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Abstract Background Bariatric surgery has been widely distributed as an effective treatment method for morbid obesity. An increased volume of the left hepatic lobe may affect the ergonomics of bariatric surgery, which could complicate the surgical techniques and require special instruments. CT of the abdomen is considered the gold standard imaging modality in the assessment of the left hepatic lobe volume; nevertheless, it has some drawbacks, such as exposure to ionizing radiation, besides the contrast and gantry limitations. The objective of this study is to investigate the diagnostic accuracy of abdominal US in comparison to CT in measuring the left hepatic lobe volume in morbidly obese patients as part of their preoperative evaluation. Seventy-two morbidly obese patients of different ages (between 22 and 55 years) and genders were included in this study who were scheduled for bariatric surgery. Results The intraclass coefficient and Cronbach's alpha reliability coefficient with their 95% CI were used. There was a strong positive correlation between left hepatic lobe volumes as measured by US and CT (r = 0.999, p value

Background: Bariatric surgery has been widely distributed as an effective treatment method for morbid obesity. An increased volume of the left hepatic lobe may affect the ergonomics of bariatric surgery, which could complicate the surgical techniques and require special instruments. CT of the abdomen is considered the gold standard imaging modality in the assessment of the left hepatic lobe volume; nevertheless, it has some drawbacks, such as exposure to ionizing radiation, besides the contrast and gantry limitations. The objective of this study is to investigate the diagnostic accuracy of abdominal US in comparison to CT in measuring the left hepatic lobe volume in morbidly obese patients as part of their preoperative evaluation. Seventy-two morbidly obese patients of different ages (between 22 and 55 years) and genders were included in this study who were scheduled for bariatric surgery. Results: The intraclass coefficient and Cronbach's alpha reliability coefficient with their 95% CI were used. There was a strong positive correlation between left hepatic lobe volumes as measured by US and CT (r = 0.999, p value < 0.001), indicating a significant linear relationship between them. The mean of the two variables was very close (474.2 ± 164.9 cm3) by US and (475.1 ± 164.5 cm3) by CT. Conclusions: Abdominal US examination for assessment of the left hepatic lobe volume is considered a valid diagnostic method compared to CT (with a clinically accepted slight difference between values) in preoperative assessment of morbidly obese patients. It provides an accurate, simple, and inexpensive diagnostic tool that avoids the drawbacks of CT. [ABSTRACT FROM AUTHOR]

ABSTRACTBackground Enhanced recovery after bariatric surgeries and resumption of complicated physiological functions are properties of ideal anaesthetic. The goal of the current study was to compare the effects of desflurane and sevoflurane on intra-operative haemodynamics and recovery profiles in obese individuals undergoing laparoscopic sleeve gastrectomy.Settings and Design Prospective randomized controlled trial.Methods After Local Ethical Committee approval, 50 obese patients, between ages 20 and 40, undergoing elective LSG were randomly assigned to receive desflurane (group D) or sevoflurane (group S). Entropy value was maintained between 40 and 60. Haemodynamic parameters including cardiac index (CI) were recorded. Minimum alveolar concentration that maintained target entropy (MACEN) values were calculated immediately after intubation and every 30 minutes until the end of procedure. After weaning from anaesthesia, time to fully awake entropy values and immediate recovery parameters were recorded. In post anaesthesia care unit (PACU), intermediate recovery was assessed using Modified Aldrete’s Score (MAS) and Digit Symbol Substitution Test (DSST).The duration of PACU stay was documented.Results Intra-operative haemodynamic parameters were comparable between two groups. The mean MACEN values for D group were significantly higher than S group immediately after intubation; however, they were significantly less than S group during the whole intra-operative period. Post-operatively, time to reach fully awake entropy values and immediate recovery parameters were shorter in group D than in group S. Desflurane anaesthetized patients had higher MAS than sevoflurane patients upon arrival at PACU and after 5 minutes. DSST restored to baseline values more quickly after desflurane anaesthesia. In comparison to group S, group D’s PACU stay was shorter.Conclusions Desflurane and sevoflurane both had similar haemodynamic parameters; however, the recovery profiles were significantly quicker after desflurane anaesthesia enabling fast-tracking and patients to be early discharged.

Background: Enhanced recovery after bariatric surgeries and resumption of complicated physiological functions are properties of ideal anaesthetic. The goal of the current study was to compare the effects of desflurane and sevoflurane on intra-operative haemodynamics and recovery profiles in obese individuals undergoing laparoscopic sleeve gastrectomy. Settings and Design: Prospective randomized controlled trial. Methods: After Local Ethical Committee approval, 50 obese patients, between ages 20 and 40, undergoing elective LSG were randomly assigned to receive desflurane (group D) or sevoflurane (group S). Entropy value was maintained between 40 and 60. Haemodynamic parameters including cardiac index (CI) were recorded. Minimum alveolar concentration that maintained target entropy (MACEN) values were calculated immediately after intubation and every 30 minutes until the end of procedure. After weaning from anaesthesia, time to fully awake entropy values and immediate recovery parameters were recorded. In post anaesthesia care unit (PACU), intermediate recovery was assessed using Modified Aldrete's Score (MAS) and Digit Symbol Substitution Test (DSST). The duration of PACU stay was documented. Results: Intra-operative haemodynamic parameters were comparable between two groups. The mean MACEN values for D group were significantly higher than S group immediately after intubation; however, they were significantly less than S group during the whole intra-operative period. Post-operatively, time to reach fully awake entropy values and immediate recovery parameters were shorter in group D than in group S. Desflurane anaesthetized patients had higher MAS than sevoflurane patients upon arrival at PACU and after 5 minutes. DSST restored to baseline values more quickly after desflurane anaesthesia. In comparison to group S, group D's PACU stay was shorter. Conclusions: Desflurane and sevoflurane both had similar haemodynamic parameters; however, the recovery profiles were significantly quicker after desflurane anaesthesia enabling fasttracking and patients to be early discharged. [ABSTRACT FROM AUTHOR]

Background: Controlling the airway is the anesthesiologist's primary concern, as all sedatives and the general anesthesia technique require a patent airway for the transfer of gases between the lungs and the surrounding airway. The evaluation of the patient's airway during the preanesthetic examination assists the anesthesiologist in planning the intubation technique to safeguard the airway. One reliable sign of airway blockage is body mass index (BMI). Case: A 62-year-old male with BMI 43 kg/m² was posted for open umbilical hernia repair. Vital parameters were estimated. The chosen anesthesia technique was general anesthesia combined with epidural analgesia. The patient was put in the Risk Assessment and Management Program (RAMP) position using pillows to create a 25° angle that lined up the external auditory meatus and sternal notch on a level plane. Auscultation and the EtCO2 graph were used to confirm that the endotracheal tube was positioned correctly. Conclusion: A severely obese patient with limited neck extension was successfully intubated using a videolaryngoscope in the RAMP position, and the intubation went smoothly after extubation. [ABSTRACT FROM AUTHOR]

Aims: Obesity is associated with an increased risk of hip osteoarthritis, resulting in an increased number of total hip arthroplasties (THAs) performed annually. This study examines the peri- and postoperative outcomes of morbidly obese (MO) patients (BMI ≥ 40 kg/m2) compared to healthy weight (HW) patients (BMI 18.5 to < 25 kg/m2) who underwent a THA using the anterior-based muscle-sparing (ABMS) approach. Methods: This retrospective cohort study observes peri- and postoperative outcomes of MO and HW patients who underwent a primary, unilateral THA with the ABMS approach. Data from surgeries performed by three surgeons at a single institution was collected from January 2013 to August 2020 and analyzed using Microsoft Excel and Stata 17.0. Results: This study compares 341 MO to 1,140 HW patients. Anaesthesia, surgery duration, and length of hospital stay was significantly lower in HW patients compared to MO. There was no difference in incidence of pulmonary embolism, periprosthetic fracture, or dislocation between the two groups. The rate of infection in MO patients (1.47%) was significantly higher than HW patients (0.14%). Preoperative patient-reported outcome measures (PROMs) show a significantly higher pain level in MO patients and a significantly lower score in functional abilities. Overall, six-week and one-year postoperative data show higher levels of pain, lower levels of functional improvement, and lower satisfaction scores in the MO group. Conclusion: The comorbidities of obesity are well studied; however, the implications of THA using the ABMS approach have not been studied. Our peri- and postoperative results demonstrate significant improvements in PROMs in MO patients undergoing THA. However, the incidence of deep infection was significantly higher in this group compared with HW patients. Cite this article: Bone Jt Open 2023;4(5):299–305.

Abstract Background The benefit of apixaban to reduce stroke risk in morbidly obese patients with nonvalvular atrial fibrillation (AF) is still undetermined. The International Society of Thrombosis and Hemostasis recommends avoiding the use of direct oral anticoagulants (DOAC)s in morbidly obese patients (body mass index > 40 or weight > 120 kg) because of limited clinical data. This exploratory study aims to evaluate the effectiveness and safety of using apixaban in morbidly obese (body mass index (BMI) ≥ 40) patients with AF. Methods An exploratory retrospective cohort study was conducted at a single-center, including adult patients with non-valvular AF using apixaban between 01/01/2016 and 31/12/2019. Patients were excluded if they were known to have liver cirrhosis Child-Pugh C, mechanical valve, serum creatinine > 1.5 mg/dL, follow up 10 mg/day. Included patients were categorized into two groups based on their BMI (BMI

Aims: There is evidence that morbidly obese patients have more intra- and postoperative complications and poorer outcomes when undergoing total hip arthroplasty (THA) with the direct anterior approach (DAA). The aim of this study was to determine the efficacy of DAA for THA, and compare the complications and outcomes of morbidly obese patients with nonobese patients. Methods: Morbidly obese patients (n = 86), with BMI ≥ 40 kg/m2 who underwent DAA THA at our institution between September 2010 and December 2017, were matched to 172 patients with BMI < 30 kg/m2. Data regarding demographics, set-up and operating time, blood loss, radiological assessment, Harris Hip Score (HHS), International Hip Outcome Tool (12-items), reoperation rate, and complications at two years postoperatively were retrospectively analyzed. Results: No significant differences in blood loss, intra- and postoperative complications, or implant position were observed between the two groups. Superficial wound infection rate was higher in the obese group (8.1%) compared to the nonobese group (1.2%) (p = 0.007) and relative risk of reoperation was 2.59 (95% confidence interval 0.68 to 9.91). One periprosthetic joint infection was reported in the obese group. Set-up time in the operating table and mean operating time were higher in morbidly obese patients. Functional outcomes and patient-related outcome measurements were superior in the obese group (mean increase of HHS was 52.19 (SD 5.95) vs 45.1 (SD 4.42); p < 0.001), and mean increase of International Hip Outcome Tool (12-items) was 56.8 (SD 8.88) versus 55.2 (SD 5.85); p = 0.041). Conclusion: Our results suggest that THA in morbidly obese patients can be safely and effectively performed via the DAA by experienced surgeons. Cite this article: Bone Jt Open 2022;3(1):4–11.

Background: Bariatric surgery (BS) patients may experience the progression of periodontitis during recovery. We aimed to determine whether non-surgical periodontal therapy before BS improves the periodontal and systemic health parameters after the surgery. Methods: BS candidates with periodontitis were randomized into the test (TG) and control group (CG). One month before BS (pre-BS), patients in the TG (n = 15) received non-surgical periodontal therapy, while patients in the CG (n = 15) received only mechanical plaque removal. Patients were re-examined 3 and 6 months after BS. Differences between the TG and CG in clinical periodontal parameters, systemic health-related serum biomarkers, parameters of obesity, and prevalence of obesity-related diseases were evaluated. Results: From the 30 included patients, 26 were re-examined at 3 months and 20 patients at 6 months. Periodontal parameters bleeding on probing (p = 0.015), periodontal pocket dept (PPD, p = 0.0015), % PPD > 4 mm (p < 0.001), and full-mouth plaque levels (p = 0.002) were lower in the TG than in the CG at 6 months after BS. There is a general improvement in systemic health after BS without significant differences (p > 0.05) between the TG and CG at the 6-month follow-up. The TG shows a tendency for improvement in metabolic syndrome components at the 6-month follow-up compared to pre-BS (p < 0.05). Conclusions: Non-surgical periodontal therapy in periodontitis patients before the BS may improve periodontal health 3 and 6 months after the surgery. The possible benefits of periodontal therapy on the overall health of BS patients should be further explored. [ABSTRACT FROM AUTHOR]

The number of total hip and total knee replacements has increased steadily each year. Today, they are routinely performed all over the world. The increasing prevalence of obesity has led to an increase in the number of total knee arthroplasties (TKAs) performed in patients with a higher body mass index (BMI) and also has a higher rate of complications. Possible complications are infection, instability, misalignment, osteolysis, or fracture. Revision arthroplasty can be challenging due to bone defects, ligament instability, and difficulty in fixation. We present the case of a 66-year-old morbidly obese patient who underwent TKA. After the operation, infection and a mechanical complication of periprosthetic fracture of the tibial component occurred. The infection made the treatment more difficult. The patient had to undergo several surgeries in several stages to address the post-surgical complications. TKA in obese patients leads to a higher risk of postoperative complications., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bocea et al.)

Infective endocarditis (IE) is a rare but potentially life-threatening condition characterized by inflammation and infection of the inner lining of the cardiac chambers, native or prosthetic valves, or indwelling cardiac devices. In recent decades, its incidence has increased exponentially in healthcare-associated settings such as hemodialysis (HD). The primary causative agent is typically Staphylococcus aureus , followed by streptococci and, in some instances, even fungal infections, although infectious agents do not exclusively cause the condition. In this case report, we detail the clinical presentation of a 46-year-old morbidly obese male with a medical history notable for hypertension, poorly controlled diabetes, and end-stage renal disease necessitating HD. Upon arrival at the emergency department, he presented following a two-week lapse in dialysis sessions, reporting symptoms of altered mental status and lethargy. Shortly after that, the patient's condition rapidly deteriorated, marked by fever, vomiting, and indications of septic shock. Physical examination revealed signs consistent with meningism, alongside the identification of a clotted radio-cephalic fistula, impeding vascular access essential for HD. Furthermore, severe uremia was evident, attributed to the prolonged absence of dialysis treatment. Concurrently, given the patient's presentation of meningeal signs, we were concerned about a potential diagnosis of meningitis. Our immediate priority was to stabilize the patient's vital signs and address the resolution of potential uremic encephalopathy. Additionally, we prioritized the investigation of possible sources of bacterial infection that could be contributing to septic shock and sudden deterioration. This case highlights the complex presentation of IE, which necessitated the collaboration of multidisciplinary teams to address the patient's condition. Additionally, emphasis is placed on HD as a major risk factor for IE, with discussion of associated factors such as constant manipulation of skin flora during dialysis, types of vascular access utilized, and the potential for fistula infection to directly or indirectly contribute to IE. Furthermore, we explore the idea of a possible link between meningism or meningitis and IE., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kumar et al.)

Background Portomesenteric venous thrombosis (PMVT) is a life-threatening rare postoperative complication after laparoscopic sleeve gastrectomy (LSG). Thromboprophylaxis is essential to guard against venous thrombosis after laparoscopic surgery. This study points out the benefits of postoperative use of anticoagulation to prevent PMVT after LSG in morbidly obese patients with BMI of 35–45kg/m² . Patients and methods A retrospective comparative pilot study was conducted that included 60 patients with;Deg;BM;Deg;I between 35 and 45kg/m² who underwent LSG between January 2020 and January 2021 at El-Demerdash Hospital. Half of the patients received antithromboembolic dosage scheme of 0.5mg/kg/day with the induction of anesthesia and for 14 days postoperatively (group A), whereas the other half had no postoperative anticoagulation prophylaxis (group B). Results Patients were followed up with lower limb venous duplex at 2-week, 3-, and 6-month interval from the operation or on appearance of symptoms of PMVT. No patient had PMVT in group A, whereas four patients had PMVT in group B confirmed by venous duplex. Conclusion The anticoagulated group showed better outcomes regarding the prevention of PMVT after surgery. Yet, the incidence of PMVT after LSG in patients with BMI of 35–45kg/m2 was not affected only by anticoagulation. Evidence about PMVT prevention and thromboprophylaxis plan is still lacking, so we recommend further large prospective trials. [ABSTRACT FROM AUTHOR]

Background: Knee joint arthroplasty is a commonly performed procedure. However, number of obese patients undergoing total knee arthroplasty is on a rise. In such cases, post closure using routine techniques, there have been an increasing number of cases of wound dehiscence and complications like persistent discharge and delayed healing. To overcome this problem, the author has come up with an innovative technique in closure. Materials and Methods: 27 patients, who were obese, were included in the study and operated at Orthopaedic Arthroscopic Knee and Shoulder clinic. The patients were evaluated pre operatively clinically and planned for retention stitches for closure. Same technique was followed for closure in all the patients. Suture removal was done at 2 weeks and patients were followed up for a period of 6 months for any complications. Results: In 27 patients undergoing retention stitches post total knee arthroplasty, patients were followed up for a mean period of 14 months, with minimum being 6 months and maximum being 5 years. Patients showed no complications such as wound dehiscence, discharge, localised skin necrosis or cut-through of stitches. Conclusion: Retention stitches in knee arthroplasty is an innovative, ideal, yet easily replicable method of wound closure in obese patients, especially with BMI > 30 (Obesity grade 1 or more). Patients undergo better and uneventful wound healing, which is of paramount importance in a surgery like this. In all these patients, the rehabilitation post surgery is also similar to the other patients, hence not affecting the outcome. [ABSTRACT FROM AUTHOR]

Background: The benefit of apixaban to reduce stroke risk in morbidly obese patients with nonvalvular atrial fibrillation (AF) is still undetermined. The International Society of Thrombosis and Hemostasis recommends avoiding the use of direct oral anticoagulants (DOAC)s in morbidly obese patients (body mass index > 40 or weight > 120 kg) because of limited clinical data. This exploratory study aims to evaluate the effectiveness and safety of using apixaban in morbidly obese (body mass index (BMI) ≥ 40) patients with AF. Methods: An exploratory retrospective cohort study was conducted at a single-center, including adult patients with non-valvular AF using apixaban between 01/01/2016 and 31/12/2019. Patients were excluded if they were known to have liver cirrhosis Child-Pugh C, mechanical valve, serum creatinine > 1.5 mg/dL, follow up < 3 months, or using apixaban with a dose of ≤5 or > 10 mg/day. Included patients were categorized into two groups based on their BMI (BMI<40 Vs. BMI ≥ 40). The primary outcome was all thrombotic events, while the secondary outcomes were major and minor bleeding after apixaban initiation. Propensity score (PS) matching was used (1:1 ratio) based on the patient's age, gender, and HAS-BLED score. Results: A total of 722 patients were eligible; 254 patients were included after propensity score matching based on the selected criteria. The prevalence of all thrombotic events was similar between the two groups in the first year of apixaban initiation (OR (95%CI): 0.58 (0.13, 2.5), p-value = 0.46). In addition, the odds of developing major and minor bleeding were not statistically significant between the two groups (OR (95%CI): 0.39 (0.07, 2.03), p-value = 0.26 and OR (95%CI): 1.27 (0.56, 2.84), p-value = 0.40), respectively). Conclusion: This exploratory study showed similar effectiveness and safety of apixaban use in both morbid and non-morbid obese patients with non-valvular AF. However, a larger randomized controlled trial with a longer follow-up period needs to confirm our findings. [ABSTRACT FROM AUTHOR]

Background: Preoxygenation efficacy with high-flow nasal cannula (HFNC) in obese patients is not clearly established. The primary aim of this study was to compare heated, humidified, high-flow nasal cannula with face mask for preoxygenation in this population.Methods: We conducted a single-centre, randomised, controlled trial. Forty subjects with BMI ≥ 35 kg m-2 were randomly assigned to receive 5.0 min of preoxygenation with face mask and 7 cm H2 O of PEEP (PEEP group) or HFNC at 70 L min-1 (HF group). Following induction, bag-mask ventilation continued until laryngoscopy, whereas HFNC was maintained before and during intubation. The primary outcomes were end-tidal fraction of oxygen (EtO2 ) at 2.5 and 5.0 min duration of preoxygenation. Secondary outcomes included PaO2 and PaCO2 at 2.5 and 5.0 min of preoxygenation and at intubation.Results: Mean (±SD) EtO2 was 0.89 (±0.04) versus 0.90 (±0.05) after 2.5 min (95% CI for mean difference -0.02, 0.04) and 0.93 (±0.02) versus 0.91 (±0.02) after 5.0 min of preoxygenation (95% CI for mean difference -0.03, -0.002) in the PEEP (n = 18) and HF group (n = 20), respectively. All subjects reached an EtO2  ≥ 0.85 at 5.0 min. There were no differences in mean PaO2 or PaCO2 during preoxygenation. Subjects in the HF group had a mean (±SD) apnoea time of 199 (±38) s, but no desaturation (SpO2  < 100%) occurred.Conclusions: Face mask with PEEP was superior to HFNC for preoxygenation in obese subjects. HFNC provided adequate preoxygenation quality in all subjects and may be considered as an alternative to face mask in selected patients.Trial Registration: #ISRCTN37375068 (www.isrctn.com). [ABSTRACT FROM AUTHOR]

In this paper, based on the association of methylenetetrahydrofolate reductase (MTHFR) with type 2 diabetes (T2D), we evaluated the association of polymorphism with morbidly obesity on risk type 2 diabetes. A case-control study of 74 health morbidly obese and 76 healthy non-obese was conducted in Iraq. MTHFR (C677T, A1298C and G1793A) genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). The study revealed a significant association between cytidine/thymine (CT) genotype of C677T and morbid obesity (odds ratio (OR): 1.26, 95% confidence interval (CI): 0.91-1.60, probability (P) = 0.0003), but did not show any significant association in thymine/thymine (TT) genotype (OR: 0.258, 95% CI: 0.88-1.60, P = 0.082). On the other hand the second single nucleotide polymorphism (SNP) A1298C showed highly significant association in adenine/adenine (AA) genotype (OR: 1.39, 95% CI: 0.91-1.58, P = 0.0001) and significant association between adenine/cytidine (AC) and cytidine/cytidine (CC) genotypes (OR: 0.702, 95% CI: 0.88-1.61, P = 0.0377), (OR: 0.844, 95% CI: 0.91-1.59, P = 0.0273), respectively, but showed no significant relation in three types of normal homozygous, heterozygous and rare homozygous in MTHFR-G1793A. The results suggested that A1298C substitution might pose a direct effect on being type 2 diabetes in morbidly obese patients, and C677T had moderate effect, while G1793A had no effect. However, further case-control studies are required to provide a more robust conclusion.

Objectives: To document the frequency of complications following Laparoscopic Sleeve gastrectomy in morbidly obese patients in population of Khyber Pakhtunkhwa province, Pakistan Material and Methods: This descriptive study was conducted at Lady Reading Hospital and Mohmand Medical Center, Peshawar from 1st May 2018 to 30th April 2019. All patients who underwent Laparoscopic Sleeve Gastrectomy were included in this study whether operated in public or private hospital. All patients were operated by a single surgeon. Data of complication was collected and analysed by using SPSS version 16.0. Results: A total of 22 patients enrolled with mean age of 36.2±8.1 years. Male to female ratio was 3.4:1. Mean pre-operative weight was 133.2±33.1 Kg and pre-operative Body Mass Index (BMI) was 47.6±7.5 kg/m2. Post-operative weight loss at one month was 10.79±15.6 kg, and post-operative BMI was 39.7±5.3 Kg/m2 at same point. Mean percentage of excess weight loss at one month was 38.9%. Post-operatively 2-patients had developed suture line bleed and 1-patient has developed pulmonary complication, while 1-patient needed invasive ventilation in post-operative period. 3-patients presented with rapid weight loss at one month follow up. Re-exploration and mortality was zero. Conclusions: Sleeve Gastrectomy is a safe and easy procedure to perform in a wide range of BMI's in obese patients with greater earlier benefits of significant weight loss. Consideration to a gastric bypass as a definitive procedure at a later date may be required in some patients. [ABSTRACT FROM AUTHOR]

This study was aimed to investigate differences in antioxidant and anti-inflammatory effects of propofol at two commonly used dosing schedules on morbidly obese patients. Twenty-two morbidly obese patients were randomly divided into two groups, namely, TBW (dosing based on total body weight) and LBW (dosing based on lean body weight) groups. Three biomarkers, i.e. superoxide dismutase (SOD), malondialdehyde (MDA) and nitric oxide (NO) were measured as indicators of the level of oxidation stress reaction. Pro-inflammatory cytokines including Interleukin-6 (IL-6) and Interleukin-8 (IL-8) were used to describe the degree of inflammation. Plasma levels of SOD, MDA and NO were increased and reached a peak value 0.5h after anesthesia induction, but the increase was smaller in the LBW group compared with the TBW group. Besides, plasma concentrations of IL-6 and IL-8 were also increased and attained a peak level 0.5h after anesthesia induction, but the increase was higher in the TBW group compared with the LBW group. The LBW-based dosing of propofol had more potent antioxidant and anti-inflammatory effects than the TBW-based dosing during anesthesia induction period on morbidly obese patients. This study provided a dosing recommendation of propofol for morbidly obese patients. [ABSTRACT FROM AUTHOR]

Background The escalating prevalence of obesity worldwide presents unique challenges in critical care management, especially in the context of mechanical ventilation and weaning processes in intensive care units (ICUs). The present study aimed to determine the incidence of weaning failure in obese patients in an ICU. Methods A prospective observational study was carried out to gather data on patients in the ICU of Shifa International Hospital located in Islamabad, Pakistan. The target population consisted of adult patients who were both male and female, ages 18 years and above. These individuals required intubation procedures as well as mechanical ventilation during their hospitalization. The researchers followed these patients prospectively and observed their medical conditions closely to gather data about how obesity might impact critical care interventions and outcomes. Results The sample size was 288 bearing a median age of 61.0 with an interquartile range of 19 years. Older age manifested a significantly higher frequency of failed extubation (p=0.065). Higher body mass index (BMI) was significantly associated with failed extubation among the study population. It was found that a higher significant difference was associated with BMI > 30 kg/m 2 (obese) in failed and successful extubation. One-half of the patients with failed extubation and only 16 (5.9%) patients with successful extubation had end-stage renal disease (p<0.001). It was found that patients who underwent failed extubation had notably increased ICU mortality (p=0.108), 28-day mortality (p=0.067), as well as mean ICU (p<0.001) and hospital stay (p=0.007). Conclusion Our study revealed some insightful correlations between obesity, age, comorbidities, length of hospitalization, ICU stay, and mortality rate in terms of weaning failure among the study population., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Ilyas et al.)

Background: Although morbid obesity is an established risk factor for periprosthetic joint infection following total hip arthroplasty and total knee arthroplasty, little is known regarding the infection control rate of this cohort following debridement, antibiotics, and implant retention (DAIR). The purpose of this study is to investigate the infection control rate following DAIR in a morbidly obese patient cohort compared to a nonobese patient cohort and discern the relationship between time from diagnosis to treatment and risk of DAIR failure.Methods: Results of all DAIR procedures were retrospectively reviewed across 4 institutions. Those with a body mass index of at least 40 kg/m2 were matched 2:1 on the basis of patient age, sex, date of surgery, and presence of staphylococcal species in culture to a cohort of patients with body mass index of <30 kg/m2. Demographic variables were collected for each patient. Kaplan-Meier survivorship curves were constructed and multivariable Cox regression was performed for analysis.Results: The morbidly obese group experienced a higher treatment failure rate (57.9%) compared to the nonobese group (36.8%; P = .035). Morbid obesity and major depressive disorder/generalized anxiety disorder diagnosis significantly increased the risk of failure, with hazard ratios of 1.82 and 2.09, respectively. Morbidly obese patients who received DAIR within 48 hours of symptom presentation did not face an increased risk of reinfection compared to nonobese patients.Conclusion: Our findings suggest morbidly obese patients face an increased risk of DAIR failure; however, this risk can be mitigated if DAIR is received within 48 hours of symptom onset. [ABSTRACT FROM AUTHOR]

Background: Umbilical hernias are especially common along with overweight, multiparous women. Laparoscopic hernia repair is preferred due to many advantages. On the other hand, the risk of trocar site hernia is disadvantageous. Trocars do not go through the abdominal wall via transvaginal natural orifice transluminal endoscopic surgery (V-NOTES). We investigate the V-NOTES hysterectomy and concomitant umbilical hernia repairment feasibility and outcomes. Methods: Six morbidly obese patients underwent V-NOTES hysterectomy and concurrent umbilical hernia repair between April 2020 and January 2021. Demographic features of patients, operating time, hernia size, complications, hospitalization time, recurrence of the hernia, visual analog scale (VAS) at 6th, 12th, and 24th hours, first, fourth, 12th weeks, and sixth months were recorded. Results: The average age of patients was 47.667 ± 2.422 (45–52). Mean body mass index (BMI), hernia and operating time size were 44.367 ± 3.217 kg/m2 (40.3–48.5), 6.167 ± 1.722 cm (4–9) and 88 ± 12.791 minutes (75–110), respectively. Intraoperative complications did not occur. Seroma was detected in one patient(16.6%). In six month follow-up period, we did not establish a diagnosis of hernia recurrence and postoperative chronic pain. Conclusion: Our study offers a novel perspective on V-NOTES umbilical hernia repair and hysterectomy in morbidly obese patients. According to our study, performing V-NOTES umbilical hernia repairment in a risky patient population is feasible and has promising outcomes.

Abstract Background Dexmedetomidine infusion improves oxygenation and lung mechanics in patients with chronic obstructive lung disease; however, its effect in patients with restrictive lung disease has not been thoroughly investigated yet. The aim of this work was to evaluate the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. Methods Forty-two morbidly obese patients scheduled for bariatric surgery were included in the study. Patients were randomized to receive either dexmedetomidine infusion at a bolus dose of 1mcg/Kg followed by infusion at 1 mcg/Kg/hour for 90 min (Dexmedetomidine group), or normal saline infusion (Control group). Both groups were compared with regard to: oxygenation {P/F ratio: PaO2/fraction of inspired oxygen (FiO2)}, lung compliance, dead space, plateau pressure, blood pressure, and heart rate. Results Dexmedetomidine group showed significant improvement of the PaO2/FiO2 ratio, and higher lung compliance compared to control group by the end of drug infusion. Dexmedetomidine group demonstrated decreased dead space, plateau pressure, blood pressure, and heart rate compared to control group by the end of drug infusion. Conclusion A 90-min dexmedetomidine infusion resulted in moderate improvement in oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. Trial registration clinicaltrials.gov: NCT02843698 on 20 July 2016.

Background Pain is a significant problem for many patients after major surgery. The transversus abdominis plane (TAP) block is a new technique that provides analgesia following abdominal surgery. TAP block can be done blindly or by using ultrasound that include posterior and subcostal approach. Aim The primary aim was to study the clinical utility of TAP block as analgesia after lower abdominal surgeries in morbidly obese. The secondary aim was to assess the advantages and disadvantages of the same. Patients and methods A total of 60 patients fulfilling inclusion criteria who were undergoing elective lower abdominal surgeries were divided into two equal groups. Group T (TAP group), which received bilateral ultrasound-guided subcostal TAP block at the end of the surgery before emergence, and group C (control group) that received general anesthesia, with no further narcotic administration. Postoperative mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough, PaCO2, time to first request of analgesia, average frequency of analgesia, average total analgesics consumption, average total local anesthetic (bupivacaine) consumption, postoperative complications, and frequency of antiemetic were recorded. Bromage score was assessed at 20 min postoperatively. Results There were significant decrease in mean arterial pressure, heart rate, respiratory rate, visual analog scale, and visual analog scale on cough in group T than group C at 10, 20 min. There wasa high significant decrease in peak expiratory flow rate and significant increase in PaCO2 in group C than group T at 2, 6 h postoperatively. There was a high significant increase in the time to first request of analgesia, and a high significant decrease of both frequency of analgesia and average total consumption of analgesia. A high significant increase was observed in local anesthetic consumption in the first 24 h postoperatively in group T than group C. There were significant differences in nausea, vomiting, and frequency of antiemetic, whereas they did not occur in group T. There were no significant differences in the grade of motor block between two groups at 20 min or any other time. Conclusion TAP block was safe, and easy to perform, and more effective in the early postoperative period with significant reductions in opioid requirement, pain score, and complications, and did not produce motor block.

A morbidly obese patient with history of deep vein thrombosis and pulmonary embolism was diagnosed with an acute left upper extremity deep vein thrombosis and started on rivaroxaban. Three months later, the patient returned with swelling in the right arm and was found to have a right brachial thrombosis. Anticoagulant therapy was switched to a low-molecular-weight heparin, and patient was discharged on enoxaparin along with an order to follow-up with a hematologist. Subanalyses from randomized controlled trials, pharmacokinetic/pharmacodynamic, and real-world studies suggest that rivaroxaban may be effective and safe in morbidly obese patients for primary and secondary prevention of venous thromboembolism. However, the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis does not recommend the use of direct-acting oral anticoagulants in this population. If used, drug levels should be monitored to guide the therapy. Due to the disparity in data to show efficacy and safety of rivaroxaban in morbidly obese subjects, the interpatient variability of rivaroxaban's effects in subjects, and the lack of defined therapeutic range for rivaroxaban drug concentration, rivaroxaban should be used cautiously in this population. [ABSTRACT FROM AUTHOR]

Aim: this study aimed to investigate how Laparoscopic sleeve gastrectomy (LSG) Surgery affect the weight reduction and level of serum adipokines (Visfatin, Ghrelin and Leptin) in Morbidly Obese Subjects because of the Conflicting results that obtained from previous studies regarding the changes of adipokines following sleeve operation and weight reduction. Method: 20 Iraqi severely obese patients (12 females and 8 males), Mean ±SD of aged are 34.45±9.47, and 40 healthy lean controls (24 females and 16 males) Mean ±SD of aged are 33.90±9.31were studied. Anthropometric parameters and biochemical parameters (insulin resistant IR) as well as visfatin, ghrelin and leptin were analyzed before and 6 weeks after the operation. Results: after surgery Anthropometric indices (BMI) decreased significantly. The reduction of visfatin and the elevation of ghrelin were statistically not significant, whereas leptin level decrease significantly and insulin resistant (IR) decrease not significantly. moreover, there is a significant positive correlation between the change of serum leptin and (BMI)and visfatin correlated positively with insulin resistant (HOMA-IR). Conclusions: sleeve Gastrectomy resulted in significant decrease in the (BMI), decreased serum visfatin, insulin resistant and increased ghrelin levels statistically not significant, while significant decrease in leptin level. Further studies with different design are suggested to clarify these changes. [ABSTRACT FROM AUTHOR]

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A obesidade mórbida se associa a várias alterações fisiopatológicas que afetam o desfecho da anestesia e cirurgia. É, portanto, um desafio anestesiar tais pacientes. Apresentamos uma mulher adulta de 59 anos, obesa mórbida, hipertensa, diabética, com hipotiroidismo, submetida a cirurgia devido a fratura proximal do úmero e que compareceu ao serviço com fratura não consolidada, e com indicação de injeção percutânea de aspirado de medula óssea da crista ilíaca na fratura não consolidada. A paciente estava extremamente ansiosa e recusou o procedimento sob anestesia local ou sedação e exigiu anestesia. Em função de suas comorbidades, Anestesia Geral (AG) foi evitada e o procedimento foi realizado usando bloqueio do Plano Transverso Abdominal (PTA) guiado por Ultrassonografia (USG) e bloqueio do Nervo Cutâneo Femoral Lateral (NCFL) para aspiração de medula óssea da crista ilíaca. O bloqueio do nervo Intercostobraqueal (T2) foi realizado para evitar dor durante a injeção do aspirado. Dexmedetomidina e ketamina foram dadas para sedação profunda e analgesia. O Bloqueio PTA e bloqueio NCFL geralmente são usados para analgesia pós‐operatória, mas também podem ser usados para anestesia cirúrgica substituindo a anestesia geral em condições clínicas específicas. O emprego desses bloqueios no perioperatório e seu uso potencial no lugar de AG têm sido discutidos. Morbid obesity is associated with various pathophysiological changes which affect the outcome of anesthesia and surgery. So it's challenging to give anesthesia to such patients. We present a 59‐year‐old adult morbidly obese, hypertensive, diabetic female with hypothyroidism operated for proximal humerus fracture and now presented with non‐union of fracture, requiring percutaneous injection of bone marrow aspirate from the iliac crest to the site of non‐union. The patient was extremely anxious and refused to undergo the procedure under local anesthesia or sedation and demanded anesthesia. Given her comorbidities general anesthesia (GA) was avoided and the procedure was accomplished using Ultrasound (USG) guided Transversus abdominis plane (TAP) block and Lateral Femoral Cutaneous Nerve (LFCN) block for the bone marrow aspirate from the iliac crest and Intercostobrachial nerve block (T2) was given to prevent pain while injecting the aspirate into the non‐union site. Dexmedetomidine and ketamine were given for deep level sedation and analgesia. TAP block and LFCN block is generally used for post‐op analgesia but can be also used for surgical anesthesia instead of General anesthesia in specific scenarios. Its perioperative application and its potential use instead of GA have been discussed. [ABSTRACT FROM AUTHOR]

Management of anticoagulation has become a hot topic in the last decade. Health-care professionals are encountering increasing number of patients diagnosed with a thromboembolic episode, probably as a result of heightened awareness. In addition, the recognition that hospital-acquired thrombosis causes substantial mortality has led to an emphasis on appropriate thromboprophylaxis in all patients deemed at risk of thrombosis. However, the use of anticoagulants for both treatment and prophylaxis of thrombosis can pose a challenge in individuals who are obese. There are no detailed studies in this area and as such the dosing and monitoring of anticoagulants in these individuals can be problematic. [ABSTRACT FROM AUTHOR]

Study Objective: An increasing number of overweight and obese patients are presenting for ambulatory surgical procedures and may be at risk of complications including longer surgeries, longer length of stay (LOS), and possible increase in unanticipated return visits or hospital admissions.Design: Observational study using prospectively-collected data.Setting: Freestanding and hospital-based ambulatory surgery facilities.Patients and Interventions: 13,957 patients underwent ambulatory cancer surgery procedures at the Josie Robertson Surgery Center (JRSC) since opening in 2016, and 4591 patients eligible for ambulatory surgery at JRSC underwent surgery at the main hospital during the same timeframe.Measurements: We assessed whether BMI was associated with increased operative time, post-operative LOS, hospital transfer after surgery, or hospital readmission or urgent care center visits within 30 days. Using multivariable logistic regression, we assessed whether BMI was associated with decision to do surgery at JRSC controlling for age, ASA score and surgical service.Main Results: While higher BMI was associated with a higher rate of transfer out of JRSC (p = 0.014), the difference in rate was small (mean risk 0.8% for BMI 25 vs 1.3% for BMI 40, difference in risk 0.52%, 95% CI 0.05%, 1.0%). We found no evidence that higher BMI increased the risk of urgent care visits or readmissions within 30 days or outpatient LOS (p = 0.7 for all). There was a statistically but not clinically significant difference in operative time for outpatient procedures (p = <0.0001), with a mean operative time of 59 vs 63 min for BMI 25 vs 40. Ambulatory extended recovery patients with higher BMI had shorter operative times (p < 0.0001). Patients with higher BMI were not significantly less likely to undergo surgery at JRSC (84% vs 83% vs 82% probability of treatment at JRSC for BMI 25, BMI 40 or BMI 50, respectively, p = 0.089).Conclusions: Ambulatory cancer surgeries can be performed safely among clinically eligible patients. Patients with BMI up to 50 or more can be treated safely in an ambulatory setting if they otherwise meet eligibility criteria. [ABSTRACT FROM AUTHOR]

Anna Wåhlén,1 Arvo Haenni,2,3 Hans-Erik Johansson1–3 1Östervåla Primary Health Care Centre, Östervåla, 2Department of Public Health and Caring Sciences/Geriatrics, Uppsala University, Uppsala, 3Skönvikt, Outpatient Clinic of Obesity Care, Säter, Sweden Objective: We aimed to investigate the prevalence of B12 deficiency in metformin-treated, morbidly obese, type 2 diabetes mellitus (T2DM) patients, compared to morbidly obese controls, as well as to evaluate the magnesium status. Design: Retrospective cross-sectional analysis of plasma vitamin B12, plasma magnesium, glucometabolic status and clinical measurements in all consecutive morbidly obese patients was conducted during 1 year. Setting: Outpatient Clinic of Obesity Care. Subjects: One hundred forty-seven patients were evaluated: 107 morbidly obese controls and 40 metformin-treated, morbidly obese patients with T2DM. Main outcome measures: Circulating plasma concentrations of vitamin B12 (cobalamin), magnesium, clinical measurements and metformin medication. Results: There were differences between the two groups regarding age, sagittal diameter, glucose parameters and magnesium concentrations. Longer diabetes duration was associated with lower magnesium. Metformin-treated T2DM patients had lower magnesium (0.76±0.07 mmol/L) than controls (0.82±0.07 mmol/L). A subgroup analysis of 26 non-metformin-treated T2DM patients showed a normal magnesium concentration compared to controls, that is, 0.81±0.06 mmol/L. We found no statistical difference in B12 concentrations between the two groups. Conclusion: To fully benefit from metformin medication, routine testing of B12 as well as magnesium in metformin-treated, morbidly obese patients should be performed, with consideration of substitution to avoid low levels. Keywords: metformin medication, vitamin B12, magnesium, type 2 diabetes mellitus, morbidly obese

Bariatric surgery is considered to be the most effective treatment modality in maintaining long-term weight reduction and improving obesity-related conditions in morbidly obese patients. In Korea, surgery for morbid obesity was laparoscopic sleeve gastrectomy first performed in 2003. Since 2003, the annual number of bariatric surgeries has markedly increased, including adjustable gastric banding (AGB), Roux-en-Y gastric bypass, sleeve gastrectomy, mini-gastric bypass, and others. In Korea, AGB is much more common than in others countries. A large proportion of doctors, the public, and government misunderstand the necessity and effectiveness of bariatric surgery, believing that bariatric surgery has an unacceptably high morbidity, and that it is not superior to non-surgical treatments to improve obesity and obesity-related diseases. The effectiveness, safety, and cost-effectiveness of bariatric surgery have been well demonstrated. The Korean Society of Metabolic and Bariatric Surgery recommend bariatric surgery confining to morbidly obese patients (body mass index ≥40 or >35 in the presence of significant comorbidities).

Background: The implementation of high-resolution manometry (HRM) and the Lyon Consensus statement facilitate evaluation of gastroesophageal reflux disease and motility disorders in morbidly obese patients. Therefore, we aimed to investigate prevalence and phenotype of (borderline) GERD and esophageal motility disorders in this population. Methods: Consecutive morbidly obese (BMI ≥ 35 kg/m2) patients were offered evaluation by means of HRM, ambulatory 24-h pH impedance monitoring, endoscopy, and a clinical examination at our tertiary academic center. Data were collected prospectively. Results: Out of 448 eligible individuals, 147 patients (females = 75, 51%) with a median age of 41.6 (33.4; 52.3) years and a BMI of 44 (40.9; 49.4) kg/m2 were included during the study period. The Chicago Classification revealed motility disorders in 50 (34%) patients, dominated by outflow obstruction (18.4%, n = 27) and a novel disorder (7.5%, n = 11), nicknamed jackhammer esophagus (JE). According to the Lyon Consensus, 52 (35.4%) patients had evidence of true GERD, whereas borderline GERD was noted in another 60 (40.8%). Hypersensitive esophagus was observed in 6.8% (n = 10). Sensitivity and specificity of symptoms for GERD were 53.8% and 68.4%, respectively. Conclusions: The current gold standard of assessment revealed that the prevalence of esophageal motility disorders and (borderline) GERD is high in the morbidly obese population. Further longitudinal data are needed to delineate the natural course of novel motility disorders like JE in obesity and to identify risk factors for adverse outcomes following bariatric surgery. [ABSTRACT FROM AUTHOR]

Purpose: The effect of being obese on the long-term survival of total joint arthroplasty is persistently discussed. Considering only studies with large cohort of patients and meta-analysis, a high body mass index has been correlated with a higher incidence of complication but not univocally with a lower survival rate. In this study, we analyzed, retrospectively, the data of patients that received unicompartmental knee prostheses in order to examine if obesity has an effect on clinical outcomes.Methods: A retrospective multi-centre study was carried out on 4964 unicompartmental knee replacements between July 2000 and December 2016, the patients involved were 3976, with 988 bilateral cases. The patients were categorized into three groups: non-obese with a body mass index (BMI) < 30 kg/m2, obese with BMI ranged between 30 and 39 kg/m2, and morbidly obese (BMI ≥ 40 kg/m2). The outcome was measured using the Cox proportional hazards model with end point UKA revision for any reasons. Results were stratified for sex, age, weight, and bi-laterality.Results: The morbidly obese group was significantly younger and required a significantly longer operating time. No statistical significant differences were observed considering the BMI groups in terms of type of insert, type of tibial component, prosthetic condyle, and prosthesis fixation (p > 0.05; chi-square test).Conclusions: Obese and morbidly obese patients have as much to gain from total knee replacement as non-obese patients. [ABSTRACT FROM AUTHOR]

Background: Obesity is an increasingly serious public health problem on a global level. Morbid obesity is defined as a Body Mass Index (BMI) of 40 Kg/m2 or more or a BMI of 35 Kg/m2 or more with obesity related comorbidities. Morbid obesity is associated with an increased incidence of wide spectrum medical and surgical pathological problems. Objective: To clarify the relation between morbid obesity, rapid loss of weight after sleeve gastrectomy and gallstone formation and if there is a need for adding prophylactic cholecystectomy during sleeve gastrectomy to obtain the best possible results after surgery. Patients and Methods: A total number of 50 morbidly obese patients were included in the study from September 2018 to April 2019 (prospective study). All patients were treated at Surgery Department of Al-Azhar University Hospitals. Males and females were considered for inclusion. Results: In our study, five cases (10%) underwent simultaneous cholecystectomy (selective cholecystectomy) for their asymptomatic gall stones detected by routine pre-operative pelvi-abdominal ultrasound. Simultaneous cholecystectomy was associated by a significant increase in the operative time by about 36 minutes without effect on the post-operative morbidity or hospital stay compared with other patients with no gallstones. Conclusion: Sleeve Gastrectomy for morbidly obese patients was followed by gall bladder stones in only 6.2%. Therefore, prophylactic intra-operative cholecystectomy seems to be not indicated and should be replaced by short-term (3 months only) of oral ursodeoxycholec acid during the period of maximum weight loss. [ABSTRACT FROM AUTHOR]

In this paper, because the methylenetetrahdrofolate reductase (MTHFR) association with many disease, we to evaluate the apolipoprotein-A5 (Apo-A5) levels and association of the polymorphism with morbidly obesity on risk of cardiovascular disease (CVD), a case-control study of 74 healthy morbidly obese and 76 healthy non-obese was conducted in Iraqi populationthat matched in gender and age. Apolipoprotein-A5, is main lipoprotein composing triglycerides rich lipoprotein and involving the risk of heart disease. Therefore Apo-A5 plays important role in regulation of lipids in the body. Although there are adequate traditional factors for cardiovascular risk but knowledge of genetic factor risk is still incomplete. Different biochemical parameters were measurement and polymorphism was genotyped by polymerase chain reaction (PCR-RFLP). The mean ± standard error (SE) and T test were estimate for clinical parameter and odds ratio (OR) with 95% confidence interval added to chi squire estimated for genotype to assess the strength of association between genetic and other factors. The results shows that morbidly obese have higher levels in blood pressure, cholesterol (Ch), triglyceride (TG), very low density lipoprotein (VLDL-C) and low density lipoprotein (LDL-C) than non-obese. In other hand shows not significant differences between two groups in value of high density lipoprotein (HDL-C) but show lower level in Apo-A5 in morbidly obese than non-obese groups. The study revealed that MTHFR-G1793A has not significant relation in three type normal homozygous ,heterozygous and rare homozygous with obesity. [ABSTRACT FROM AUTHOR]

Apolipoprtein-A1(APO-A1) is the essential material for transport cholesterol in revers process and may play important role in cholesterol overload in body. Therefore, Apo-A1 play important role in regulation of lipids, and although there are adequate traditional factors for cardiovascular risk but knowledge of genetic factor risk is still incomplete. To assess the participation of genetic factor with other risk factors, a case-control study was conducted. A 74 morbidly obese and 76 normal non-obese that matched in gender and age was collected. Biochemical parameters were measurement and polymorphism was genotyped by polymerase chain reaction (PCR-RFLP). The mean ± standard error (SE) and T test were estimate for clinical parameter and odds ratio (OR) with 95% confidence interval added to chi squire estimated for genotype to assess the strength of association between genetic and other factors. The results shows that morbidly obese have higher levels in blood pressure, cholesterol, triglyceride, very low density lipoprotein, low density lipoprotein than non-obese. In other hand shows not significant differences between two groups in value of high density lipoprotein but show lower levels in Apo-A1 levels in morbidly obese than non-obese groups. The study revealed a, A1298C show high significant association in AA genotype (OR: 1.39, 95%CI: 0.91-1.58, P= 0.0001) and significant in AC and CC genotypes (OR: 0.702, 95%CI: 0.88-1.61, P = 0.0377), (OR: 0.844, 95%CI: 0.91-1.59, P=0.0273) respectively, who are more at risk of heart disease. However, further case-control studies are required to provide a more robust conclusion. [ABSTRACT FROM AUTHOR]

Introduction: Studies have shown that Epworth sleepiness scale (ESS) is not a good tool to predict obstructive sleep apnea (OSA). However, data regarding the accuracy of ESS in the prediction of OSA among morbidly obese patients are scarce.Methods: The study involved a retrospective review of the charts of the consecutive patients who underwent bariatric surgery at a tertiary care teaching hospital. All the patients underwent polysomnography (PSG) and undertook the ESS questionnaire. The sensitivity and specificity of ESS were calculated based on its correlation with the PSG findings. Furthermore, a new score was devised to improve the utility of ESS to predict OSA.Results: A total of 232 consecutive patients from January 2014 to July 2017 were included in the study. The mean age and body mass index (BMI) were 40.5 ± 11.8 years and 47.6 ± 7.3 kg/m2, respectively. Among the 162 patients who had an ESS <10, 57.4% had moderate-to-severe OSA. The sensitivity of ESS to predict moderate-to-severe OSA was found to be 38.8% and the positive predictive value was 84.2% (positive likelihood ratio 2.82, 95% confidence interval = 1.57-5.06). A predictive score was identified as 0.031Age (years) +0.039BMI (kg/m2) + 0.038ESS + Gender (1 for male, 0 for female). The score had a sensitivity of 80% at a cutoff of 3.3.Conclusions: Among the morbidly obese, ESS is a poor predictor of OSA. Its utility as a tool for prediction of moderate-to-severe OSA can be improved by use of a new formula incorporating age, gender, and BMI beside ESS. [ABSTRACT FROM AUTHOR]