months, was tested for correlation with the absolute and percentage (%) change in inflammatory markers. Results: We found the following results: at 6 months, there was a correlation between %change in IL-6 and fold change in HSPA4 (rho = −0.659, p = 0.038) and in SERPINF1 (rho = 0.714, p = 0.020), at 12 months, there was a positive correlation between %change in IL-6 and fold change in the following proteins—LGALS3BP (rho = 0.700, p = 0.036), HSP90B1 (rho = 0.667, p = 0.05) and ACE (rho = 0.667, p = 0.05). We found significant inverse correlations at 12 months between %change in TNFα and the following proteins: EPHX2 and ACE (for both rho = −0.783, p = 0.013). We also found significant inverse correlations between %change in CRP at 12 months and SHBG (rho = −0.759, p = 0.029), L1CAM (rho = −0.904, p = 0.002) and AMBP (rho = −0.684, p = 0.042). Conclusion: Using SWATH-MS, we identified several proteins that are involved in the inflammatory response whose levels change in patients who achieve remission of T2DM after bariatric surgery in tandem with changes in IL6, TNFα and/or CRP. Future studies are needed to clarify the underlying mechanisms in how MBS decreases low-grade inflammation.

A 41-year-old woman presented to hospital with anterior neck swelling and pain, made worse with swallowing, after a week of febrile upper respiratory illness. She had an exquisitely tender goitre and fine hand tremor. Her temperature was 37.1°C, with a resting heart rate of 92–122 beats/minute and blood pressure of 116/68 mm Hg. Her thyroid-stimulating hormone was undetectable at < 0.01 (normal range 0.35–5.50) mU/L, with elevated free thyroxine (59.0 pmol/L; normal range 10.0–20.0), and free triiodothyronine (27.4 pmol/L; normal range 3.5–6.5). Her C-reactive protein and erythrocyte sedimentation rate were also elevated (Appendix 1, available at www.cmaj.ca/lookup/doi/10.1503/cmaj.202787/tab-related-content). The emergency physicians excluded suppurative thyroiditis and thyroid abscess by computed tomography (CT), which showed thyroid enlargement (Figure 1). An endocrinologist diagnosed subacute thyroiditis and prescribed a short course of oral prednisolone, ibuprofen and propranolol; the patient’s pain and goitre size reduced within 24 hours. After discharge from hospital, her symptoms resolved without further intervention, followed by a period of asymptomatic hypothyroxinaemia, eventually returning to euthyroidism (Appendix 1).

Background: We have previously shown that subjects with obesity have elevated vibration and thermal perception thresholds and central corneal nerve loss and patients with diabetic neuropathy have greater corneal nerve loss at the inferior whorl compared to the central cornea. In the current study, we assessed whether there is evidence for a dying-back neuropathy in subjects with obesity with and without diabetes. Methods: 57 obese subjects, with and without diabetes (DM+, n=30; DM-, n=27 respectively) and age- and sex‑matched controls (n=21) underwent venous blood sampling and assessment of the neuropathy symptom profile (NSP), neuropathy disability score (NDS), vibration, cold and warm threshold testing, cardiac autonomic function, and corneal confocal microscopy (CCM).Results: NSP and NDS were significantly elevated in obese DM+ (p- (p+ (p=0.001), but not in DM- (p=0.06), compared to controls, whilst cold (p = 0.87) and warm (p = 0.52) perception thresholds did not differ between groups. Deep breathing heart rate variability was significantly lower in DM+ (p=0.01), but not DM- (p=0.9) subjects compared to controls. Corneal nerve fibre density [26.8 ±6.22 vs 26.8 ±6.01 vs 35.3 ±7.41, p+ (47.3% vs 25.5%) and DM- (49.3% vs 34.1%).Conclusion: We demonstrate evidence of peripheral neuropathy characterised by neuropathic symptoms, neurological deficits, elevated vibration perception and autonomic dysfunction with a dying-back neuropathy affecting the corneal nerves in obese subjects with and without type 2 diabetes.

Bariatric surgery (BS) results in metabolic pathway recalibration. We have identified potential biomarkers in plasma of people achieving type 2 diabetes mellitus (T2DM) remission after BS. Longitudinal analysis was performed on plasma from 10 individuals following Roux-en-Y gastric bypass (n = 7) or sleeve gastrectomy (n = 3). Sequential window acquisition of all theoretical fragment ion spectra mass spectrometry (SWATH-MS) was done on samples taken at 4 months before (baseline) and 6 and 12 months after BS. Four hundred sixty-seven proteins were quantified by SWATH-MS. Principal component analysis resolved samples from distinct time points after selection of key discriminatory proteins: 25 proteins were differentially expressed between baseline and 6 months post-surgery, 39 proteins between baseline and 12 months. Eight proteins (SHBG, TF, PRG4, APOA4, LRG1, HSPA4, EPHX2 and PGLYRP) were significantly different to baseline at both 6 and 12 months post-surgery. The panel of proteins identified as consistently different included peptides related to insulin sensitivity (SHBG increase), systemic inflammation (TF and HSPA4—both decreased) and lipid metabolism (APOA4 decreased). We found significant changes in the proteome for eight proteins at 6- and 12-months post-BS, and several of these are key components in metabolic and inflammatory pathways. These may represent potential biomarkers of remission of T2DM.

Aim: To assess the association of country-level obesity prevalence with COVID-19 case and mortality rates, to evaluate the impact of obesity prevalence on worldwide variation. Methods: Data on COVID-19 prevalence and mortality, country-specific governmental actions, socioeconomic, demographic, and healthcare capacity factors were extracted from publicly available sources. Multivariable negative binomial regression was used to assess the independent association of obesity with COVID-19 case and mortality rates. Results: Across 168 countries for which data were available, higher obesity prevalence was associated with increased COVID-19 mortality and prevalence rates. For every 1% increase in obesity prevalence, the mortality rate was increased by 8.3% (incidence rate ratio [IRR] 1.083, 95% confidence interval [CI] 1.048-1.119; P < 0.001) and the case rate was higher by 6.6% (IRR 1.066, 95% CI 1.035-1.099; P < 0.001). Additionally, higher median population age, greater female ratio, higher Human Development Index (HDI), lower population density, and lower hospital bed availability were all significantly associated with higher COVID-19 mortality rate. In addition, stricter governmental actions, higher HDI and lower mean annual temperature were significantly associated with higher COVID-19 case rate. Conclusion: These findings demonstrate that obesity prevalence is a significant and potentially modifiable risk factor of increased COVID-19 national caseload and mortality. Future research to study whether weight loss improves COVID-19 outcomes is urgently required.

Background Bariatric surgery for severe obesity can lead to micronutrient/vitamin deficiencies. Aims To study baseline and post-surgical prevalence of vitamin D deficiency in patients undergoing bariatric surgery. Participants and Setting Patients undergoing bariatric surgery in a university teaching hospital in North West England. Methods We performed an observational cohort analysis of longitudinal data on vitamin D and related parameters in patients who underwent bariatric surgery. Patients were routinely recommended daily combined calcium and vitamin D supplementation post-surgery. Results We studied 460 patients who had completed at least 12 months post-operatively; mean (standard deviation) age was 48.0 (10.5) years, weight 144.7 (27.3) kg and body mass index 50.0 (7.6) kg/m2; 292 (63.5%) underwent gastric bypass and 168 (36.5%) sleeve gastrectomy. Vitamin D level was 33.1 (23.9) nmol/L at baseline, rising to 57.1 (23.1) nmol/L at 12 months post-surgery. Whereas 43.2% had vitamin D deficiency and 34.7% insufficiency preoperatively, 8.9% and 26.7% had deficiency and insufficiency, respectively, at 12 months with similar trends up to 4 years of follow-up. There were no significant differences between procedures or sexes in vitamin D levels or sufficiency rates. Conclusion Vitamin D deficiency and insufficiency were prevalent pre-surgery and reduced significantly with routine supplementation post-surgery.

The potential usage of coriander seed spent which is a nutraceutical industrial by-product in the removal of Acid Black 52 (AB52) dye from aqueous solutions was evaluated with respect to various experimental parameters including pH, initial dye concentration, adsorbent dosage, adsorbent particle size, duration of contact time and temperature. The optimal qe value at pH 2, pH 7 and pH 12 was 432 mg g−1, 164 mg g−1 and 220 mg g−1, respectively. Two-level fractional factorial experimental design model yielded maximum adsorption value of 867.00 mg g−1. The influence of each parameter and combination of parameters on the final adsorption capacity of the system has been shown by analysis of variance (ANOVA). Equilibrium data were analyzed by four two-parameter and five three-parameter isotherm models. The dye uptake obeyed pseudo-second order kinetic expression. Intra-particle diffusion showed that the adsorption mechanism was more governed by external mass transfer. AB52 dye adsorption on nutraceutical industrial coriander seed spent (NICSS) was endothermic and almost spontaneous. The NICSS has a highly fibrous matrix with hierarchical porous structure as evidenced by SEM images. The FTIR analysis of the spent confirmed the presence of cellulosic and ligno-cellulosic matter imparting both hydrophilic and hydrophobic properties. The results proved that NICSS efficiently removes AB52 dye from water and textile industrial effluent. For the aforesaid reasons; we believe, the readership of the journal will be most interested in: It is envisaged that NIS as new class of biosorbent will foster innovation and provide competitive edge over reported agriculture waste.