Cardiovascular disease risk scores in patients with optimal vs suboptimal weight loss after bariatric surgery: Translating improvements into clinical practice.

INTRODUCTION: The aim of this study was to evaluate cardiovascular disease (CVD) risk modification in patients with optimal weight loss (OWL) versus suboptimal weight loss SWL following MBS. METHODS: This was a retrospective analysis. The 10-year risk CVD was estimated before and after one year of surgery using the "Framingham Score". RESULTS: 191 patients were included in our study. Mean baseline Framingham score was 7.2 â€‹± â€‹6.9%. According to the score, 54% of patients were classified as low risk (n â€‹= â€‹104), 23% as moderate (n â€‹= â€‹43), 20% moderately high (n â€‹= â€‹39) and 3% as high risk (n â€‹= â€‹5). One year after surgery, 91% of the patients showed reduction of their Framingham score. Mean CVD risk score decreased significantly to 4.1 â€‹± â€‹3.7% when compared to baseline (p-value is â€‹< â€‹0.001); 80% of patients classified as low risk (n â€‹= â€‹153), 13% as moderate (n â€‹= â€‹25), 7% moderately high (n â€‹= â€‹13) and 0% as high risk (n â€‹= â€‹0). CONCLUSION: Weight loss after bariatric surgery reduces CVD risk scores and the magnitude of effect correlates with the degree of weight loss.

The role of dietitian follow-ups on nutritional outcomes post-bariatric surgery.

BACKGROUND: Current evidence recommends dietary counselling with a registered dietitian (RD) for successful weight loss after metabolic bariatric surgery; however, there are limited data on the effect of RD follow-ups on micronutrient deficiencies. This study evaluated the effects of the number of postoperative RD visits on nutritional outcomes, including weight loss and micronutrient deficiencies. OBJECTIVES: The aim of this study was to evaluate the effects of the number of postoperative registered dietitian visits on nutritional outcomes, including weight loss and micronutrient deficiencies after metabolic and bariatric surgery. SETTING: Cleveland Clinic Abu Dhabi, United Arab Emirates METHODS: This retrospective study included patients who underwent bariatric surgery between September 2015 and June 2020. Demographics, weight loss, micronutrients, and the number of postoperative RD visits were evaluated. Baseline and 12-month postsurgery outcomes were compared based on the number of RD follow-ups. RESULTS: A total of 174 primary and 46 revisions were included. Patients were 73.6% female, with a mean age of 40 years. The initial mean body mass index was 42.8 kg/m2. Number of RD visits were as follows: 0-1 (39 patients), 2 (59 patients), 3 (55 patients), and 4 or more (67 patients). Baseline (pre-operative) micronutrient values were within normal range. In comparison with the reference group (REF = 0-1 post-op RD visits), patients with 3 RD visits had 7% higher total body weight loss (P < .001) and maintained micronutrients within the normal range at 12 months postoperative. Mean differences in postoperative values were statistically significant (P < .05) for weight, vitamin B12, and vitamin D but not for hemoglobin, ferritin, calcium, folate, vitamin B1, copper, and zinc. CONCLUSION: Our study suggests that three or more RD visits during the first 12 months after bariatric surgery are associated with improved outcomes, including significant percent total body weight loss and lower rates of micronutrient deficiencies.

The prevalence of cardiorenal anemia syndrome among patients with heart failure and its association with all-cause hospitalizations: a retrospective single-center study from the Middle East.

Background and aim: Little is known about the burden of cardiorenal syndrome (CRS) and cardiorenal anemia syndrome (CRAS) in the Middle East Region. Furthermore, whether the occurrence rates of CRAS differ across heart failure (HF) phenotypes is not widely investigated. We aimed to examine the prevalence of CRS and CRAS in patients with HF, compare characteristics of patients with CRAS-HFrEF vs. CRAS-HFpEF, and investigate anemia association with 1-year all-cause hospitalizations. Methods: HF patients who visited a multidisciplinary HF clinic at a single center between 10-2015 and 06-2022 (n = 968) were retrospectively included. Differences in rates of CRAS prevalence, and patients' characteristics of those with CRAS-HFrEF vs. CRAS-HFpEF were determined using appropriate testing methods. Generalized estimating equation (GEE) models were used to determine if anemia was associated with higher rates of hospitalization. Results: CRS was prevalent in 34.4% of subjects, while 25.3% had CRAS. CRAS prevalence rates among patients with HFpEF vs. HFrEF were comparable (27.2% vs. 24.2%, p = 0.3). Compared to patients with HFrEF-CRAS, those with HFpEF-CRAS were more likely females (p < 0.001), had a higher burden of hypertension (p = 0.01), and lower hemoglobin (p = 0.02). In an adjusted GEE model, anemia was associated with an average increase of 1.8 admissions in CRS patients (p = 0.015). Conclusion: In patients with HF, 1 in 3 patients presented with CRS, and 1 in 4 patients had CRAS. The prevalence of CRAS was comparable among those HFpEF and HFrEF. Anemia was associated with an increased rate of 1-year all-cause hospitalization in CRS patients.

Maryland dentists' perceptions and attitudes toward dental therapy.

OBJECTIVES: To learn dentists' perceptions, attitudes, and concerns about the problems of access to oral health care for low income and rural Marylanders and to ascertain whether the dentists believe dental therapy is a viable solution. METHODS: We conducted three focus group discussions of 27 dentists during August and September 2018 in three locations in urban and rural areas of Maryland. RESULTS: Focus group participants felt that problems with access to dental care for low income and rural Marylander were not due to a shortage of dental providers. They believed there are more than enough dentists in the state. Access problems in Maryland are due in large part to inadequate insurance coverage and low oral health literacy. With the exception of one participant, the dentists would not use dental therapists in their practices to expand access. CONCLUSIONS: Maryland dentists in our focus group strongly oppose the use of dental therapists to address the state's unmet oral health care needs. Any effort to expand the state's dental workforce using dental therapists must address Maryland dentists' concerns and opinions.