Long-term Outcomes of Sleeve Gastrectomy in Adolescent Patients: The Effect of Weight Loss in Younger Years to Outcomes in Adulthood.

BACKGROUND: Childhood obesity is associated with a variety of complications that see their light throughout adulthood. Due to the serious side effects of these morbidities, early intervention is essential. Laparoscopic sleeve gastrectomy (SG) is a safe and effective procedure for the treatment of obesity, however, the long-term data on its use in adolescents is lacking in the literature. METHODS: A retrospective analysis was conducted on all patients that underwent SG aged between 12 and 21 years old at a public hospital in Kuwait. Data on their weight and comorbidities was collected and analyzed. RESULTS: 164 adolescent patients with a mean age of 19 underwent SG. 71% of the patients were female, while the mean weight at surgery was 128.6 kg, corresponding to a BMI of 47.8 Kg/m2. 32% of patients had a starting BMI more than 50, while 6.7% had a BMI over 60. The highest weight loss was achieved at 18 months post-op, corresponding to an EWL of 82.66%. On long-term follow-up, weight loss was maintained over the 13 years post-op. Obstructive sleep apnea resolved in 75% of the patients while hypertension persisted in the 2 patients who were diagnosed with it pre-op. 21 patients developed gastro-esophageal reflux disease 5.7 years post-op, while 20 patients were treated for gall bladder stones 4.4 years post-op. CONCLUSION: It is of ample importance to tackle obesity during childhood before complications ensue later in life. Bariatric surgery, specifically SG, has been found to be an effective and safe weight loss tool, with sustained long-term weight maintenance and resolution of early comorbidities.

Knowledge, attitude, practice, and barriers of evidence-based medicine among physicians in general hospitals in Kuwait: A cross-sectional study.

BACKGROUND: Evidence-based medicine (EBM) is renovating the field of medicine as it is being acknowledged as the standard and basis of clinical judgment. As general governmental hospitals are at the forefront of health-care in Kuwait, the practice of EBM among physicians could improve the health of the population. The aim was to assess the knowledge, attitude, practice, and barriers of EBM among physicians practicing in general governmental hospitals in Kuwait. METHODS: A cross-sectional study with self-reported questionnaires was used to survey 439 physicians in Kuwait's 6 general hospitals with a response rate of 74%. RESULTS: Respondent's knowledge of EBM was considerably low with a median knowledge score of 13 out of 20. Overall female physicians, undergraduates from Kuwait and Ireland, and those that received formal EBM training scored higher knowledge scores. Most respondents were unaware of well-known EBM resources, however more than half (69.3%) were aware of 'Up-to-date' and used it for clinical decisions. Most of the respondents had positive attitudes towards EBM: 88.2% either 'strongly welcomed' or 'welcomed' the promotion of EBM. Lack of investment by health-care authorities was the main perceived barrier to EBM. CONCLUSION: Overall, even though participants were not well-informed in regards to EBM, half of them claim that their practice is EBM-based and use EBM resources to support clinical decisions. Formal EBM training and integration of EBM in undergraduate programs considerably promotes EBM practice.

The Effect of Laparoscopic Sleeve Gastrectomy on Glycemic Control in Type 2 Diabetic Patients.

Introduction The prevalence of diabetes mellitus type II (T2DM) in Kuwait in 2013 was 23.09%, ranking ninth globally and second in the Middle East and North Africa (MENA) region. It's been frequently reported as a growing public health concern. Our retrospective study will focus on the effect of laparoscopic sleeve gastrectomy (LSG) on the glycemic control of T2DM. Methods From December 2012 to January 2014, 70 patients with T2DM underwent LSG during the study period. A retrospective patient file review was performed and a follow-up on participants was carried out in February 2014. Fasting plasma glucose (FPG) was taken pre- and post-operatively. Patients were followed up to monitor the change in diabetic medications in terms of quantity, type and dose. Results The mean reduction of FPG after surgery was 2.94+3.66 (P < 0.001) over a mean interval of eight days (range, 0-34 days). Immediate reduction in FPG was seen in 61 patients (87%), and the greatest reduction was seen in the age group <40 years. Diabetes remission was seen in 49 patients (70%), while 20 (29%) had reduction in medication. All patients underwent a safe surgical procedure. There were no conversions to open surgery and no significant complications or mortalities. Conclusions Our study shows that LSG procedure has an immediate positive effect on the glycemic control of T2DM, in addition to the long-term evidence of complete resolution of diabetes in most patients or improvement in glycemic control, which has further highlighted the positive outcome of LSG, diminishing morbidity, risk factors, co-morbidities and health-expenditure.

Effectiveness of inspectors' team in increasing compliance with personal protective equipment use and reducing COVID19 infection spread among healthcare workers.

BACKGROUND: Healthcare workers (HCW) were amongst the front-liners in the mission to tackle the COVID-19 pandemic and thus bore a huge risk of infection. Therefore, personal protective equipment (PPE) is of vital importance. There are several methods described in the literature to increase compliance with PPE use and reduce occupational infections. One of those methods is the institution of PPE inspectors that ensure proper adherence to PPE protocols and ultimately improve the outcomes of many HCWs. METHODS: A team of PPE inspectors was introduced in a tertiary care university hospital, where they randomly evaluated and reinforced PPE use in accordance with the guidelines set by the local health authority. The study period was from the 10th of May 2020 until the 31st of August 2020. The evaluations were divided into three categories; appropriate, missing, or unnecessary use of PPE and were compared to trends in healthcare workers' COVID-19 infection rates. RESULTS: A total of 720 HCWs were evaluated from the 10th of May 2020 until the 31st of August 2020. The appropriate use of PPE increased from 56% to 89% during the study period. Meanwhile, the incidence of COVID-19 infection among HCWs, which has peaked to 31 cases per day on the 18th of May 2020, has been declining to below 5 cases per day towards the end of the study period. CONCLUSION: PPE inspectors' team served a positive role in increasing compliance with PPE use and was associated with a reduction in the transmission of SARS-Cov-2 among HCWs.

Omentopexy during laparoscopic sleeve gastrectomy: Is it effective in reducing postoperative gastrointestinal symptoms. A retrospective cohort study.

BACKGROUND: Postoperative gastrointestinal symptoms are common in patients undergoing sleeve gastrectomy. This study is aimed to assess the effectiveness of omentopexy during laparoscopic sleeve gastrectomy in reducing gastrointestinal symptoms. METHODS: A retrospective analysis of patients who underwent laparoscopic sleeve gastrectomy with and without omentopexy in the period between January 2016 to September 2017. All procedures were performed by three surgeons utilizing the same surgical technique. Data extracted included patient socio-demographics', preoperative body mass index (BMI), hospitalization period, treatments and post-operative gastrointestinal symptoms. It contained the GERD-Health Related Quality of Life Questionnaire (GERD-HRQL) measuring symptom severity in gastro esophageal reflux disease (GERD). Data were analyzed at 6, 12 and 18 months with reference to weight loss. RESULTS: A total of 140 patients were included in this study, 70 in each group arm. Age, preoperative BMI, pre-operative co-morbid conditions like hypertension, diabetes, and asthma were considered as confounding variables among the two groups. None of the previous factors were statistically significantly different among both groups. The outcomes of both groups were compared in terms of postoperative nausea, vomiting, regurgitation, intra-hospital stay, medication use, early return to work, and EWL%. None of the previous outcomes except for days of hospital stay and ondansetron use was found to be significantly different between both groups. CONCLUSION: Omentopexy does not change the outcome for laparoscopic sleeve gastrectomy in terms of gastrointestinal symptoms or weight loss results.

Female Physicians Leading Health Care in the Arab World.

BACKGROUND AND OBJECTIVES: A global trend in female leadership roles in the medical profession is on the rise, and females have been taking up leadership roles in varying and increasing levels. This study aims to identify changes in trends in the medical field in terms of gender in the last decade in Kuwait. METHODS: A case study was conducted, in which data on leadership positions in Kuwait's government hospitals were obtained from hospital registries. Demographic data about female to male physicians were collected from statistics published by the Department of Manpower, Statistics and Planning of Kuwait's Ministry of Health. In addition, statistics on medical graduates were obtained from the Faculty of Medicine (FOM), Kuwait University (KU). RESULTS: In general, every government hospital in Kuwait has experienced an increase in leadership roles among females; in 2008, among all leadership positions in Kuwait's general hospitals, males occupied a majority of positions (60%); whereas in 2016, the male to female ratio was 1:1. The most change in gender trends was witnessed at Mubarak Al-Kabeer Hospital, where female leaders went from 38% in 2008 to 73% in 2016. The specialties that have the highest number of females in leadership positions across all hospitals from 2008 to 2016 were nuclear medicine, radiology, and laboratory medicine. In KU's FOM, female graduates outweighed male graduates, except in 2005-2006, where females reached a minimum of 48%. The number of female physicians has also increased from its lowest of 31% of the total number of physicians in 2004-2006, to 37% in 2015. CONCLUSION: While women make up more than half of medical graduates in Kuwait at present, significant barriers had restricted their entry into formal medical leadership roles in the past. However, it is now seen that females currently occupy more leadership positions in government hospitals in Kuwait.

Lutein modulates transcription dysregulation of adhesion molecules and spermatogenesis transcription factors induced by testicular ischemia reperfusion injury: it could be SAFE.

Testicular ischemia reperfusion injury (tIRI) is considered as the underlying mechanism of testicular torsion, which can cause male infertility. tIRI-induced damage was investigated by assessing the gene expression of spermatogenesis master transcription factors (TFs) and that of major adhesion molecules of the blood-testis barrier. The effect of lutein, a hydroxyl carotenoid, in alleviating tIRI-induced damage was also studied. Male Sprague-Dawley rats were divided into three groups: sham, unilateral tIRI, and tIRI + lutein (0.2 mg/kg). tIRI was induced by occlusion of the testicular artery for 1 h, followed by 4 h of reperfusion. Lutein was injected 15 min after the start of ischemia. Histological analysis and real-time polymerase chain reaction revealed significant decreases in tissue biopsy scores, reduced seminiferous tubule diameters, and downregulated the mRNA expression of the TFs cAMP-responsive element modulator (CREM), TATA box-binding protein-related factor 2 (TRF2), and regulatory factor X 2 (RFX2) compared with the sham group. Lutein treatment reversed these effects. The mRNA expression of the adhesion molecules N-cadherin, nectin-2, claudin-11, occludin, and connexin-43 was significantly downregulated during tIRI, but this change was prevented by lutein treatment. In addition, lutein normalized the tIRI-induced increase in total antioxidant capacity, increased malondialdehyde (MDA) levels, augmented number of TdT-mediated dUTP-X nick-end labeling (TUNEL)-positive nuclei, and activated caspase-8 pathway. The components of survivor activating factor enhancement (SAFE) were also activated during tIRI. Increased tissue expression of TNF-α and its receptor, TNFR1, was accompanied by increased phosphorylation of Janus kinase (JAK) and STAT3, which was prevented by lutein treatment. Our findings suggested that tIRI-induced spermatogenic damage may involve modulation of the SAFE pathway and could benefit from lutein treatment.