جستجوی مقالات مرتبط با کلیدواژه « morbid obesity » در نشریات گروه « پزشکی »

The standard surgery for endometrial cancer can be deferred in some situations, including morbid obesity, comorbidities, and the patient's desire for fertility. One of the options to improve patients' circumstances is bariatric surgery.

Case report: 

This study presented two patients with stage IA, grade I endometrioid endometrial adenocarcinoma. Both patients had morbid obesity and had comorbidities. In case 1, because of fertility preservation, and in case 2, because of severe comorbidities, hormone therapy was started, followed by bariatric surgery after counseling patients. Both patients had acceptable changes in body mass index during follow-up, so cancer surgery through laparoscopy was done. Both patients did not need adjuvant therapy; months after cancer surgery, there is no recurrence, and their body mass index is also decreasing.

Bariatric surgery can improve outcomes in patients with morbid obesity who suffer endometrial cancer.

Bariatric surgery delivers substantial weight loss for obese patients with comorbidities like diabetes mellitus. We aimed to investigate the impacts of bariatric surgery on diabetic markers after 5 years of follow-up.

This is a retrospective study on patients with diabetes and a history of bariatric surgery between 2016-2017. The diabetic markers before and 5 years following surgery, including a lipid profile, glucose level, and the required antidiabetic medications, were evaluated.

34 consecutive patients were included, 30 (88.2%) women, with a mean age of 52.71±8.53 years. The majority (65%) of surgeries were Roux-en-Y gastric bypass (RYGB), and the remaining were one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG). The serum levels of diabetic markers reduced during follow-up (P=0.001), except for high-density lipoprotein levels and serum total cholesterol, which increased (P=0.011, P=0.838). Low-density lipoprotein levels reduced, but it was insignificant (P=0.194). Surgery types had affected the changes of diabetic markers (P>0.05). Demand for oral medication was reduced significantly, but insulin injection reduction was not significant (P=0.006 and P=0.099, respectively).

Our study showed favorable bariatric surgery results on patients with diabetes in long-term follow-up. However, dyslipidemia is still a concern.

 Obesity is a growing problem worldwide and can affect both the pharmacodynamics and pharmacokinetics of various drugs, including anesthetics, resulting in the under-or overdosing of certain drugs. There is no consensus on the ideal dosing regimen for obese populations.

 In this study, 2 weight-based dosing of propofol used for induction of anesthesia were compared in terms of the onset of action time, adequacy of anesthesia, and effects on hemodynamic indices (eg, heart rate [HR] and blood pressure).

 In this randomized, double-blind clinical trial, 40 patients with morbid obesity (MO) scheduled for bariatric surgery with body mass index (BMI) > 35, age 18 - 59 years, American Society of Anesthesiologists physical status (ASA-PS) II and III were randomly divided into 2 groups, using block randomization method, to receive 2 mg/kg of propofol for induction of anesthesia based on either fat-free mass (FFM) group or ideal body weight (IBW) group. The primary outcome was the time duration to reach the bispectral index (BIS) ≤ 60. Time to the disappearance of eyelash reflex, signs of inadequate anesthesia (ie, BIS > 60, straining during intubation, or eye-opening), requirements for additional doses, and hemodynamic indices (including HR and mean arterial pressure [MAP]) were also compared.

 The mean time to reach BIS ≤ 60 was 134.1 s in the FFM group and 148.7 s in the IBW group. This difference was not statistically significant (P = 0.334). The time of disappearance of eyelash reflex was also not significantly different between the study groups (P = 0.814). However, 2 patients in the FFM group and 8 patients in the IBW group showed signs of inadequate anesthesia and required additional doses. This difference was statistically significant (P = 0.032). Hemodynamic variables, before and 2 min after propofol induction dose administration were comparable between the study groups (P = 0.520, P = 0.327, P = 0.847, P = 0.516 for pre-intervention MAP, post-intervention MAP, pre-intervention HR, and post-intervention HR, respectively).

 Propofol dosing, based on FFM and IBW, for induction of anesthesia, provides comparable onset time of action and hemodynamic effects; however, in terms of the adequacy of anesthesia, the dosing based on FFM is more favorable compared to the dosing based on IBW.

We aimed to evaluate the safety and efficacy of single anastomosis sleeve ileal (SASI) bypass surgery on obese patients with type II diabetes mellitus during a one-year follow-up period.

We included patients with a body mass index (BMI) more than 35 kg/m2 and at least one-year history of type II diabetes mellitus. We excluded patients aged under 25 or above 66 years, those who were not candidates for surgery, needed another bariatric surgery, and those not willing to participate in the study. All the patients were visited in the outpatient office on the 10th and 45th days as well as the 3rd month of the post-operative period until the end of the first year.

in this study, we investigated 14 male (23.0%) and 47 female (77.0%) morbidly obese patients with type II diabetes mellitus who underwent SASI bypass. The mean excess weight loss (%EWL) was 60.99 ± 15.69 and the mean total weight loss (%TWL) was 30.39 ± 6.52 at the end of the one-year follow up. Finally, 44 patients (72.1%) had a complete and 15 patients (24.6%) had partial remission of type II diabetes mellitus. Of note, severe complications were recorded in two patients (3.2%). Paired t test analysis demonstrated a significant decrease for fasting plasma sugar (FBS) after one-year follow-up in comparison with FBS before surgery (P < 0.0001). Furthermore, this difference was observed in HbA1c (P < 0.0001).

SASI bypass is an effective method for weight loss and controlling type II diabetes mellitus. 

For patients with morbid obesity, different cisatracurium dosage regimens are recommended. This study aimed to compare the onset of action, the sufficiency of neuromuscular blockade during infusion, and the recovery of the three distinct cisatracurium dosage scalars in patients with morbid obesity undergoing laparoscopic bariatric surgery. In this randomized clinical trial, 55 patients were scheduled for bariatric surgery at Firoozgar Hospital from March 2020 to August 2021. Using a block randomization method, they were randomly divided into three groups, based on total body weight (TBW group), fat-free mass (FFM group), or ideal body weight (IBW group), to receive a bolus of cisatracurium 0.2 mg/Kg, followed by an infusion of 2 µg/Kg, to maintain a train-of-four (TOF) count≤2. Data were analyzed using SPSS software. P<0.05 was considered statistically significant.  The mean time (seconds) to reach TOF0 in the TBW group was significantly shorter (201.89, 95%CI=192.99-210.79; P=0.004) than the IBW group (233.53, 95%CI=218.71-248.34; P=0.01). However, this difference was not statistically significant between TBW and FFM groups (220.83, 95%CI=199.73-241.94; P=0.81) or between FFM and the IBW groups (P=0.23). The rescue dose and increments of cisatracurium infusion were not required in the TBW group, whereas their probability was 4.81 times higher in the IBW group than the FFM group. Furthermore, the TBW and FFM groups had higher mean surgical condition scores than the IBW group (P<0.001, and P=0.006, respectively).  Cisatracurium loading and infusion dosing based on FFM provide a comparable onset of action and surgical field condition to the TBW-based dosing with a shorter recovery time. However, IBW-based dosing of cisatracurium was insufficient for laparoscopic bariatric surgery. Trial Registration Number: IRCT20151107024909N9.

Upper airway management in morbid obese patients undergoing bariatric surgery is a major challenge during induction of anesthesia. Bed side Thyromental Height Test (TMHT) is an easy and valid predictor for prediction of difficult airway in non‑obese patients, but its precision in morbid obese patients haven’t been evaluated yet. The purpose of present study is to find the accuracy of TMHT for the prediction of difficult laryngoscopy in morbid obese patients undergoing bariatric surgery. The present prospective observational study was performed on 95 morbid obese patients at Sina hospital during 2020. Preoperative exams of patients include the assessment of Mallampati classification, thyromental height, thyromental, sternomental and interincisor distances. After induction of anesthesia, the laryngoscopy view was evaluated using the Cormack Lehane classification, and the relationship between these tests to prediction of difficult laryngoscopy view based on the Cormack Lehane degrees (grades 3,4) were evaluated. A total of 95 morbid obese patients with a mean BMI of 44.7±5.6 kg/m2.were included in the study. 67.3% of them were women. The incidence of difficult laryngoscopy (C & L III, IV) was 16.8%. TMHT less than 56.5 mm, with 98% positive predictive value and 93% accuracy was the best predictor of difficult intubation in these patients. The accuracy of thyromental, sternomental and interincisor distance, with cut off value less than 51.5 mm, 89.5 mm, 41.5 mm respectively was less than TMHT in prediction of difficult laryngoscopy in morbid obese patients. In morbid obese patients with a BMI greater than 40, thyromental height less than 56.5 mm with 98% positive predictive value and 93% accuracy is the best predictor for difficult laryngoscopy view.

There have been conflicting reports regarding the effects of obesity on both surgical time and blood loss following anatomic shoulder arthroplasty. Varying categories of obesity has made comparison amongst existing studies difficult. A retrospective review of consecutive anatomic shoulder arthroplasty cases (aTSA) was undertaken. Demographic data, including age, gender, body mass index (BMI), age-adjusted Charleson Comorbidity Index (ACCI), operative time, hospital length of stay (LOS), and both POD#1 and discharge visual analogue score (VAS) was collected. Intra-operative total blood volume loss (ITBVL) and need for transfusion was calculated. BMI was categorized as non-obese (<30 kg/m2), obese (30-40 kg/m2) and morbidly obese (≥40 kg/m2). Unadjusted associations of BMI with operative time, ITBVL and LOS were examined using Spearman correlation coefficients. Regression analysis was used to identify factors associated with hospital LOS. There were 130 aTSA cases performed, including 45 short stem and 85 stemless implants, of which 23 (17.7%) were morbidly obese, 60 (46.2%) were obese and 47 (36.1%) were non-obese. Median operative time for the morbidly obese cohort was 119.5 minutes (IQR 93.0, 142.0) versus 116.5 minutes (IQR 99.5, 134.5) for the obese cohort versus 125.0 minutes (IQR, 99.0, 146.0) for the non-obese cohort. (P=0.61) The median ITBVL for the morbidly obese cohort was 235.8 ml (IQR 144.3, 329.7) versus 220.1 ml (IQR 147.7, 262.7) for the obese cohort versus 216.3 ml (IQR 139.7, 315.5) for the non-obese cohort. (P=0.72). BMI ≥40kg/m2 (IRR 1.32, P=0.038), age (IRR 1.01, P=0.026), and female gender (IRR 1.54, P<0.001) were predictive of increased LOS. There was no difference with regards to in-hospital medical complications (P=0.13), surgical complications (P=1.0), need for re-operation (P=0.66) and 30-day return to the ER (P=0.06). Morbid obesity was not associated with increased surgical time, ITBVL and perioperative medical or surgical complications following aTSA, though it was predictive of increased hospital LOS. Level of evidence: III

A large liver size is a factor that may increase the difficulty of bariatric surgery (BS) and unwanted complications. Some agents have been used to decrease the liver size before BS. Silymarin has been used as an antioxidant agent to improve liver function tests. This study was designed to evaluate the effects of silymarin on liver dimensions, function, and lipid profile.

A double?blind randomized clinical trial was performed on 56 patients. The patients were divided into silymarin and placebo groups. Blood samples and sonographic examinations were taken from the patients before and 4 weeks after the administration of the silymarin or placebo. In the first group, 140 mg silymarin was prescribed every 8 h for 4 weeks, and the other group received placebo in the same way with the same tablet  hape. After the completion of the 4?week treatment, laboratory tests and ultrasonography were carried out again.

Thirty?nine (69.6%)  atients were female with a mean body mass index (BMI) of 46.2 kg/m2 and a mean age of 36.8 years. Most of the patients had a compliance of 80% and higher. The analysis did not show any significant difference in aspartate transaminase, alkaline transaminase, liver size, cholesterol, and triglyceride changes among the silymarin and placebo groups. BMI loss was slightly higher in the silymarin group although the difference was not statistically significant.

The present findings show that silymarin administration for 4 weeks does not affect liver size and  unction, but further evaluations should be carried out on the subject.

Changes in cognitive profile, such as memory and other functions in patients with morbid obesity after bariatric surgery have been reported in the literature with inconsistent results.

This study aimed to evaluate cognitive changes, executive function and depression severity before and after bariatric surgery in patients with morbid obesity.

In this prospective cohort study, 70 patients with morbid obesity (40 patients undergoing bariatric surgery and 30 patients in the waiting list) referred to the Rasool Akram Medical Complex, obesity clinic, Tehran, Iran, in 2016 entered the study. The two groups were assessed using the Wechsler Memory Scale (WMS) (consists of 7 subscales and assesses memory), the Wisconsin Cart Sorting test (WCST) (includes 64 cards and assesses cognitive skills), the Hamilton Depression Scale (HAM-D) (for measuring depression) and bariatric analysis and reporting outcome system (BAROS) questionnaire (scale to report of the therapeutic results of bariatric surgery and including the three criteria of the weight loss percentage, the change in health state, and the quality of life) at the beginning of the study and three months after the surgery. Moreover, the Bariatric Analysis and reporting outcome system (BAROS) questionnaire was filled three months after surgery.

The average changes in WMS score (P = 0.043), working memory (P = 0.002), HAM-A (P = 0.032), weight, and BMI (P = 0.0001) in the surgery group were significantly higher than the control group. There was a significant positive correlation between change in the number of preservative errors in WCST within the surgery group with BAROS score (P = 0.004). Moreover, there was a significant correlation between changes in the score of WMS and those in BMI in the surgery group.

Bariatric surgery is associated with improvements in some cognitive functions and worsening of depressive scores in patients with morbid obesity.

The number of patients with obesity undergoing various surgeries is increasing annually, and ventilation problems are highly prevalent in these patients.

We aimed to evaluate ventilation effectiveness with pressure-controlled (PC) and volume-controlled (VC) ventilation modes during laparoscopic bariatric surgery.

In this open-label randomized crossover clinical trial, 40 adult patients with morbid obesity candidates for laparoscopic bariatric surgery were assigned to VC-PC or PC-VC groups. Each patient received both ventilation modes sequentially for 15 min during laparoscopic surgery in a random sequence. Every 5 min, exhaled tidal volume, peak and mean airway pressure, oxygen saturation, heart rate, mean arterial pressure, and end-tidal CO2 were recorded. Blood gas analysis was done at the end of 15 min. Dynamic compliance, PaO2/FiO2 ratio, P (A-a) O2 gradient, respiratory dead space, and PaCO2-ETCO2 gradient were calculated according to the obtained results.

The study included 40 patients with a mean age of 35.13 ± 9.06 years. There were no significant differences in peak and mean airway pressure, dynamic compliance, and hemodynamic parameters (P > 0.05). There was no significant difference between the two ventilation modes in pH, PaCO2, PaO2, PaO2/FIO2, dead space volume, and D(A-a) O2 at different time intervals (P > 0.05).

If low tidal volumes are used during adult laparoscopic bariatric surgery, mechanical ventilation with PC mode is not superior to VC mode.

An enlarged liver, which is resulted from fatty liver and/or steatohepatitis, makes difficulties in gastric bypass surgery procedure and increases the risk of liver laceration. omega-3 polyunsaturated fatty acids (ω-3 PUFAs) recently have been suggested as a potential intervention to reduce liver inflammation and volume. This review aimed to provide a comprehensive overview of the recent advances on fish oil/ ω-3 PUFAs supplementation to reduce the liver volume proceeding to bariatric surgery.

This review summarizes studies that were investigated the influence of fish oil/omega-3 PUFA in the liver volume of bariatric surgery candidates. Scopus and PubMed databases were systematically searched up to May 2021, for studies providing knowledge relating to the effects of omega-3 and/or fish oil supplementation on liver size, fatty liver, or steatohepatitis.

Most of the randomized controlled trials showed that ω-3 PUFA supplementation, mostly due to its anti-inflammatory and antioxidative properties, is a practical and effective treatment for fatty liver, and to decrease ALT, AST, and GGT.  Omega-3 fatty acids as important regulators of hepatic gene transcription can reduce hepatic steatosis and inflammation markers, also improve insulin sensitivity. As well, the access to the gastroesophageal junction was reported as simple.

The collective data suggest that preoperative fish oil ω-3 PUFA supplementation could be an effective approach in improving liver function and decrease liver volume before bariatric surgery. Although, well-designed randomized clinical trials are needed to confirm these results and determine a clear protocol of supplementation regarding the optimal dose and duration before surgery.

In this study, we aimed to evaluate the effect of bariatric surgery on constipation followed by the surgery.This prospective cohort study included 237 patients with morbid obesity, who were candidate for Laparoscopic Roux-en-Y Gastric Bypass (RYGB), and One-Anastomosis Gastric Bypass (OAGB) in Obesiyt Clinic of Rasoul Akram Hospital, Tehran, Iran, 2012-2014. The severity of constipation was measured by Wexner Constipation Score (WCS) before and three months after the surgery. Paired t-test, Mc Nemar test, and logistic regression were applied for the analyses. Mean age and BMI of the 237 patients were 31.59±5.92 years and46.59±5.81kg/m2, respectively. Mean WCS decreased significantly in OAGB group (3.1±4.27 vs. 4.72±4.81, P=0.003), while the reduction in WCS mean score was not significant in RYGB group (4.5±4.73 vs. 4.63±5.19, P=0.793). The proportion of constipation reduced (48/103 vs. 32/103) significantly in OAGB group (P=0.002). Conversely, the decrease in this proportion (from 58/134 to 57/134) was not significant in RYGB group (P=0.06). Considering the confounding role of diet and supplementary intake of the patients, the results of this study showed that the frequency of constipation reduced in morbidly obese patients undergoing obesity surgery and postoperative nutritional recommendations. The comparison between techniques showed that OAGB reduced the constipation score and proportion, while this decrease was not significant in RYGB.

Cardiac remodeling and functions are affected after laparoscopic sleeve gastrectomy (LSG); although, the degree of the LSG impression on cardiac function is unclear. The purpose of this study was to determine the effect of LSG on echocardiographic factors in morbidly obese patients.

In this prospective study, patients with morbid obesity who underwent LSG in Loghman Hakim Hospital, Tehran, Iran in 2017 were evaluated. Echocardiographic parameters such as ejection fraction (EF), left ventricle (LV) diastolic function, LV mass, LV mass index, epicardial fat (EPF), and valvular heart disease including mitral regurgitation (MR), mitral stenosis (MS), aortic regurgitation (AR) and aortic stenosis (AS) were evaluated before and after LSG. All of the data were entered into SPSS software and were analyzed by statistical tests. P values of less than 0.05 was considered significant.

Ninty (90) patients were enrolled in this study. The EF (P=0.012), LV diastolic function (P=0.0001), valvular heart disease (P=0.0001), and LV mass (P=0.002) were significantly improved after LSG. The EPF and LV mass index had no significant difference before and after surgery (P > 0.05).

LSG would have significant effects on echocardiographic factors and cardiac remodeling in patients with morbid obesity.

Obesity is the most common human metabolic disorder that causes many complications for patients worldwide. On the other hand, Sleeve Gastrectomy is one of the bariatric surgeries that are used by surgeons in morbid obese patients to treat obesity. The aim of this study was to survey on results of Sleeve gastrectomy and its subsequent complications among Iranian patients.

This is a case series study in which data of 92 morbid obese patients were gathered. Patients were followed up at intervals of 1.5, 3, 6, 12, and 18 months after operation. History of post-operative complications, appetite and satisfaction were taken from patients, physical examination was performed as well as measuring weight and BMI in follow-up visits. Ultrasonography was performed in 6, 12 and 18 months after the surgery for assessing gallbladder.

Mean BMI (body mass index) was 45.43 (± 8.41) kg/m2 in patients. Mean BMI reduction was respectively 4.5 (±1.12), 9.03 (±2.44), 13.45 (±3.45), 17.57 (±4.66), 19.82 (±5.78), 17.57 (±4.66) and 19.82 (±5.78) kg/m2 at 1.5, 3, 6, 12, and 18 months after operation, respectively. Mean weight loss was 71.5% 18 months after operation.

Current study reveals that Sleeve Gastrectomy is an effective method of bariatric surgery in which patients encounter a small number of side effects, and, also, is highly recommended for morbid obese patients.

Vitamin D3 deficiency is associated with insulin resistance and metabolic syndrome. Although, the evidence was not conclusive. The aim of this study is to investigate the relationship between serum 25-hydroxy vitamin D3 (25(OH) D3) levels with some adiposity and metabolic indices related to metabolic syndrome.

In this cross-sectional study, the anthropometric, body composition information, the clinical laboratory tests including fasting blood sugar (FBS), insulin, lipid profile, liver enzymes, and serum 25(OH) D3 of 3750 patients with morbid obesity are extracted from Iran National Obesity Surgery Database. HOMA-IR and QUICKI were computed based on the standard formula. Associations were tested using analysis of variance and Kruskal–Wallis test.

Approximately 69% of patients with morbid obesity had sub-optimal vitamin D3 levels (<20 ng/mL). An inverse significant relationship between serum 25(OH) D3 and body weight, body fat percentage, waist, and hip circumstance was observed (p<0.05 for all). Low serum 25(OH) D3 levels are significantly associated with higher FBS and A1C, dyslipidemia (higher LDL and TG), and also the elevated level of liver function enzymes (p<0.05 for all). Moreover, the patient with the higher serum 25(OH) D3 had a lower level of HOMA-IR and higher insulin sensitivity (QUICKI index); this association was not statistically significant, though.

Vitamin D3 deficiency has been associated with adiposity, impaired glucose metabolism, and metabolic disorders related to insulin resistance. Thus, vitamin D3 supplementation could be a potential approach in treatment or decrease of the metabolic complication of obesity before and after bariatric surgery.

 Morbid obesity negatively affects all aspects of quality of life (QOL); therefore, the assessment of QOL can be a useful criterion to evaluate obesity outcome.

 The present study aimed to design a QOL questionnaire in morbid obesity and assess its validation features.

 This sequential-exploratory mixed-methods study was conducted in both qualitative and quantitative stages. The qualitative stage was carried out through 20 semi-structured interviews with morbidly obese people. Furthermore, the initial items of the questionnaire were obtained by a review of related literature. In the next stage, face, content, and construct validity were assessed. The construct validity was examined by exploratory factor analysis with 319 people. Moreover, Cronbach’s alpha and test-retest correlation coefficient were calculated to evaluate the reliability of the questionnaire. Furthermore, confirmatory factor analysis was assessed.

 Based on the results of the quantitative stage, an 80-item pool was extracted. The exploratory factor analysis yielded six factors that explained 50.62% of the variance. The factors of one to six were as follows: self-dissatisfaction (15 items), functional disorders (7 items), spiro-mental experiences (11 items), perso-social isolation (7 items), physical changes (7 items), and financial pressure (3 items). The final Cronbach’s alpha coefficient of the 50-item questionnaire was calculated at 0.94. Moreover, the intra-class correlation coefficient between the test and retest scores was estimated at 0.97. All indicators of confirmatory factor analysis demonstrated that goodness of fit was acceptable for each factor. Furthermore, this questionnaire had appropriate interpretability, feasibility, and did not have any floor and ceiling effects.

 This valid and reliable questionnaire can be used as a suitable measurement tool for assessing the QOL of morbidly obese people in Iran and other countries with similar cultural features. This questionnaire can improve the quality of future clinical research on obesity. In addition, health care providers can perform a peculiar role in the provision of efficient services to patients to prevent obesity and its associated complications.