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T Michelle Brown,1 Montserrat Vera-Llonch,2 Chisom Kanu,1 Asia Sikora Kessler,2 Aaron Yarlas,2 Sheri E Fehnel1 1Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA; 2Health Economics & Outcomes Research, Ionis Pharmaceuticals, Carlsbad, CA, USACorrespondence: Asia Sikora Kessler, Ionis Pharmaceuticals, Carlsbad, CA, USA, Email ASikoraKessler@ionisph.comBackground: Familial chylomicronemia syndrome (FCS) is a rare metabolic disorder that impacts physical, emotional, social, and cognitive functioning. The FCS-Symptom and Impact Scale (FCS-SIS) patient-reported outcome (PRO) measure assesses common symptoms and impacts of FCS. This study was conducted to evaluate cross-sectional psychometric properties of the FCS-SIS and its scoring method.Methods: This multisite, cross-sectional, observational study of individuals with FCS was conducted in the United States and Canada. Participants completed a survey composed of 7 PRO measures, including the FCS-SIS, and questions about clinical characteristics and demographics. The structure of the FCS-SIS was evaluated using inter-item and item-scale correlations and internal consistency reliability. Construct, known-groups, and criterion validity were evaluated by examining associations between FCS-SIS item and composite scores and other measures included within the survey.Results: Most of the 33 participants were female (63.6%) and White (78.1%). On average, participants reported first noticing FCS symptoms at ~16 years, with abdominal pain the most frequently reported initial symptom (n=20). Participants reported 2.5 acute pancreatitis attacks on average over the past year. Average FCS-SIS symptom item scores ranged from 1.8 to 3.9 (on a 0-to-10 scale [none-to-worst-possible]) within the 24-hour recall period, with an average Symptom composite score of 2.7. The average impact item scores on the FCS-SIS ranged from 1.6 to 3.0 (on a 0-to-4 scale), with an average Impact composite score of 2.1. Inter-item correlations between the FCS-SIS Symptom items ranged from 0.32 to 0.78. Corrected item-total correlations were highly satisfactory for Impact items, ranging from 0.62 to 0.85. All a priori validity hypotheses were supported by observed correlations and score differences between known groups.Conclusion: The results of this study support the structure, reliability, and validity of the FCS-SIS, laying the psychometric groundwork for longitudinal evaluation of its utility in assessing treatment benefit in FCS clinical studies.Keywords: psychometric evaluation, FCS, validity, reliability, rare disease, patient reported outcome measure

The study aimed to assess the single and joint lethal toxicity, type of interaction and the extent to which simple mathematical model of concentration addition (CA), independent action (IA) and generalized concentration addition (GCA) could predict the joint toxicity of copper hydroxide and glyphosate mixture in Clarias gariepinus. Static bioassay were setup to determine the individual and combined (based on ratio 1:2) lethal concentrations (LCx) of the pesticides. Data from the static bioassays were then fitted into the synergistic ratio (SR), concentration-addition (toxicity unit; TU) and isobologram model to determine the type of interaction between the different classes of pesticides, while the CA, IA and GCA models were used to predicted the observed mixture effects. The estimated 24 h, 48 h, 72 h and 96 h LC50 for copper hydroxide were 198.66 mg/L, 167.51 mg/L, 138.64 mg/L, and 104.82 mg/L; glyphosate were 162.92 mg/L, 103.88 mg/L, 61.95 mg/L, and 52.6l mg/L; while the mixtures were 63.18 mg/L, 59.06 mg/L, 56.42 mg/L, and 50.67 mg/L, respectively. Glyphosate was 2 times more toxic than copper hydroxide to C. gariepinus when acting singly. The SR and RTU was

Background: It has been observed that most malaria patients especially G6PD-deficient patients usually experience oxidative stress and severe anemia when treated with primaquine. This calls for the need to search for a treatment option that will ameliorate these side effects. Objective: The effect of co-treatment of malaria with aqueous extract of Ocimum gratissimum leaves (AEOGL) and primaquine on G6PD activity, antioxidant indices and hematological parameters in Plasmodium berghei-infected mice was investigated. Materials and methods: Thirty mice divided into six groups of five mice each were recruited for this study. Whilst Group 1 (G1) served as the negative control (group not infected with plasmodium parasite), Groups 2 to 6 (G2-G6) were inoculated intraperitoneally with 0.2 ml of 1 × 105/ml Plasmodium berghei (NK 65 strain) infected erythrocytes. G2 (parasite control) received no treatment. Groups 3,4,5 and 6 were administered 0.25 mg/kg bw of primaquine only; 100 mg/kg b. w of AEOGL +0.25 mg/kg bw of primaquine; 200 mg/kg b. w of AEOGL +0.25 mg/kg bw of primaquine; 200 mg/kg b. w of AEOGL respectively, for 14 days. Results: Treatment with only primaquine gave the highest mean malaria parasite clearance (82.10 ± 0.45 percent), followed by 100 mg/kg b. w of AEOGL + Primaquine (75.59 ± 0.47 percent), 200 mg/kg b. w of AEOGL + Primaquine (67.35 ± 0.67 percent), and AEOGL alone (55 ± 0.56 percent). In comparison with the untreated malaria groups, co-treatment with AEOGL + Primaquine produced a significant (p 0.05) difference in these parameters. Conclusion: Co-treatment of Plasmodium berghei-infected mice with AEOGL and primaquine improved the G6PD activity, hematological parameters and antioxidant status relative to treatment with only primaquine.

Anaemia constitutes a major challenge in the livestock industry worldwide. This study was carried out to determine the haematopoietic potential of methanol extract of Tetrapleura tetraptera (T. tetraptera) in male albino rats. Twenty five rats weighing between 147 and 166 g were used for the study. Anaemia was induced by daily removal of 2ml of blood per 100g body weight for ten days. The extraction was by cold maceration. Thereafter, the animals were administered with the extract for seven days. The rats were treated with graded doses of the extract, 50mg/kg, 100mg/kg and 200mg/kg for groups A, B and C respectively while groups D (negative control) and E (positive control) received 5 ml/kg of water. Results showed successful induction of anaemia. There was significant (p<0.05) increases in the erythrocytic parameters and plasma protein after administration of the methanoloic extract of T. tetraptera. The concentration dependent increase in the PCV, HBC, RBC, MCH and MCHC in the groups treated with the extract when compared with the untreated groups indicates haematopoietic potentials of T. Tetraptera. [ABSTRACT FROM AUTHOR]

Glucose disorders associated with critical illness are common in veterinary medicine and availability of efficient, easy and affordable diagnostic process is vital in combating the menace. Point-of-care glucometers readily come to mind in achieving this goal considering their importance in research and critical case management in veterinary clinics as they are cheap, user friendly, can use small sample quantity and quick generation of results. However, there have been concerns about generation of erroneous results in certain species. This study compared the accuracy and agreement of two point-of-care glucometers for blood glucose determination in rats. Blood samples were obtained from 20 healthy Sprague-Dawley albino rats. Blood (2 ml) was collected through the retro-bulbar plexus and two glucometers were used to determine the blood glucose concentrations immediately. Thereafter, 1 ml was put into a clean test tube treated with ethylene diamine tetracetic acid and the remaining 1 ml was also put into another test tube without anticoagulant. The samples were processed appropriately to harvest the plasma and serum. Blood glucose test kit was used to measure glucose concentrations in plasma and serum by the glucose oxidase method. Data generated were analysed using one way analysis of variance. Results showed that the mean value generated by one glucometer was relatively comparable with the values generated by the laboratory methods while the other significantly overestimated the glucose concentration. This underscores the importance of validation of glucometers before use in any species as unvalidated glucometers can lead to erroneous research conclusions and clinical decisions with dire consequences. [ABSTRACT FROM AUTHOR]

A thermodynamic modification of an ORC integrated with turbine bleeding and regeneration (ORCTBR) is presented. The objective is to modify the ORCTBR for both cooling and power generation (ORCNOV). First, a thermodynamic break down of the components based on exergy was performed followed by a sensitivity analysis. The results indicate that at based conditions the maximum efficiency obtained with ORCNOV was about 52% using R245fa at a heat input of 252 kW. The improvement in efficiency was estimated at 7.2% when compared with ORCTBR. The highest cooling rate was achieved using R1234yf, R245fa, and R1234ze by 11.14, 10.60, and 10.11 kW, respectively. Additionally, the ORCNOV showed improved performance in turbine output power of approximately 2%. However, the sensitivity studies show that the exergy destruction gap was not greater than 45% between the ORCTBR and ORCNOV, and high cooling rates are feasible at increased condenser (1) pressure. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the antihyperglycemic, anti-dyslipidemic and antioxidant properties of hydromethanol extract of Eremomastax speciosa leaf in alloxan monohydrate-induced hyperglycemic rats. Methods: Hydromethanol extract of Eremomastax speciosa leaf was tested at dose range of 25 to 100 mg/kg against vehicle (distilled water) and glibenclamide (2 mg/kg, reference standard) in alloxaninduced hyperglycemic rats. Gas chromatography mass spectrometry (GC-MS) was employed in the identification of phytoconstituents. The fasting blood glucose (FBG), serum lipid profile, malondialdehyde, catalase and superoxide dismutase levels as well as the histopathology of the pancreas of the animals were evaluated. Results: The extract (25 mg/kg) significantly reduced FBG, lipid profile and malondialdehyde levels relative to vehicle treated group but increased the superoxide dismutase and catalase levels and reversed alloxan-induced pancreatic islet cell degeneration. GC-MS analysis showed the presence of 4,5-dimethylthiazole (4.38%), benzenesulfonic acid, methyl ester (15.62%), benzenesulfonyl chloride (40.62%), benzopyran-4-one, 5,7-dihydroxy-2-phenyl- (21.25%), 2(5H)-furanone, 4-methoxy-5-phenyl- (12.50%), and p-chlorobenzenesulfonyl chloride (5.62%). Conclusion: The hypoglycemic effect of the extract validates the folkloric uses of E. speciosa leaf in the ethnobotanical care of diabetes mellitus. [ABSTRACT FROM AUTHOR]

Background: Patients with heart failure, a preserved ejection fraction (HFpEF), and obesity have significant disability and suffer frequent exacerbations of heart failure. We hypothesized that tirzepatide, a long-acting agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptors, would improve a comprehensive suite of clinical endpoints, including measures of health status, functional capacity, quality of life, exercise tolerance, patient well-being, and medication burden in these patients., Methods: 731 patients in class II-IV heart failure, ejection fraction ≥50%, and body mass index ≥30 kg/m 2 were randomized(double-blind) to tirzepatide(titrated up to 15mg subcutaneously weekly)(n=364) or placebo(n=367), added to background therapy for a median of 104 weeks (Q1=66, Q3=126 weeks)., Primary Endpoints: tirzepatide reduced the combined risk of cardiovascular death or worsening heart failure and improved Kansas City Cardiomyopathy Questionnaire Clinical Summary Score(KCCQ-CSS). The current expanded analysis included sensitivity analyses of the primary endpoints, 6-minute walk distance(6MWD), EQ-5D-5L health state index, Patient Global Impression of Severity Overall Health(PGIS), NYHA class, use of heart failure medications, and a hierarchical composite based on all-cause death, worsening heart failure, and 52-week changes in KCCQ-CSS and 6MWD., Results: Patients were aged 65.2±10.7, 53.8%(n=393) were female; BMI 38.2±6.7kg/m 2 , KCCQ-CSS 53.5±18.5, 6MWD 302.8±81.7meters, and 53%(n=388) had a worsening heart failure event in the prior 12 months. Compared with placebo, tirzepatide produced a consistent beneficial effect across all composites of death and worsening heart failure events, analyzed as time-to-first-event (hazard ratios 0.41-0.67). At 52 weeks, tirzepatide increased KCCQ-CSS 6.9 points (95%CI, 3.3, 10.6, P<0.001), 6MWD 18.3 meters (95%CI, 9.9, 26.7, P<0.001) and EQ-5D-5L 0.06 (95%CI, 0.03, 0.09, P<0.001). The tirzepatide group shifted to a more favorable PGIS (proportional odds ratio 1.99 (95%CI, 1.44, 2.76) and NYHA class (proportional odds ratio 2.26 (95%CI, 1.54, 3.31), both P<0.001 and required less heart failure medications (P=0.015). The broad spectrum of effects was reflected in benefits on the hierarchical composite (win ratio 1.63, 95%CI, 1.17, 2.28;P=0.004)., Conclusions: Tirzepatide produced a comprehensive, meaningful improvement in heart failure across multiple complementary domains; enhanced health status, quality of life, functional capacity, exercise tolerance and well-being; and reduced symptoms and medication burden in patients with HFpEF and obesity.

Introduction: Discussions of weight-management strategies between patients and healthcare providers can yield positive outcomes for people with overweight or obesity. Nonetheless, people with overweight or obesity encounter communication challenges and other barriers to pursuing effective weight-management strategies with their healthcare providers. The aim of this study was to develop a new self-completed assessment tool to initiate and facilitate conversations related to weight management between patients and healthcare providers., Methods: Developing the assessment tool involved a series of steps and draft versions of the tool, based on feedback from key opinion leaders in the field of obesity (N = 4) and input from people with overweight or obesity (N = 18). Three iterative rounds of qualitative interviews were conducted in the USA. A targeted review of prior qualitative research was conducted to identify common and important impacts of obesity on patients' functioning. Standard qualitative analytical methods were used to identify concepts of importance in a concept elicitation exercise during the interviews and were evaluated for potential inclusion in the tool. Potential problems with the tool were flagged during cognitive debriefing of the draft tool., Results: During 18 individual interviews, participants referenced the impact of their weight on their lives, including health and comorbidities, physical function, emotional/mental functioning, social life, and physical appearance. Over the course of the tool's development, 24 common and important impacts of obesity on patients' functioning were reduced to a final set of eight concepts in the final tool that were deemed important and relevant to both patients and key opinion leaders., Conclusions: The assessment tool is a five-item, self-completed measure expected to foster patient self-advocacy for individuals with overweight or obesity by giving them an opportunity to define their weight-management goals and discuss these, along with various medical interventions, with a healthcare provider., (© 2022. The Author(s).)

Health literacy is recognized as a critical factor affecting communication across the continuum of cancer care and plays a key role in patients' ability to meaningfully discuss their condition with healthcare providers. However, there is no consensus on the best approach to measure health literacy in clinical practice. The aims of this study were to compare general and disease-specific measurements of health literacy in patients with breast cancer as well as examine their relationships with patient-provider communication. During office visits, patients with HER-2 + breast cancer who received care at oncology clinics with value-based models of care completed a survey including the 6-item cancer health literacy tool (CHLT-6), 6-item newest vital sign (NVS), 2 items measuring difficulty of patient-provider communication, and 11 demographic/clinical items. The mean age of 146 participants was 57.1 ± 10.8 years. Most participants had adequate general health literacy as measured by the NVS (79%) and a high probability of adequate cancer health literacy (≥ 0.7) as measured by the CHLT-6 (92%). Most patients easily communicated with healthcare providers (90.2%) and understood information they provided (83.5%). However, there was no significant relationship between patient-provider communication and health literacy. Both the CHLT-6 and NVS may be useful tools to assess the health literacy of patients with cancer in clinical practice. Study findings of adequate health literacy and ease of communication might have been influenced by the value-based care models adopted by participating clinics. Further research in more diverse samples of patients with cancer and different types of oncology practice settings is warranted., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: Patients face a myriad of personal and system-based challenges in accessing breast cancer care, but less is known about access as expressed and experienced by patients themselves. The objective of this qualitative study was to further explore the breadth of issues related to access from the perspective of patients with breast cancer across their care journey., Methods: Twelve women participated in 1-h semi-structured interviews and 48 women participated in 2-h focus groups at six oncology practices in 2018. Grounded theory was used to analyze the data., Results: Six primary themes emerged concerning access to care: information, psychosocial support, health insurance, financial resources, timeliness, and emotions., Conclusions: This study identified six core dimensions of access to care. Access encompassed not only gaining entrée to care services-in the traditional sense of access-but also the continuing support needed to effectively use those services throughout the cancer care journey. Future strategies aimed at improving access to breast cancer care should attend to these ongoing patient-centric and system-based issues which are mostly amenable to change., (© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: Assessing health literacy and patient activation at the beginning of care could facilitate the provision of appropriate information to patients with breast cancer and increase the effectiveness of interventions geared toward improving patient involvement in self-managing their health and, consequently, their quality of life., Objective: The aim of this study was to evaluate cancer health literacy and patient activation in patients with breast cancer as well as examine their relationships to health-related quality of life (HRQoL) and resource use., Methods: Patients with breast cancer positive for human epidermal growth factor receptor 2 (HER2+) receiving care at 12 oncology clinics in Texas were offered participation in the study via convenience sampling. The survey consisted of the 6-item Cancer Health Literacy Tool, the 13-item Patient Activation Measure, the 27-item Functional Assessment of Cancer Therapy - General (version 4), and single-item measures for number of emergency department visits and hospitalizations as well as clinical and demographic characteristics., Key Results: The mean age of the 146 study participants was 57.1 ± 10.8 years; 92% ( n = 134) had a high probability (≥0.7) of adequate cancer health literacy whereas 68% percent ( n = 99) had high patient activation (level 3 or 4). Cancer health literacy had significant positive relationships with education and household income. Patient activation, education, and number of treatment types received explained 23% of the variation in HRQoL, and all except cancer health literacy were positive and significant predictors. No bivariate/multivariate analysis was conducted for emergency department visits and hospitalizations because there were few reported incidents., Conclusions: Interventions that aim to improve HRQoL in patients with breast cancer could target modifiable factors like patient activation. The homogeneity of cancer health literacy among study participants might have influenced its nonsignificant relationship with HRQoL and patient activation. Further assessments of health literacy and patient activation in larger and more diverse populations of patients with breast cancer are warranted. [ HLRP: Health Literacy Research and Practice . 2021;5(3):e171-e178.] Plain Language Summary: In this study, the majority of patients with breast cancer were found to have high levels of cancer health literacy, patient activation, and health-related quality of life (HRQoL). The significant relationship between patient activation and HRQoL implies that patients with breast cancer who are able to actively participate in managing their health and health care are more likely to have higher HRQoL. Interventions that aim to improve HRQoL in patients with breast cancer could target modifiable factors like patient activation.

Introduction: Obesity rates have reached an epidemic level and bariatric surgery is the most effective method of sustainable weight loss. Pregnancy following bariatric surgery is associated with an increased prevalence of small babies. The objective of the study is to compare the fetal fat distribution, as assessed by fractional arm and thigh volume using three-dimensional ultrasonography, in pregnancies following maternal bariatric surgery with those without such history., Material and Methods: This is a prospective, longitudinal, observational study conducted in a Maternity Unit in the UK. The study included 189 pregnant women; 63 with previous bariatric surgery [27 restrictive (13 with gastric band, 14 with sleeve gastrectomy) and 36 malabsorptive procedures] and 126 with no previous surgery but similar maternal booking body mass index. Fetal arm and thigh volume were obtained at 30-33 and 35-37 weeks' gestation and fractional limb volumes were calculated using a commercially available software. Women underwent a 75 g, 2 h oral glucose tolerance test at 28-31 weeks of gestation., Results: Overall, adjusted fetal arm and thigh volume were smaller in the post-bariatric, compared to the no surgery, group and this was more marked in women who had undergone a previous sleeve gastrectomy (P < .001 and P = .002, respectively) or a malabsorptive procedure (P < .001 for both). There was a strong positive correlation between maternal fasting/post-prandial (2 h) glucose levels, at the time of the oral glucose tolerance test, and arm and thigh volume at both 30-33 and 35-37 weeks (P < .01 for all)., Conclusions: The study has demonstrated that in the third trimester of pregnancy, fetuses of women with previous bariatric surgery have smaller fractional limb volumes, therefore less soft tissue, compared to fetuses of women without such surgery and this may be related to the lower maternal glucose levels seen in the former pregnancies., (© 2020 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).)

Aims: System-level efforts have been deployed to improve oncology care and access while reducing utilization and costs. Understanding the nature of access to care from the perspective of patients themselves is an unmet need. This study examined access to care in a population of women with breast cancer and its relationship to overall patient satisfaction., Materials and Methods: Patients with breast cancer from six oncology clinics in five states completed a survey during routine office visits. Access to care (higher scores indicated increasing access barriers), overall patient satisfaction, and patient demographic/clinical characteristics were measured. The relationships between access (composite and factor scores) and satisfaction were assessed using multivariable analyses controlling for age (the only significant characteristic from bivariate analyses)., Results: A total of 180 patients completed the survey. Factor analysis of access to care items revealed an 8-factor measure - Insurance, Health System, Emotional, Holistic Treatment, Family Support, Knowledge/Understanding, Information Quality, and Financial Support - with high reliability (Composite: Cronbach alpha = 0.93; Factors: Cronbach alpha range = 0.85-0.91). Access composite score was moderately low (mean = 1.90), indicating an overall low level of access barriers, and overall patient satisfaction was high (mean = 4.59). The composite score ( p  < .001) and the Health System and Knowledge/Understanding factors ( p  < .01) were significant and negative predictors of overall satisfaction., Limitations: Study sites were high functioning clinics and all, but one, are Oncology Care Model practices. Thus, the scope of access to care issues for patients of under-resourced clinics might not be well addressed., Conclusions: Access to care overall and by factor was significantly predictive of patient satisfaction with care. In addition, access to care factors varied across several demographic and clinical characteristics. Future strategies that address access to care challenges should consider these modifiable, patient-centric, and system-based issues.

Objectives: The purpose of this study was to assess factors that influence use of mammography screening among African American women, with a focus on social and cultural influences using Andersen's behavioral model (ABM), and to assess the methodological quality of the included studies., Methods: A literature review was conducted using PubMed, CINAHL, PSYCINFO, and Web of Science. Search terms included a combination of the following words using Boolean operators: breast cancer screening, mammography, repeat mammography, and African American. Studies that met the following criteria were included in the review: 1) examined factors associated with mammography screening, 2) included African American women as a majority, 3) published in a peer-reviewed English language journal between 2005 and 2017, and 4) conducted in the United States. Literature reviews, commentaries and non-research studies were excluded. Cited references from identified studies were examined for additional, relevant articles. Associated factors were grouped into predisposing, enabling, and need factor domains of ABM. The reviewed studies were rated using a methodological quality score (MQS) ranging from 0 to 20, with higher scores indicating higher methodological quality., Results: Twenty-four studies met the inclusion criteria. Fifteen factors that affect breast cancer screening in African American women were identified: predisposing (age, education, knowledge, beliefs, mistrust, religiosity, fears and fatalism), enabling (health insurance, access to care, income, health utilization), and need (physician recommendation, family/personal history, pain/discomfort, family responsibilities) factors. The most common factor was insurance status, although cultural issues (e.g., mistrust) were evident. Most of the identified factors are modifiable. The mean MQS was 12.2, indicating that the studies were slightly above average in quality., Conclusions: Financial and cultural issues were important hindrances to breast cancer screening in African American women. These findings highlight the importance of affordable health care for preventive health services as well as the relevance of culturally embedded issues to health, while the MQS accentuates the need for more rigorous research articles. Breast cancer screening interventions in this population should attend to barriers identified in this review., Competing Interests: Declaration of competing interest The authors declare that they have NO conflicts of interest., (Copyright © 2020 National Medical Association. Published by Elsevier Inc. All rights reserved.)

Objective: Due to the global increase in obesity rates and success of bariatric surgery in weight reduction, an increasing number of women now present pregnant with a previous bariatric procedure. This study investigates the extent of bariatric-associated metabolic and gut microbial alterations during pregnancy and their impact on fetal development., Design: A parallel metabonomic (molecular phenotyping based on proton nuclear magnetic resonance spectroscopy) and gut bacterial (16S ribosomal RNA gene amplicon sequencing) profiling approach was used to determine maternal longitudinal phenotypes associated with malabsorptive/mixed (n=25) or restrictive (n=16) procedures, compared with women with similar early pregnancy body mass index but without bariatric surgery (n=70). Metabolic profiles of offspring at birth were also analysed., Results: Previous malabsorptive, but not restrictive, procedures induced significant changes in maternal metabolic pathways involving branched-chain and aromatic amino acids with decreased circulation of leucine, isoleucine and isobutyrate, increased excretion of microbial-associated metabolites of protein putrefaction (phenylacetlyglutamine, p- cresol sulfate, indoxyl sulfate and p- hydroxyphenylacetate), and a shift in the gut microbiota. The urinary concentration of phenylacetylglutamine was significantly elevated in malabsorptive patients relative to controls (p=0.001) and was also elevated in urine of neonates born from these mothers (p=0.021). Furthermore, the maternal metabolic changes induced by malabsorptive surgery were associated with reduced maternal insulin resistance and fetal/birth weight., Conclusion: Metabolism is altered in pregnant women with a previous malabsorptive bariatric surgery. These alterations may be beneficial for maternal outcomes, but the effect of elevated levels of phenolic and indolic compounds on fetal and infant health should be investigated further., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)