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The worldwide obesity epidemic represents a severe threat to global health and is driving the scientific quest for a greater understanding of the mechanisms that regulate bodyweight, in order to develop effective preventative and therapeutic strategies. These research efforts have identified gut hormones as key regulators of energy and glucose homeostasis and have implicated them in the pathogenesis of obesity, the weight recidivism that frequently plagues dietary interventions and the marked changes in eating behaviour, weight reduction and metabolic benefits that accompany bariatric surgery. Consequently, therapeutic strategies aimed at modulating gut hormone levels or targeting their receptors are now being used to treat people with obesity and obesity-associated diseases, such as type 2 diabetes, and represent the most promising therapeutic avenue to combat the obesity epidemic.

Background Loss of smell and taste are commonly reported symptoms associated with coronavirus disease 2019 (COVID-19); however, the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in people with acute loss of smell and/or taste is unknown. The study aimed to determine the seroprevalence of SARS-CoV-2 antibodies in a community-based population with acute loss of smell and/or taste and to compare the frequency of COVID-19 associated symptoms in participants with and without SARS-CoV-2 antibodies. It also evaluated whether smell or taste loss are indicative of COVID-19 infection. Methods and findings Text messages, sent via primary care centers in London, United Kingdom, invited people with loss of smell and/or taste in the preceding month, to participate. Recruitment took place between 23 April 2020 and 14 May 2020. A total of 590 participants enrolled via a web-based platform and responded to questions about loss of smell and taste and other COVID-19–related symptoms. Mean age was 39.4 years (SD ± 12.0) and 69.1% (n = 392) of participants were female. A total of 567 (96.1%) had a telemedicine consultation during which their COVID-19–related symptoms were verified and a lateral flow immunoassay test that detected SARS-CoV-2 immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies was undertaken under medical supervision. A total of 77.6% of 567 participants with acute smell and/or taste loss had SARS-CoV-2 antibodies; of these, 39.8% (n = 175) had neither cough nor fever. New loss of smell was more prevalent in participants with SARS-CoV-2 antibodies, compared with those without antibodies (93.4% versus 78.7%, p < 0.001), whereas taste loss was equally prevalent (90.2% versus 89.0%, p = 0.738). Seropositivity for SARS-CoV-2 was 3 times more likely in participants with smell loss (OR 2.86; 95% CI 1.27–6.36; p < 0.001) compared with those with taste loss. The limitations of this study are the lack of a general population control group, the self-reported nature of the smell and taste changes, and the fact our methodology does not take into account the possibility that a population subset may not seroconvert to develop SARS-CoV-2 antibodies post-COVID-19. Conclusions Our findings suggest that recent loss of smell is a highly specific COVID-19 symptom and should be considered more generally in guiding case isolation, testing, and treatment of COVID-19. Trials registration ClinicalTrials.gov NCT04377815, In a UK-based cohort, Janine Makaronidis and colleagues investigate COVID-19 seropositivity in individuals with loss of smell and/or taste., Author summary Why was this study done? Coronavirus disease 2019 (COVID-19), an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, was declared a pandemic in March 2020. COVID-19 can cause loss or reduced ability to smell (anosmia) or taste, without cough or fever, but few countries recommend self-isolation and testing on the basis of smell or taste changes alone. This study aimed to find out the proportion of people who have developed SARS-CoV-2 antibodies in a community-based population with a newly developed loss in their sense of smell and/or taste in London, UK. What did the researchers do and find? Text messages were sent out to people registered with a number of primary care centers in London inviting people with a new loss in their sense of smell and/or taste to participate. Recruited participants completed online questionnaires regarding demographics, their loss of smell and/or taste, and other COVID-19 symptoms, before they had a telemedicine consultation with a healthcare professional who confirmed the history of their symptoms and supervised a test to find out if they had SARS-CoV-2 antibodies. A total of 78% of 567 people with smell and/or taste loss had SARS-CoV-2 antibodies; of these, 40% had neither cough nor fever, and participants with loss of smell were 3 times more to have SARS-CoV-2 antibodies, compared with those with loss of taste. What do these findings mean? Loss of smell is a highly specific symptom of COVID-19. COVID-19 can present with loss of smell and/or taste without cough or fever. Loss of smell should be take into consideration in case isolation, testing, and treatment strategies for COVID-19.

Summary Bariatric surgery is recognized as the most clinically and cost‐effective treatment for people with severe and complex obesity. Many people presenting for surgery have pre‐existing low vitamin and mineral concentrations. The incidence of these may increase after bariatric surgery as all procedures potentially cause clinically significant micronutrient deficiencies. Therefore, preparation for surgery and long‐term nutritional monitoring and follow‐up are essential components of bariatric surgical care. These guidelines update the 2014 British Obesity and Metabolic Surgery Society nutritional guidelines. Since the 2014 guidelines, the working group has been expanded to include healthcare professionals working in specialist and non‐specialist care as well as patient representatives. In addition, in these updated guidelines, the current evidence has been systematically reviewed for adults and adolescents undergoing the following procedures: adjustable gastric band, sleeve gastrectomy, Roux‐en‐Y gastric bypass and biliopancreatic diversion/duodenal switch. Using methods based on Scottish Intercollegiate Guidelines Network methodology, the levels of evidence and recommendations have been graded. These guidelines are comprehensive, encompassing preoperative and postoperative biochemical monitoring, vitamin and mineral supplementation and correction of nutrition deficiencies before, and following bariatric surgery, and make recommendations for safe clinical practice in the U.K. setting.

Introduction Evidence from bariatric surgical procedures (e.g. Roux-en-Y gastric bypass) suggests that the duodenum plays a crucial role in glycaemic control in patients with Type 2 Diabetes (T2DM). Duodenal mucosal resurfacing (DMR), a novel endoscopic therapy that resurfaces the duodenal mucosa via hydrothermal ablation, exerts an insulin-sensitising effect likely through modification of nutrient-mucosa signalling. DMR involves placing a catheter in the proximal duodenum distal to the papilla under endoscopic and fluoroscopic guidance. The duodenal mucosa is injected with saline to ‘lift’ it and a balloon is inflated with water and heated to 90°C to circumferentially ablate the mucosa for 10 cm. We describe the first series of patient cases from the UK treated with DMR at at University College London Hospitals (UCLH). Methods Cases were derived from two clinical studies: REVITA 1 a single arm, open-label multi-centre in T2DM, and the open-label phase of REVITA-2 an internationl, multi-centre, randomised, double-blinded, sham controlled study in T2DM. Eligible paitents were adults with T2DM and HbA1c of 7.5%–10.0% on ≥1 oral glucose lowering medication. Baseline blood tests were collected and following a 4–6 week run-in period, patient’s were treated with the DMR procedure. Patients received dietetic advice were given a specific 2 week post procedure diet. Blood tests were analysed at regular intervals following the procedure to assess changes in HbA1c over time. Hepatic transaminases were also measured and calulations were made for Homeostasis Model Assessment index (HOMA-IR) – a measure of insulin resistance. Information on adverse events was recorded at each visit. Results A total of 11 patients (n=5 female, 58±11 years) were treated with DMR at UCLH from May 2015 – Dec 2017. Mean (±SEM) change in HbA1c at 3 months post DMR was 0.5% (±0.2) for all patients and −0.7% (±0.2 when one patient was excluded for whom gliclazide had to be stopped due to symptomatic hypoglycaemia in the month following DMR. A total of 5/11 patients completed 6 and 12 months of follow-up with mean changes in HbA1c of −1.3% and −1.5% respectively. Favourable directional changes were also observed in HOMA-IR and hepatic transaminases. Patients tolerated the procedure well and no SAEs or UADEs were reported. Two of the eleven patients (18%) patients experiencing transient constipation. Conclusion Based on our centre’s experience, DMR appears to provide a safe and effective method of improving glycaemic control in patients with T2DM. We contintue to enrol patients in the REVITA-2 trial and the results of this study will be crucial in determining the effectiveness and durability of DMR.

Background: Spontaneous diaphragmatic hernia without a previously documented history of trauma is uncommon and clinical presentation can often be atypical ranging from an incidental radiological finding to patients presenting with complications. Case presentation: In this video we present the case of a patient presenting with gastric perforation within a large spontaneous diaphragmatic hernia in the central part of the left hemidiaphragm. Conclusions: Management of a complicated diaphragmatic hernia could be achieved using laparoscopic approach. The rarity of these hernias means that the operative strategy necessary for safe dissection and repair has to be individualized for each patient.

Introduction: Both converted and difficult laparoscopic cholecystectomies (LC) have impact on operating time and training of juniors. The aim of this study is to evaluate parameters that predict difficult LC or conversion (C), and find predictive values for different cut-off points of C-reactive protein (CRP) for conversion. Materials and Methods: A retrospective cohort study of cholecystectomies performed from January 2011 to December 2012 at NHS trust was undertaken. Association of intra-operative difficulties or conversion with the following factors was studied: Age, gender, CRP, white blood cell count (WBC), history of pancreatitis, and endoscopic retrograde cholangiopancreatography (ERCP). Results: Two hundred and ninety one patients were analysed (222 laparoscopic, 45 difficult LC and 24 C). Only 141 patients had a recorded CRP. Median CRP was highest for patients who were converted (286.20) compared to those who had difficult LC (67.40) or LC (7.05). Those patients who did not have preoperative CRP (8/150, 5.3%) had less chance of conversion than those who had CRP (16/141, 11.34%) (P = 0.063). Patients with CRP of ≤220 (3/91, 3.2%) had significantly less chance of conversion than those with CRP >220 (13/21, 61.9%) (P < 0.001). High preoperative CRP, WBC count and ERCP, were predictors of conversion. These factors were only marginally better than CRP alone in predicting conversion. Conclusion: CRP can be a strong predictor of conversion of LC. Further validation of the results is needed.